Dr Pradeep Moonot, Orthopaedic Surgeon & Podiatrist, Nanavati Hospital, Mumbai.

If the joint that connects your big toe to your foot has a sore bump, then chances are you may have a bunion, a common deformity. Largely, Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons in your feet. This imbalance in pressure makes your big toe joint unstable, eventually molding the parts of the joint into a hard knob that juts out beyond the normal shape of your foot.

While tight, high-heeled or too-narrow shoes could be one of the cause for bunions, inherited foot type, foot injuries or any deformity present during the birth are also accountable for the foot deformity. Surprisingly, bunions may also be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis.

How Bunion Affects

With a bunion, the base of your big toe (metatarsophalangeal joint) gets larger and sticks out and results in the skin over it may become red and tender. Wearing any type of shoe may be painful and this joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk. Normally, your big toe may angle toward your second toe, or even move all the way under it to an extent that the skin on the bottom of your foot may become thicker and painful. Sometimes an advanced bunion may make your foot look grotesque. And if it gets too severe, it may be difficult to walk. Therefore, your pain may become chronic and you may develop arthritis.

Prevention and Cure

Though bunions are curable, at times they tend to become permanent unless surgically treated. Your podiatrist or a Foot and Ankle Specialist can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. In case conservative treatments like padding your shoe, medication, changing your shoe type, etc, doesn't provide relief, you may need surgery. The goal of bunion surgery is to relieve discomfort by returning your toe to the correct position. There are a number of surgical procedures for bunions, and no one technique is best for every situation. Surgery may involve removal of the swollen tissue from around your big toe joint, straightening your big toe by removing part of the bone, realigning the long bone between the back part of your foot and your big toe, to straighten out the abnormal angle in your big toe joint, etc.

In case of bunion deformity, the surgery helps to produce a narrow foot and the straighter big toe. The toe area needs little extra care much like in any other surgery. "The capsule repair must be protected with the specialised dressing for 2 weeks. The surgery allows to give a 3D cut for precision.

It's possible you may be able to walk on your foot immediately after a bunion procedure. However, full recovery can take weeks to months. After the surgery, usually doctors advise post-operative shoes for almost 6 weeks until the foot is completely healed. The post-operative shoe allows for heel weight bearing (walking) immediately, though this is often too uncomfortable for the first week. Otherwise too, the foot must be elevated (above the level of the pelvis) for 90% of the time for the first 10 days. This helps to reduce swelling and the risk of infection, and helps in healing of the wound. And to prevent a recurrence, you'll need to wear proper shoes after recovery.

 Surgery isn't recommended unless a bunion causes you frequent pain or interferes with your daily activities. But in any case, if you suspect a bunion on your feet, don't delay and see a Foot and Ankle Specialist or a Podiatrist.

Tips to help prevent bunions:

Be sure your shoes don't cramp or irritate your toes.

Choose shoes with a wide toe box — there should be space between the tip of your longest toe and the end of the shoe.

Your shoes should conform to the shape of your feet without squeezing or pressing any part of your foot.

Avoid pointy-toed shoes. 

Dr Pradeep Moonot is an Orthopaedic Surgeon & Podiatrist, Nanavati Hospital, Mumbai.

Dr. S. Veda Padma Priya

Little did she dream that the very genes that fascinated her during the pursuit of her post graduation would betray her later in life. Her euphoria of being just married had not worn off when she was detected with breast cancer. “They lived happily ever after” fairy tale dream was shattered and she was pushed onto the rollercoaster ride of chemotherapy, surgery, radiation and hormonal treatment. This   story has now become commoner than before in day to day practice of any oncologist specializing in breast cancer treatment.

The recent Globacan 2018 data published by the WHO last month declares that Breast Cancer is the most common cancer in India (both sexes).It has outranked all other cancers with about 1.6 lakh new breast cancers detected every year contributing to 14 % of all cancers put together. But what is more disturbing is that breast cancer also ranks first in deaths due to all cancers. If one in 25 women are at risk of developing breast cancer in India, only one out of two breast cancer patients make it beyond 5 years after treatment. The common reasons for this abnormally high death rate are:

1. Most of the women in India present in late stages .Even though the trend is changing in the cities where women are more aware and come early for evaluation the vast majority in the whole of the country present late.

2. There is a huge disparity in healthcare facilities available between rural and urban areas.

3. The majority of women in India have neither financial independence nor insurance coverage.

4. The stigma of cancer, the promise of cure by alternative treatment, the fear of side effects of chemotherapy delay treatment in a sizable proportion of women even after diagnosis.

