Leprosy Mailing List – September 8th, 2007
Ref.:
Main factors contributing to foot ulcers in leprosy
From: Warren G., Sydney,
Australia
Dear Dr Noto
,
I refer to the letter from Dr Salafia (LML
September 8th, 2007).
I agree there is more to the problem than lack of protective
sensation and motor unbalance
.
Part of that is what you mean by “Protective
sensation” In many places it is defined as an inability to
feel monofilament pressure indication
.
This is one area of
sensory perception that has become commonly tested. It is relatively easy to test
this put and to record it and follow it regularly- BUT It does
not tell you anything about pain perception
.
Many patients will have completely normal touch
and pressure sensation and so are listed as “normal” but when one tests
heat, they cannot feel heat (I had one patient burn the skin off both
heels because when she was “cold” her husband gave her a hot water
bottle!). Also in early days we used to use a pin to test pain
perception
.
Many patients with normal
sensation have no idea you are “Cutting” the foot when doing minor
surgery and many have no idea of discomfort when a fracture
occurred.
My teaching is that if anyone has any evidence
of nerve damage he ought to he instructed to treat the limb as if
there was a total loss of all nerve function (especially the sensory
and autonomic) in that limb. Teach the checking for hot spots to
look o for internal trauma and may sure removal of callus as the
mass of callous will increase the local anoxia and increase the
possibility of ulceration by summation (this is all deal with in
my book “The care of the neuropathic limb“ which is still
available from me here or the Leprosy Mission in Victoria Australia-
at A$66
.
Hoping that this will help. He is welcome to write to me if
he needs further
.
Best regards,
Grace
