Foot and Ankle Muscles Activation and Plantar Sensory Deficit in Leprosy and Its Implication to Foot Deformity and Walking Capacity

Fitri Anestherita,Johanes Putra,Andri Setiawan Kokok,Ibrahim Agung,Nelfidayani Nelfidayani

doi:10.4236/ojtr.2021.94010

Abstract

Objective: To observe extrinsic foot muscle activity ratio and sensory disturbance in Leprosy and its implication to foot deformity and walking capacity. Design: Cross sectional study in Singkawang, West Kalimantan. Materials and Methods: Thirty-three leprosy patients without walking aids and/or orthotic prosthetic were enrolled using consecutive sampling. Foot deformity score was calculated and muscle activity was measured using surface EMG. Muscle activation ratio was calculated in Tibialis anterior-to-Gastrocnemius (TA/GA) and Tibialis Anterior-to-Peroneal (TA/PE). Walking capacity was assessed using Timed up and Go test. Results: Significant differences of foot ulcer (p = 0.001) and foot deformities (p = 0.001) were found in plantar sensory deficit group. There was strong correlation between foot deformities and decreased TA/GA ratio (p = 0.001, r = ﹣0.787) and decreased TA/PE ratio (p = 0.001, r = ﹣0.663). There were significant differences of TA/GA ratio (p = 0.00) and TA/PE ratio (p = 0.09) based on the foot ulcer, and no significant difference of Timed Up and Go Test result within plantar sensory deficit group (p = 0.427). No significant correlation was found between walking capacity and TA/GA ratio (p = 0.055), and TA/PE ratio (p = 0.165). Conclusion: Plantar sensory deficit and decreased extrinsic muscle activation ratio during gait had been proven to affect foot impairment, but have not been proven to inhibit walking capacity.

Highlights

No significant correlation was found between walking capacity and Tibialis Anterior/Gastrocnemius (TA/GA) ratio (p = 0.055), and Tibialis Anterior/Peroneus (TA/PE) ratio (p = 0.165)
Previous study conducted by Frederik et al, showed that there was an increase in foot pressure especially in the metatarsal head section in leprosy patients
We found that the occurrence of foot deformity and a pressure ulcer on the plantar is significantly higher on subject group with plantar sensory deficit

Summary

Introduction

The posterior tibial and peroneal neuropathy in leprosy may result in sensory loss and muscle weakness causing gait abnormalities. Previous study conducted by Frederik et al, showed that there was an increase in foot pressure especially in the metatarsal head section in leprosy patients. It was associated with peripheral neuropathy and toe deformities. Impaired nerve function on posterior tibial nerve and common peroneal nerve affects foot function and walking. It can cause callus, foot deformities, and decrease muscle strength, which can lead to increased foot pressure [6]. The objective of this study is to evaluate extrinsic foot muscle activation pattern during gait and to determine its correlation with foot deformities and walking capacity in leprosy patients

Methods

Results

Conclusion