5. Lack of robust mammographic or any other screening programme for breast cancer in India.

6. In India the percentage of younger women with breast cancer is about 15 % i.e double that of the west. In younger women they are more aggressive, present at a later stage and may have a genetic predisposition.

Is there something that we can do about this alarming epidemic?

Yes. Definitely there is something which each of us can do to bring down the crisis.

1. Be aware of changes in the breast.

2. Avoid or Reduce the Risk.

3. Be Screened.

4. Manage your genes.

Be Aware of changes in the Breast:

The first step towards being aware of changes in the breast is Breast Self Examination. A woman needs to be aware of her breast and its changes .Any abnormal change needs expert consultation.

Signs to beware:

1. Any painless lump in the breast

2. Any recent changes in the skin of the breast (dimpling or in drawing of skin)

3. Any discharge from the nipple

4. Any lump in the arm pits

5. Changes in the shape and symmetry of the breast.

6. Orange peel appearance of the skin with redness.

7. Indrawn nipple or retraction.

Be Screened:

Screening refers to regular checkups either by a doctor or health care professional and periodic testing with x-rays of the breast. Women more than 50 years of age need yearly mammograms along with six monthly health checkups. In India because breast cancer  occurs 10 years earlier in women  it is more prudent to start early screening (i.e > 40 years).The biggest advantage of  screening mammogram is that cancer can picked up at a stage where it not even felt  and early detection improves outcomes of treatment.

Avoid or reduce Risk:

The risk factors for breast cancer are either modifiable or unmodifiable. Unmodiable risk factors are age, gender and genes. The modifiable risk factors that can be reduced or avoided are

1. High Fat Diet

2. Obesity

3. Alcohol

4. Delayed Childbirth

5. Hormonal pills.

Manage your Genes:

About 10 % of breast cancers are hereditary. They are capable of passing on from one generation to another. Even though a number of genes are implicated the most common are BRCA 1 & 2.Mutations in these genes increase the lifetime  risk of breast cancer to 50 to 80 %  by age 75.It is important to know if you harbor these genes and if so take measures  to reduce the risk ,

1. Increased surveillance: MRI of the breasts yearly in addition to mammogram.

2. Chemoprevention: Tamoxifen or Raloxifene daily halves the risk of breast cancer.

3. Risk reducing surgeries: Either removal of both ovaries or breasts or both reduces the risk of breast cancer in the high risk women.

Dr. S. Veda Padma Priya is a Senior Consultant - Breast Oncology, Max Super Speciality Hospital, Shalimar Bagh

By AK Mishra

In this face paced life, we all largely rely on medicines, doctors, gym and such other modern medical specialties to keep our body fit and healthy. But do we really achieve those desired results with these modern beliefs and practices? Why our ancestors possessed robust physique and sound health whereas today’s young generation is perturbed by minor health ailments.This is because our bodies are not getting the natural rejuvenation which can only be acquired through gaining the benefits of major elements, nature has offered to us. The 4natural elements; earth (Soil), Air, Water andsunlight not only give us many health benefits, but also keep our body, mind and soul rejuvenated. Employing these 4 elements a person can lead a contended and fulfilled life.

Let’s dig into few scientific and spiritual proven facts about how nature helps enhance our wellbeing:

Earth (Sand): Throughout the history, humans have spent much more time outdoors and have been in direct contact with the soil than we do in modern generation. From gardening or tilling the soil to walking on the ground barefoot, humans have always been in touch with the earth and knowingly or unknowingly have been gaining amazing benefits from the earth and sand too.

Now, with the changing beliefs and increasing stress of life, we spend most of the time in our homes or in offices, travel through cars, wear rubber shoes and rarely come into the direct contact of the ground.

Have you ever noticed that you get more sound and calm sleep on a beach or after taking a walk in sand? Your body becomes suffused with negative charged free electrons and equalizes to the same electric energy level as earth when you directly get in contact with the earth.

Let’s have a look at some other scientifically proven benefits we acquire from earth:

        It helps reduce chronic pains

        Reduce inflammation by defusing excess positive electrons

        Increase our energy level

        Improve our sleep

        Normalize biological rhythms including circadian rhythm

        Improve blood pressure and blood flow

        Lower our stress level and promote calmness by reducing stress hormones

        Helps in reliving muscle tension

        Helps support adrenal health

        Reduce the recovery time athletic activity or injure


We all are very well aware how essential role air plays in our life to acquire a healthy wellbeing. While we grew up swinging at the park, skipping through fields, and cruising along on our bicycles or bikes; as grown-ups; most of us invest a large portion of our energy and time inside our home, workplaces, etc. You must have noticed the increasing rate of your stress level with your growing age and lesser contact with the fresh air. Science shows how some fresh air can do wonders for you.

