The clinical course and foot roentgenograms of twentytwo consecutive patients with severe diabetic neuropathy were reviewed. All but one patient had skin breakdown with adequate arterial circulation. Cutaneous lesions responded well to local care, the majority healing within one month, despite widespread bone destruction. In seventeen of the twenty-two cases, (77 per cent), there were multiple bone lesions that tended to be bilateral and to follow the peripheral distribution of the neuropathy. The osseous abnormalities were radiologically indistinguishable from osteomyelitis except for a characteristic thinning of the metaphysis of proximal phalanges. Follow-up X rays showed progressive bone destruction in four patients although they had no further difficulty with their feet. We conclude that widespread osteopathy of the foot occurs frequently in severe diabetic peripheral neuropathy and has a better prognosis than osteomyelitis, from which it must be distinguished clinically.