Foot ulcers and diabetic neuropathy are two conditions that can
eventually lead to
lower extremity amputation, but also can be caught early. With
the right preventive measures, the risk of amputation can be lessened. The
Lower Extremity Amputation Prevention Program (LEAP) was developed as a tool to
do just that.
The program, which was developed in 1992, is designed to prevent ulcers
and catch patients with diabetic neuropathy before their condition reaches the
point of amputation. The prevention program is the result of wanting to better
understand leprosy and neuropathy, according to Alicia Hoard, LOTR, CPed, chief
of the hand and occupational therapy department at the National Hansen’s
Disease Program in Baton Rouge, La.
“LEAP is a simple but comprehensive program that can dramatically
reduce lower extremity amputation due to neuropathy,” Hoard told the
audience at the 2010 North American Pedorthic Congress in Orlando, Fla.
According to the Health Resources and Services Association’s
website, the 5-step LEAP program consists of:
- annual foot screenings;
- patient education;
- daily self inspection of the foot;
- appropriate footwear selection; and
- management of simple foot problems.
“This program is designed for any health care professional and
particularly for the patient,” Hoard told O&P Business
News. “If the patient does not have protective sensation, they need
to notify their health care professional whether it is a primary care doctor,
podiatrist or pedorthist.”
LEAP offers individuals who have lost protective sensation in their foot
or feet an online do-it-yourself screening test. The LEAP program is
recommended for individuals with diabetes or Hansen’s Disease (HD), also
known as leprosy. The program recommends patients test themselves for loss of
protective sensation on a yearly basis.
If a patient had protective sensation on their foot, he or she would
feel the injury, such as a blister or sore. If he or she does not have
protective sensation, the patient is at greater risk for injury. Protective
sensation is a key component to the program.
“There is a real uniqueness with neuropathy,” Hoard explained.
“There is a certain psychology to it.”
According to Hoard, it is difficult for health care professionals to get
full compliance from patients when they are not feeling any pain. If a patient
has neuropathy, they do not have that warning system that signals to the
individual that something is wrong. Hoard described a situation where one of
her patients lost her sewing needle the night before her appointment. When she
came in to the office to see Hoard, the patient found the needle stuck in the
bottom of her foot. The patient was unaware that she had been walking with a
needle in her shoe.
“It is so foreign to us because we can practically feel their pain,
but they can not,” she said.
The LEAP program offers individuals the opportunity to test their own
sensation levels using a 10g sensory testing monofilament. Diagrams with target
areas on both feet are available online. The diagrams indicate where a patient
should place the monofilament, which is similar to a fishing line, for
sensation. This will help identify potential foot problems.
“It is important for individuals who have lost their protective
sensation to get into the habit of checking their feet every single day,”
Hoard said. — by Anthony Calabro
For more information:
If you give diabetics, who are at greater risk of foot complications and
amputation, access to an annual foot examination, the statistics show that
serious complications and amputation can be prevented. How do we get diabetics
examined in order to find problems and prevent future problems?
The LEAP Program’s filament test is a simple examination that can
be performed by professionals or the lay person. The question that needs to be
asked is: can the patient feel the filament when it is pressed against several
areas of the foot? If the patient tests themselves and has concerns, they can
seek medical care and may have saved themselves the likelihood of long-term
— Lawrence M. Rubin, DPM