One-hundred-twenty-six diabetic patients had a toe amputation due to infection or ulcer. By a review of the files 1 year later the incidence of Charcot breakdown in patients with normal peripheral perfusion was found to be 23% (7/30 patients) following transmetatarsal amputation of the first toe and occurred only in patients with normal peripheral perfusion and neuropathy. No cases of Charcot were recorded in patients with vascular insufficiency, which had a partial amputation of the first toe or if only one or more of the small toes were amputated. The onset of the arthropathy was within 3 month after surgery in five cases and after 4 and 6 months in two cases. Meticulous attention in the postoperative course is required for recognition and early treatment of this complication. We recommend offloading and immobilization of the foot and ankle in a period of 1-2 months to prevent the Charcot breakdown.