Sensory recovery in the plantar aspect of the foot after surgical decompression of posterior tibial nerve. Possible role of steroids along with decompression

Abstract

Summary In leprosy, involvement of the posterior tibial nerve leads to sensory loss in the plantar aspect of the fo ot. As a result plantar ulcers are common and lead to deformity and disability. Restoration of plantar sensation can prevent ulcer fo rmation.Posterior tibial decompression was done for the recovery of sensation in the plantar aspect of the fo ot. Seventy-two patients under went decompression on 84 feet, 25 received steroids pre-and post-operatively. The recovery of sensation was better if surgery was done before 6 months of onset of anaesthesia. Decompres sion along with steroids gave better results than decompression alone in patients with active neuritis especially in BT cases whereas in BB, BL and LL cases there was no significant improvement of sensation. The results are discussed.Involvement of the posterior tibial nerve is common in leprosy and leads to loss of sensation in the plantar aspect and paralysis of the small muscles of the fo ot. Plantar ulcers are an unfortunate problem due to anaesthesia of the fe et. If sensory function is restored to the foot it is possible to prevent ulcers and late complications.Various studies1•2.4.6 have reported recovery of sensation and motor function after decompres sion of the ulnar nerve. An analysis of the recovery of sensation after PT decompression was done at CL T & RI, Chengalpattu. Initially PT decompression was done for painful neuritis and patients were on steroid therapy as well. Because there was a good recovery of sensation after surgery, patients with plantar anaesthesia but without neuritis were also considered for surgery although they were not given steroids. The results were analysed for recovery of plantar sensation after PT decompression with and without steroids. Steroids help in suppressing the immunological response in the nerve and relieve the tension by decreasing the oedema and inflammation. Surgical decompression relieves external and internal compression of the nerve.

Effectiveness of neurolysis as a treatment for complications of leprosy neuritis: a systematic review

“…The 11 studies included in the final sample were comprised of a single RCT 13 , classified as level II evidence, and 10 prospective cohort studies, classified as level IV evidence, published between 1976 and 2020, and written in English and French 7,[14][15][16][17][18][19][20][21][22] . Four studies were conducted in India 7,13,18,20 , one in Ecuador 14 , one in Nepal 16 , one in Madagascar (Africa) 17 , and one in France 19 , while three studies did not provide information regarding the study site 15,21,22 . The sample sizes ranged from 10-500 participants, and the follow-up time ranged from 15 months 7,13-22 to 20 years 15,18 , as shown in Table 1.…”

“…Four studies were conducted in India 7,13,18,20 , one in Ecuador 14 , one in Nepal 16 , one in Madagascar (Africa) 17 , and one in France 19 , while three studies did not provide information regarding the study site 15,21,22 . The sample sizes ranged from 10-500 participants, and the follow-up time ranged from 15 months 7,13-22 to 20 years 15,18 , as shown in Table 1.…”

“…Of the 10 cohort studies included and submitted for methodological quality analysis, three were considered to have a low risk of bias 7,16,17 , three a moderate risk 18,20,22 , and four a high risk 14,15,19,21 . Studies classified as having a high or moderate risk of bias showed methodological weaknesses in terms of group recruitment, exposure measures, reliability of exposure measures, confounding factors, follow-up time, and statistical analysis, as seen in Table 3.…”

“…All of the studies evaluated sensory function 7,[13][14][15][16][17][18][19][20][21][22] , with no beneficial changes found in two 18,20 . Ten studies evaluated motor function 7,[13][14][15][16][17][20][21][22] , with positive effects observed in nine 7,[13][14][15][16][17]21,22 .…”

A Review of Therapeutic Nerve Decompression for Neuropathy in Hansen's Disease with Research Suggestions

“…The leprosy literature includes reports 35,42,55,[65][66][67][68] of sensory or autonomic recovery and improved ulcer healing after posterior tibial ND. Prospective reporting on ND in the similar situation of diabetic foot neuropathy, without control groups, noted reduced ulcer risk, recurrence rates, amputation risk, and foot-related hospitalizations in comparison with the literature.…”