Leprosy Mailing List – August 13th, 2007
Ref.:
Foot care in leprosy and diabetes.
From:
Warren G., Sydney, Australia
"I can do it myself! Tips for people affected by
leprosy who want to prevent disabilities."
W.H.O. Regional Office for
South-East Asia, New Delhi
Dear Salvatore,
Thank you very much to Dr
Pannikar for circulating the above mentioned booklet. I would like here to answer
some of Prof. Ryan’s queries (LML August 11th, 2007).
Patients with neuropathy
usually have some involvement of all three type of nerve fibres. The autonomic nerve
involvement frequently results in abnormalities of sweat and sebum
production so that many of the patients have very dry skin, that is
then more prone that normal to be damaged by minor trauma. Well hydrated oily skin is
more resistant to trauma of all sorts.
So, the limb is soaked in water to
completely hydrate the skin. Say duration 15-20 minutes. Water at room
temperature so the patients do not burn themselves. Plain water is best so they
will not use detergents that may damage the skin and remove what oil
is still in the skin. If
there is fungus add potassium permanganate that is available round the
world and cheap and usually will not damage! If there are infected ulcers you
may wish to use something like Magnesium sulphate or cetrimide in the
water.
Some endocrinologists are
horrified at soaking diabetic feet, but none that I have asked has been
able to give me a good reason for stating that feet should not be
soaked. Some say to avoid
fungus! If the skin is dry to knees Ok soak to knees if
possible. If there is a
water shortage wrap the limbs in wet towels and cover with plastic bag
for 30 minutes.
To scrape I teach the patient
to use a green nylon pot scraper: a "Scotchbrite "! Do not teach them to use a
knife unless trained fully as they do not feel pain and so will cut
themselves and not know it. A
little every day is the best rule.
Dry callus will split and crack and cause deep
ulceration. Moist callus
is softer and will do less harm but any callus produces an
increased degree of pressure on the area where the callus is so
the patient needs to learn to remove the callus so it will not
be the cause of a deep haematoma/ulcer when the patient walks on the
callus.
Vaseline is suggested to keep the water in and prevent
evaporation. We have used
it for years in third world countries as it is about the cheapest oil
available and if put on over well soaked skin it will prevent
evaporation and so "moisturise". The so called
moisturising lotions will also prevent evaporation if put onto well
soaked skin but certainly in most places the patients are told to
apply it to dry skin in which case it is virtually useless because it
is mostly mineral oil which is not absorbed into human skin. It is important to realise
that Mineral oil is virtually not absorbed into human skin. Animal oil (i.e. lanoline and
fish oils) are absorbed well and vegetable oil absorption is in
the middle. For many
years in India we used deodourised fish oil as this was much cheaper
than lanoline and nearly as good.
Lanoline is usually refused by vegans. So I do not recommend vaseline
at all now ever. In
Australia we recommend lanoline.
In Thailand we mixed 50/50 fish oil and Vaseline, this
made a mixture easier to apply than Lanoline alone or vaseline and
supplied some readily absorbable oil and was cheaper than the
lanoline.
I would advice Prof. Ryan to acquire a
copy of: "The Insensitive feet" A practical
handbook on foot problems in leprosy. Written by Dr Paul Brand,
originally in 1966, and reprinted often, published by The Leprosy
Mission International with who Dr Brand worked for many years. Paul is the one who really
realised that the problems of leprosy feet were due to loss of pain
protection. This book was
published by the Leprosy Mission and although it is I believe out of
print at present I am sure that a request to HQ with an explaination
of why it is needed will allow for a photocopied volume. E-mal to <friends@tlmint.org> attention June Nash.
If Prof. Ryan wishes to contact me he is
welcome to do so. I have
been using these principles for nearly 50 years now, AND THEY WORK FOR DIABETIC AND
OTHER NEUROPATHIES AS WELL AS LEPROSY.
Grace Warren
