The neuropathic/Charcot joint represent a challenging clinical dilemma. The lack of available evidence furthers the challenge when dealing with these patients. Frequently, there is a significant delay in the diagnosis such that when finally presenting to the orthopaedic surgeon, the disease is much advanced. As such, non‐operative treatments including bracing, activity modification and protected weightbearing no longer suffice. Surgical treatment, therefore, is the preferred method of treatment. Historically arthrodesis was offered, however recently total joint arthroplasty has become the preferred treatment modality. Despite higher complication rates, continued range of motion of the joint, better alignment, decreased pain and higher functional scores tend to favor arthroplasty over arthrodesis. Much research is needed within this field, as there is very little available evidence to guide management of this difficult problem.