<p>Managing foot ulceration is a challenge for all concerned. This article argues that the key to successful management of ulceration lies with the accurate identification of the underlying cause of the ulcer and consideration of the additional factors that are likely to impair healing. The common causes of foot ulceration are discussed, the means of evaluation and assessment are outlined and appropriate management strategies are identified. As with all care pathways, patient concordance is essential in reaching successful clinical outcomes and foot ulceration is no exception.</p>