Hesperian Health Guides

Prevention of Contractures and Deformities in Persons with Paralysis

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HealthWiki > Disabled Village Children > Chapter 26: Leprosy: Hansen’s Disease > Prevention of Contractures and Deformities in Persons with Paralysis


Prevention of contractures from paralysis due to leprosy is similar to prevention of hand and foot contractures due to polio and other forms of paralysis. However, loss of feeling makes prevention more difficult.


Exercises to maintain full range of motion are covered in Chapter 42 (see especially "Guidelines for Doing Stretching and Range-of-Motion Exercises").

  • Exercises to prevent fixed clawing of the hands can be done by gently straightening the fingers like this:

Clawed right hand being opened by straightening fingers with the left hand


and like this:

A normal hand with fingers flat and hand straight and a clawed hand

Open your fingers as much as you can without help. Then use your other hand to open them the rest of the way. Close fingers and repeat.


A child squating and holding onto support with heels down while defecating
a child leaning forward against wall with heels down
  • A good exercise to prevent ‘tiptoe’ contractures with ‘foot drop’ is to stretch the heel cords by leaning forward against a wall or by squatting with heels on the ground.

Footwear for persons without feeling in their feet

AVOID:
nails poking through sandal into foot
NO!
  • plastic shoes or sandals
  • soft-soled sandals or thongs that thorns can pass through
  • using nails to fasten heels and soles (These might poke through and injure the foot. Better to sew on soles or use glue.)

The best footwear has:

 soft furry open toe shoe
a well-fitted upper part that does not rub and has plenty of toe room (or leaves toes open).
a soft innersole about 1 cm. thick.
a tough under-sole so thorns, nails, and sharp rocks do not injure foot.
Footwear should be acceptable (not look too strange or unusual) so that the person will use it.

Possible ways to get footwear

  • Contact a leprosy hospital with a footwear workshop. They can make sandals if you send a tracing of the foot.
A foot being traced on paper
  • Check the market. You may find a canvas shoe or tennis shoe that already has a good insole.
A tennis shoe with sole shown
  • Or you can put soft insoles into the shoes. But CAUTION: If you put an insole that is thick into a standard shoe, there may not be enough room for the toes—unless you cut out the part over the toes and leave them open.
Side angle of the show showing a sole in the front too
An insole that is thick may work if the foot is already short.
soft insole
  • Make (or have a local shoemaker make) special footwear.
For the inner sole, you can use a soft, sponge sandal or ‘thong’. Or buy ‘microcell’ rubber, which is soft but firm.
DVC Ch26 Page 225-4.png
DVC Ch26 Page 225-5.png
For the under-sole you can use a piece of old car tire.
DVC Ch26 Page 225-6.png
DVC Ch26 Page 225-7.png
  • For persons who have developed sores on their foot here,
a bar here or a foot support here may help take pressure off the ball of the foot and prevent new sores.
  • A very helpful lining for preventing sores is
    a soft, heat-moldable foam plastic called ‘Plastazote’. For instructions on making footwear with ‘Plastazote’, see "Insensitive Feet".
DVC Ch26 Page 225-8.png


  • For persons with a ‘drop’ foot, a brace or ‘lift’ can help prevent sores and injuries.
You can get a brace or support at a rehabilitation workshop, or make a specially-fitted, well-padded plastic brace (see Chapter 58).
DVC Ch26 Page 225-9.png
Or make a simple device to hold the foot up. A shoe and boot like device hodling foot up



This page was updated:21 Nov 2019