Diabetic foot infections are a common and serious clinical issue, with about 50% of patients who undergo foot amputations dying within five years. Proper management can cure most infections, but many patients undergo unnecessary amputations due to poor diagnosis and treatment. This review discusses the natural history of diabetic foot infections and the impact of the Infectious Diseases Society of America (IDSA) clinical practice guidelines on surgical management. Diabetes affects 30 million people worldwide, with most having type 2 diabetes. Diabetic patients are at higher risk of infections, neuropathy, retinopathy, and renal failure. Poorly controlled diabetes increases susceptibility to infections. Foot ulcers affect 1 in 10 diabetics and are more common in males. Ischaemia, infection, and neuropathy contribute to tissue necrosis. High blood glucose impairs white blood cell function and damages the vascular endothelium, leading to poor circulation and increased bacterial growth. Common pathogens include aerobic gram-positive cocci, especially Staphylococci, and aerobic gram-negative bacilli, which are often co-pathogens in chronic infections. Anaerobes may also be involved in ischaemic or necrotic wounds. Imaging is helpful in diagnosing osteomyelitis, which is often difficult to detect. Surgical interventions are often needed, and proper wound care is crucial for successful treatment. Prompt surgical debridement can reduce the need for more extensive amputations. Risk factors include poor circulation, barefoot walking, and smoking. Clinical features include redness, warmth, tenderness, and swelling. Diagnosis involves assessing the patient, limb, and wound. Infections are classified as mild, moderate, or severe based on clinical findings. Treatment involves antibiotics, wound care, and surgical interventions. Revascularization may be necessary to improve blood flow. Amputation is considered when infection and ischaemia lead to irreversible tissue damage. Prognosis depends on factors such as smoking, age, and infection severity. About 50% of patients with foot amputations die within five years. Proper care can prevent many amputations. Guidelines and multidisciplinary teams improve outcomes and reduce mortality. The IDSA guidelines emphasize the importance of early diagnosis, appropriate treatment, and surgical intervention. The prognosis is influenced by the patient's overall health and the effectiveness of treatment.Diabetic foot infections are a common and serious clinical issue, with about 50% of patients who undergo foot amputations dying within five years. Proper management can cure most infections, but many patients undergo unnecessary amputations due to poor diagnosis and treatment. This review discusses the natural history of diabetic foot infections and the impact of the Infectious Diseases Society of America (IDSA) clinical practice guidelines on surgical management. Diabetes affects 30 million people worldwide, with most having type 2 diabetes. Diabetic patients are at higher risk of infections, neuropathy, retinopathy, and renal failure. Poorly controlled diabetes increases susceptibility to infections. Foot ulcers affect 1 in 10 diabetics and are more common in males. Ischaemia, infection, and neuropathy contribute to tissue necrosis. High blood glucose impairs white blood cell function and damages the vascular endothelium, leading to poor circulation and increased bacterial growth. Common pathogens include aerobic gram-positive cocci, especially Staphylococci, and aerobic gram-negative bacilli, which are often co-pathogens in chronic infections. Anaerobes may also be involved in ischaemic or necrotic wounds. Imaging is helpful in diagnosing osteomyelitis, which is often difficult to detect. Surgical interventions are often needed, and proper wound care is crucial for successful treatment. Prompt surgical debridement can reduce the need for more extensive amputations. Risk factors include poor circulation, barefoot walking, and smoking. Clinical features include redness, warmth, tenderness, and swelling. Diagnosis involves assessing the patient, limb, and wound. Infections are classified as mild, moderate, or severe based on clinical findings. Treatment involves antibiotics, wound care, and surgical interventions. Revascularization may be necessary to improve blood flow. Amputation is considered when infection and ischaemia lead to irreversible tissue damage. Prognosis depends on factors such as smoking, age, and infection severity. About 50% of patients with foot amputations die within five years. Proper care can prevent many amputations. Guidelines and multidisciplinary teams improve outcomes and reduce mortality. The IDSA guidelines emphasize the importance of early diagnosis, appropriate treatment, and surgical intervention. The prognosis is influenced by the patient's overall health and the effectiveness of treatment.