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.

An evaluation of the Semmes-Weinstein 6.10 monofilament as compared with 6 nylon in leprosy patients.

In a previous study Birke and Sims (1986) identified the 5.07 (10 y) Semmes-Weinstein monofilament, as the most useful tool, in measuring protective sensation in the sole of the foot of leprosy patients. This study has demonstrated that the standard 6 Nylon being used in Karigiri, is as good as the monofilament, in assessing protective sensation in leprosy patients. However there is a need for standardising procedures for measuring sensory loss in leprosy patients.

Foot pressure measurement in leprosy and footwear design.

Leprosy patients deprived of sensory feedback allow excessive pressures to be applied to feet, thereby cause foot ulcers. Quantitative knowledge of the pressure distribution under leprotic feet is helpful to prevent further damage to foot by designing suitable footwear. This paper describes barographic technique for measurement of pressures under the leprotic feet and the design of special footwear for prevention of foot ulcers.

[Frequency of the association of perforating plantar leprotic lesions and truncal involvement of the posterior tibial nerve]. / Fréquence de l'association entre les maux perforants plantaires lépreux et l'atteinte tronculaire du nerf tibial postérieur.

This study was performed to determine the electrophysiological status of the posterior tibial nerve and its muscular innervation in patients both with and without plantar ulcers without osteitis. In both cases, motor distal latencies remained normal, but the denervation of the plantar muscles was significantly more important in patients with ulcers. These results show that axonal degeneration is predominant in leprous neuritis affecting the tibial nerves. Neurolysis was performed in twelve patients in the retromalleolar part of the tibial nerve. All patients have recover from their ulcers, but no improvement of their electrophysiological parameters was observed.