Any persistent nonhealing ulcer, particularly when associated with a callus, should alert the clinician to neurotrophism as the cause. Opinion is divided to some degree on the bone and joint changes seen by radiography in patients with neurotrophic lesions of the feet. Roentgenographic changes of a degenerative character in any foot with proved peripheral sensory impairment are indicative of neurotrophic arthropathy. The association of bony proliferation that is meaningless or excessive should further alert the clinician. Periosteal thickening, if affecting a site remote from an ulcer, may be significant. Therapeutic measures include simple curettage, removal of the metatarsal head, toe amputation, and major amputation.