Appropriate footwear and orthoses are essential components in the management of the foot at risk of ulceration in leprosy

Abstract

Ulcers are a serious complication and a common cause of morbidity in leprosy. The exact roles of impairments and distorted mechanics of the foot are not fully understood in the development of ulcers in patients with anaesthetic feet. A simple biomechanical evaluation of the foot along with the routine neurological assessment helps to identify feet at risk for developing an ulcer and also to prescribe appropriate orthoses, which are inserts designed to improve biomechanical function, encourage proper joint alignment and protect the foot. The orthotic intervention along with protective footwear offloads the peak plantar pressure sites of the foot, preventing ulceration. The provision and use of foot orthoses have generally been limited to tertiary leprosy referral centres. Advances in technology have made the fabrication of orthoses more rapid and precise, enhancing user acceptance and adherence. Effort should be made to provide simple orthoses that are easy to fabricate and effective in preventing plantar ulcers in leprosy, in the community health setting.