Multidisciplinary approach for diabetic and leprosy feet

Leprosy Mailing List, May 23rd, 2008

Ref.: Multidisciplinary approach for diabetic and leprosy feet
From: Warren G., Sidney, Australia


Dear Salvatore,

Interested in this bit of correspondence and a couple of others that have recently come through.

Yes the care of the neuropathic limb was really perfected by Dr Paul Brand working in Karigiri and many diabetic specialists now acknowledge this and are grateful to have eh finer points we have developed in leprosy to pass on to their patients and students. My teaching now is that “IT DOES NOT MATTER WHAT IS THE CAUSE OF THE NEUROPATHY, THE MANAGEMENT IS VIRTUALLY THE SAME ONCE THE CAUSAL AGENT IS ADEQUATELY DEALT WITH.”

IN 1999 we published “The care of Neuropathic limbs a practical manual” by Grace Warren and Sydney Nade. It was published by Parthenon Publication who unfortunately are no longer publishing. As far as we can ascertain this is the only text book that does deal with the care of neuropathy as a medical entity and not just as a side effect of leprosy, or diabetes or any other problem. It deals with all the basic testing and methods of care but does not deal in great details with the surgical techniques applicable to those with neuropathy. Some of these are to be found in text books such as “Surgical Reconstruction and Rehabilitation in Leprosy and other Neuropathies” edited by Richard Schwartz and Wim Brandsma and published by EKTA in Nepal in 2004. I have also contributed a chapter on the surgery of leprosy that is often relevant in other neuropathies, to “Primary Surgery” Volume One Published by Oxford Medical Publications, in 1990.

Over 3000 copies of “The Care of Neuropathic limbs” have been sold and distributed round the world, many as gifts from The Leprosy Mission International to Leprosy Institutions, but also sold through the Internet and through TALC. When Parthenon closed down the remaining copies came to The Leprosy Mission in Box Hill Australia and we still have a few hundred copies for sale if required, from The Leprosy Mission, P. O. Box 293, Box Hill Vic 3128, Australia,
Email is: tlmaust@leprosymission.org.au

Good care of diabetic feet and neuropathy from other causes does depend very much on self care and getting the patients, his relatives and his carers, to understand that the main problems are reduced sensory perception and muscle weakness or paralysis. That the patient must understand what are his problems and attempt to care for himself. No one else can really do it for him 24 hours each day. I must agree with Dr Premkumar (LML May 8th, 2008) that a multidisciplinary approach is needed and we, who have done so much on detail what is needed, are still trying to spread the information right across the medical fields of the world.

Grace Warren
Am., M.D., M.S., FRCS., FRACS., F AOrth A.,
Previously Adviser in Leprosy and reconstructive surgery to The Leprosy Mission in Asia