Effectiveness of prevention: Several studies have suggested that foot complications can be prevented by a focused team approach to identify and treat lower extremity complications. This approach generally involves de-weighting pressure areas with special shoes, patient education and self-care practices, re-vascularization, optimal glucose control, infection control, use of appropriate referral patterns, and regular foot care.18, 26-30 Several studies have demonstrated a significant decrease in the incidence of ulceration and re-ulceration when therapeutic footwear, education, and regular diabetic foot care was provided. However, 19-28% of these patients still re-ulcerated within 12-18 months.26,31,32 Edmonds and coworkers18 reported a 26% re-ulceration rate in high-risk diabetics with special shoes and insoles compared to an 83% re-ulceration rate in patients that wore their own shoes. Likewise Uccioli26 reported a 28% re-ulceration rate in diabetics treated with custom shoes and insoles compared to 50% re-ulceration among patients without special footwear. In a descriptive report, Helm and co-workers32 reported a 19% re-ulceration over an 18-month period among patients that healed neuropathic ulcers in total contact casts. As in other studies, after wound closure patients received custom shoes or healing sandals and regular clinical follow-up care. All of these studies were performed at specialty foot centers with a focus on diabetes. Even in these centers, the risk of re-injury was very high.