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The JAIPUR FOOT…….From Sobs to Smiles!

Too many, in fact, to recount here.

There is no denying the fact that the optimal management for diabetes related foot problems is to prevent them. If one is unable to prevent them, then at the very least, foot problems should be treated at the earliest so that the feet can be salvaged completely. But as has it famously been said, “Stuff happens!” and for whatever be the reason the foot has to be amputated.

It is not that artificial limbs are not available. But the question is…. are they affordable? One has to realize that more than 70% of all people with diabetes come from poor and transitional countries. How many people can afford these costly artificial limbs, many of them costing in the vicinity of 5000 to 8000 U.S. Dollars! In this context one has to realize that in many countries, the average daily per capita income is around one U.S. dollar, and there is no universal health care which especially covers diabetes and diabetes related complications.

Moreover, many of these western style artificial limbs may not be suitable for the lifestyles and habits of people in other countries. The lower limbs are not meant only for locomotion. They serve a number of diverse functions and must be culturally and socially acceptable to people of different ethnicity.

Take India for instance.

The life style of an average Indian demands long times spent in position of squatting, sitting cross legged on floor etc. While squatting the ankles have to dorsiflex fully, the knees have to flex till the soft tissues of the thighs and calf can flatten against each other.
It is this which allows our center of gravity to fall within our point of support to provide a stable equilibrium so that we do not fall backwards. An average Indian would also disapprove of using the street shoes inside the house.

Also, the "shoe" attached to the old artificial limb was made of heavy sponge, making it worthless for any farmer working in the rain or in irrigated paddies, and 72% of India lives, and works, in its villages.

Although one can always say that “beggars cannot be choosers” and that they should use whatever is available, one must also accept the fact that a person with diabetes and a diabetes related amputation is also a human being and must get along with his or her life.

Thus an artificial limb should be cosmetically acceptable as far as possible, allow one to function in a socially and culturally acceptable manner. The artificial limb should not absolutely require the wearing of a shoe, should allow a person to squat at least for a short interval, sit cross legged and should have sufficient flexibility to allow one to walk on uneven ground, and be durable and waterproof to allow work in rough terrain of farm fields, water ditches, mud paths etc. It should also be fabricated out of cheap and easily available materials without requiring very sophisticated machinery and personnel training!

Needless to say, having such artificial limbs available is one thing, but being affordable is all the more important especially to the poor and vulnerable sections of society.

The Jaipur Foot with its modifications which meets many of these requirements.

A Brief History

Many a step has been taken since the Jaipur Foot was first developed way back in 1968.

The People……The inventors were as different as chalk and cheese! Pramod Karan Sethi, was an orthopedic surgeon, a fellow of Britain's Royal College of Surgeons, while his partner was an artisan named Ram Chandra who had studied only up to the 4th standard. But he came from a family of known artisans and his work itself was par excellence!

The Place…….the Sawai Man Singh Hospital in Jaipur. There, Sethi was helping his orthopedic patients wobble down the corridor on their crutches, and Chandra was teaching lepers to make handicrafts so that they could earn a living.

The Invention……..Seeing the plight of the patients wobbling around in considerable discomfort, Chandra was convinced that a better and more lifelike artificial limb could be made. He spoke to Sethi who was also enthused about this, possibly with the thought that anything could be better than what they had at that time. In any case, Sethi took pains to explain to Chandra concepts of bone movements within the feet and as importantly the importance of guarding against the pressure points which could lead to significant problems.

For almost a couple of years, they worked fashioning a variety of limbs the out of willow, sponges and other molds, but all these failed to meet their expectations. And then one day whilst riding his bicycle to work, Chandra had a flat tire and when he took the cycle to have the tire repaired, he saw the person re-treading a truck tire with rubber.

Eureka!

After talking to Sethi, Chandra returned to the shop with an amputee patient and a foot cast and asked if he could cast a rubber foot.  "He agreed,'' Sethi says, "and refused to accept any money once he found out why we were doing it."

The result was much better than whatever they had made before but the rubber shredded after just a few days. So they made the rubber foot around a hinged wooden ankle wrapping this in flesh coloured lighter rubber and then vulcanizing the whole. The resulting limb took only 45 minutes to build and fit onto the patient and was sturdy enough to last for many years.

In 1971 Sethi felt confident enough about the invention to present it to British orthopedic surgeons at Oxford, who were impressed by the artificial limb's suppleness and durability. But there was a lot of opposition from other doctors, and between 1968 to 1975 only 59 patients were outfitted with the Jaipur foot.

But with the Afghan war which started in the late 1970s, the Jaipur Foot suddenly gained widespread international recognition. Land mines--some diabolically shaped like butterflies to attract curious children--caused thousands of injuries, and the International Committee of the Red Cross discovered that the Jaipur foot was the hardiest limb for the mountainous Afghan terrain. Moreover, the low cost and the use of simple and locally available materials as well as the simplicity of making it, were its major plus points. In Afghanistan craftsmen hammer the foot together out of spent artillery shells. In Cambodia, where roughly 1 out of every 380 people is a war amputee, part of the foot's rubber components are scavenged from truck tires


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