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Times of India
27 June 2011

The Special Olympics currently underway in Athens might bring to the world′s attention a branch of medicine few know about: podiatry or the study of diseases of the foot and ankle. Dr Govind Singh Bisht, consultant podiatrist at Max Hospitals, is an expert and clinical director of ‘Fit Feet′ at the Special Olympics. He spoke to Shobha John:

Why Is Foot Care So Important For Special Children?
They are often neglected, not just by society, but by their families too. They have many requirements, be it the eyes, ears, feet, teeth or diet. While the Special Olympics was started in 1968, screenings for these children began in 1993. Foot screenings began only in 2003. These children have many foot-related problems – stiffness, flattening or collapse of the foot arch, fungus infection of the nails, etc.

Why Is Podiatry So Important For Diabetic Patients?
Most diabetics have footrelated problems. In fact, it′s one of the commonest causes of hospital admission for them. India has some 50.8 million diabetics, out of which 40,000 amputations take place annually. But it needn′t be so – 50% of them can be avoided with good foot care.

Diabetes affects the nerves of the foot, reducing blood supply. This can lead to loss of sensation and greater risk of injury. Even a small injury can lead to a nonhealing ulcer, gangrene and then, amputation. This can become a major financial and psychological burden.

Unfortunately, there is a lot of ignorance even among medical practitioners regarding diabetic foot care. For most diabetologists, this is not their area of specialisation and most don′t even see the foot of the patient. In a survey based on a camp conducted by the Delhi Diabetes Centre, 1,500 respondents were asked how many times their doctor had examined their feet in the last one year. Shockingly, 59% said not even once, 23% said sometimes and only 18% said during every visit. Most doctors don′t have the patience to take care of an ulcer that takes a long time to heal and is messy.

What advice would you give to diabetics about foot care?
Selecting the right footwear can make all the difference to a diabetic non-healing ulcer, so make sure you are wearing the right type of shoe. Sometimes, slippers just don′t work if there′s an ulcer on the foot. Shoe bites can also cause ulcers. So buy shoes with extra width and depth, good cushioning and shock absorption. This can help in grip and balance. Also, buy footwear in the latter half of the day as that′s when swelling in the feet is more likely.

Howoftenshouldadiabetic see a podiatrist?
If there are ulcers, it could be on a daily or weekly basis.

What are the common causes of ulcers among diabetics?
Corns, calluses, wrong footwear, injury from heating pads, skin infections, dry and cracked skin.

Is podiatry a branch of medicineinmedicalcolleges?
Sadly, it isn′t. Most podiatrists finish MBBS and then do a fellowship in podiatry abroad. I did it from Boston, for example. A comprehensive diabetic programme should be introduced in medical colleges. What′s worse is that in most hospitals in India, there is no separate department for podiatry. So, diabetics are often left floundering, going to orthopaedics or skin doctors in their attempt to heal their ulcers. Sometimes, it can take years for ulcers to heal.

However, good skin dressings in the market help in healing them and protect the wound against bacterial and other contamination.

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