Purpose: Diabetic foot sepsis leading to lower extremity amputation is associated with significant morbidity and mortality. Further, it leads to increased operating theatre utilization which disproportionately affects low- and middle-income countries with limited surgical resources such as the Pacific Island Country of Samoa. Samoa has implemented public health initiatives over the last decade to attempt to address the diabetes endemic. Methodology: This is a retrospective, single-centre observational study looking at adults who underwent lower extremity amputation secondary to diabetic foot sepsis in 2016, 2022 and 2023 at Tupua Tamasese Mea’ole Hospital in Samoa. Patient demographics including sex and age as well as clinical information pertaining to comorbidities, HgbA1c, and urban/rural data were obtained. Results: Records were obtained for 420 individuals (51% male) with a mean age of 59.1 years who underwent lower extremity amputations secondary to diabetic foot sepsis in Samoa. There was a statistically significant increase in patients undergoing lower extremity amputations due to diabetic foot sepsis from 81 (2016) to 143 (2022) to 196 (2023) (p < 0.001). Patients from urban areas constituted 47.2% of all amputations compared to 35.4% and 17.4% in the two surrounding rural communities of the islands Upon and Savai’i despite urban areas representing less than 20% of the population (p < 0.001). Conclusion: Despite public health initiatives, there has been a statistical increase in the number of patients undergoing lower extremity amputations secondary to diabetic foot sepsis in Samoa with urban areas experiencing a disproportionate number of amputations compared to rural counterparts.