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

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.

Effect of Computer Assisted Designing / Manufacturing (CAD-CAM) Insoles in Leprosy Affected Patients

“…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. [4] Bulk production of ready to fit orthoses could help reduce the burden on the health care worker in peripheral settings. Availability of cost effective rigid and semi rigid, ready to fit anti-pronatory and supinatory orthoses for different foot sizes could help patients in remote location.…”

“…[3] The posterior tibial nerve is frequently affected in leprosy leading to loss of sensation and sweating, and intrinsic muscle paralysis in the foot, predisposing to ulcer formation. [4] Ulcers and neuropathic bone disorders develop by overload, repetitive mechanical stress, and shear; diabetic gangrene from metabolic and vascular factors; direct injury or cutting; continuous pressure resulting in ischemia; heat or cold. [2] High foot pressures have been shown to be predictive of future foot ulceration.…”

Prevalence of plantar ulcer and its risk factors in leprosy: a systematic review and meta‐analysis

“…The simple podiatry assessments [ 59 ] can identify foot alignment which can indicate abnormal plantar pressure distribution in the foot [ 60 ]. The podiatry assessment in routine clinical practice can help not only to identify person at risk of ulcer but also help determine podiatric intervention which will reduce the impact of high plantar pressures [ 20 , 61 , 62 ]. The podiatry interventions are found to be effective in reducing the plantar ulcers in diabetes [ 63 ] but are least utilised in leprosy.…”

Prevalence of plantar ulcer and its risk factors in leprosy: a systematic review and meta-analysis

“…[59] The podiatry assessment can help not only to identify person at risk of ulcer but also help provide podiatric intervention which will reduce the impact of high plantar pressures. [19,60,61] The podiatry interventions are found to be effective in reducing the plantar ulcers in diabetes [62] but are least utilised in leprosy . The prospective studies are needed to determine the role of biomechanical factors in identifying person at risk of ulcer for a focused podiatry intervention.…”