Lower Extremity Amputation Prevention (LEAP) can dramatically reduce lower extremity amputations in individuals with Hansen's disease or any condition that results in loss of protective sensation in the feet.
HRSA's National Hansen's Disease Program (NHDP) developed LEAP in 1992.
The Five-Step LEAP Program
STEP ONE: Annual Foot Screening
The foundation of this prevention program is a foot screening that identifies those patients who have lost protective sensation.
The initial plantar ulcer usually results from an injury to a foot that has lost sensation. In the absence of protective sensation, even normal walking can result in such injuries.
The LEAP Foot Screen uses a 5.07 monofilament, which delivers 10 grams of force, to identify patients with a foot at risk of developing problems.
Perform an initial foot screen on all patients at diagnosis and at least annually thereafter.
To help prevent foot problems, at-risk patients should be seen at least four times a year. This is to check their feet and shoes to help prevent foot problems from occurring.
STEP TWO: Patient Education
Teaching the patient self-management skills is the second component of the LEAP Program.
Once taught simple self-management techniques, the patient assumes personal responsibility and becomes a full partner with the health care team in preventing foot problems.
STEP THREE: Daily Self-Inspection
Daily self-inspection is an integral part of the self-management program.
Every individual who has lost protective sensation must regularly and properly examine their feet on a daily basis.
Studies have shown that daily self-inspection is the single most effective way to protect feet in the absence of the pain warning system.
Early detection of foot injuries (blister, redness, or swelling), callus or toe nail problems (thick, tender, long, or discolored) is necessary to prevent potentially more serious problems.
Some problems should be reported immediately to a health care provider while the patient can manage others if they have been taught simple, basic self-management techniques.
STEP FOUR: Footwear Selection
Shoes, like feet, come in a variety of styles and shapes.
A person with normal sensation in their feet can wear almost any shoe style with little risk of injury. If the patient has lost protective sensation, poorly designed or improperly fitting shoes can seriously complicate the condition of the feet.
Once a patient has lost protective sensation, they should never walk barefoot, even around the house.
The patient should never wear narrow toe shoes or boots, heeled shoes, shoes with vinyl tops, thongs or any shoe that is too loose or too tight.
This person will need special assistance in selecting the appropriate style and fit of shoes.
The shoe should fit the shape of the foot. There should be at least ½ inch between the longest toe and the end of the shoe.
In a properly fitting shoe, a small amount of leather can be pinched up.
The patient, the family and the health care team need to recognize that wearing appropriately styled shoes that fit can prevent most foot problems.
STEP FIVE: Management of Simple Foot Problems
In addition to causing loss of protective sensation, neuropathy can also affect the autonomic nerves in the foot. And this can lead to dry cracked skin, increasing the probability of foot injuries and wounds.
This prevention program emphasizes the importance of reporting all injuries to the health care provider.