Eficácia e eficiência das palmilhas na prevenção e reabilitação de ulceras plantares em pés neuropaticos na hanseníase e diabetes / Efficacy and efficiency of insoles in the prevention and rehabilitation of plantar ulcers in neuropathic feet in leprosy and diabetes

As neuropatias periféricas causadas pela hanseníase e diabetes podem causar perda de sensibilidade protetora, trofismo muscular e função autonômica da pele, e consequentemente deformidades em pés e desequilíbrios biomecânicos e da distribuição da pressão, gerando alto risco de desenvolvimento de úlceras plantares. Um dos meios para prevenir é o uso de palmilhas customizadas associadas ou não ao uso de calçados ortopédicos. O objetivo dessa revisão foi verificar a eficácia, eficiência das palmilhas na prevenção e reabilitação de úlceras plantares e conhecer novidades acerca do design e do material. Foram realizadas pesquisas nas plataformas PUBMED, LILACS, EMBASE e Cochrane e foram incluídos todos os modelos de artigos, livros, monografias, no total foram encontrados 17 estudos. Apesar das palmilhas serem eficazes no alívio de pressão plantar e na diminuição da incidência das ulceras plantares, neste estudo foi encontrado poucas evidências sobre inovações e durabilidade das palmilhas que levassem em conta o custo benefício e sua efetividade.

[International cooperation for prosthetics and orthotics in Myanmar].

"Effectiveness of the sole protection and the plantar ulcer treatment of Micro Cellular Rubber (MCR) sandals" was investigated as a part of research enterprise "Research concerning the diagnosis, treatment, and the prevention of disability of an effective Leprosy in Myanmar" of the international medical treatment cooperation for three years since 2007. Furthermore "Introduction of Orthotics for the footdrop" was recently attempted through those activities. We participated for two research items from 2007, and reported on the research content and the result. We discussed the ideal way of international technical support for the developing countries in the future. Conclusively we recognized further expected works in this field 1) to train more numbers of orthotic practitioners for MCR sandals; 2) to make them skillful; 3) to train Prosthetists and Orthotists (PO) in Myanmar leaders; and 4) to organize helpers in Japan including preparation for publishing guidelines for PO workers.

Techniques for covering soft tissue defects resulting from plantar ulcers in leprosy: Part I - general considerations and summary of results

Recurrent plantar ulceration is a common and serious complication occuring consequent to impairment of the tibial nerve in leprosy patients. In spite of many therapies and long therapeutic course, it is extremely difficult to abolish this complication in many cases because of extensive skin and soft tissue cushion loss due to repeated infection. Since the early 70 we have been using microscopic surgical techniques to reconstruct the ulcerated area using eight types of the flaps. In this series of papers we review out experience. Post operatively, the flapes survived in all cases, the long term results have proved satisfactory, and recurrent ulceration occurred in only three patients

Techniques for covering soft tissue defects resulting from plantar ulcers in leprosy: Part III - use of plantar skin or musculocutaneous flaps and anterior leg flap

Anatomical studies suggest that five types of plantar flaps namely, the lateral and medial plantar flaps, the Abductor hallucis, the Flexor digitorum brevis, and the Abductor digiti minimi myocutaneous flaps, can be incised from the central section of the sole. The advantages of a plantar flap are recognizable neurovascular bundles of the sole, wide calibre of constantly located blood vessels, identical histological structure of the donor and the recipient sites, hidden donnor site and absence of functional deficit. We have used the palntar flaps in seven cases. There has been no recurrence of ulceration in any of them during the follow up period of 12 to 108 month. An anterior leg flap based on the cutaneous branches of the anterior tibial artery, with firmly anchored vessels, a long pedicle with wide vessels may used not only as a free flap graft for reconstruction of moderate degree distant defects but also as a retrograde island flap graft for the reconstruction of adjacent tibial artery in five cases of plantar ulceration with satisfactoryresults. there was no recurrence of ulceration during the follow up period of 48 to 72 months

Cost-effective footwear for leprosy control programmes: a study in rural Ethiopia.

