Sensory testing with monofilaments in Hansen's disease and normal control subjects.

Sensory testing with Semmes-Weinstein filaments was conducted on: 112 normal subjects to determine the effects of age, gender and occupation on threshold perception, 27 Hansen's disease (HD) patients to determine inter-observer and intra-observer reliability of testing, and 101 patients with HD and a history of hand and/or foot ulceration to identify thresholds for injury risk. Filament thresholds were found related to age (p < 0.002) and occupation (p < 0.001) but not gender (p > 0.1). Inter-observer and intra-observer reliability was found to be high (intraclass correlation coefficient = 0.88-0.93). The 4.93 (7.0-7.7 g) filament had 97% sensitivity and 100% specificity for identifying a history of foot injuries, and the 4.17 (1.2-1.6 g) filament had 100% sensitivity and 100% specificity for identifying hand injuries.

Measurement of pressure walking in footwear used in leprosy.

Pressure measurements were made on 10 leprosy patients while walking barefoot and while using 6 sample shoes. The sample shoes, which represented footwear currently used worldwide in leprosy programmes, included: 1, a USA extradepth shoe without insole; 2, a USA extradepth shoe with insole; 3, a Chinese tennis shoe; 4, a Mozambique sandal; 5, a Bombay sandal; 6, a Bombay sandal with rigid sole; and 7, the patients' prescribed footwear. Peak pressure was significantly lower while walking in all footwear, except with the extradepth shoe without an insole, when compared to barefoot walking. Peak pressure was significantly lower walking in the Bombay sandals, the Chinese tennis shoe, the extradepth shoe with an insert and the patients' prescribed shoe when compared to the extradepth shoe without an insert. Regression analysis showed a significant inverse relationship between pressure and insole thickness (P < 0.001, R2 = 0.17).

Healing rates of plantar ulcers in leprosy and diabetes.

Comparison was made of wound healing time in a consecutive series of leprosy and diabetic patients with plantar ulceration. In the leprosy group, 66 of 70 (94%) ulcers healed in a mean time of 42.7 (+/- 36.1) days, and in the diabetic group, 75 of 80 (94%) ulcers healed in a mean time of 39.7 (+/- 32.1) days. Analysis of all healed ulcers using a general linear model found wound depth (p < 0.03), and wound diameter (p < 0.05) significantly related to ulcer healing time. Diagnosis, healing devices (cast, splint and cut-out sandal), age and sex were not significant. In diabetic subjects a regression model including depth, diameter and age explained 36% of the variation in healing time. A meaningful regression model was not found in leprosy patients.

Methods of treating plantar ulcers.

The purpose of this article is to describe the indications, precautions, and fabrication techniques for orthotic devices the authors use to facilitate the healing of plantar ulcers. The methods of fabricating and applying three types of orthotic devices developed by the staff at the Gillis W Long Hansen's Disease Center--walking casts, walking splints, and cutout sandals--are described. Patient examples are given for each of the methods. These techniques, in conjunction with patient education and the use of special footwear, provide clinicians with procedures they can use to aid in the healing of plantar ulcers secondary to leprosy, diabetes, or other neuropathic conditions.

The Martin-Gruber innervated hand.

Two patients with a complete ulnar nerve lesion at the elbow and a median nerve lesion at the wrist secondary to leprosy neuropathy retained good function of the first dorsal interosseous and flexor pollicis brevis muscles. One patient also lacked the typical finger clawing associated with ulnar and median paralyses. These findings were attributed to the presence of Martin-Gruber anastomoses that were confirmed by nerve-conduction studies.