Background: Diabetic foot osteomyelitis presents a significant challenge in clinical management, often necessitating aggressive interventions such as surgery. However, the optimal approach remains debated, with conservative antibiotic therapy emerging as a potential alternative. Materials and Methods: A retrospective cohort study was conducted involving diabetic patients diagnosed with foot osteomyelitis. Patients were divided into two groups: those treated with antibiotics alone (Antibiotics group) and those treated with conservative surgery in addition to antibiotics (Surgery group). Clinical data, including demographics, infection characteristics, treatment modalities, and outcomes, were analyzed. Results: A total of 150 patients were included, with 75 in each group. The mean age was 62 years, and 60% were male. In the Antibiotics group, the mean duration of antibiotic therapy was 6 weeks, while the Surgery group underwent surgical intervention within a mean of 10 days from diagnosis. The rate of complete healing was 65% in the Antibiotics group and 82% in the Surgery group. The median time to healing was 12 weeks in the Antibiotics group compared to 8 weeks in the Surgery group. Complications such as wound dehiscence occurred in 15% of the Antibiotics group and 8% of the Surgery group.Conclusion: Conservative surgery combined with antibiotics appears to be associated with faster healing and lower complication rates compared to antibiotic therapy alone in diabetic foot osteomyelitis. However, further prospective studies are warranted to validate these findings and guide clinical decision-making.