diff --git a/src/Renderer/HtmlRenderer.php b/src/Renderer/HtmlRenderer.php
index 466ae8e..91bc7ec 100644
--- a/src/Renderer/HtmlRenderer.php
+++ b/src/Renderer/HtmlRenderer.php
@@ -942,17 +942,24 @@ protected function renderFootnotesSection(): string
         foreach ($renderedContents as $number => $content) {
             $html .= '<li id="fn' . $number . '">' . "\n";
 
+            // Find the label for this footnote number to get ref count
+            $label = array_search($number, $this->footnoteNumbers, true);
+            $refCount = $label !== false ? ($this->footnoteRefCounts[$label] ?? 1) : 1;
+
+            // Generate backlinks - multiple if footnote referenced multiple times
+            $backlinks = $this->generateBacklinks($number, $refCount);
+
             // Add backlink - if content ends with </p>, insert before it
             // Otherwise add as separate paragraph
             if ($content !== '' && preg_match('/^(.*)(<\/p>\n?)$/s', $content, $matches)) {
-                $content = $matches[1] . '<a href="#fnref' . $number . '" role="doc-backlink">↩︎</a></p>';
+                $content = $matches[1] . $backlinks . '</p>';
                 $html .= $content . "\n";
             } else {
                 // Content doesn't end with paragraph (e.g., code block or empty)
                 if ($content !== '') {
                     $html .= $content . "\n";
                 }
-                $html .= '<p><a href="#fnref' . $number . '" role="doc-backlink">↩︎</a></p>' . "\n";
+                $html .= '<p>' . $backlinks . '</p>' . "\n";
             }
 
             $html .= '</li>' . "\n";
@@ -964,6 +971,32 @@ protected function renderFootnotesSection(): string
         return $html;
     }
 
+    /**
+     * Generate backlink(s) for a footnote
+     *
+     * @param int $number Footnote number
+     * @param int $refCount Number of times footnote was referenced
+     */
+    protected function generateBacklinks(int $number, int $refCount): string
+    {
+        if ($refCount <= 1) {
+            // Single reference - simple backlink
+            return '<a href="#fnref' . $number . '" role="doc-backlink">↩︎</a>';
+        }
+
+        // Multiple references - generate numbered backlinks
+        $links = [];
+        for ($i = 1; $i <= $refCount; $i++) {
+            $refId = 'fnref' . $number;
+            if ($i > 1) {
+                $refId .= '-' . $i;
+            }
+            $links[] = '<a href="#' . $refId . '" role="doc-backlink">↩︎<sup>' . $i . '</sup></a>';
+        }
+
+        return implode(' ', $links);
+    }
+
     protected function renderFootnoteRef(FootnoteRef $node): string
     {
         $label = $node->getLabel();
@@ -975,8 +1008,21 @@ protected function renderFootnoteRef(FootnoteRef $node): string
         }
         $number = $this->footnoteNumbers[$label];
 
+        // Track reference count for this footnote to generate unique IDs
+        if (!isset($this->footnoteRefCounts[$label])) {
+            $this->footnoteRefCounts[$label] = 0;
+        }
+        $this->footnoteRefCounts[$label]++;
+        $refCount = $this->footnoteRefCounts[$label];
+
+        // Generate unique ID: fnref1 for first, fnref1-2 for second, etc.
+        $refId = 'fnref' . $number;
+        if ($refCount > 1) {
+            $refId .= '-' . $refCount;
+        }
+
         // Format: <a id="fnref1" href="#fn1" role="doc-noteref"><sup>1</sup></a>
-        return '<a id="fnref' . $number . '" href="#fn' . $number . '" role="doc-noteref"><sup>' . $number . '</sup></a>';
+        return '<a id="' . $refId . '" href="#fn' . $number . '" role="doc-noteref"><sup>' . $number . '</sup></a>';
     }
 
