The human and economic consequences of the diabetic foot are extreme. Due to various complications of diabetes, a person’s foot can become vulnerable. Nerve damage, vascular problems and delayed wound healing can lead to chronic ulceration of the foot. As a result of infection or the non-healing of an ulcer, amputation may be necessary. In the general population, lower-leg amputation is suffered by between five and 25 people per 100 000; among people with diabetes, the figure is between six and eight for every 1000. Yet the situation need not be so dire. With relatively low investment, governments can advance education and prevention that will result in lower rates of amputation than the unacceptable figures we see today. This is the message behind the World Diabetes Day campaign for this year. Karel Bakker and Phil Riley report.