COVID-19 Foot Registry

Image by Pond5.com

The COVID-19 Foot Registry’s mission to gain insight into the signs and symptoms of COVID-19 in the feet and toes (“COVID toes”). The goal to improve treatment and prevention of COVID-19.

To accomplish this goal, we need your help. The Registry is open to receive photographs and information about persons who have COVID-19 or may have COVID-19. The information and photographs may be provided from physicians, podiatrists, dermatologists, healthcare workers, researchers and individuals, including patients themselves.

There is no fee to use this registry. This registry does not provide medical treatment or medical advice. If you have COVID-19 (coronavirus 2019) or any medical problem, see a physician promptly.

By participating in submitting data, materials and/or images to this registry you are responsible for ensuring that you are authorized to submit the data, materials and/or images and for de-identifying any Protected Health Information that you submit in accordance with HIPAA regulations.

Note: If you are the person with the foot or toe issue, do not use your real name. Use a pseudonym to protect your privacy.

First Name (Required)
Last Name (Required)
Birth Month
Birth Year

Are you 18 years of age or older? YesNo

Is this a new case or an update to a prior-submitted case?

NewUpdate

Your Case Number
(Important: Keep this number in a safe place should you wish to update this case)
Enter Your Case Number

City / Town
Postal Code / Zip Code
State / Province
Country

Preferred Language (if not English)

Are you a Doctor? YesNo
What is your Specialty?

Age of person with the foot problem? (Required)
Sex of Person
Is the foot problem causing? (Check all that apply)
ItchingBurningPainNumbnessDrainageSwellingRednessBruising / DarkeningDifficulty walkingJoint PainDeformity
Is the pain mild, moderate or severe?
MildModerateSevereUnknown

Is the pain worse when walking?
YesNoUnknown

Explain the foot problem and any treatments (did any treatments help?)

Is the foot problem on one foot or both feet?
One footBoth feet

Was a Biopsy done?
YesNoUnknown
Please put the findings of the biopsy here.
(or upload the biopsy report on next page)

Has any blood testing (blood work) or x-rays been done?
YesNoUnknown
Please tell us the results.
(or upload the x-ray images or test results on the next page)

If this person has been tested for COVID-19, are they positive?
YesNoUnknown

Does this person have other symptoms of COVID-19?
YesNoUnknown
Please explain all other symptoms present

What other diseases or medical problems does this person have?

Did the person’s foot problems appear before other symptoms of COVID-19?
YesNo
How many day prior to other COVID symptoms did foot problems appear?

Are other members of the person’s household or workplace positive for COVID?
YesNoUnknown
Please list who these person are and their relationship to the person.

Does the person smoke or vape?
YesNoUnknown

Your E-Mail? (Required)
Confirm E-Mail? (Required)
Alternate E-Mail?
Your Phone Number?
Alternate Phone Number?

Other Information you wish to add

Do you have any photographs, biopsy, x-rays or test results to upload?
YesNo

On the next page you can upload photos, x-rays and test results.
Check the box below and then press Register to go the next page.

 

Thank you for your interest in participating in this registry. At this time you must be 18 years of age or older to participate. Please ask a parent or guardian to enter information on your behalf.