Tarsal disintegration (T.D.) in leprosy

Tarsal Disintegration in leprosy has been a challenge as far as its prevention is concerned. It is, no doubt, a complex and less understood phenomenon influenced by many factors. In this study made at Dr. Bandorawalla Leprosy Hospital, Kondhawa, factors like insensitivity, loss of protective reflex, infection, lepromatous infiltration of bones etc. have been taken into consideration, but, more emphasis is laid on the biomechanical factors (i.e. altered muscle pulls due to muscular paralysis resulting in imbalance) and the resulting change in weight bearing areas and weight transmission lines. Sixteen cases of neuropathic feet were examined clinically and radiologically. All were burnt out cases of tuberculoid and borderline tuberculoid variety excepting one which was active being of lepromatous variety. Tracings made from actual radiographs of the patients were studied. It was found that apart from insensitivity, biomechanical factors play a lot of importance in accentuating the process of T.D. The changes are predominantly seen in Tuberculoid variety of Leprosy. Attempts have been made to understand this process more closely by drawing conclusions based on the kinetic and kinematic analysis of the normal human foot and comparing it with neuropathic feet.