Situation Of The Foot At Risk Due To Leprosy In The Municipality Of Rio De Janeiro

Management of tibial neuritis is often hindered by silent neuropathy. The morbidity could be easily detected when the healthcare provider uses the systematic approach of simplified neurological evaluation recommended by the Brazilian Ministry of Health. Evolution from grade 1 disability (G1D) to grade 2 disability (G2D) is not uncommon after treatment with WHO/MDT owing to the development of plantar ulcers, osteomyelitis, and the need for surgical amputation.Objective: We aimed to analyze the clinical course of patients with leprosy who presented with plantar anesthesia and G1D in the feet.Methods: This is a retrospective longitudinal observational case study. We reviewed the records of Hansen's disease between 2004 and 2018 in four healthcare units in the Municipality of Rio de Janeiro. The sample comprised patients with leprosy (G1D or G2D) and anesthetic foot who underwent treatment and completed follow-up until discharge from WHO/MDT. Descriptive analysis and comparison between variables were performed using Fisher's exact test with p < 0.05.Results: Forty-nine patients were selected from 135 medical records. There was an increase in the physical disability grade in 20.4% of the cases due to the occurrence of plantar ulcers in 10.2% and in 49% of the patients with post-discharge complications. Chronic pain was the most reported symptom (22.4%).Conclusion: Inadequate and prolonged use of glucocorticoids for chronic pain, noncompliance in the use of orthosis and adequate footwear, and nonreferral for surgical decompression of the tibial nerve suggest the need for professional training in the therapeutic approach to nerve damage in leprosy.