Goal:

Through a program that systematically applies recognized standards of foot care to all patients with Diabetes Mellitus, reduce the number of lower extremity amputations, the development of foot complications and the rate of hospitalization for foot related problems in Louisiana by 50% within five years.

CD-LEAP Program: Combines prevention (Basic LEAP) with a conservative management approach.

1.  Annual foot screening

2.  Ongoing patient education

3.  Selection of proper fitting and designed footwear

4.  Daily foot self inspection

5.  Care of callous, nail and skin problems

6.  Treatment of foot ulcerations and Charcot fractures.

7.  On-site fabrication and modification of Custom molded footwear.

The program sponsors Level I, II and III LEAP training programs and seminars to assist health professionals in developing the full range of foot care skills required in a Comprehensive Diabetes LEAP Program..

LSUHSC-DFP Overview:

The LSU Health Sciences Center Diabetes Foot Program (LSUHSC-DFP) in Baton Rouge LA specializes in the prevention and treatment of foot problems in patients with Diabetes Mellitus and related neuropathic conditions. The program uses the conservative management techniques developed by the multidisciplinary rehabilitation staff of the Gillis W. Long Hansen’s Disease Center, known as the Carville Approach.

The program serves as the hub for the Louisiana LEAP Initiative, networking Community Health Centers and the LSUHSC State Hospital System (SHS) to provide 100% access and 0% disparity of care to under-served populations.  This comprehensive lower extremity amputation prevention program provides patient education, evaluation, treatment, protective footwear, professional training and  research for foot problems in people with Diabetes Mellitus. Similar "Satellite" LEAP Programs will be implemented at all LSUHSC affiliated hospitals and interested Community Health Centers.

The LSUHSC Diabetes Foot Program will work with Statewide LEAP coalitions to help form clinical networks to improve coordination of care in the multi-parish region served by their respective facilities. This project promotes improvement of  health care services to underserved and indigent populations,  improvement of health outcomes,  and facilitates the development and delivery of focused preventive, educational and disease management health care services.

The program will evaluate the implementation, effectiveness and the cost/effectiveness of a comprehensive Staged Diabetes Foot Management and  CD-LEAP program in a medically under-served population. Other areas of  research interest include: 1. Computer assisted / supported decision making in diabetes foot care and 2. Plantar ulcer healing rates, ulcer recurrence, patient compliance and digitized plantar pressure assessment.

The Lower Mississippi Delta Region, which encompasses adjacent rural counties/parishes in Mississippi and Louisiana, has been shown to be at extreme risk for Diabetes complications and has amongst the worst access and parity in health care in the United States. The Mississippi and Louisiana LEAP Initiatives will collaborate to form the Delta LEAP Initiative that will specifically target this area for expanded LEAP services. Training modules consisting of videotaped lectures and “self study” guides will be developed, along with two-way video conferencing between the LA and MS programs, to enhance Level I and II LEAP training.

A standardized Diabetes Foot Screen, Outcome Measures and a “Decision Path for Staged Management of Foot Problems” in Diabetes Mellitus based on the Carville Approach have been developed for use in the four State LEAP Grant region.

The LSUHSC-DFP has developed a computerized database (using Access 2000) with common data elements for Statewide and multi-State programs to evaluate the implementation, effectiveness and cost/effectiveness of LEAP programs. The common data elements are from the Diabetes Foot Screen and the Outcome Form.These and other forms are available for download. This automated data system can be used to do a population based study and regional data analysis. Programs interested in using the database can contact cpatou@lsuhsc.edu.

• Foot Evaluation and Consultation
• Diabetes Foot Screening
• Patient Foot Self Management Education
• Basic LEAP including: Nail, Callous and Skin Care
• Unna Boot Application
• Wound Debridement and Dressings
• Total Contact Casting and Other Off-Loading Devices
• Assistive Walking Devices
• Exercise Programs
• Functional and Gait Training
• Shoe Fitting
• On-Site Fabrication of Custom molded Foot Orthoses and Footwear