Charcot arthropathy of the ankle is an uncommon but limb-threatening neurogenic arthropathy that may rapidly progress to instability, deformity, ulceration, and deep infection. A diagnosis is often delayed because pain can be mild, and inflammatory signs can mimic infection. This review summarizes the current concepts in the management of ankle Charcot arthropathy, emphasizing early assessment and individualized treatment. The initial evaluation is based on a clinical assessment and weightbearing radiographs. Computed tomography (CT), magnetic resonance imaging, and radiolabeled white blood cell SPECT/CT may be used selectively to define the anatomy, assess the disease activity, or evaluate suspected infections. In the active phase, prompt immobilization and strict off-loading, typically with total contact casting, are fundamental, and a transition to therapeutic footwear and custom orthoses should be gradual. Surgery may be indicated for progressive deformities or instability that threatens the skin integrity despite the appropriate conservative management, but the optimal timing remains controversial. Procedure selection should be individualized based on the disease extent, bone loss, soft-tissue status, and infection. Robust internal, external, or hybrid fixation can be used, and staged approaches are preferred when ulceration or osteomyelitis is present.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by excess fibroblast growth factor-23 (FGF-23), leading to renal phosphate wasting, hypophosphatemia, osteomalacia, and multiple insufficiency fractures. TIO is often mistaken for stress fractures, osteoporotic fractures, and overuse injuries because of the nonspecific symptoms, such as bone pain, decreased muscle strength, and fatigue, leading to delayed diagnosis. This paper reports a patient with years of ankle pain in whom hypophosphatemia on a laboratory test led to the suspicion of TIO; the causative lesion was identified and excised, resulting in clinical improvement. Therefore, checking the serum phosphate level is essential in patients with recurrent, nonspecific, and multiple fractures. Hypophosphatemia is the most specific finding suggestive of TIO and, when present, should prompt an evaluation and treatment of the underlying lesion. Although uncommon, TIO can be recognized with basic blood tests, reducing diagnostic delay and improving patient outcomes.