Prevention of Contractures and Deformities in Persons with Paralysis

This content is from pages 224 to 225 of Disabled Village Children

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:

and like this:

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 good exercise to prevent 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:

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:

a well-fitted upper part that does not rub and has plenty of toe room (or leaves toes open).

a soft and thick innersole

a tough under-sole so thorns, nails, and sharp rocks do not injure foot.

an acceptable appearance (should not look too unusual) so the person will wear 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.
Check the market. You may find a canvas shoe or tennis shoe that already has a good insole.
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.		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 buy “microcell” rubber, which is soft but firm. For the outer sole, hard, resistant rubber or plastic sole should be used.


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.