Aim: The study aimed to assess the outcomes of patients with diabetic foot osteomyelitis (DFO), comparing cases with and without soft tissue infection (STI). Method: The study is a retrospective observational study including consecutive patients who referred to a specialized diabetic foot service due to DFO located in the forefoot (toes and rays). Patients were categorized in two groups: DFO with STI (type 1) and DFO without STI (type 2). All patients were managed by a conservative surgical approach aiming to remove only the infected bone in association to the antibiotic therapy, evaluated for each specific case. After 1 year of follow-up, the following outcomes were evaluated and compared between groups: healing, healing time, minor amputation, major amputation, hospitalization. Results and Discussion: Overall, 166 patients were included. The mean age was 68.5±13.2 years, 94.9% of them were affected by type 2 diabetes with a mean duration of 19.3±7.1 years; 52.4% showed peripheral arterial disease (PAD), 4.9% had severe infection with sepsis at the baseline. One hundred forty-four patients (68.7%) had type 1 DFO, while 52 (31.3%) had type 2 DFO. The outcomes for type 1 and type 2 DFO were: healing (95.6% vs 52%, p=0.005), healing time (7.8±5.8 vs 4.6±2.7 weeks, p=0.0002), minor amputation (13.1 vs 3.8%, p=0.04), major amputation (0 vs 0%, ns), and hospitalization (66.7 vs 48.1%, p=0.002) respectively. Conclusion: Patients with DFO complicated by STI showed higher risk of hospitalization and minor amputation, and longer healing times in comparison to those without STI.