Thursday, 03 November 2022 | Dr BKS Sanjay & Dr Gaurav Sanjay
GUEST COLUMN
Locomotion is important at every stage of life; however, it is more important in childhood. Normal walking contributes a lot for the overall development of any child. Locomotor disability means a problem in moving from one place to another, that is, disability in the legs. According to the 2011 census, 26.8 million people in our country were disabled and 20.30 per cent had locomotor disability. We believe that the health of the limbs is as important as that of the heart and the lungs. Whatever mankind has achieved so far is mainly due to its ability of locomotion. If all of us had not walked on our feet, we would not have reached where we are today. A healthy and educated person not only can do his work but he can also help others because help is the basis of our life.
Strong bones, strong muscles and flexible joints form the iron triangle that carries the most important load i.e. the human body. Interestingly, 50 per cent of a person’s bones and the muscles are in the two legs. Both the legs together have 50 per cent of the nerves and blood vessels of the human body and 50 per cent of the blood flows through them. It is the largest circulatory network that connects the body. 70% of the human activities in one’s life are done by two feet. The foot is the centre of body locomotion. Only when the feet are healthy then the conventional current of blood flows smoothly so people who have strong legs will definitely have a strong heart.
Overall physical, mental, social and economic development of any individual takes place only by locomotion. Aging starts from the feet upwards. As a person gets older, the accuracy and speed of transmission of instructions between the brain and the legs decreases, unlike when a person is young.
Cerebral palsy, polio, club foot are the main causes of limb deformities and orthopaedic disabilities in children. Cerebral Palsy (CP) means paralysis of the brain. CP is caused due to obstruction in breathing during or after the birth due to any reason. The CP patients present commonly with scissoring gait and with deformed feet and hands. As the deformity increases so does the difficulty in walking. In certain cases the child becomes bedridden. CP a lifelong problem is caused due to damage to the brain which is permanent. If the deformity is not corrected in childhood, then not only the physical problems increase but also the social and mental problems. This thing should be understood and explained to the family very well. Therefore, treatment should be done in such a way that disability and the related problems of the individual, family and society can be reduced as much as possible. There is a need for a team to achieve this goal and such a team requires a neurologist, physiotherapist, occupational therapist, rehabilitation expert, paediatrician, psychologist, sociologist and counsellor in addition to orthopaedic surgeon.
Any type of disability causes not only physical harm but also mental, economic and social loss. The needs of people with disabilities are the same as those of a capable person. Disability caused due to deformity can be reduced significantly with exercises, manipulation and orthosis and/or after undergoing various surgeries. When the deformity is minimal, it can usually be corrected with exercises and splints, but when the deformity is severe, it requires surgery. There are several types of operations. In which muscle operations and bone operations are mostly done. To correct any deformity, there is only one principle of surgery that if one muscle is weak and the other is strong then either the strength of the weak muscle is increased or the strength of the strong muscle is decreased. In simple words the muscle strength is balanced. And if the bone or joint becomes crooked, then first break or cut that part of the bone with the operation, then straighten it and then keep it in a corrected position for one and a half to three months. To fix the bone, plaster bars, plates or fixators are applied after discussion between the patient and the doctor.
Flexible deformities can be corrected with soft tissue surgeries and rigid bony deformities can be corrected with Ilizarov external fixator. Our surgical results revealed what surgery can achieve often in an hour, physiotherapy cannot in a year. Sooner the better, the surgery is. Here we do not mean to say that physiotherapy is not required in such patients, rather we say that surgery and other therapies are complementary to each other in treatment.
Patients who have only one hand or one leg problem get better results, in comparison to the children who have the multiple deformities. Problem gets more complicated if there is involvement of the brain as well. Most of the patients become better after operation but some patients get worse, mainly due to either over correction or under correction of the deformities. The patients who have athetoid CP, the outcome of surgery is not good.
The correction of deformities should be done as soon as possible. The perception of the common people is that children should be operated only when they become mature but sooner the correction, better the result. Development of any child depends upon locomotion. If he can walk well and do his work with his hands. Only then will he be able to go to school and get education and by which he will not only do his work but will also contribute smoothly in the work of others. This will make the future bright not only for them but for all of us.
We all need a conducive environment to grow and develop in existing environments and circumstances but disabled people need more. The longer the disability lasts, its ill effect increases proportionally. Government, non-government organizations and society should try to prevent any kind of disability. Deformity and disability due to any reason should be rectified as soon as possible because the plants can be straightened easily, not the trees.
(The writers are orthopaedic surgeons based in Dehradun)
