Purpose: Together with pain and paraesthesia, another complication of diabetic sensorimotor polyneuropathy (DSPN) are diabetic foot ulcers (DFU). Currently, the treatment to prevent DSPN is strict glycaemic control. Decompressive nerve surgery (DNS) has been researched in the prevention and treatment of DSPN. Thus, this systematic review analyses the incidence of primary and recurrent DFU in patients with DSPN following DNS. Methodology: In this systematic review and meta-analysis, a search of six databases was completed for articles published from data inception to 1 July 2023 that included patients with DSPN who underwent DNS, and the incidence of their primary or recurrent DFU. A total of 1074 studies were identified and 208 screened for inclusion. Data were independently extracted by two authors. Random-effects model of meta-analysis was used to measure the incidence of primary and recurrent DFU. Results: Thirteen studies met eligibility criteria, yielding 2466 and 540 patients for the rate of new and recurrent DFU, respectively. The pooled incidence rate of primary and recurrent DFU in patients with DSPN receiving DNS was 1 and 5 per cent, respectively. A sub-group analysis based on sample size and follow-up length supported a similar low incidence of DFU following DNS. Conclusion: These results indicate that patients with DSPN receiving DNS have a low incidence of new and recurrent DFU. However, given the low level of evidence of primary studies giving rise to these outcomes, the true effect of DNS is uncertain and requires randomised controlled trials to confirm this effect and influence clinical practice.