Optimising surgical interventions in diabetic foot ulcers has proven to markedly improve outcomes when attempted partial amputations or reconstructions are carried out. Establishing a truly multidisciplinary team led by a vascular surgeon and foot surgeon with prearranged input from other specialties has dramatically increased long-term success. It can reduce the likelihood of further ulceration and mainly reduce below-knee amputations. Timing is essential; reactionary surgery will often fail without adequate planning. Patient's systemic health must be optimised to create an environment where their own body contributes to success and does not prove to be a significant contributing factor to failure. Surgery ideally should be elective to prevent ulceration in the first place. Facilities that can predict foot breakdown and instigate prophylactic surgery have been shown to reduce below-knee amputations dramatically. If surgery is required, the foot's fundamental structure, function and biomechanics must be understood. This can ensure the surgery will leave the foot as a weight-bearable structure that can resist damaging forces and avoid producing prominences that will re-ulcerate. Repeated reactionary surgery has a substantial psychological impact on the patient and their family, costs the health system millions, and ultimately often leads to a below-knee amputation and the severe ramifications that ensue.