Diabetes is a leading cause of lower extremity amputation in Australia. Identifying patients 'at-risk' and preventing first diabetic foot ulcer are paramount. This mixed methods study delivered a multifaceted intervention in rural Western Australia to implement national guidelines for the diabetic foot. Interventions were based on the WHO Innovative Care for Chronic Conditions framework and included education and training for rural practitioners, decision support and telehealth support. Identified barriers and facilitators show that high level commitment is needed to resource systematic efforts to align and coordinate the necessary components to prevent and manage diabetic foot disease across the health system.