Lakshmi Kant Shankhdhar
L K Diabetes Centre, India
90% amputations are preceded by an ulcer which is mostly preventable. Increased plantar foot pressure is the leading cause of plantar ulceration in the diabetic population. Many factors such as deformity, partial amputation, limited joint mobility (LJM), calluses, corns, wrong footwear and a foreign body in the foot wear may be responsible for raised plantar pressure and plantar ulceration; hence offloading should have pivotal role in ulcer management. Many methods of offloading are available currently but Total Contact Casting (TCC) is known to be the gold standard of offloading but is used only in 1.7% clinics in US owing to its cost, needing specially trained personnel to apply and remove and consuming too much of time in its application and removal. Removable Cast Walkers (RCWs) are the measure of choice since they cost lesser than TCC, can be applied and removed by anyone and offer comparable offloading and hence ulcer healing. Other options such as custom foot wear, half shoes, ankle arthroses and internal offloading measures such as metatarsal head resection are sparingly used even in developed countries. Most of the methods need time, money and man power which is not affordable or available everywhere. The team of physicians at LK Diabetes Centre, Lucknow, India, have researched and developed an altogether new offloading device, called the â??samadhan system of offloadingâ? which is very affordable, costing lesser than 1 USD, simple, needing no special training for its application and removal, least time consuming and can be instantly installed. It has both removable (SS-R) and irremovable versions (SS-IR). The samadhan system comprises of a rubberized foam cylinder, the â??samadhan unitâ? to be placed on plantar surface to offload body weight, a piece of an elastocrepe bandage, the â??retainerâ? to retain the samadhan unit in position and a fastening device, the â??fastenersâ? to retain the edge of the retainer. In one of the oral abstracts, presented in American Diabetes Association, 2005 (OR 199), the removable version of samadhan system (SS-R) revealed much better healing rates of Wagner grade one diabetic foot wounds compared to common footwear 73.3% vs. 13.3% with much lesser healing time (42 vs. 60 days).
Lakshmi Kant Shankhdhar is a Principal of a Medical College of Diabetology besides working as Medical Director and Endocrinologist in his own clinic, L K Diabetes Centre. He is triply Post-graduate in Medicine (MD), Nutrition (PGDND) and Radiology (DMRE). He is also heading an exclusive private Diabetes Clinic in Lucknow, India. He has received Visiting Fellowship of Harvard Medical International, International Arm of Harvard Medical School (Boston), as Life Time Achievement Award. Currently, he is a Reviewer of two most prestigious journals of Diabetes, namely Diabetes Care and Diabetes. He has presented several abstracts and faculty orations in many international conferences on Diabetes and Podiatry. He has published articles and care reports in some indexed international journals.
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