Easy Foot Test Just a LEAP Away 

By John West


Closing the Gap, Diabetes • February/March 1999


We fish with it. We use it in our weed-wackers. Some 

people even use it to hang pictures. So, how does some 

thing that simple make such a big difference to thousands of people with diabetes? 

It’s called monofilament—a small piece of clear nylon wire-like, 

string 37 mm long, 5.07 mm in diameter, that will exert 10 grams of 

force when applied to the skin and it is all that is needed to perform a 

simple, yet effective foot screen test for those at risk of developing 

circulatory foot problems from diabetes. 

The test, called the Diabetic Foot Screen, 

empowered with awareness of their own disease-related problems, 

treatment options, and tools for self-care, make healthier choices in the 

management of their diabetes. 

Lower extremity amputation is a serious consequence of diabetes 

complications. In fact, 50 percent of all non-traumatic amputations 

are the result of complications from diabetes, while 15 percent of 

persons with diabetes sustain lower extremity ulcers. 

Each year, almost 67,000 lower extremity amputations cost health 

care providers nearly $268 million. Additionally, people with diabetic foot ulcers are responidentifies those patients who have lost vascular Each year, almost 67,000 lower sible for 20 percent of all hospital stays. 

protective sensation. It is the brainchild of extremity amputations cost health Sharley Chen, Division of Programs for Spe1992 efforts by the Lower Extremity Ampu- cial Populations, Bureau of Primary Health Care, 

tation Prevention (LEAP) Program, at the care providers nearly $268 million. HRSA, said that Congress mandated $3 million 

Health Resources and Services Administration’s of the FY 1999 Budget to be set aside for imple­

(HRSA) Gillis W. Long Hansen’s Disease Cen- And people with diabetic foot mentation and evaluation of the diabetes Lower 

ter, Carville, La., to create a simple program to Extremity Amputation Prevention (LEAP) proreduce lower extremity amputations due to dia- ulcers are responsible for grams in areas served by community health cenbetes by 40 percent. 20 percent of all hospital stays. ters in the states of Louisiana, Alabama, Georgia 

According Bob Rolfsen, director of the 

LEAP Program at Carville, the filament was 

originally designed to be used in a Patient Empowerment Program 

study. 

“We wanted to determine if patients, sometimes with the help of 

family members, could use the filament to test themselves and get the 

right answer without special training,” he said. 

In the study, nine centers in eight states were selected because of 

their ability to represent a diverse socioeconomic group. In all, 196 

self-screening kits with surveys were sent to patients with 145 surveys 

being returned for a 74 percent response rate. 

“The study was successful and the results were published in the 

January 1998 issue of Diabetes Care, the professional journal of the 

American Diabetes Association,” Rolfsen said. 

“Authors of the study reported that 87 percent of the patients 

who participated in the study obtained the correct results as documented by their primary care provider,” he added. 

Rolfsen pointed out that the filament has now become the “tool 

of choice” and that it has made a dramatic difference in early detection. 

“Seven years after the LEAP program started and sensory testing 

began, it has become the accepted and recommended method for 

determining loss of protective sensation in the diabetic foot,” he said. 

“It is recommended that patients be screened at least once a year and 

if there is a loss of sensation at any of the tested sites, the patient should 

go see a provider as soon as possible,” he added. 

Since diabetes is generally a self-managed disease, patients provide most of their own daily care. Statistics show that patients who are 

and Mississippi. 

“These states have high incidences of diabetes that result in lower extremity amputations,” she said. “Congress 

also funded pilot programs in conjunction with the Louisiana State 

University School of Medicine, the University of South Alabama, and 

the Roosevelt Warm Springs Institute for Rehabilitation,” she added. 

Rolfsen said that the Centers for Disease Control and Prevention 

(CDC) statistics show that minorities are more at risk of diabetes and 

the complications that go with it such as blindness, kidney problems 

and hypertension. 

“We need to stress an increase in the level of awareness about 

diabetes and its complications and make sure that people are aware of 

the existence of federal health centers, where anyone can be seen 

regardless of their ability-to-pay or status of citizenship,” he said. 

The LEAP Program, the National Diabetes Education Program 

and its partners are charged with the responsibility of developing a 

national awareness coalition. The American Pharmaceutical Association has joined forces with the group and is spearheading a project to 

place a LEAP Filament into every diabetes medication prescription 

filled by every pharmacist in the country during the month of November 1999. 

“We need to get people in leadership positions or provider roles 

to take advantage of every opportunity to get filaments and instructions on how to use them into the hands of individuals,” Rolfsen said. 

In addition to pharmacies, patients can call 1-800-373-4325 to 

obtain a filament or browse the LEAP Program Web site at: http:// 

www.bphc.hrsa.dhhs.gov/leap and fill out the order form to receive one free 

by mail.

continued>>>> 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Easy Foot Test Just a LEAP Away 

By John West


Closing the Gap, Diabetes • February/March 1999


Diabetic Foot Screen: 

Patient Empowerment Program 

Foot Screen Instructions


(You may screen your own feet or ask a relative, friend or neighbor to do it for you.)


1. Holding the filament by the paper handle, touch each foot at the four circled 

sites as shown below in Figure1. (Note: Touch the filament along side of and NOT 

on a scar, callus or ulcer.) 

2.	 Touch the filament to the skin with a smooth motion, lasting a second or two, 

like in the Step 1, Step 2, and Step 3 drawings below. 

3.	 Push hard enough with the filament to make it bend (See Step 2). 

4.	 Place a ( [ ) in the circle if you can feel the filament at that site and a ( , ) if you 

cannot feel the filament at that site. 

NOTICE: If you have a ( , ) in any circle, take this form as soon as possible to your nurse or 

physician. 

Office of Minority Health Resource Center	 2 U.S. Department of Health and Human Services