Introduction: the prevalence of diabetics in the old population, and the enhancement of medications actually cause an enormous augmentation of the incidence of diabetic foot. Aim: aim of the study is to report authors’ experience about the transmetatarsal amputation. Patients were enrolled according to skin conditions, arteriography and life expectation. However, based on personal experiance arteriography has not been one of the main criteria in selecting the level of amputation. Methods: Since jenuary 1997 up to december 2002 thertyfour patients were treated. 26 were male, 8 females, the mean age was 69 years. The total amount of transmetatarsal amputation has been 36 surgical procedures. Those were performed after a peripheral anesthesia, the surgeon always avoided the use of torniquette. A short leg cast was made in order to let the wound heal and to avoid equinus deformity untill the weightbearing gait was allowed. Results: At a mean follow-up of 48 months 28 patients were able to walk using one or without crutches, two patients needed two crutches full time, four patients underwent to a further procedure of resection at a more proximal level. Conclusion: the outcome showed to be dependent by many variables, however middle term results are encouraging, patients can walk and attend again their own daily activities fairly soon. Although it is well understood that the long term result will be worst, we suggest to try whenever it is possible to perform a transmetatarsal amputation expecially in old people who can not easily ricover from a leg resection.