how to prevent amputations

the five-step
lower extremity amputation prevention (LEAP)



Lower Extremity Amputation Prevention (LEAP) is a comprehensive program that 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.

LEAP was developed at the HRSA National Hansen’s Disease Program in 1992.

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The five-step LEAP Program



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.

An initial foot screen should be performed on all patients at diagnosis and at least annually thereafter. Patients who are at risk should be seen at least four times a year to check their feet and shoes to help prevent foot problems from occurring.



Teaching the patient self-management skills is the second component of the LEAP Program.

As a result, 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. 



Daily self-inspection is an integral part of the self-management program. Every individual who has lost protective sensation must regularly and properly examine his/her 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 he/she has been taught simple, basic self-management techniques.



Shoes, like feet, come in a variety of styles and shapes. A person with normal sensation in his/her 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, he/she 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



In addition to causing loss of protective sensation, neuropathy can also affect the autonomic nerves in the foot and 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.


Diabetic Foot Ulcer
before & after treatment

Slide the arrows left and right to see the incredible before and after success images of this patients chronic diabetic wound that he was unable to heal on his own. 

This wonderful patient of ours came to us with a Diabetic wound he was unable to heal on his own. After working closely with Dr. Silvester, trusting the process, his treatment plan and eventually needing surgery to treat the problem at it’s source with Achilles Tendon Lengthening, A.D. (our patient) was able to finally heal his wound.

The Five-Step Lower Extremity Amputation Prevention (LEAP) Program

In this image, you will see progression of this patients chronic ulcer treatment. This patient of ours suffered for years with chronic ulcer’s. This ulcer in particular (shown in the image above) had been present for over 2 months and only getting worse. 

Within four weeks after his Achilles Tendon Lengthening and Posterior Tibial Tendon Recession, this patient’s open wound had closed and was on the way to recovery. 

Being pro-active and getting ahead of this ulcer and the infection it could cause this diabetic, we were able to prevent further amputation. 

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