Ulceration of the foot in diabetes is one of the most neglected aspects of clinical medicine and yet it is the source of very considerable suffering. The associated mortality of 40% at 5 years is worse than that of common cancers (such as breast and prostate: 7% and 6% in age-adjusted populations). The HRQoL for DFUs is worse than for COPD, haemodialysis, breast and prostate cancer. The cost of care amounts to approximately £1 billion – 1% of the total NHS budget. Despite this enormous clinical and financial burden, routine management is inconsistent and is based on limited scientific evidence and it is not surprising that outcome (incidence of major amputation) varies sevenfold between CCGs in England. Infection occurs in 50% of all ulcers and is a major factor contributing to ulcer severity and yet the trial evidence to guide infection treatment is limited. Without clear markers of remission broad spectrum antibiotics are frequently prescribed for long periods. This talk explores the reasons which underlie the relative lack of scientific data relating to the management of infection in this field and highlights areas relating to infection which require urgent attention.