Critical limb ischemia (CLI) is the most advanced form of occlusive peripheral artery disease and often leads to amputation. The prognosis is significantly worsened in patients with diabetes as without intensive management > 50% of patients die within one year of CLI onset or have to undergo a lower extremity amputation. In diabetes CLI is mostly present as diffuse, long-segmented occlusions in two or three arteries of the lower leg, which may co-exist with significant atherosclerosis of the femoropopliteal segment and/or, less frequently, the iliac segment. Also, in diabetes CLI due to atherosclerosis limited to the tibial segment is significantly more common than in non diabetes individuals as well increased arterial wall calcification. These conditions affect the outcome of all revascularization techniques, including percutaneous balloon angioplasty (PTA). The effectiveness of balloon angioplasty as the essential technique for revascularization of below-the-knee arteries in diabetic patients has been confirmed as it repeatedly showed reduction of amputation rates. The latest developments include drug-eluting balloons which appear to be promising in terms of limiting the amount of restenosis. The article presents the current data on the efficacy and safety of PTA in patients with CLI.