Three great pathologies come together in the diabetic foot, neuropathy, ischaemia and immunopathy and this combination can defeat every healthcare system in the world. The natural history of the diabetic foot is rapidly progressive and complex, and a break in the skin or a minor foot injury can quickly progress to necrosis or severe foot deformity. The diabetic foot can be classified into two groups: the neuropathic foot with palpable pulses and the ischaemic foot without pulses and a varying degree of neuropathy. The neuropathic foot may be further divided into two clinical scenarios, the foot with neuropathic ulceration and the Charcot foot, which may be secondarily complicated by ulceration. The Charcot foot is an acute osteoarthropathy, with bone and joint destruction commonly presenting in the midfoot but also in the forefoot and hindfoot. The prognosis for the hindfoot is much more serious with the high risk of instability of the ankle. The ischaemic foot may be divided into four clinical scenarios: the neuroischaemic foot characterised by both ischaemia and neuropathy and complicated by ulcer; the neuroischaemic foot has a moderate reduction in blood supply and usually develops ulcers on the margins of the foot and toes, often at sites of pressure from poorly fitting shoes. The critically ischaemic foot results from a severe reduction in blood supply and presents as a pink often painful foot with pallor on elevating the foot and rubor on dependency. The acutely ischaemic foot results from a sudden massive reduction of blood supply usually due to a thrombosis or an embolus and presents initially with sudden pallor. The renal ischaemic foot is complex with ischaemia from both macrovascular and microvascular components. The major complication of ulceration is infection, which is the main driving force towards necrosis in the diabetic foot. The microbiology of the diabetic foot is unique. Infection can be caused by Gram-positive aerobic, Gram-negative aerobic and anaerobic bacteria, singly or in combination. Successful management of the diabetic foot needs the expertise of a multidisciplinary team. The fundamental approach comprises an initial rapid assessment, leading on to prompt interventions of wound care and revascularisation.