Patella ferruginea is the most threatened macroinvertebrate in the western Mediterranean, where it is at serious risk of extinction. There is little information on the status of the various populations and most data were published more than 25 years ago. This study provides updated information on the global status of this species, and implications for management and conservation, and tests the hypothesis that population structure can be influenced by collection by people and by the type of substrate. Fifty-five localities were surveyed in Corsica, Sardinia, Tuscany and Sicily, on the islands of Egadi and Pantelleria, and on the Zembra archipelago and Tunisian coasts. The species is extinct on mainland Italy and Sicily but isolated individuals can be found on Egadi and Pantelleria. Populations on Corsica and Sardinia have declined dramatically during the last 25 years. The population in the Zembra archipelago is well preserved, although more widely on Tunisian coasts the species is highly threatened. The information provided here, combined with information from the literature, indicates a strong decline and/or extinction of many populations throughout the western Mediterranean and the presence of healthy populations only in some locations along the north African coast. The species exhibits an increase in density and mean size in areas free of human pressure but the type of substrate (natural or artificial) has no strong influence.