Urban red foxes (Vulpes vulpes) are established in cities across Europe and North America, raising welfare and human-wildlife coexistence questions. Sarcoptic mange (Sarcoptes scabiei) is the primary welfare concern, causing intense pruritus, alopecia, skin thickening, and death in severe untreated cases. Urban fox populations cycle through periodic mange epidemics with 50-80% mortality. Treatment with homeopathic mange remedies (widely promoted online) is ineffective; oral ivermectin provided through medicated bait is effective and welfare-positive. Urban fox welfare challenges include road mortality, intentional poisoning and trapping, snare injuries, and complications from supplementary feeding (dental disease, obesity). Fox culling programmes are ineffective for population management as territory is rapidly recolonised; welfare organisations advocate for coexistence approaches. Research demonstrates urban foxes show reduced flight distance and altered behaviour compared to rural conspecifics, developing genuine urban ecological adaptations.