Background: Diabetic foot disease (DFD) is a leading cause of preventable hospitalisation and lower-limb amputation in Australia, with a disproportionate burden among Aboriginal and Torres Strait Islander peoples in remote regions. General surgeons in Central Australia frequently manage advanced DFD complicated by infection, ischaemia, and systemic comorbidity. Context and Challenges: Remote Central Australia is characterised by high diabetes prevalence, earlier disease onset, barriers to primary care, limited access to podiatry and vascular services, and significant social and cultural determinants of health. Workforce shortages and episodic outreach services mean patients often present late, leaving general surgeons to manage complex disease beyond standard metropolitan multidisciplinary pathways. Surgical Practice and Systems Response: From a surgical perspective, management commonly involves repeated debridement, drainage of deep infection, staged minor amputations, and, when unavoidable, major amputation. Open wound management and negative pressure therapy are frequently required due to infection burden and delayed tissue viability. Consent and decision-making are often iterative, reflecting cultural considerations, strong connection to land, and the personal significance of limb loss. The establishment of a podiatry-led multidisciplinary high-risk foot service at Alice Springs Hospital has improved coordination between general surgery, endocrinology, infectious diseases, nursing, vascular surgery, and Aboriginal liaison services, supporting earlier intervention and clearer surgical decision-making. Conclusion: DFD in remote Central Australia represents both a surgical and systems challenge. General surgeons play a central role in operative management, multidisciplinary leadership, culturally safe care, and local audit. Strengthening high-risk foot services and culturally informed surgical pathways is essential to reducing avoidable amputations in this high-risk population.