Despite these diagnostic challenges, there is growing evidence linking acro-osteolysis to specific diabetic complications, including longstanding peripheral neuropathy (e.g., Charcot neuroarthropathy), chronic microvascular ischaemic changes, repeated unnoticed physical or thermal microtrauma, impaired autonomic and peripheral nervous systems, and heightened inflammatory cytokine activity, particularly tumour necrosis factor-alpha (TNF-α) and RANKL [2-4,7]. Here, TNF is linked to peripheral neuropathy.