Acute fracture and dislocation at the Lisfranc joint complex in the neuropathic patient often follow insignificant or unrecognized trauma. On account of lack of pain due to neuropathy, these injuries are at times overlooked and patients may dismiss them as sprains and not seek medical attention. The redness in the foot and the accompanying swelling, which can involve the entire leg, are often mistaken and treated for infection or cellulitis. A high index of suspicion, early recognition, and appropriate management can avert complications such as a rocker-bottom type foot deformity in the long-term chronic or recurrent ulceration and amputation. This chapter describes emerging surgical techniques in the treatment of acute Lisfranc fracture dislocation and current trends in medical management in patients with acute Charcot neuroarthropathy.