Background: Diabetic foot infections represent a significant healthcare challenge with considerable morbidity and economic burden. This study aimed to compare the efficacy of silver-based dressings and vacuum dressings in the management of diabetic foot infections. Methods: This prospective, randomized, comparative study enrolled 96 patients with diabetic foot infections (Wagner grade 2-3) who were randomized to receive either silver-based dressings (n=48) or vacuum dressings (n=48). The primary outcome was time to complete wound healing, with secondary outcomes including infection clearance, percentage reduction in wound area, time to granulation, pain scores, complications. Results: Complete wound healing at 12 weeks was achieved in 64.6% of the silverbased dressing group versus 81.3% of the vacuum dressing group (p=0.042). The median time to complete healing was significantly shorter with vacuum dressings (51.2 days vs. 68.5 days, p=0.008). The vacuum dressing group demonstrated superior outcomes in percentage reduction in wound area at 4 weeks (57.8% vs. 43.2%, p=0.001), 8 weeks (79.4% vs. 67.9%, p=0.003), and 12 weeks (92.7% vs. 81.5%, p=0.005), faster granulation tissue formation (17.6 vs. 24.3 days, p=0.007), and earlier infection clearance (12.7 vs. 15.2 days, p=0.042). The vacuum dressing group reported lower pain scores after week 1 (p<0.05) and higher satisfaction scores (p=0.014). Conclusion: Vacuum dressings demonstrated superior efficacy compared to silverbased dressings in the management of diabetic foot infections across multiple parameters including healing time, infection clearance, and patient comfort. These findings support the preferential use of vacuum dressings in the management of diabetic foot infections, particularly in moderate to severe cases.