Podiatry services within the Veterans Health Administration delivers care to more than 600,000 patients annually. It is estimated that 24% of Veteran patients carry a diabetes diagnosis, with 780,000 of them considered at increased risk for amputation, therefore requiring routine podiatry services. The Prevention of Amputations in Veterans Everywhere (PAVE) Program was established in 1993 and is arguably the benchmark in amputation prevention in the United States. While there are several components of PAVE that require the cooperation and collaboration of different specialties and medical services, one requirement is a referral to podiatry for any patient at increased risk for amputation. Risk level is determined by past medial history and lower extremity clinical findings. Amputation prevention measures include routine basic foot care services, including a foot exam, nail cutting, callus cutting and fitting of diabetic footwear. The High-risk Eye and Limb Preservation Program (HELPP) was developed at the Atlanta VA Health Care System, offering an innovative approach to deliver this critical service to more patients in more geographic areas. The program utilizes Intermediate Care Technicians (ICT) who are former military medics and corpsmen. ICTs are trained to perform an accurate foot exam, basic foot care, basic wound care, and measurement for diabetic shoes. They are then deployed to rural VA outpatient clinics absent of podiatry services. The care is rendered under the telesupervision of a podiatrist to allow for appropriate interview, observation of the foot exam, supervision of the care rendered, and identification and management of acute foot issues. Eligible patients are also enrolled in remote patient monitoring for additional surveillance between appointments. The ICTs are also trained by ophthalmology to perform an eye screening given the risk of blindness in this patient population. Outcomes from this program over the course of four years have included: a 40% improvement in amputation ratios, improvement in access with a 20+day reduction in wait times, retention of 2200 patients within the system that has reduced the money spent on care in the community by $600,000 annually. This program has allowed VA to deliver more care to more patients, particularly patients in rural and highly rural areas that were not previously receiving this care. This innovative program, designed as a one-stop shop, has improved health outcomes, optimized patient care access and has reduced travel burden by offering care closer to home. Preventing major amputations preserves the quality of life and systemic health of the patient.