The surgical treatment of foot wounds in patients with diabetes is an art and a science. I summarize the surgical management presentation of The Diabetic Foot Wound Symposium at the 2004 Musculoskeletal Infectious Disease Society meeting in Pittsburgh, PA. The science of surgical management of the diabetic foot wound is seen in the accurate diagnosis of its severity. This is accomplished by a simple to use five assessment wound score that grades wound base appearance, size, depth, bio-burden and perfusion each from 0 (worse) to 2 (best) using objective criteria. The resultant 0 to 10 score quantifies the severity and provides a guideline for what treatments should be done. The art of surgically treating foot wounds in patients with diabetes is exemplified in doing minimally invasive surgeries in the office or their more complex counterparts in the operating room. The surgeries are classified into five types: debridements, correction of deformities, wound closures, partial amputations, and miscellaneous procedures including nail care and Charcot arthropathy treatment. The information presented in this paper reflects my 25 years of experience caring for problem foot wounds in patients with diabetes.