OBJECTIVES Diabetic Foot Syndrome (DFS) is a serious and common complication of diabetes, often leading to limb amputation and disability. Disability and productivity loss in patients with DFS can generate significant indirect costs and potentially significant economic consequences. The purpose of the study is to estimate productivity loss and indirect costs associated with foot ulceration in patients with DFS. METHODS We conducted a prospective survey in a population of DFS patients with foot ulceration. Loss of productivity was measured with a modified WPAI questionnaire. Indirect costs of both absenteeism and presenteeism were estimated using the human capital approach on the basis of the measure of gross value added per employee. RESULTS Nearly one third of respondents (32%) declared that foot ulceration was the direct reason why they abandoned their professional activity. 40% and 34% of respondents, respectively, were forced to limit or change their professional activity at some point in the past because of the foot ulceration. More than 40% of respondents who changed or limited their professional activity because of the foot ulceration experienced reduction in earnings by 22.9% on average. Mean absenteeism was estimated at 32.63% of the nominal working time, while presenteeism was estimated at 23.48% of real working time. Total annual indirect costs associated with productivity loss amounted to EUR 170.8 million, including EUR 117.3 million of the costs of sickness absence and EUR 53.5 million of the costs of presenteeism. CONCLUSIONS Foot ulceration in patients with DFS is a common cause why patients are forced to give up or change their professional activity, which usually leads to a reduction in earnings. Indirect costs associated with foot ulceration in DFS impose a significant burden on the Polish economy. There is no rationale that would clearly link productivity loss associated with ulceration in DFS and the ulceration severity.