A study was carried out on 381 feet during the period 1999 to 2010. All the patients operated during this period were included in the study. The CT route was used for those with peronei power 4 or 5, while the IO route was used when peronei power was 3 or less.

In this case series the mean effective range of motion (above 90^°) was 11 and 12 degrees in CT and IO routes, respectively. The results were comparable in terms of rest position, active dorsiflexion and effective range of motion. All patients had a post-operative heel to toe gait, except for one of the 381 operated feet. Only three of the 381 feet had a reduction in navicular height of more than 2 cm, the medial arch being maintained in the others.

TPT is a standard procedure to correct foot drop deformity in leprosy. Pre-selection for route of transfer, CT or IO, based on peronei strength avoids the complication of iatrogenic inversion. The technique of insertion and routine tendo-achilles lengthening provides a good range of movement. The deep tunnelling has not compromised the results, while giving excellent cosmetic appearance.

A random sample of 250 leprosy patients visiting the hospital for the first time during 2011–2012 were chosen, 50 each from those with only hidden patches (Grade 0a), patients with visible patches (Grade 0b), those with only anaesthesia or weakness (Grade I), patients with paralytic deformities (Grade 2a), and patients with visible disabilities and ulcers Grade 2b). The P-scale consisting of 18 items was administered in the local language (Hindi) and used by the Counsellor along with relevant clinical and socioeconomic details.

There were 84 women and 166 men, distributed in all the five categories. Overall, 142 patients out of 250 (56.8%) had no participation restrictions; 39 (15.6%) had mild social restrictions; 20 (8.0%) had moderate, 28 (11.2%) had severe and 21 (8.4%) had extreme participation restrictions. Paradoxically, there were some cases without severe deformity who are also subjected to restrictions. Patients in Grades 0a and 0b, had practically no severe or even moderate restrictions in their social participation, but their perceived stigma was high, requiring suitable leprosy education, family counselling and coping skills to feel confident that they were capable of normal work like any of their peers. Counselling became more intensive in Grade 1 and for almost all in Grade 2, who experienced moderate to severe restrictions in meeting new people, participating in social activities and indulging in socioeconomic activities. Counselling for such groups of patients required multiple approaches, including in-depth leprosy education for regular treatment, self-care measures, mobilisation of coping skills, self-confidence and acceptance counselling, and follow-up counselling for those released from treatment after multidrug therapy.

The P-scale provides essential information to enable a Counsellor to offer more meaningful and balanced counselling to leprosy-affected people, especially in coping with enacted stigma. Education oriented counselling and psychological supportive counselling are necessary adjuncts for clinical care and treatment. Client-oriented counselling allows clients to freely express their fears and anxieties, and promotes coping skills and confidence.

A retrospective chart review of leprosy patients treated at a state referral centre for leprosy in Natal, Rio Grande do Norte, Brazil was completed. Chart review focus was on adverse effects necessitating modification of MDT regimen.

Six hundred and twelve records were reviewed with detection of 91 (14.8%) adverse effects with associated change in MDT regimen. The most common recorded causes of medication intolerance were anemia (8.7%), headache (4.2%), cyanosis (1.8%), and gastrointestinal symptoms (1.6%). Both female gender (OR = 2.63) and age less than 42 years old (OR = 2.7) remained risk factors for MDT intolerance in a multivariate model including gender, age, and WHO regimen type. With intolerance due to anemia as the outcome, female gender (OR = 2.36) and age less than 42 years (OR = 1.86) were associated.

In this study, female gender and younger age were associated with greater risk of medication intolerance and medication intolerance related to anemia. These findings have important operational implications for drug intolerance monitoring during therapy for leprosy.