Sensory nerve transfer to restore sole sensation in Hansen’s disease

Introduction
Loss of sensation in the sole due to Hansen’s disease (HD) may lead to repeated trauma, chronic non-healing ulcers and even amputations. We hypothesised that Saphenous Nerve (SN) to Posterior Tibial Nerve (PTN) sensory nerve transfer can restore sensation in the sole.

Method
All patients who underwent sensory nerve transfer surgery were assessed by pre- and post-operative sensory tests performed on the sole, including tests for touch, pain, temperature, pressure, vibration and two-point discrimination. Results were classified as per British Medical Research Council (MRC) scoring system.

Results
Twenty-six patients (37 feet) diagnosed with loss of sensation of the sole due to HD were included in this study. 23 patients (26 feet) had associated ulcers on the sole. All sensory parameters improved in all patients at 6 months follow-up after sensory nerve transfer surgery. All ulcers healed completely in all feet. MRC scores improved from S0 in 27 feet and S1 in 10 feet (pre-operative) to S3+ in 29 feet, S3 in 6 feet and S2 in 2 feet.

Conclusions
SN to PTN transfer can restore protective sensation to the sole in HD.