Protective footwear for leprosy patients with sole sensory loss or ulceration of the foot.

Sir, We would like to respond to the letter on this topic published in Lepr. Rev. ( 1 994) 65, 400-402. We agree with the need for protective footwear and ALERT has a well-equipped orthopaedic workshop employing 1 5 technical staff. We have supplied MCR sandles, plastazote shoes and boots as well as lower limb prostheses, as necessary, for many years . In recent years we have found that it is impossible to . supply these in sufficient quantity for all the former patients who need them. We have also noted some of the problems found in India and reported by Dr Krishnamoorthy, especially an unacceptable design causing greater stigma for people affected by leprosy. Because of infrequent use many patients have not been helped by their shoes. An additional problem has been that shoes made far from the patient's home may not be properly fitted or reviewed and may actually cause new ulcers . Amidst this rather depressing scenario we are attempting to do more education in selfcare, to get patients to take greater responsibility for their own feet. However, we have been very encouraged by the initial results of using canvas shoes produced by a commercial company here in Addis Ababa. They were able to make a new design incorporating an MCR layer and these shoes are sold at a subsidized price to patients . We are currently discussing with the manufacturer how the upper canvas part can be strengthened as durability is a problem. Different models for men, women and children are available. We have just started a study to compare canvas shoes with plastazote shoes for patients with damaged feet and hope to report the results within one year, including the relative costs . In the meantime we have already noted a vast difference in acceptability and a number of chronic ulcers have quickly healed with the canvas shoes. It seems likely that a more attractive shoe helps to develop a more positive attitude in patients, as well as providing some physical protection for the feet.