Diabetic foot lesions are one of the most serious causes of morbidity among diabetic people and often require a long hospital stay. Despite intensive therapy, many of these patients will require a lower-extremity amputation (LEA), with a high economic and social cost. The estimated cost due to LEAs in diabetic patients in Spain was 5,289 million pesetas ($39.5 million US)(1). Area 7 in Madrid has the lowest LEA incidence of all Caucasian populations (2), with a progressive decline since 1989, reaching a 50% decrease in 1997. Preventive strategies are mainly focused on early peripheral neuropathy detection, diagnosed by a neuropathy disability score (NDS) 6. Diabetic people diagnosed with neuropathy are then included in a continuous prophylactic foot care program (FP). This program has been available in our area since 1993. Our study assessed the effectiveness of the FP in reducing the foot ulcer incidence in diabetic patients included in this program between 1993 and 1996 and in the followup completed in December 1999. We designed a prospective clinicbased study in which all diabetic patients who attended the outpatient clinic of the endocrinology service and who were diagnosed as having peripheral neuropathy based on an NDS 6 were included in a screening and prophylactic FP. The NDS is included in the standards of medical care for diabetic people from area 7 in Madrid (population of 565,000). The number of people with diagnosed diabetes is estimated to be 19,000. The design of the screening program has been described previously elsewhere (3). In short, we recruited diabetic patients with an NDS 6 who were considered to be suffering from peripheral neuropathy according to standard criteria (4). All of these diabetic patients were tested for peripheral vascular disease (PVD) and morphological plantar deformities; for visual and motor capacity that enabled them to inspect their own feet; and for self–foot care that included the manner in which they walked barefoot, correct performance of foot hygiene, callus care, nail trimming, water temperature checking, the use of heating pads and other methods to warm up the feet,“bathroom surgery,” the use of products for foot care, the method used for inspection of feet and shoes, and the proper use of shoes, socks, and clothes. Patients with severe PVD (grade 2 ischemia or higher), which was defined as the presence of intermittent claudication or the absence of at least one foot pulse (dorsalis pedis or posterior tibial), were excluded because these patients are unlikely to be influenced by FPs. The other patients were included in a continuous FP that consisted of four 90-to 120-min sessions held during 1 week. The first session was individual, and personal characteristics of the foot care of each patient were noted. The main goal of this session was to make the patient realize his/her lack of normal sensitivity in the feet compared with the rest of the body and his/her loss of sensory perception of pain. Patients should agree that because of the decrease or loss in their protective pain sensation, it should be carefully evaluated. First, visual and motor capacity to inspect their own feet was explored. Patients were considered to have adequate eyesight capacity if they were able to read a letter 0.4 cm in size from 50 cm away (with their usual glasses if necessary) and acceptable physical mobility if they could see the soles of their feet, using a mirror if necessary. The patients were evaluated for the proper use of shoes, socks, and clothes; the manner in which they walked barefoot; the correct performance of foot hygiene; callus care and nail trimming; water temperature checking; the use of heating pads …