Leprosy mailing list – September 3rd, 2005
Ccn:
all.
Ref.:
management of plantar ulcer.
From: W
Theuvenet, Apeldoorn, The Netherlands.
Dear Linda,
Your statement (L
Lehman LML AUG 17th, 2005):
"It is important to have the
involvement of orthopaedics and plastic surgery but I think one of the
greatest needs is knowing how to indicate and provide adequate
footwear based on a better biomechanic evaluation".
The latter is
to my personal opinion indeed the key-issue of the foot-ulcer problem!
Please allow for some personal comments.
During the
training programmes that I personally was involved in during these
past 20 years I have always shared that to me:
"Healing
an ulcer is in most cases the least a problem (even for dum-dums), but
to prevent these it is the real intellectual and practical
challenge".
Setting the
indication of footwear is not like the opening of a can of tricks
but should be based upon the proper understanding of the biomechanics
of the healthy foot (and the lower extremity) in rest and during
walking, the understanding of the pathology (far wider than only the
loss of sensation) that results from neuritis in leprosy, and a proper
knowledge how to rehabilitate and to protect the foot. As everywhere on the globe there
are significant differences in the actual situation and thus the
acceptability of different types of footwear for each patient, in
the accessibility and in the facilities of the nearest referral
centre.
Often the
recurrence of an ulcer is blamed upon the patient, but when assessed,
it can in general be ascribed to the provision of inadequate footwear.
The setting up
of "self care groups" like e.g. successfully introduced by
Kerstin Beise in Sulawesi, and the practical training by
people like Jan Robijn of Vietnam, may compensate for some of the
loss of quality in foot care now leprosy is abandoned as a public
health problem by WHO.
Am delighted to
read that Dr. Hugh Cross had a similar positive input in Brazil and want
to congratulate you on the progress that you have made in your foot
care programme in Brazil!
At the end, we
urgently need to agree upon simple parameters to assess the efficacy
of our foot ulcer programmes; do you have such an evaluation in place
in Brazil?
Wishing you the very best in
your programme,
Wim J. Theuvenet
Plastic, Reconstructive and
Hand Surgeon
Consultant for TLMI and the
NLR