A randomized, controlled trial of commercially available canvas shoes was carried out in a rural area of Ethiopia. Subjects with deformed and anaesthetic feet, most with ulceration, were given either canvas shoes or plastazote/moulded shoes and followed up for one year. Seventy-five percent of subjects with ulcers who used canvas shoes had no ulcer at the end of the study, while no significant change was noted in the plastazote group. The durability and acceptability of the shoes were also examined. Clients in remote areas who have no access to an orthopaedic workshop, but who have anaesthetic feet, with or without deformity, should have access to canvas shoes with an MCR insole. Two pairs are needed per year at a cost of US$6.7 per pair.

Management of plantar ulcers in leprosy-early results / ?

Plantar ulcers in leprosy is not specific of the disease, it instead represents one of the neuropathic disorders. However, plantar ulcer is one of the commonest lesion in leprosy (Cochrane 1967) and no singular method of its treatment is known to provide the best results. Neuropathic plantar ulcers therefore continue to exist as a challenge to most leprologists and orthopaedic surgeons. A study fo 68 plantar ulcers among lepers and its treatment by the author is presented

Contribuição para o tratamento do mal perfurante plantar na hanseníase / Contribution for the treatment of the armor-piercing evil plantar in leprosy

O autor apresenta o resultado de 18 anos de atividade como médico em Hospitais de doentes de hanseníase e sua experiência no tratamento do MPP. Aprecia os elementos constituintes do pé normal como inervação, irrigação e coxins adiposos protetores, compara-os com os do pé hansênico cuja estrutura óssea, tegumentar, vascular e nervosa estão em desarmonia, perturbando toda a biodinâmica, com formação de irregularidades e escaras plantares. A falta de padronização de lesões e de tratamento se associa à falta de motivação pessoal dos próprios doentes que em maioria, não se preocupam. Após considerar rapidamente o mecanismo de formação do MPP o autor descreve seu tratamento, desde o método conservador ao cirúrgico. No tratamento conservador aplica o método curativo inicial e complementa-os com a colocação de bota gessada modificada no apoio; suplementa o tratamento com o uso de palmilhas adequadas, desde o material de cortiça até ao emprego da plastazote

Léprosarie de St. Vicent de Paul d`Ambatoabo (près de Farafangana)

Abbiamo chiest al R.P.Dr. Zévaco di farci avere una breve relazione sul lebbrosario di Ambotoabo (nei pressi di Farafangana) da lui diretto. Ambotoabo rappresenta il tipico antico villaggio-colonia per lebbrosi che tende a transformasi poco a poco in un centro di cura per gli hanseniani. Il vecchio concetto di colonia per l´internamento dei malati è stato abbandonato quasi avunque. Tuttavia non è facile modificare la mentalità delle popolazioni né quella dei lebbrosi stessi, specialmente in alcune località rurali molto arretrate, rimane il problema grave degli irrecuperabili, dei grandi mutilati che non possono o non vogliono fare ritorno nelle loro famiglie, oppure che le famiglie stesse non vogliono riprendersi...

Ulcera perforante plantare negli hanseniani: trattamento medico e nuovo e semplice trattamento chirurgico

L`auteur, au cours d`une description rapide des ulcères perforants plantaires que L´on rencontre chez les hanséniens, fait remarques les associations possibles, avec les > ou mieux avec les > et étude les différents aspects, causes et mécanismes des sièges d`élection et de développement cliniques de ces ulcères. En mentionnant les bons effects d`un traitement aux enzymes pancréatiques des cas initiels, il décrit une méthode nouvelle et simple d´intervention chirurgicale qui s`est rèvélée, dans une prémiére série de cas, utile pour le traitment des cas avancés. Il souhaite que la méthode soit pratiquée sur une plus grande échelle pour mieux étudier et si possible confirmer les résultats