Reduction of plantar pressures in leprosy patients by using custom made shoes and total contact insoles.

OBJECTIVE: The purpose of this study was to observe whether our custom made shoes and total contact insoles can effectively increase the plantar contact areas and reduce peak pressures in patients with leprosy. DESIGN: In the rehabilitation laboratory of a tertiary medical center. Six male and two female leprosy patients were recruited in this study. In this study, parameters related to foot pressures were compared between these patients wearing commercial available soft-lining kung-fu shoes and our custom made shoes with total contact insoles. The custom made shoes were made with larger toe box and were able to accommodate both the foot and the insoles. Custom made total contact insoles were made with the subtalar joints under neutral and non-weight-bearing positions. The insole force measurement system of Novel Pedar-X (Novel, Munich, Germany) was used to measure the plantar forces. The parameters of contact area (cm(2)), peak plantar pressures (kPa), contact time (s), and pressure time integral (kPa s) were measured. RESULTS: There were significant contact area increases in the right and left foot heel areas, left medial arch, and second to fifth toes after wearing the custom made shoes and insoles. There were significant decreases in peak plantar pressures in bilateral heels, left lateral midfoot, bilateral second to fourth metatarsal areas, and left fifth metatarsal head after wearing the custom made shoes and insoles (p<0.05). CONCLUSIONS: Plantar ulceration is a common serious disability in leprosy patients. As a result, footwear and measures able to reduce plantar pressures may be beneficial in preventing plantar ulcers from occurring in these patients. Our custom made shoes and total contact insoles were proven to be effective in increasing contact areas and decreasing peak pressures in plantar surfaces, and may therefore be a feasible treatment option in preventing leprosy patients from developing plantar ulcers.

Factors influencing physical activity in institutionalized elderly patients with leprosy.

PURPOSE: The nursing literature has devoted little attention to the long-term influence of infectious diseases and the subsequent rehabilitation needs of the affected patients. This study was conducted to identify the factors associated with physical activity (PA) in older institutionalized adults with leprosy. METHOD: A cross-sectional research design was used. RESULTS: Data from 248 subjects (75.28 ± 8.64 years old) were analyzed. We found that fewer subjects in PA compared to older adults in general. Amputation, fear of falling (FF), the ability to perform activities of daily living, and instrumental activities of daily living (IADL) were the influencing factors of PA. Doing laundry, preparing a meal, taking medicines, and making telephone calls accounted for 23.4% of the PA variance. CONCLUSION: We suggest incorporating FF in the psychosocial indicators of the mobility assessment. The importance of promoting or maintaining four specific IADL abilities and participating in PA for leprosy patients living in a sanatorium is emphasized.

[Activity of daily living and life quality of patients with Hansen's disease in Taiwan].

BACKGROUND: Hansen's Disease incidence in Taiwan has declined to the goal set by the World Health Organization. However, this population does not receive adequate attention due to the stigma attached to the disease. PURPOSE: The purpose of this study was to investigate the demographic characteristics, activities of daily living, and quality of life of patients with Hansen's Disease in Taiwan. METHODS: A cross-sectional design was used. A structured questionnaire that incorporated a personal data survey form, basic activity of daily living (BADL) form, instrument ability of daily activity of living (IADL) form and quality of life (QOL) survey was used to collect data. Patients with Hansen's Disease in Taiwan who lived in the institution, rural villages, and communities were invited to participate. RESULTS: Four hundred and ninety-seven participants with an average age of 71.93 (± 12.8) years participated in this study. Institutionalized participants (76.97 ± 7.41) were older than those in the other two groups. Participants were found to have in general more than one chronic disease (2.05 ± 1.33), with more chronic diseases found amongst institutionalized subjects (2.70 ± 1.23). Activities of daily living scores were generally higher for urban community dwellers than those who were institutionalized. Relatively low BADL scores for personal hygiene, bathing, walking and climbing stairs were noted, as were poor IADL scores for cooking, shopping, washing clothes and riding public transportation. Results found that activities of daily living declined with participant age (p < .001). The QOL score was mid-range, while the mental dimension of QOL was poorer than the physical dimension. Higher QOLs were observed in participants who lived in villages, while poorer QOLs were observed in participants who lived in communities. CONCLUSIONS: The results of this study indicated activities of daily living scores declined among Hansen's Disease patients with age. In order to promote quality of life among patients with Hansen's Disease, several suggestions for health policy with regard to Hansen's Disease patients are raised in this paper, including helping maintain daily living activity functions in Hansen's Disease patients, hiring more assistants and nurses to help Hansen's Disease patients maintain daily living activities and personal hygiene, and enhancing living environment quality and medical service appropriateness.