Volume 15 | Issue 2 | Apr-Jun 2020 | Page 27-30 | Sushil Mankar, Abhijit Chandrakant Kawalkar, Rahul Sakhare, Anil Golhar
Authers: Sushil Mankar [1], Abhijit Chandrakant Kawalkar [1], Rahul Sakhare [1], Anil Golhar1 [1]
[1] Dept of Orthopaedics,NKP Salve institute of Medical Sciences and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra, India.
Address of Correspondence
Dr. Abhijit Chandrakant Kawalkar
Assistant professor
Dept of Orthopaedics, NKP Salve institute of Medical Sciences and Lata Mangeshkar Hospital,
Digdoh Hills, Nagpur, Maharashtra, India. Pin- 440019
E-mail: dr.abhijitkawalkar@gmail.com
Abstract
Introduction: Damage to the peripheral nerves due to neuritis caused by Mycobacterium leprae is responsible for most of the deficits and deformities associated with leprosy. The trophic or chronic plantar ulcer of leprosy due to involvement of posterior tibial nerve is one of the principle causes of disability. Multiple treatment options are mentioned in the literature but none of them is found to be gold standard. Thus we formulated this study to evaluate the results of posterior tibial nerve neurolysis in treatment of plantar ulcers in leprosy.
Patients and methods: Diagnosed patients of leprosy with plantar ulcers and who have positive Tinel’s sign, numbness in feet with thickened tender posterior tibial nerve underwent posterior tibial nerve decompression and debridement of the ulcers were included in the study. Post operatively ulcers were assessed after 2, 6 and 12 weeks after surgery for the signs of healing and according to the grading system described by Sehgal et al.
Results: 34 patients with mean age of 48 years with plantar ulcers we included in the studies. There were 4 patients with grade IV, 21 patients with grade III and 9 patients with grade II ulcers. All the patients except one had clinical improvement and showed signs of healing at 12 weeks of follow up. Also the sensations in the sole of foot improved in all our patients.
Conclusion: Posterior tibial nerve decompression or neurolysis is an effective method to treat plantar ulcers in leprosy which also improve the plantar sensations.
Keywords: Posterior tibial nerve, Leprosy, Neurolysis, Plantar ulcers, Trophic ulcers..
References
1. Bhat RM, Prakash C (2012). Leprosy: an overview of pathophysiology. Interdiscip Perspect Infect Dis; 2012:181089.
2. Hatano K, Matsuki T, Makino M (1998). The trend of leprosy treatment in which the prevention of peripheral nerve damage being as its main theme. Nihon Hansenbyo Gakkai Zasshi. 67: 353-60.
3. Mankar S, Kawalkar AC, Sakhare R, Faizan M, Gohlar A (2020). Results of Modified Bunnel’s Technique in Management of. Claw Hand Deformity Caused by Leprosy Indian journal of leprosy. 92 (1): 31-37
4. Madhusudhan C, Moorthy NLN, Udaykumar B, Ravikumar M, Sumitra B (2018). High Resolution Ultrasonographic Evaluation of Peripheral Nerves in Leprosy- A Prospective Study. JMSCR.; 6 (1); 32114-32120.
5. Garbino JA (2000). Neuropatia hanseniana. Aspectos clínicos, fisiopatológicos, dano neural e regeneração. In: Opromola DVA. Noções de hansenologia. Bauru: Instituto Lauro de Souza Lima. Centro de estudos Dr. Reynaldo Quagliato; 79-89.
6. Sehgal VN, Prasad PVS, Kaviarasan PK, Rajan D (2014). Trophic skin ulceration in leprosy: evaluation of the efficacy of topical phenytoin sodium zinc oxide paste International Journal of Dermatology; 53, 873–878
7. Fernandes TR, Santos TS, Lopes RR (2016). Leg ulcer in lepromatous leprosy – case report. An Bras Dermatol; 91(5):673–5
8. Batista KT, Monterio GB, Y-Schwartzman UP et al. (2019) Treatment of leprosy-induced plantar ulcers Rev. Bras. Cir. Plást; 34(4):497-503
9. World Health Organization (WHO) (2014). Global leprosy update, 2013; reducing disease burden. Weekly Epidemiol Rec.; Sep; 89(36):389-400
10. Brandsma JW, Van Brakel WH (2003). WHO disability grading: operational definitions. Lepr Rev; 74: 366-73
11. V. Kumar, G.N. Malaviya, R.B. Narayanan, and M. Nishiura (1998). Ultrastructural Studies of peripheral nerves in lepromatous leprosy patients. Ind. J. Lepr.; 60: 360-363.
12. Ridley DS, Jopling WH (1966). Classification of leprosy according to immunity – a five-group system. Int J Lepr Other Mycobact Dis; 34: 255 – 273
13. Carayon A (1971). Investigations on the physiopathology of the nerve in leprosy. Int J Lepr Other Mycobact Dis.; 39:278–294.
14. Jeng SF, Wei FC (1997). Classification and reconstructive options in foot plantar skin avulsion injuries. Plast Reconstr Surg; 99(6):1695-703
15. Husain S, Mishra B (2008). Decompression of peripheral nerve trunks in leprosy to prevent the development and progression of deformities. Indian J Orthop; 42:78–82.
| How to Cite this article: Mankar S, Kawalkar A C, Sakhare R, Golhar A. Posterior tibial nerve neurolysis for treatment of leprosy induced plantar ulcers. Journal of Trauma and Orthopaedic Surgery. April – Jun 2020;15(2):27-30. |