Baropodometric Evaluations and Sensitivity Alterations in Plantar Ulcer Formation in Leprosy

Leprosy is a chronically evolving granulomatous disease caused by the bacillus Mycobacterium leprae, which exhibits tropism for peripheral and motor nerves and slow-growing inflammation that affects the peripheral nervous system, especially the sensory fibers. The aim of this study was to observe the relationship between peak pressure and abnormal sensitivity for the formation of plantar ulcers in patients with multibacillary (MB) and paucibacillary (PB) leprosy. A total of 51 individuals with leprosy were evaluated and classified as either MB or PB and then submitted to the Semmes-Weinstein sensitivity test; 20 normal individuals were examined as a control group and took a baropodometric test. The pressure peaks and sensitivity alterations were noted and compared within groups. Leprosy patients exhibited a greater loss of sensitivity at the heel area that might compromise gait. During dynamic analysis, the MB group with altered sensitivity for right and left feet and PB (left feet) group showed the highest plantar pressure values. Skin damage (calluses or ulcers) did not occur within the areas of high plantar pressure in 80% of MB patients, whereas skin damage was observed in 38% of PB patients in the areas of higher peak pressures. According to these findings, baropodometry and sensitivity tests play an important role in the understanding of ulcer biodynamics. In addition, it could be inferred that the loss of protective sensibility in MB patients is predictive of plantar ulcers, whereas plantar pressure peaks seem to be of greater importance in PB patients.