Plantar trophic ulcers in patients with leprosy

Sabato, Stefano Santo; Yosipovitch, Z; Simkin, Ariel; Sheskin, J

doi:10.1007/bf00267731

Cited by 13 publications

(8 citation statements)

References 9 publications

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“…Our finding that nerve function is independently associated with peak pressure confirms previous findings in diabetes and leprosy [7,15,35]. Impaired nerve function affects foot function and walking and causes callus, foot deformities and decreased muscle strength, which may lead to increased foot pressure [12,24,36].…”

Section: Discussionsupporting

confidence: 88%

“…Increased peak pressure has been shown to be an important predictive risk factor for the development of foot ulceration in diabetes and has also been associated with the presence of foot ulcers in persons affected by leprosy [6,7,12,30,31]. This indicates that a substantial proportion of our participants are at risk of developing foot ulceration.…”

Section: Discussionmentioning

confidence: 76%

“…Since then, research into foot pressure due to leprosy has been limited. Although a few studies have indicated that increased foot pressure is found in the presence of neuropathy, active ulcers and scars from healed ulcers, the aetiology of increased foot pressure is not fully clarified [7][8][9]. Foot problems in leprosy are often compared to diabetic foot problems [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Increased plantar foot pressure in persons affected by leprosy

et al. 2012

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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Increased plantar foot pressure in persons affected by leprosy

et al. 2012

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“…One study fo und a significant association between the presence of an ulcer and the degree of sensation to pinprick in the fe et ofleprosy patients. 4 Another study using Von Frey aesthesiometers fo und higher pressure thresholds in the fe et of diabetic patients compared to normal controls.6 A fu rther study using vibration perception fo und elevated sensory thresholds were associated with a history of plantar ulceration in diabetic patients.7 There is general agreement among these investigators that impaired sensation may lead to frequent fo ot injuries but the degree of sensory loss required for a patient to be at risk of plantar ulceration has not been determined.…”

mentioning

confidence: 99%

Plantar sensory threshold in the ulcerative foot

Ja¹,

Ds²

1986

Leprosy Review

138

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Pressure threshold measurements were made using a set of three Semmes-Weinstein monofilaments on 132 plantar u\cer sites in 72 leprosy patients and 45 plantar u\cer sites in 28 diabetic patients. The most common sites of u\ceration were the great toe and first metatarsal head. No patient could feel monofilaments smaller than 6•\0 (75 g). The next smallest filament, 5•07 (10 g), was identified as the level of protective sensation in leprosy patients who customari1y use fo otwear. Similar results were shown in a small group of diabetic patients.

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“…The aetiology of plantar ulcer is multifactorial. The loss of protective sensation in particular (defined as an inability to feel 10 grams of force), [16] foot deformities, and a resulting abnormal pressure distribution in plantar aspect of the foot are some of documented risk factors for ulcer [17,18]. The role of occupation, activity level and other demographic factors are not known.…”

Section: Introductionmentioning

confidence: 99%

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

Govindasamy,

Darlong,

Watson

et al. 2023

Preprint

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BackgroundPlantar ulcers are a leading complication of leprosy that requires frequent visits to hospital and is associated with stigma. The extent of burden of ulcers in leprosy and its risk factors are scant impeding the development of targeted interventions to prevent and promote healing of ulcers. The aim of this review is to generate evidence on the prevalence of plantar ulcer and its risk factors in leprosy.Methodology/Principal findingsDatabases (Medline, Embase, Web of Science, CINAHL, BVS), conference abstracts and reference lists were searched for eligible studies. Studies were included that reported a point prevalence of plantar ulcer and/or its “risk factors” associated with development of ulcers (either causatively or predictively), including individual level, disease related and bio-mechanical factors. We followed PRISMA guidelines for this review. Random-effects meta-analysis was undertaken to estimate the pooled point prevalence of ulcers. Reported risk factors in included studies were narratively synthesised. This review is registered in PROSPERO: CRD42022316726.Overall, 15 studies (8 for prevalence of ulcer and 7 for risk factors) met the inclusion criteria. The pooled point prevalence of ulcer was 34% (95% CIs: 21%, 46%) and 7% (95% CIs: 4%, 11%) among those with foot anaesthesia and among all people affected by leprosy, respectively. Risk factors for developing ulcers included: unable to feel 10 grams of monofilament on sensory testing, pronated/hyper-pronated foot, foot with peak plantar pressure, foot with severe deformities, and those with lower education and the unemployed.Conclusions/SignificanceThe prevalence of plantar ulceration in leprosy is as high as 34% among those with loss of sensation in the feet. However, the incidence and recurrence rates of ulceration are least reported. The inability to feel 10 grams of monofilament appears to be a strong predictor of those at risk of developing ulcers. However, there is a paucity of evidence on identifying those at risk of developing plantar ulcers in leprosy. Prospective studies are needed to estimate the incidence of ulcers. Identifying individuals at risk of ulcers will help design targeted interventions to minimize risk factors, prevent ulcers and promote ulcer healing.

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Plantar trophic ulcers in patients with leprosy

Cited by 13 publications

References 9 publications

Increased plantar foot pressure in persons affected by leprosy

Increased plantar foot pressure in persons affected by leprosy

Plantar sensory threshold in the ulcerative foot

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

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