Background: Diabetic foot ulcers are critical complications and challenging health concerns for the elderly that can lead to hospitalization and amputation. Aim: This study aimed to assess patterns and risk factors of diabetic foot ulcers among elderly with diabetes. Design and setting: A case-control research method was used to conduct this study at the outpatient clinics and inpatient department of Menofia University Hospital and Shebin Elkom Teaching Hospital, Egypt. Subject: A total sample of 100 elderly with diabetes was selected and allocated into two groups (group a: Elderly with DFUs (n=50) and group b: Elderly without DFUs (n=50)). Tools of data collection: (I): interviewing questionnaire. (II): Ten rules of the foot care questionnaire (III): Meggitt–Wagner classification. (IV): Diabetic neuropathy symptom (DNS) scores. Results: Studied elderly mean age was 66.81±7.55. Regarding DFU risk factors, rural residence (60%), illiteracy (52%), unemployment (70%), smoking (50%), history of DFU (58%), callus (74%), cracked skin (58%), poor foot care (78%), lack of protective sensation (78%), lack of peripheral pulse (50%), elevated blood glucose (M±SD 199.54±71.0) and increased BMI (M±SD 29.35 ± 7.52), all represented significant risk factors for DFU in the current study. Conclusion: The study concluded that illiteracy, rural residence, no work, smoking, obesity, callus, cracked skin, and foot deformity, uncontrolled blood glucose, previous history of DFU, absent distal pulse, loss of protective sensation, and lack of proper foot care were all of the most risk factors for DFUs in this study. Recommendations: Design educational programs for the elderly with diabetes about foot care and risk factors for diabetic foot ulcer (DFU). Screen the at-risk elderly diabetic patients regularly for early detection and appropriate management of diabetic foot ulcer (DFU).