An acutely infected diabetic foot can be a very serious complication of diabetes, associated with high morbidity and risk of amputation, and a substantial healthcare burden. The National Institute for Health and Care Excellence, the British Orthopaedic Association, and the International Working Group on the Diabetic Foot have provided guidelines to support the timely and effective management of these patients. This review provides an update on current management strategies for acute diabetic foot infections. Evolving practices and controversies are discussed, including innovations in the techniques of debridement and primary wound closure, the use of local antibiotic carriers, and challenges such as biofilms and multidrug resistance. Adjunctive physical forms of treatment such as negative pressure wound treatment, laser and photodynamic treatment, and larval debridement are also examined, as well as the expanding role of plastic surgeons in reconstructive strategies and the integration of skin substitutes and advanced dressings. In order to support clinical decision-making and improve outcomes, a suggested algorithm for managing new, deteriorating, or non-healing foot ulcers is presented, offering a roadmap for multidisciplinary team pathways. This approach aims to implement enhanced local strategies, reduce delays, and optimize care. The review provides insights for those who treat these patients by addressing the evolving practices and ongoing challenges. Cite this article: Bone Joint J 2026;108-B(3):322–330.
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