Appropriate footwear and orthoses are essential components in the management of the foot at risk of ulceration in leprosy

Karthikeyan Govindasamy,Sathish Kumar Paul

doi:10.47276/lr.92.4.366

Abstract

Ulcers are a serious complication and a common cause of morbidity in leprosy. The exact roles of impairments and distorted mechanics of the foot are not fully understood in the development of ulcers in patients with anaesthetic feet. A simple biomechanical evaluation of the foot along with the routine neurological assessment helps to identify feet at risk for developing an ulcer and also to prescribe appropriate orthoses, which are inserts designed to improve biomechanical function, encourage proper joint alignment and protect the foot. The orthotic intervention along with protective footwear offloads the peak plantar pressure sites of the foot, preventing ulceration. The provision and use of foot orthoses have generally been limited to tertiary leprosy referral centres. Advances in technology have made the fabrication of orthoses more rapid and precise, enhancing user acceptance and adherence. Effort should be made to provide simple orthoses that are easy to fabricate and effective in preventing plantar ulcers in leprosy, in the community health setting.

Highlights

The posterior tibial nerve is frequently affected in leprosy[1,2] leading to loss of sensation and sweating, and intrinsic muscle paralysis in the foot, predisposing to ulcer formation.[3]
Recurrent ulcers can lead to shortening and amputation of the affected limb[4] and delayed or non-healing ulcers can transform into squamous cell carcinoma.[5]
While the newer technologies are attractive, providing simple and effective orthoses at the peripheral level is needed and effort should be made to include the provision of basic accommodative orthoses such as the tarsal platform, plantar metatarsal pads and medial arch support in leprosy programs to improve the effectiveness of the footwear provided

Summary

Introduction

The posterior tibial nerve is frequently affected in leprosy[1,2] leading to loss of sensation and sweating, and intrinsic muscle paralysis in the foot, predisposing to ulcer formation.[3]. Protective footwear can reduce the prevalence of ulcers,[9,10,11] the role of orthoses in protective footwear in preventing ulcers has not been satisfactorily studied.[12] The consensus statement on prevention of disability in leprosy emphasises the accessibility of footwear with soft insoles and orthoses to all those with anaesthetic feet.[13] An orthosis is a device designed to improve biomechanical function, encourage proper joint alignment or to protect an existing limb.

Results

Conclusion