Aim: This case series reviewed challenging cases of Charcot neuropathy (CN) of the ankle joint and the efficacy of limb salvage procedures. Background: Charcot neuroarthropathy (CN) is a chronic debilitating pathology involving bone and joints, especially when affecting weight-bearing joints. Unfortunately, due to its relatively mild initial symptoms, many patients come to the hospital when CN is already in an advanced stage. When deciding between amputation and limb salvage, some aspects must be considered—general condition, local ankle condition, and availability of surgical equipment. Case description: We report three CN cases that presented late because of a lack of patient awareness or physician underdiagnosis. Despite ankle joint obliterations, all cases were successfully treated by limb salvage comprising debridement, reduction, and fixation using an intramedullary nail to achieve tibiocalcaneal arthrodesis. Patients’ weight-bearing ability was restored, and short-term quality of life was improved, despite varied fusion rates. Conclusion: Limb salvage by tibiocalcaneal arthrodesis using an intramedullary nail is a feasible option for CN, even in advanced stages with massive periarticular obliteration. Clinical significance: To avoid worsening conditions resulting from the underdiagnosis of CN, health promotion should be emphasized not only for the primary care clinician but also for the community as a whole. Although normal function is still difficult to achieve, treating advanced-stage CN by limb salvage will improve patients’ quality of life and daily activities.