| The JAIPUR FOOT…….From Sobs to Smiles!
The Jaipur Foot in Diabetes
The widespread publicity gained by the Jaipur Foot in treating war and accident ravaged subjects masked its use in subjects with other ailments such as polio and importantly diabetes!
In 1991, Pooran et al in a paper published in the West Indian Medical Journal had this to say, “The amputation rate at the Port-of-Spain General Hospital has doubled over the last 10 years from 114 and 102 in 1979 and 1980 to 274 and 225 in 1988 and 1989. The majority of the amputees are not able to work again because of the unavailability of a suitable prosthesis and physical and psychological rehabilitation are severely compromised. In order to overcome this, we decided to carry out a programme of fitting of prostheses. Of 200 amputees who were assessed 92 were fitted with prostheses, 60 (65 percent) above and 32 (35 percent) below the knee. Most were diabetics ranging in age from 18 to 62 years with a M:F ratio of 1.2:1. The Jaipur foot prosthesis was chosen for its light weight (about 2 kg), low cost (US$8 - $18), and good features (waterproof, well ventilated, good grip, shock absorbent, flexible and cosmetic appearance). Four patients returned for minor adjustments to the stump/socket interface and 90 percent expressed extreme satisfaction with their prosthesis. The Jaipur foot prosthesis seems ideal for West Indian amputees and there is a strong case for an on-going well co-ordinated programme involving trained technicians, physiotheraptists and surgeons to address the needs of the large amputee population in Trinidad and Tobago.”
But it is a fact that there very few published papers validating the use of the Jaipur Foot in people with diabetes and there are many so-called “experts” who still refuse to accept that the Jaipur Foot can be of any practical use in people with diabetes, especially for above knee amputations. Whether this reflects a total ignorance of the changes which have been made in the Jaipur foot since its initial invention or is this the power of companies making costlier artificial lower limbs is not for us to say!
Conversely, there are many leading authorities who feel that the Jaipur Foot does indeed have a role to play in managing diabetes amputations especially in the economically handicapped.
The Jaipur Foot 2007
The Jaipur Foot of 2007 is different from the Jaipur Foot of 1968!
Today, the foot has basically two parts. The foot piece and the socket which is basically the “Jaipur Foot” and the extensions which are the joints depending on whether the limb needed was Below-Knee or Above-Knee. There is this total misconception that the japir Foot can only be used in below knee amputations. This is a total misconception. The Jaipur foot can be used with all levels of amputations starting from partial foot amputation to hip disarticulation with equal efficiency and case.
Although lightweight aluminum shanks crafted by tinsmiths are still available, it is recommended that that for people with diabetes, the material used for the sockets is EVA and a polypropylene based material. This is much more user friendly and safer for use in people with diabetes. Moreover, the open ended sockets are a thing of the past and have been replaced by total contact sockets again improving the user friendliness of the artificial foot.
Jaipur Limb is light weight. For a middle sized person the socket with belt and Jaipur Foot, the total weight of a below knee limb varies between 1.3 Kg. to 1.5 Kg. Similarly for a similar kind of person the total weight of the above knee limb varies between 2.25 Kg. to 2.5 Kg whereas, average weight of the whole leg + foot in living human weighing 55 kg. is 3.36 kg so this artificial limb does not place a weight burden on the patient.
Importantly, it allows most of the social, cultural and work related needs discussed above to be met. Importantly, since wearing shoes is not essential, the Jaipur foot user can go to places of worships like Temple, Mosque, Gurudwara etc.
Fig. 3 A man squatting wearing the Jaipur Foot.
The one drawback to the wider use of the Jaipur Foot is the requirement for the patient to come to Jaipur for the fitting. For quite a few people the cost of the travel is prohibitive and although there are NGOs which do help out, many people are still left out of the loop. One way out for this would be to set up clinics in different places so that the distance a person has to travel is minimised. The personnel are trained by the Jaipur Foot Clinic and they also help set up the center, examine if local materials are available which can also be used and are available to sort out difficulties. Interestingly the personnel do not have to be highly trained technicians, but even uneducated people and workers such as cobblers, tinsmiths, etc. can be taught to make the artificial feet under the supervision of a doctor who may want to undergo a brief 2 week course at the Clinic.
Today, a good western style lower limb prosthesis which is usually mostly cosmetic, is very costly, and prohibitively so, in many countries especially in the poor sections of society. The SACH foot which is often used as a benchmark costs around U.S. Dollars 8000 ( Indian rupees 340,000). Even cheaper versions for below knee amputation replacements can cost around Indian Rupees 100,000. Compare this to the cost of below knee Jaipur Foot replacement of Indian Rs. 3000 ( U.S. Dollars 70) and an above knee replacement of around Indian Rs. 6000 ( U.S. Dollars 140-150)!
We intend starting ten such centers all over India over the next few years. In fact, we have been receiving many queries about the Jaipur Foot from other countries and the people at the Jaipur Foot Center are more than willing to show them the facilities and to help in setting up centers in other different countries. It is always possible that modifications and alterations may be made depending on the circumstances, but the basic principle behind the Jaipur Foot “stands”.
It is true that more work needs to be done to validate the longterm usefulness of the Jaipur Foot use in diabetes related amputations, but then the same can easily be said of many so called “preventive” regimens.
Lastly, whilst we argue about the need for more studies and validation etc., let us get out of our academic towers and realize that most of the people want to get along with their lives and are not willing to wait until the “experts” agree.
If you do not believe us, ask the young man H.S. or the farmer Y.G. and many others like them whose sobs have turned to smiles and they will tell you so.
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