[log in to unmask] wrote:
> 
> I have had some questions put to me from Jean Watson - a physiotherapist with
> many years of experience working with Prevention of Disability in Leprosy.
> She spends a lot of time working with foot / wound issues, including footwear
> and plantar pressure reduction, within Leprosy Organisations. Having recently
> talked to some UK podiatrists (and LANGER) regarding biomechanics, she is
> considering the usefulness of heel posts as part of the management of the
> neuropathic foot.
> Jean is going to China where the majority of people with Leprosy wear shoes
> with heel counters and have to walk miles on a daily basis to support
> families, etc.
> In the absence of podiatrists, any insole therapy will be prescribed, fitted
> and reviewed by local Physiotherapy Technicians Shoe Technicians or similar.
> The level of training for these staff has not been determined in relation to
> biomechanics, but it is assumed it would have to be very basic.
> The questions revolve around this problem
> For those situations in which individually-made insoles are not feasible and
> in which,  although there is some danger in doing something inappropriate,
> there is even more danger in doing nothing in that sole wound recurrence will
> be impossible to avoid if pressure stay the same?   The question is:  In the
> field, how can one minimise these risks and maximise help?
> 
> - Can excessive pronation in the foot be identified by the staff observing
> everted heels in stance alone?
> - With excessively pronating neuropathic feet, would the fitting of 5 or 8
> degree posted rearfoot wedges under a Micro Cellular Rubber insole:
> 1) Stop ulcers forming?
> 2) Improve healing outcomes in feet with existing ulcers?
> 3) Be more effective than the traditional orthopaedic plantar pads currently
> being used?
> - With the historical and current absence of significant numbers of
> podiatrists within Leprosy Organisations, is it possible to integrate basic
> biomechanics into current footwear / orthotic prescription?
> 
> My initial reply to Jeans questions having liaised with Hugh Cross and
> Justine Bolton (podiatrists with experience of Leprosy work) included:
> 
> >My general opinion is:
> >Update and further training of Leprosy field staff in orthoses prescription
> >and fitting (including biomechanical evaluation at a basic level) is an
> >important issue in foot ulcer prevention and management. It is definitely an
> >area for further discussion before any large scale implementation can take
> >place. This discussion must take place between key persons in Leprosy POID
> >work, such as yourself, Hugh Cross and any other Health Care Professionals
> >with relevant knowledge. An agreed strategy should be developed which could
> be >incorporated into all Leprosy Organisations at a realistic and workable
> level.
> >
> >Biomechanics has a part to play (along with education and good wound care)
> >in the future of the management of the foot in leprosy, but it is not the
> magic
> >ingredient.
> >Keep in touch.
> >Regards
> >Martin
> 
> We would value opinions and evidence relevant to Jeans questions from other
> podiatrists.
> 
> Martin Fox
> Leprosy Focus Group for Podiatrists
> 
You might wish to contact Jimmy Foto, a pedorthist who has worked with 
Dr. Paul Brand at the Long Hansen's Disease Center (sp?) in Carville,
Louisiana. Dr. Brand has written many interesting and insightful books
which have accounted his dealings with trying to help that very special
population. I think you might be able to track him down through the
Pedorthic Footwear Association.  (PFA)
Sincerely yours,
Freeman Churchil, Certified Pedorthist (Canada)


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