LEAP Alliance pushes for creation of certified foot exam assistants

Larry Rubin, a retired podiatrist, is asking people to bare their "soles": He and his wife, Arlene, are the founders of the Lower Extremity Amputation Prevention Alliance, which seeks to ensure more diabetics get their feet checked for loss of sensation and poor circulation.

To do that, the LEAP Alliance is taking input from health professionals and diabetic patients on how to create awareness of how the simple test can save limbs. It is also proposing Nevada have health care workers become certified foot examination assistants to help physicians perform annual preventative foot exams for diabetic patients.

The state currently has no certified assistants.

"This is new, never been done," Rubin said. "We're not setting an exact number (on how many it would like to see certified), as this is a proof of concept period. Personally, in two years, I'd like to see a minimum of 30 doing this in Southern Nevada."

Early-stage diabetics often experience loss of feeling in their extremities. An initial screening includes simple pokes to the soles of the feet using a flexible filament and threading a rod between the toes to check for sensation. Further testing can determine the extent of the damage.

LEAP held a workshop July 13 at Tivoli Village, 440 S. Rampart Blvd., where more than 30 people, mostly health care professionals, were alerted to the problem. The emphasis was on preventative testing and how best to forward that initiative so that more people get care before their diabetic foot problems become unmanageable and require amputations.

"We want to determine if there's a problem before it gets to be a problem," said Dr. Leonard Franklin of Summerlin Foot & Ankle, 3320 N. Buffalo Drive, Suite 107, who is part of the alliance. "There are 85,000 amputations a year for people with diabetes. ... Nevada is one of a handful of states which has no Medicaid coverage for podiatrists to provide diabetic foot care."

The LEAP Alliance and its partners are seeking to solve this problem.

In the past, LEAP has partnered with various Lions Clubs to do filament screenings at health fairs and other community events. Now, it is looking to expand the effort so that those who work in doctor's offices are trained and certified for more in-depth testing. Rubin said he hopes the effort will eventually trickle out to other states until it covers the entire country. LEAP says foot checks for diabetics should be a part of every doctor visit.

"In my day, you'd go in for a health exam, and the doctor would say, 'Take off all your clothes, but keep on your shoes and socks,' " Franklin said. "Well, we want you to take off your shoes and socks."

For diabetics, 60 percent to 70 percent will develop peripheral neuropathy, or loss of sensation, in their feet, according to the National Institutes of Health. Up to 32 percent of those will develop a foot ulcer, and the study found that more than half of those ulcers will become infected, with 20 percent resulting in amputation.

Barbara Nunez, a health coach, told of one diabetic woman who came in for a checkup and was found to have a nail stuck in her toe.

"She had no idea it was there," Nunez said.

Visit leapalliance.org, call 702-233-5253 or email lrubin@leapalliance.org.

— To reach Summerlin Area View reporter Jan Hogan, email jhogan@viewnews.com or call 702-387-2949.