Advanced stages of the diabetic foot syndrome complicated by ischemia and osteomyelitis frequently result in minor amputation, followed by impaired wound healing and higher-level amputation in the context of regular health structures. Even in specialized foot care centers, peripheral arterial occlusive disease and osteomyelitis still represent the greatest challenge in the strife for limb salvage. Whereas the treatment of nonischemic foot lesions has increasingly become a matter of conservative medicine within recent years, for advanced diabetic foot wounds a multidisciplinary treatment policy is essential. A well-coordinated treatment concept aiming at the elimination of the most relevant prognostic factors ischemia and osteomyelitis is required to achieve high limb salvage rates. Surgical revascularization by distal bypass is a crucially important element of this approach. Percutaneous transluminal angioplasty represents a complementary option for short-segment arterial occlusive disease. Foot-sparing minor surgery improves healing time and rates. A specialized diabetologic foot care clinic provides preclinical diagnosis, planning of inpatient procedures, and selection of patients requiring hospitalization for surgical intervention. In addition, it safeguards postinterventional care for wounds with secondary healing and measures of secondary prevention.