F-3-13-02
TOP AUTHOR: MS. ADITI P RAJENDRA, HARDIKAR HOSPITAL, PUNE-5, INDIA
Co-AUTHOR: Dr. PRADIP D POONEKAR, ARTIFICIAL LIMB CENTRE, PUNE, INDIA
TITLE: PODIATRIC MANAGEMENT OF LEPROSY PATIENTS IN THE PROCESS OF REHABILITATION
The management of neuropathic arthropathy of the foot in Hansen's disease remains a difficult problem in any developing country not only due to the pathological changes and often presenting gross deformity of the foot, but also due to the associated socio-economical factors. Seldom surgical procedure is undertaken and is necessary in face of ulceration and unacceptable deformity. The protocol for surgery in terms of grading of foot pathology and its surgical management follows closely with the time-tested protocol for diabetic neuropathic foot. The other area where surgery comes to play is ensuing plantigrade weight bearing by correction of foot deformity and/or foot drop using tend transfers or rechannelisation to give the desired end results.
Orthotic management of neuropathic foot due to Hansen's disease constitutes prolonged protection to the foot with uniform weight distribution on a plantigrade foot so as to ensure maximum contact surface area and simultaneously providing relief at susceptible high pressure points. This involves heel, base of metatarsal joints. Sometimes the medial arch is also collapsed. Often an avoidable element in the podiatric management is footdrop which is controlled by AFOs, and various type of foot drop splints specially designed for these patients.
F-3-13-03
PERONEAL REACTION TIME IN THE PATIENTS WITH FUNCTIONAL INSTABILITY OF THE ANKLE
Khin-Myo-Hla, T. Ishii, M. Sakane, H. Tsuchiyama, K. Hayashi (University of Tsukuba, Japan)
Abstract: Several authors reported prolonged peroneal reaction time in patients with chronic lateral instability of the ankle. It is well documented that injection of local anesthesia into sinus tarsi reduces pain and sense of instability in post traumatic sinus tarsi syndrome induced by severe ankle sprains. So, we observed peroneal latency changes after the anesthesia in order to identify contribution of mechanoreceptors to proprioceptive mechanism in functionally unstable ankles.
Method: Peroneal latency changes were recorded by using surface EMG in 9 patients suffering from chronic ankle sprain and symptoms of giving way and in 8 voluntary controls. Latency time from peroneus brevis and longus were recorded before and 5 minutes or more after the anesthesia.
Results: Senses of instability reduced after the anesthesia. The mean latency time for the peroneus brevis was significantly different between the control (71.8 msec) and the patient (81.3 msec) before the injection and the patient became normal (69.5 msec) after the injection.
Conclusion: Proprioceptive deficit resulting from damage to mechanoreceptors in lateral ligaments has previously been considered as a cause of prolonged peroneal reaction time. Our results suggest that the delay originates not from proprioceptive deficit but rather the hypersensitivity of mechanoreceptors and the prolonged latency reflects the degree of functional instability.
