Distribution of Deformities of Hands and Feet in Old Cases of Leprosy in a Tertiary Care Hospital in Chennai
Background: Leprosy is a chronic debilitating granulomatous disease caused by an acid-fast bacillus, Mycobacterium leprae. This disease is known for its mutilating deformities and disabilities that impair the quality of life of patients. Deformities of hands and feet are seen frequently in untreated or inadequately treated cases of Leprosy. Deformities can be trivial like mild muscle wasting and paraesthesia to more severe presentation like trophic ulcer, auto-amputation of digits, claw hands, and hammer toes etc. this study thereby aims at analysing the occurrence of such deformities in previously diagnosed cases of Leprosy in a tertiary care hospital in Chennai.
Materials and Methods: In this study, 54 pre-diagnosed cases of Leprosy with deformities of hands and feet, were included after due consent. A thorough history was recorded followed by a dermatological examination. Photographs were taken and the data was systematically tabulated.
Results: This study comprised of 54 old cases of Leprosy in which, 28 males (51.85%) and 26 females (48.14%) were included. 4 cases (7.4%) each of isolated hand and foot involvement and 46 cases (85.18%) of combined hand and foot deformities were studied. Majority of cases (81.48%) were in the age-group of 41-70 years. All the cases were of Lepromatous Leprosy (LL-HD). 30 patients (55.55%) gave a history of having completed a full course of MB-MDT in the past. The rest (n=24) were inconsistent in their treatment history. Hand deformities encountered were: Claw hands, ulcers, callosities, muscle wasting, twisted fingers, absorption/auto-amputation of fingers, banana fingers, frozen hand etc., Foot deformities encountered were: Hammer toes, foot drop, absorption of toes, trophic ulcers, twisted toes, flat foot, pseudoainhum.
Conclusion: In our study, claw hand (ulnar, median or complete claw hand) was the most common hand deformity present in 44 of the 50 cases of hand deformities (88%), whereas foot drop and absorption of toes were the most common foot deformities seen in 42 of 50 cases (84%), followed by trophic ulcers seen in 34 of 50 cases (68%). The least found hand deformity was twisted fingers, seen in 6 of 50 cases (12%) and similarly the least found foot deformity was twisted toes seen in 18 of 50 cases (36%).