For patients with a diabetic foot wound the risk for amputation is high. The three main reasons for developing foot ulcers in diabetes are biomechanical factors, neurologic and vascular alterations. According to this the ulcers can be categorized in neuropathic (50%), ischemic (15%) and neuroischemic (35%). Sensomotoric polyneuropathy leads to the loss of perception of pain in the feet and in combination with extrinsic and intrinsic biomechanical factors, chronic wounds evolve (malum perforans). The therapy should take place within an interdisciplinary network and based on guidelines. Besides pressure off-loading debridement of the wound is mandatory. The arterial occlusions in diabetes mainly affect the cruropedal vessels and when ischemia occurs a reconstruction must be attempted. The risk of recurrence is high so that regular follow-up examinations, screening to detect high risk patients and education are necessary.