Wax therapy for dry feet in leprosy.

A comparative study of the effect of wax therapy and foot soaks on dry plantar skin was conducted in patients with leprosy. Thirty patients with varying grades of fissures and callosities were given wax therapy for feet, and 20 similar patients were given foot soaks. Patients given wax therapy felt subjectively much better than those who had soaking. Healing of cracks and fissures and softening of callosities was observed more frequently in patients with wax therapy. These differences are statistically significant. As an institutional method wax therapy has definite advantages for treating patients with fissures and callosities, whereas soaking of the feet is easy and readily available in patients' homes to restore the dry skin to normal.

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.

Management of the insensitive foot in diabetes: lessons learned from Hansen's disease.

Diabetes mellitus is the number one cause of lower extremity amputation (LEA) in the United States, accounting for about 60,000 cases per year. While the combination of reduced blood supply and the loss of sensation to the foot in a diabetic are responsible for the high incidence of LEAs, in most cases it is the loss of sensation that is primarily responsible for the initial foot wound and its failure to heal. The authors review the four mechanical causes for foot ulceration and eventual amputation. Based on an understanding of how feet ulcerate, the National Foot Treatment Center in Carville, LA has developed an insensitive foot screening and treatment program for "diabetic" foot ulcers that is more than 90% effective in healing plantar ulcers.

Neuropathic plantar ulceration.

Management of 111 trophic plantar ulcers existing in 100 patients of leprosy have been reviewed. Male preponderance with 4th and 5th decade of life predilection was observed. Most of the patients were of lepromatous type. Ulcers were grouped into superficial and deep. They were treated by various methods viz. plaster cast alone and in combination with curettage, posterior tibial neurovascular decompression and metatarsectomy. It was observed that ulcers heal faster if conservative plaster cast treatment is clubbed with surgical treatment of the ulcer. Indications of various surgical methods is defined. Role of proper footwear in the management of plantar ulcers has been emphasized.

Plantar ulcers in hereditary sensory neuropathy. A plea for conservative treatment.

Hereditary sensory neuropathy is a rare syndrome characterized by the occurrence, in childhood or early adult life, of perforating ulcers of the feet, lightning pains, and loss of cutaneous sensation and tendon reflexes in the lower extremities. Three patients with hereditary sensory neuropathy were family members. Trophic ulcers may be caused by diseases other than diabetes, syphilis, and leprosy.

[Perforating plantar ulcer. Interfascicular neurolysis of the posterior tibial nerve]. / Le mal perforant plantaire. Neurolyse interfasciculaire du nerf tibial postérieur.

The authors report the case of a 45-year-old man with perforant ulceration of the foot. The rapid evolution of the cutaneous and bone lesions (three years) necessitated a bilateral intermetacarpo-phalangeal amputation. After conventional therapy, a large necrotic zone remained on the sole of the left foot as well as hyperkeratosis of the right foot. Following Bourrel's protocol for the treatment of leprosy, the authors proposed a posterior tibial nerve neurography, which confirmed the compression of the nerve in the tarsal tunnel. In addition, histological examination of the nerve branches of the sole of the foot showed fibrous thickening of the nerve, endoneural invasion by fibroblasts, and loss of myelin. An interfascicular neurolysis of the posterior tibial nerve at the level of the tarsal tunnel together with a periarterial sympathectomy on both sides, led to rapid recovery. At the same operation, a skin graft was used to cover the skin defect with excellent results in ten days. Ten months later healing remains complete.

Clinical evaluation and care of the insensitive foot.

Until fairly recently, foot deformity was accepted as part of the natural course of a disease with associated sensory loss such as Hansen's disease or diabetes. Now we recognize that most of this deformity is caused by physical forces and that, with proper care, deformity can be prevented. The therapist must perform accurate methods of assessment such as inspecting and palpating the skin, testing for sensory loss, recording footprints, and measuring foot volume and must provide knowledgeable treatment techniques. The patient must be taught how to care for his feet and how to prevent continued trauma with subsequent infection and bony absorption, which ultimately result in deformity that could have been prevented. These evaluation, treatment, and education techniques are discussed in detail.