OBJECTIVES: Diabetes is a chronic illness and 15% of diabetic will develop foot ulceration at some point of their life. Poor psychosocial states have been identified as one of the major risk factors for foot ulcers. Good, regular foot care, strict metabolic control and better adjustment to illness can prevent or reduce suffering effect of the illness. The purpose of this study was to compare the psychosocial adjustment to illness between diabetic patients with and without diabetic foot ulcer (DFU). METHODS: A case-control study was conducted in a tertiary care teaching hospital in South India for a period of one year.  Psychosocial Adjustment to Illness Scale-Self Report ( PAIS-SR) were used to assess psychosocial  adjustment to illness. DFU patients (Case) who admitted in the surgery units were included. Diabetic patients without foot ulcers (control) were selected from medicine units during the same period. RESULTS:   The study participants were 84 people with diabetic foot ulceration and 84 people without diabetic foot ulceration. There were no significant differences between the two groups for gender, age and marital status. A significant difference was found between two groups for education level  (p= 0.001) occupational status (p=0.045). A significant difference was found between the groups in relation to smoking (p=0.000) and drinking (p=0.000). There were a significant difference seen in PAISSR scores ( lower scores means better adjustments) between the two groups (p=0.000) representing subjects without  DFU  had better psychosocial adjustment than subjects with DFU. CONCLUSIONS: The study concluded that compared to patients without DFU, patients with diabetic foot ulcer had poorer metabolic control, low educational level, bad social habits. Longer duration of diabetes, longer period of hospitalization, low level of disease knowledge and more incidence of comorbid conditions.