Posterior tibial nerve neurolysis for treatment of leprosy induced plantar ulcers

Introduction: Damage to the peripheral nerves due to neuritis caused by Mycobacterium leprae is responsible for most of the deficits and deformities associated with leprosy. The trophic or chronic plantar ulcer of leprosy due to involvement of posterior tibial nerve is one of the principle causes of disability. Multiple treatment options are mentioned in the literature but none of them is found to be gold standard. Thus we formulated this study to evaluate the results of posterior tibial nerve neurolysis in treatment of plantar ulcers in leprosy. Patients and methods: Diagnosed patients of leprosy with plantar ulcers and who have positive Tinel’s sign, numbness in feet with thickened tender posterior tibial nerve underwent posterior tibial nerve decompression and debridement of the ulcers were included in the study. Post operatively ulcers were assessed after 2, 6 and 12 weeks after surgery for the signs of healing and according to the grading system described by Sehgal et al. Results: 34 patients with mean age of 48 years with plantar ulcers we included in the studies. There were 4 patients with grade IV, 21 patients with grade III and 9 patients with grade II ulcers. All the patients except one had clinical improvement and showed signs of healing at 12 weeks of follow up. Also the sensations in the sole of foot improved in all our patients. Conclusion: Posterior tibial nerve decompression or neurolysis is an effective method to treat plantar ulcers in leprosy which also improve the plantar sensations.