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As there may also be sensory loss, the "blink" reflex is lost and corneal ulceration results, leading to phthysis bulbi and blindness (Fig. 34.7).

Damage to the peroneal nerve causes foot drop. Weakness of the muscles of the foot results in hammer toe deformity and, as the gait is altered, pressure is applied to different parts of the sole of the foot, leading to trophic ulceration (Figs. 34.5, 34.8, 34.9). The pedogram is a footprint study which may be used to show high pressure or stress points during the process of stepping, weight-bearing, and walking. It is of particular importance in the management of recurrent or nonhealing "trophic" ulcers (Fig. 34.8C).

Fig. 34.7. The complications of leprosy: inability to close the eyes properly (lagophthalmos), blindness (leprosy is one of the world's leading causes), and madarosis (loss of eyebrows).


Fig. 34.8. A Foreshortening of the left foot in comparison with the right. A few toes are seen as useless stumps. B A heel ulcer can often expose the calcaneum and any attempt to remove a sequestrum can end in removal of the entire calcaneum, which is as soft as putty and not like a normal bone with hard matrix. When these patients are put into plaster casts, and all pressure is taken off the calcaneum, the microfractures heal and reform the calcaneum. C Pedogram demonstrating pressure points, which are seen to correspond to ulcer sites.

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