     protected function renderMath(Math $node): string
diff --git a/tests/TestCase/DjotConverterTest.php b/tests/TestCase/DjotConverterTest.php
index e534674..558e97d 100644
--- a/tests/TestCase/DjotConverterTest.php
+++ b/tests/TestCase/DjotConverterTest.php
@@ -2380,4 +2380,60 @@ public function testBackticksWithClosingFenceIsCodeBlock(): void
         $this->assertStringContainsString('<pre><code class="language-python">', $result);
         $this->assertStringContainsString('x = y + 3', $result);
     }
+
+    /**
+     * Test that multiple references to the same footnote get unique IDs
+     *
+     * Fix for GitHub issue jgm/djot#348: Multiple calls to the same note
+     * should generate unique HTML-compliant IDs with suffixes.
+     */
+    public function testMultipleFootnoteReferencesGetUniqueIds(): void
+    {
+        $djot = <<<'DJOT'
+First ref[^note].
+
+Second ref[^note].
+
+Third ref[^note].
+
+[^note]: The footnote.
+DJOT;
+
+        $result = $this->converter->convert($djot);
+
+        // Each reference should have a unique ID
+        $this->assertStringContainsString('id="fnref1"', $result);
+        $this->assertStringContainsString('id="fnref1-2"', $result);
+        $this->assertStringContainsString('id="fnref1-3"', $result);
+
+        // All should link to the same footnote
+        $this->assertSame(3, substr_count($result, 'href="#fn1"'));
+
+        // Footnote should have multiple backlinks
+        $this->assertStringContainsString('href="#fnref1"', $result);
+        $this->assertStringContainsString('href="#fnref1-2"', $result);
+        $this->assertStringContainsString('href="#fnref1-3"', $result);
+
+        // Single footnote (no duplicates)
+        $this->assertSame(1, substr_count($result, 'id="fn1"'));
+    }
+
+    public function testSingleFootnoteReferenceNoSuffix(): void
+    {
+        $djot = <<<'DJOT'
+Single ref[^note].
+
+[^note]: The footnote.
+DJOT;
+
+        $result = $this->converter->convert($djot);
+
+        // Single reference - no suffix needed
+        $this->assertStringContainsString('id="fnref1"', $result);
+        $this->assertStringNotContainsString('fnref1-', $result);
+
+        // Simple backlink without numbering
+        $this->assertStringContainsString('href="#fnref1"', $result);
+        $this->assertStringNotContainsString('<sup>1</sup></a> <a', $result);
+    }
 }
diff --git a/tests/official/footnotes.test b/tests/official/footnotes.test
index 1c5cfda..76dbb56 100644
--- a/tests/official/footnotes.test
+++ b/tests/official/footnotes.test
@@ -13,13 +13,13 @@ test[^a] and another[^foo_bar].
 another ref to the first note[^a].
 .
 <p>test<a id="fnref1" href="#fn1" role="doc-noteref"><sup>1</sup></a> and another<a id="fnref2" href="#fn2" role="doc-noteref"><sup>2</sup></a>.</p>
-<p>another ref to the first note<a id="fnref1" href="#fn1" role="doc-noteref"><sup>1</sup></a>.</p>
+<p>another ref to the first note<a id="fnref1-2" href="#fn1" role="doc-noteref"><sup>1</sup></a>.</p>
 <section role="doc-endnotes">
 <hr>
 <ol>
 <li id="fn1">
 <p>This is a note.</p>
-<p>Second paragraph.<a href="#fnref1" role="doc-backlink">↩︎</a></p>
+<p>Second paragraph.<a href="#fnref1" role="doc-backlink">↩︎<sup>1</sup></a> <a href="#fnref1-2" role="doc-backlink">↩︎<sup>2</sup></a></p>
 </li>
 <li id="fn2">
 <pre><code>code
@@ -85,7 +85,7 @@ text[^footnote].
 <p>very long footnote<a id="fnref2" href="#fn2" role="doc-noteref"><sup>2</sup></a><a href="#fnref1" role="doc-backlink">↩︎</a></p>
 </li>
 <li id="fn2">
-<p>bla bla<a id="fnref2" href="#fn2" role="doc-noteref"><sup>2</sup></a><a href="#fnref2" role="doc-backlink">↩︎</a></p>
+<p>bla bla<a id="fnref2-2" href="#fn2" role="doc-noteref"><sup>2</sup></a><a href="#fnref2" role="doc-backlink">↩︎<sup>1</sup></a> <a href="#fnref2-2" role="doc-backlink">↩︎<sup>2</sup></a></p>
 </li>
 </ol>
 </section>