foot ankle scenario india
TRANSCRIPT
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Foot & Ankle Surgery Prac8ces The Scenario in India
Prof M S Dhillon President Ind Foot &
Ankle Society
Role of the Foot in India is Unique
It is considered an object of
beauty
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Role of the Foot in India is Unique
Barefoot walking is common
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A large percentage of children are s8ll barefoot
Govt School in Bangalore, 2012
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Many famous players Don’t mind playing barefoot!
So what are the FOOT problems specific to INDIA?
1. Awareness issues 2. Difficult & Neglected trauma 3. Diabe8c Foot: major problem 4. Limited sophis8cated inves8ga8ons 5. OTen innova8ve treatments 6. Pa8ents Neglect foot/ ankle
condi8ons 7. Bunions / flat feet uncommonly
operated 8. Chronic osteomyeli8s & TB s8ll
prevalent
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There are MANY
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Focused Foot Surgeons are very few…. Public does not know that FOOT is a specialty
Limited awareness in the lay public
In major meeQngs all over India Only FOOT trauma is discussed
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Even Foot & Ankle Trauma data is inadequate Limited publicaQons from India
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RURAL Injury PaWerns are different
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Different Trauma mechanisms
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Bicycle-‐spoke injuries of the foot in children
Agarwal A, Pruthi M J Orthop Surg (Hong Kong) 2010 Dec;18(3):338-‐41
• 34 of 37 reported injuries involved the rear wheel
• Heel pad injuries
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These unique pa9erns are even seen in suburban India
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Indian Toilet Seat: Tendo Achilles Injury!
Management Neglect is significant
As reflected in published literature
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Uncommon presentaQons are neglected, misdiagnosed
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O\en there is significant SURGICAL Neglect!!!
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Poor surgical technique
WHY?
MANY surgeons have limited exposure and
understanding of complex foot
issues
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Post surgical issues !
Subtalar joint is
dislocated!
Talus Malrotated
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Surgically Induced Deformity!
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PresentaQon Dec 2013
Pa8ent prone, knees flexed
Central incision?
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Sports related Injuries are being recognized more oGen
Although focus is on cricket, injury is significant in other sports also
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Arthroscopic Ankle surgery is being done more frequently
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Even subtalar joint
What about other problems of the Foot?
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DiabeQc foot is a HUGE problem
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Ideal DiabeQc Foot care: NOT available universally
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Many things are different from the WEST
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Amputa8on age is lower
Mortality is lesser
Mostly Neuropathic
Cost of Treatment is LOW as per western standards
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But even this maybe significant!
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Efforts on Foot care educaQon have shown significant benefits
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Jugaad
InnovaQve methods
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Indian InnovaQons
Special Indian tests
Shedy’s test for ankle fractures…aims to op8mise the use of limited resources
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What about Poliomyeli8s?
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20 years ago, it was rampant!
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RouQne procedures for all surgeons
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Today surgery for Residual Paralysis rare
But Leprosy persists!
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Very few orthopods are involved
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Foot specific issues are Addressed by specialized Surgeons In limited centers
TB is sQll a problem
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In 2001, we published the world’s largest series on Foot & Ankle Tuberculosis
Since then much has changed!
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BeWer awareness, earlier management
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But some TB presentaQons are sQll unique
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And this oTen delays medical interven8ons
India is Diverse
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Foot problems are only NOW being given the aden8on they
deserve
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Both by Pa8ents and Doctors
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We hope in the future this is reflected as beder pa8ent care
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Educa8onal Ini8a8ves have improved
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All are aimed at maintaining the beauty of the foot
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Why the neglect?
• Poverty • Illiteracy • Lack of Healthcare infrastructure
• Lack of surgeon awareness…
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