Footwear for the person with an anesthetic foot: what options are available?

Leprosy is predominantly a disease of peripheral nerves and it particularly affects the nerves supplying the eyes, hands and feet, leading to irreversible impairments, if not treated early. Impairments in the foot include sensory loss, motor weakness of the anterior and/or lateral compartment of the leg and intrinsic muscles of the foot and dryness in the sole of the foot due to the involvement of the common peroneal and posterior tibial nerves; these impairments act as predisposing factors for plantar ulceration. Because of sensory loss in the sole of the foot it is essential for those with leprosy to practice foot care and inspect their feet regularly for early signs of skin damage to prevent secondary impairments. Early measures such as resting the foot, pressure relief through the use of crutches and appropriate medical care will prevent secondary impairments such as plantar ulcers and consequent deformities. Appropriate protective footwear made with a micro-cellular rubber (MCR) insole is recommended by the National Leprosy Eradication programme (NLEP) in India for people affected by leprosy with sensory loss in the soles of their feet. In most instances this footwear is either pre-fabricated or ordered in bulk, and is usually made by a shoe technician with minimal equipment, so the finishing and appearance is generally not comparable with commercially available footwear. In addition, the availability of MCR footwear is limited to the colour black with fixed designs and they are usually of the same design for both genders. Most of the time acceptability of this footwear is questionable because of improper fitting, lack of suitable designs for males and females and various other reasons. Those affected by leprosy with anesthetic feet are often reluctant to use MCR footwear, in spite of realizing that protective footwear is essential to prevent secondary damage to their feet. This reluctance to use proper footwear is one of the main reasons for the progression of impairments in patients with anesthetic feet. It is recommended that those with anesthetic