Treatment of Forefoot Plantar Ulcers in Leprosy: Our Experience

Background: Chronic and frequently recurring ulcers in the sole of the foot are common complications in people affected by leprosy. Sensory loss secondary to peripheral neuropathy and mechanical stresses are considered to be the primary causes of ulceration.Patients and Methods: we reviewed all the leprosy patients with forefoot plantar ulcers treated by ulcer deviation in our institution from January 2007 to August 2009. A dorsal longitudinal incision was made to communicate with the plantar ulcer after debridement of the plantar ulcer. Excision of the metatarsal head was done and the wound was thoroughly irrigated with normal saline. The plantar ulcer was closed primarily and the dorsal wound packed loosely to heal by secondary intention.Results: A total of 16 patients with forefoot plantar ulcers were treated by ulcer deviation in our institution. Nine(56.3%) of the ulcers affected right foot and 7(43.7%) of the cases affected left foot. Majority of the ulcers were located under the head of first metatarsal(56.3%). This was followed by the second metatarsal head(25.0%) and fifth metatarsal head(12.5%). Majority of the ulcers 12(75.0%) healed between four and six weeks. Two(12.5%) cases were complicated by wound infection and only one case of recurrence.Conclusion: Plantar ulcers in leprosy usually pose great treatment challenges to the reconstructive surgeon. Ulcer deviation is a simple and effective method of treatment with low recurrence rate.Keywords: Leprosy, forefoot ulcers, metatarsal head, ulcer deviatio