In the period 2011 to 2015, St Helens and Knowsley Teaching Hospitals NHS Trust evaluated low-friction bootees (LFB) integrated into the care path for patients at-risk of heel pressure ulceration (hPU) in an initiative to reduce hospital acquired hPU related to friction and shear. In 2012, LFB were introduced and hPU reduced by 32% from 50 to 34 compared with 2011. In 2013, mandatory education and training was introduced. A further reduction to 11 hPU from 34 was recorded. In 2014 a new risk assessment tool was introduced. Thereafter the incidence of friction/shear associated hPU, identified by the depth of tissue injury, stabilised. Over the initiative, the overall reduction in all PU was 67% and for hPU, 84%. No grade 3 or 4 hPU were reported. The incidence of all PU reported was, and remains, below the national average. The five-year initiative substantially impacted on achieving zero harm targets, and led to estimated savings calculated from the reduced cost of managing hPU and the cost of acquisition and laundering of LFB versus 2011 of £53,371 in 2012 and £196,116 in 2013.