STRAIGHT FROM THE GUT: Orthotic Management of Neuropathic Limb: Leprosy and Diabetes - S.K. BEHURA

If a wound or injury does not cause pain it is likely to be neglected. Neuropathy implies a defect in nerve function. It may affect motor, sensory or autonomic system. The most serious neuropathy is diminution of sensory protection. There is a lack of recognition of pressure, force or stress that a normal person would produce as an immediate response. This leads to neglect of abnormal pressure, friction & burns resulting in non-healing ulcer. Motor neuropathy leads to muscle imbalance resulting into excessive pressure. Autonomic neuropathy indicates abnormalities of sweat gland leading to easily damaged skin.

It is the consequences of plantar anesthesia & stresses and strain develop in walking leads to plantar ulcer. Ulcer may arise from external injury to insensitive foot or infection through crack and fissures. Whenever there is a paralysis of intrinsic muscle of foot (which normally acts during push off stage of walking normally counter the stress, strain and shearing) ultimately the subcutaneous tissue breaks down and ulcer develops. Even though ulcer heals it has a tendency to recur. The ulcer recurs because the original cause persists in addition to scar tissue is more vulnerable to walking strain which may be exaggerated by deformity.

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