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The increase in the prevalence of diabetes and its complications is alarming. The incidence of diabetic foot disease, which leads to foot amputations far too often, is unacceptably high. This is particularly true for developing countries.Worldwide, every 30 seconds a lower limb is lost as a consequence of diabetes.The International Diabetes Federation (IDF) Consultative Section and the International Working Group on the Diabetic Foot (IWGDF), together with the Diabetic Foot Society of India (DFSI) and the Muhimbili University College of Health Sciences Dar es Salaam, Tanzania (MUCHS), have initiated a foot care project called ‘Step by Step, improving diabetic foot care in the developing world’. Participating countries were India, Bangladesh, Sri Lanka and Tanzania. Teams, consisting of a doctor and a nurse or paramedic, were invited to attend a basic and an advanced course. The goal was to improve educational skills and the management of diabetic foot problems. An experienced national and international faculty was responsible for teaching and the practical sessions.This article describes the design and the execution of the project. The outcome looks very positive. It is expected that the acquired knowledge and skills of the teams will sustain and that the effect of the courses will cascade from the teams to the local community. We expect that the setup of the project can ultimately help reduce the number of lower extremity amputations. The authors feel that this project is ready to be carried out in other developing countries.This pilot study was generously supported by the World Diabetes Foundation. Copyright © 2006 John Wiley & Sons.