Introduction: Conservative treatment of diabetic foot neuropathic ulcer includes offloading with orthopaedic shoes and plaster casts is usually effective in achieving primary closure of foot ulcers but take along time and recurrence rates are high. The surgery alleviates the pressure under the bony prominence, thus enabling prompt ulcer healing in short time with a lower chance of recurrence. The purpose of this protocol is to compare offloading surgery to non-surgical treatment for patients with diabetic foot neuropathic ulcers. Methods: This study included fourty patients presented with neuropathic diabetic foot ulcer. Two groups group A twenty cases were managed surgically by tenotomy and metatarsal head osteotomy, group B twenty cases were managed conservatively includes offloading with orthopaedic shoes and plaster casts. Results: In our study twenty cases group a were managed surgically take three weeks to five weeks to heal with no recurrence, group b twenty cases were managed conservatively take twelve weeks to twenty four weeks to heal with recurrence in eight patients. Conclusion:The best current strategy for management of diabetic foot neuropathic ulcer is surgical offloading.