The evidence comparing surgery with antibiotics alone is too heterogeneous to be definitive. Surgery may lead to functional impairment.
Surgery may be reserved for severe and spreading soft tissue infection, progressive bone necrosis despite antibiotics, deformities that are surgically correctable, or resistant organisms.
Antibiotics without surgery should be chosen for non complicated forefoot osteomyelitis where bone culture is available, poor postoperative biomechanics, or awaiting revascularization.
There is no evidence to support hyperbaric oxygen or negative pressure dressings in diabetic foot infections.
Glucose control (A1C<7.0), revascularization, foot protection, pressure relief, regular inspection are likely to be helpful for prevention.
Evidence for experimental biofilm inhibitors is inadequate to make treatment recommendations.