Foot note India (1)

Dr. Kshitij Shankhdhar M.B.B.S., Dip. Diab., DDM, PGDND
Diabetologist & Incharge, Lucknow Diabetic Foot Care Clinic, L.K. Diabetes Centre, Lucknow, India (Email:

After a tiring duty, during the period of Internship in February 2000 at King George’s Medical University , Lucknow , India , I halted at my parental Diabetes Clinic, the L.K. Diabetes Centre, to collect the keys of the residence. I found my father, a noted Diabetologist, Dr. L.K. Shankhdhar, examining a saintly-attired diabetic patient who had a non-healing plantar ulcer for over 5 years. I had intense interest in Diabetes, as could be imagined, since both of my parents are doctors and Diabetes was a common topic in our house even during meals, since my early childhood. So I sat there to watch how my father dealt such a case.

My father was insisting all through that he (saintly-attired diabetic patient) must give up wearing the wooden chappals (religious slippers called Kharaoon in Hindi language) and wear padded shoes for the sake of his limb, which had an impending risk of amputation but the saint was refusing to oblige owing to religious obsessions.

My father was insisting that he must give up wearing the wooden chappals (called Kharaoon) for the sake of his limb, which had an impending risk of amputation but the saint was refusing to oblige owing to religious obsessions. 


I was emotionally overwhelmed to hear of amputation and got lost for time being but had a solution when I returned into senses. I requested my father to wait a little and rushed to my residence, where Sofa repair work was going on in the lawns of my residence. I took a rectangular piece of discarded foam, applied an adhesive on one side of it and then rolled it into a cylinder, kept within my fists for some 10 minutes or so and returned to the clinic, which was at a stone throw distance from the residence. I explained to my father, why not tie the cylinder just before the ulcer for offloading and allow him to carry on with the same wooden chappals. He appreciated the idea and the device was placed after thorough debridement of the ulcer. We requested the saint to return after 15 days. Useless to inform the readers that the ulcer was healed. The miracle had taken birth. I named this simple offloading device as “Samadhan” (word meaning Solution in Hindi language). In that saint we had tied the cylinder with a piece of ordinary bandage but later we felt that elastocreppe bandage should be better to avoid any risk of compromising vascularity in the limb, which naturally carried the threat. Such a small invention was a turning point in my career. From year 2000 to 2004, we made many more changes in the design of the device and finally this developed into “The Samadhan System of offloading bodyweight”.

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