Relationship between Plantar Pressure and Sensory Disturbance in Patients with Hansen’s Disease—Preliminary Research and Review of the Literature

Abstract

Orthoses and insoles are among the primary treatments and prevention methods of refractory plantar ulcers in patients with Hansen’s disease. While dynamic plantar pressure and tactile sensory disturbance are the critical pathological factors, few studies have investigated whether a relationship exists between these two factors. In this study, dynamic pressure measured using F-scan system and tactile sensory threshold evaluated with monofilament testing were determined for 12 areas of 20 feet in patients with chronic Hansen’s disease. The correlation between these two factors was calculated for each foot, for each clinical category of the foot (0–IV) and across all feet. A significant correlation was found between dynamic pressure and tactile sensation in Category II feet (n = 8, p = 0.016, r2 = 0.246, Spearman’s rank test). In contrast, no significant correlation was detected for the entire foot or within the subgroups for the remainder of the clinical categories. However, the clinical manifestation of lesion areas showed high variability: (1) pressure concentrated, sensation lost; (2) margin of pressure concentration, sensation lost; (3) pressure concentrated, sensation severely disturbed but not lost; and (4) tip of the toe. These results may indicate that, even though there was a weak relationship between dynamic pressure and tactile sensation, it is important to assess both, in addition to the basics of orthotic treatment in patients with Hansen’s disease presenting with refractory plantar ulceration.

In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic review

“…(a) considering the number of publications resulting from research whose authors use these devices in their studies. Device and manufacturer Number of publications Publication references Utilization rate (a) Device features Application type Number of pressure sensors Technology Other sensors Battery life Communication Acquisition rate Usage cycles F-Scan TekScan, USA [ 31 ] 42 [ 35 , 36 , 47 , 48 , 72 , 86 , 87 , 94 ],[ [96] , [97] , [98] , [99] , [100] , [101] , [102] , [103] , [104] , [105] , [106] , [107] , [108] , [109] , [110] , [111] , [112] , [113] , [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] , [122] , [123] , [124] , [125] , [126] , [127] , [128] , [129] ] …”

The efficacy of topical adipose mesenchymal stem cell-conditioned medium versus framycetin gauze dressing in chronic plantar ulcer of leprosy: A randomized controlled trial

“…ulcer formation. 18 With improper wound treatment or a delay in the diagnosis, the condition could subsequently lead to the formation of a chronic ulcer.…”

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

“…14 This variation in general is not a concern but for those with loss of sensation and intrinsic muscle paralysis in the foot such as in leprosy, it can increase the risk of ulceration even with normal walking, by increasing the peak plantar pressure at vulnerable sites for ulcers such as the metatarsal heads. 15,16 This natural variation is perhaps a reason why not all patients with loss of sensation in the foot develop ulcers, 17,18 and we do not have clinical tools that can predict the feet at the risk of ulcer development. 15 Podiatry assessment is necessary to understand foot function and to plan foot orthoses to off-load the at risk sites for ulceration.…”