A clinical and radiological follow-up study in leprosy patients with asymptomatic neuropathic feet.

OBJECTIVES: An MRI study done in 2000 on 10 leprosy patients with neuropathic feet, without clinical complications such as ulcerations, osteomyelitis or Charcot deformities revealed abnormalities in nine patients, with degradation, interruption of subcutaneous fat and effusion/synovitis, all located in the first metatarsophalangeal (MTP) region. Since these MRI abnormalities may precede clinical complications of the foot, a follow-up study was performed. DESIGN: A new evaluation was based on a clinical examination and an MRI of the same patients who participated in the initial study. RESULTS: Four patients were lost to follow-up. Average follow-up period was 4-6 years. MRI abnormalities in the MTP 1 region in the first study were no longer visible in three patients, but were still present in two patients. In six patients new MRI findings were found, without clinical evidence of ulceration, osteomyelitis or Charcot deformity. No relationship was found between MRI findings in the MTP 1 region at the start of the study and the development of foot ulcers, callus or skin fissures in the MTP 1 region during follow-up. CONCLUSION: MRI findings of interruption and infiltration of the subcutaneous fat in leprosy patients with uncomplicated neuropathic feet do not necessarily have any clinical implication for the development of future foot problems.

MR imaging of neuropathic feet in leprosy patients with suspected osteomyelitis.

This study was undertaken to analyze MRI findings in leprosy patients with neuropathic feet, which are suspected of having osteomyelitis. As far as we know, there is no literature concerning osteomyelitis and MRI in neuropathic leprosy feet at present. Therefore, we have included MRI examination of 18 events of suspected osteomyelitis in 12 leprosy patients. All patients with long-standing neuropathic foot problems were clinically suspected of having osteomyelitis. All patients underwent the MRI protocol with the inclusion of Two Point Dixon Chemical Shift Imaging as a fat-suppression sequence. For the MRI evaluation, we used signs that are described in literature for detecting osteomyelitis in diabetic feet. The primary MRI signs were positive in 17 of 18 patients. The secondary MRI signs were positive in 100% of the patients. Our results show that MRI with the use of Two Point Dixon Chemical Shift Imaging is a promising diagnostic modality to detect osteomyelitis in the presence of neurosteoarthropathic changes in patients with leprosy. Whenever available, MRI could play an important role in detecting osteomyelitis in leprosy patients with long-standing neuropathic feet.

MRI in clinically asymptomatic neuropathic leprosy feet: a baseline study.

This study was undertaken to analyze the magnetic resonance imaging (MRI) findings in the clinically asymptomatic neuropathic feet of leprosy patients. Since in the literature no MRI data are available concerning the asymptomatic neuropathic foot in leprosy, the interpretation of MRI examinations in clinically suspected neuropathic feet in leprosy is difficult. We examined 10 adult leprosy patients with clinically asymptomatic neuropathic feet. Inclusion criteria were a normal or near normal neuropathic foot, without signs of inflammation. All patients underwent an MRI protocol with the inclusion of two-point Dixon chemical shift imaging as fat suppression sequence. We found MRI changes in almost all patients. The most striking were the changes located in the region of the first metacarpophalangeal (MTP) joint. These changes ranged from degradation and interruption of the subcutaneous fat to effusion/synovitis in the first MTP joint. This study reveals significant MRI changes in clinically asymptomatic neuropathic feet in patients with leprosy. These changes may relate to the development of ulcerations. MRI may play an important role in detecting feet at risk and may influence clinical decision making.

[Transposition of the tendon of M. tibialis posterior an effective treatment of drop foot; retrospective study with follow-up in 12 patients]. / Transpositie van de pees van de M. tibialis posterior effectief bij een klapvoet; retrospectief onderzoek met follow-up bij 12 patiënten.

