This article presents an overview of the pathogenesis of diabetic foot lesions that lead to lower extremity amputation surgery. The magnitude of this problem is presented together with a brief historical perspective. Indications for "local amputation" of the foot are discussed as well as preoperative noninvasive hemodynamic evaluation of the patient, with determination of level of amputation. Surgical management is covered in detail, with discussion of factors important for amputation wound healing, selection of anesthesia and operative technique, use of tourniquet, and antibiotic considerations.