foot ankle scenario india

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01/09/14 1 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 1Sep14 Prof M S Dhillon 2 Role of the Foot in India is Unique Barefoot walking is common 1Sep14 Prof M S Dhillon 3 A large percentage of children are s8ll barefoot Govt School in Bangalore, 2012 1Sep14 Prof M S Dhillon 4

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Page 1: Foot Ankle Scenario India

01/09/14  

1  

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  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   2  

Role  of  the  Foot  in  India  is  Unique  

Barefoot  walking  is  common  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   3  

A  large  percentage  of  children  are  s8ll  barefoot  

Govt  School  in    Bangalore,  2012  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   4  

Page 2: Foot Ankle Scenario India

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1-­‐Sep-­‐14   Prof  M  S  Dhillon   5  

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  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   6  

There  are  MANY  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   7  

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  

Page 3: Foot Ankle Scenario India

01/09/14  

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Even  Foot  &  Ankle  Trauma  data  is  inadequate  Limited  publicaQons  from  India  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   9  

RURAL  Injury  PaWerns  are  different  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   10  

Different  Trauma  mechanisms  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   11  

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  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   12  

Page 4: Foot Ankle Scenario India

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These  unique  pa9erns  are  even  seen  in  suburban  India  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   13   1-­‐Sep-­‐14   Prof  M  S  Dhillon   14  

Indian  Toilet  Seat:  Tendo  Achilles  Injury!  

Management  Neglect  is  significant  

As  reflected  in  published  literature  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   15   1-­‐Sep-­‐14   Prof  M  S  Dhillon   16  

Uncommon  presentaQons  are  neglected,  misdiagnosed  

Page 5: Foot Ankle Scenario India

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O\en  there  is  significant  SURGICAL  Neglect!!!  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   17  

Poor  surgical  technique  

WHY?  

 MANY  surgeons  have  limited  exposure  and  

understanding  of  complex  foot  

issues  

18  1-­‐Sep-­‐14   Prof  M  S  Dhillon  

Post  surgical  issues  !  

Subtalar  joint  is  

dislocated!  

Talus  Malrotated  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   19  

Surgically  Induced  Deformity!  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   20  

PresentaQon    Dec    2013  

Pa8ent  prone,  knees  flexed  

Central  incision?  

Page 6: Foot Ankle Scenario India

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1-­‐Sep-­‐14   Prof  M  S  Dhillon   21  

Sports  related  Injuries  are  being  recognized  more  oGen  

Although  focus  is  on  cricket,  injury  is  significant  in  other  sports  also    

1-­‐Sep-­‐14   Prof  M  S  Dhillon   22  

Arthroscopic  Ankle  surgery  is  being  done  more  frequently  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   23  

Even  subtalar  joint  

What  about  other  problems  of  the  Foot?  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   24  

Page 7: Foot Ankle Scenario India

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DiabeQc  foot  is  a  HUGE  problem  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   25  

Ideal  DiabeQc  Foot  care:  NOT  available  universally    

1-­‐Sep-­‐14   Prof  M  S  Dhillon   26  

Many  things  are  different  from  the  WEST  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   27  

Amputa8on  age  is  lower  

Mortality  is  lesser  

Mostly  Neuropathic  

Cost  of  Treatment  is  LOW  as  per  western  standards  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   28  

But  even  this  maybe  significant!  

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Efforts  on  Foot  care  educaQon  have    shown  significant  benefits  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   29  

Jugaad  

InnovaQve  methods  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   31  

Indian    InnovaQons  

Special  Indian  tests  

Shedy’s  test  for  ankle  fractures…aims  to  op8mise  the  use  of  limited  resources    

1-­‐Sep-­‐14   Prof  M  S  Dhillon   32  

Page 9: Foot Ankle Scenario India

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What  about  Poliomyeli8s?  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   33  

20  years  ago,  it  was  rampant!  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   34  

RouQne  procedures  for  all  surgeons  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   35  

Today  surgery  for  Residual  Paralysis  rare  

But  Leprosy  persists!  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   36  

Page 10: Foot Ankle Scenario India

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Very  few  orthopods  are  involved    

1-­‐Sep-­‐14   Prof  M  S  Dhillon   37  

Foot  specific  issues  are    Addressed  by  specialized    Surgeons  In  limited  centers  

TB  is  sQll  a  problem  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   38  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   39  

In  2001,  we  published  the  world’s  largest    series  on  Foot  &  Ankle  Tuberculosis  

Since  then  much  has  changed!  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   40  

Page 11: Foot Ankle Scenario India

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BeWer  awareness,  earlier  management    

1-­‐Sep-­‐14   Prof  M  S  Dhillon   41  

But  some  TB  presentaQons  are  sQll  unique  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   42  

And  this  oTen  delays  medical  interven8ons  

India  is  Diverse  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   43  

Foot  problems  are  only  NOW  being  given  the  aden8on  they  

deserve  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   44  

Both  by  Pa8ents  and  Doctors  

Page 12: Foot Ankle Scenario India

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We  hope  in  the  future  this  is  reflected  as  beder  pa8ent  care  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   45  

Educa8onal  Ini8a8ves  have  improved  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   46  

All  are  aimed  at  maintaining  the  beauty  of  the  foot  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   47  

Why  the  neglect?  

•  Poverty  •  Illiteracy  •  Lack  of  Healthcare  infrastructure  

•  Lack  of  surgeon  awareness…  

1-­‐Sep-­‐14   Prof  M  S  Dhillon   48