OBJECTIVE: To evaluate the results of transposition of the tendon of the M. tibialis posterior in patients with a drop foot. DESIGN: Descriptive, retrospective and follow-up investigation. METHODS: Surgical treatment was carried out in 12 patients with a drop foot (9 women and 3 men, with an average age of 37 years) in the period 1986-1998. The aetiology of the drop foot was a traumatic or iatrogenic lesion of the peroneal nerve or sciatic nerve in 9 patients and in 3 patients spina bifida occulta, leprosy and a herniation of a lumbar disc respectively. None of the patients had important comorbidity. Treatment consisted of lengthening the Achilles tendon according to Huckstep, transposition of the tibial posterior tendon in two tails to the dorsomedial and dorsolateral side of the foot, and six weeks of immobilisation in plaster of Paris. RESULTS: The postoperative period was without complications. The treatment improved the heel-toe steppage gait in all patients. None of the 10 patients who had used an orthosis preoperatively still used it at the time of the follow up. Fifty per cent of the patients acquired a dorsiflexion of the foot of more than 0 degree. The results were in accordance with those in the literature. CONCLUSION: Transposition of the tibial posterior tendon is a worthwhile alternative for those patients with a drop foot (and without important comorbidity) who cannot walk satisfactorily with an ankle-foot orthosis.

[Squamous cell carcinoma in neuropathic plantar ulcers in leprosy: another example of Marjolin's ulcer]. / Plaveiselkarsinoom in neuropatiese plantare ulkusse van leprose: nog 'n voorbeeld van Marjolin se ulkus.

Seven cases of squamous cell carcinoma (SCC) arising in chronic neuropathic plantar ulcers of leprosy are described. These patients (average age 59 years) presented over a 5-year period. The mean duration of neuropathic ulceration until diagnosis of SCC was 24.5 years. Six patients required limb amputations and 3 underwent lymphadenectomy for involved nodes. One patient died of disseminated disease. The history of the eponym "Marjolin's ulcer' is traced and a case put forward for recognition of malignant change in neuropathic ulcers as yet another example of Marjolin's ulcer. A plea is made for an increased awareness of the possibility of malignant transformation in chronic neuropathic ulcers in order to effect an early diagnosis of a potentially aggressive cancer. This is the first report of its kind in South Africa. Similar cases, however, have been reported from other parts of the world where leprosy is endemic.

[Cutaneous neoplasms during leprosy: 2 case reports]. / Néoplasie cutanée au cours de la lèpre: a propos de deux cas.

The authors report on two cases of dermal neoplasia in foot trophic disorders observed in leprous subjects. The report includes the description of the clinic and histologic data as well as the surgical technique used; finally, it underlines the importance of a precocious diagnostic so as to obtain a good therapeutic result.

Carcinoma in plantar ulcers of leprosy patients.

Three cases presenting clinically with carcinomata developing from long standing plantar ulcers are presented. Intra operational histopathological examination confirmed two cases of squamous cell carcinoma and one case of malignant melanoma. Two of the patients had developed distant metastases in the brain, chest and regional lymph nodes at presentation. All had below knee amputation. The regional lymph nodes were not interfered with in any of them. One finally died, one was discharged home fully fit while the third's clinical condition has been deteriorating.

Malignant transformation of trophic ulcer in leprosy.

Malignancy developing in the trophic ulcer of leprosy is no more a rarity. In four years period we detected seven cases of squamous cell carcinoma developing in the trophic ulcer in patients with lepromatous leprosy.

Squamous cell carcinoma developing in trophic ulcer in leprosy.

Two cases of leprosy patients having trophic ulcer over the heel, later developed squamous cell carcinoma are reported along with follow up.

Spina bifida occulta with atrophy of toes.

A case of lumbosacral spina bifida occulta presented with resorption of toes which started at six years of age. Its differential diagnosis with neural leprosy is discussed.

Malignant transformation in trophic ulcers in leprosy: a study of 12 cases.

Twelve cases of carcinomata arising in Trophic ulcers of Leprosy are presented. Out of these, 10 were on the plantar surface more commonly on the proximal part of foot, one on lower leg and dorsum of foot, and one in an ulcer over the lateral malleolus. Almost all presented with infected growths and regional lymphadenopathy. Three cases presented with advanced disease with fungating inguinal nodes and were fatal. Nine cases underwent below knee amputation under antibiotic cover as a definitive treatment and the lymph nodes were kept under observation. Histologically, all were low grade squamous cell carcinomas. In most cases lymph nodes regressed after removal of primary and in one case lymph nodes were positive for malignancy. This study was conducted at Dr. Bandorawalla Leprosy Hospital, Kondhawa, Pune 22 from the year 1981 to 1987.