A preliminary objective evaluation of leprosy footwear using in-shoe pressure measurement.

The primary function of leprosy shoes, insoles and podiatric orthoses is to provide an underfoot environment capable of distributing the inevitable vertical forces, so reducing areas of peak pressure and ideally the period through which they are applied. Many patients with Hansen's disease have both skeletal deformity and anesthetised feet and the presence of high plantar pressures is the key reason for foot ulceration. This objective investigation using in-shoe dynamic pressure measurements showed that the addition of a shank to control insole rigidity reduced the overall peak pressures under the foot. When a deep canvas shoe was used to test single- and double-thickness insoles of two different types of material it was found in each case that the double-thickness mode was advantageous overall. Microcellular rubber insoles in two types of leprosy shoe were replaced by the polymer Poron. The Poron proved to be superior to both microcellular rubbers. The peak pressure and pressure-time integral should be considered as complimentary variables when determining the efficacy of footwear.