Diabetes has now replaced syphilis and leprosy as the commonest cause of Charcot joint disease. The exact mechanism for the development of Charcot neuroarthropathy remains debatable and still continues to generate much controversy. In the past neurovascular and neurotraumatic theories had been proposed. More recently, research has yielded a new understanding of the Charcot process by establishing a link between the loss of bone and abnormal vascular reactivity. This has highlighted the need for a thorough understanding of the underlying etiopathogeuesis if therapeutic measures are to be successful.