        Fresh air helps bring more oxygen to the cells and improves the cleansing action of lungs. One must try few breathing exercise through lungs in the morning being in the exposure of fresh air to help your body airborne toxins.

        More oxygen also helps achieve stable state of mind and brings clarity to the brain. When you breathe in fresh air, you automatically shift your negative thoughts to the positive ones. Fresh air also helps in digestion, which is why experts recommend taking to small walk outside after having your food.

        Serotonin, a chemical in your body, notably promote a sense of happiness and wellbeing while lighten your mood. And the amount of serotonin largely affect by the amount of oxygen you inhale.


We all take paths and showers to keep the outside of our bodies clean, but very few of us put their emphasis on making our body internally clean which is equally important. Even after keeping ourselves away from toxic foods, drinks or drugs, toxins will be still attacking our bodies due the fact that the environment we are living in is highly polluted.  And nothing else can help you cleanse this pollution except water. Drink as much water as you can in a day, but make sure the water should be purified. Toxins are water soluble and hence clean water helps your do away the toxins from your body and keep you healthy. Water not only keep you away from any bacterial infection or disease but also keep your mind cleanses, as what we eat or drink largely affects our thoughts and mind.


Spending about 30 minutes in the exposure of sun can supply vitamin D to your body through skin absorption, which in turns makes you bones stronger and reduces the risk of bone diseases such as osteomalacia and osteoporosis. One can also reduce the risk of others diseases like, diabetes, metabolic syndrome, multiple sclerosis and heart disease.  Sunlight not only helps you fighting with such health ailments, but also helps reduce your stress level, increase confidence and makes you calmer. 

The Writer of the article is Mr. A.K Mishra Director of Chanakya IAS Academy

Since I do a fair amount of traveling the world over, I have a tendency of comparing the different airlines I fly with, and have been disappointed and also pleasantly surprised by various experiences I’ve been through. Finally, I’ve come to the conclusion, it’s not so much about how new or old the aircraft is, but service delivered by the crew that matters.

Yes, I agree that having a million movies to watch when you switch the screen on board is exciting, but to have an airhostess or flight steward asking whether you’d like to have something more to eat or drink, can win your permanent loyalty for that airline.

Two days ago, I was on a flight from Mumbai to New York via Abu Dhabi. The flight from Abu Dhabi to New York was incredibly pleasant, with Indian as well as foreign flight stewards looking after your every little need. No doubt the aircraft was the latest in the world, but it’s not just about the aircraft is it?

I landed in New York rested, and well fed. Yes, well fed, with even a flight attendant asking me why I didn’t want a meal and asking me whether she could get me something else to eat instead, and she did.

But the previous desi flight that connected me from India to Abu Dhabi, was horrible.

Two wooden faced statues greeted me, stoic and unsmiling as I boarded the aircraft, that had no screen to watch movies, and space that even cattle would have been ashamed to travel in!

The food was deplorable, and I really wondered whether the airline was telling its passengers, “Dare to say anything, and we’ll throw you all into the ocean below! Anyway, we’re broke, and we don’t care!”

Seeing their service, I can imagine why they were broke!

Some passengers did question the service and were met with an icy stare as flight attendants in total black walked about the aircraft as stealthily as the panthers they looked like, steadfastly avoiding any eye contact with the janta sitting on the seats. It was like, “we are the queens of the sky, we deign not to look or serve you proletarians and plebians!”

I’m not joking but I actually saw a man’s trembling finger ring the bell, but when the school head mistress, appeared, he murmured, “Nothing ma’am!” And I swear I saw him shiver the rest of the journey.

Service is the key, my dear airline owners. I’ve seen some of the best service given in old rickety aircraft flown by Air-India, but this by a private airline, begs the question, ‘If we want the world to make In India, we need to treat the world with courtesy and politeness, shouldn’t we?

It’s not just bear hugs to world leaders, it’s about service from black panthers..! 

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By Dr Shubnum Singh

Current narrative on a continual challenge of health workforce deficits and imbalances,  at all levels of socioeconomic development, combined with ageing populations and epidemiologic transformations, requires a robust platform to showcase and  recognize meaningful initiatives which have a positive impact on the issues at hand . The India Skills and World skills competition gives an opportunity to do just this.

It is imperative that healthcare work force be agile in responding to alternative scenarios and importantly in communities which are seeing a rapid and incremental change in their economic and demographic profiles. This will influence and change the character of training and deployment  of healthcare resource workers  and  see millions of potential new entrants and jobs into the active workforce. There is a unique and  unprecedented opportunity  in Ayushman Bharat to re design and implement  strategies that address the equity ,coverage gaps and the potential to be a driver for socioeconomic development at large and we from the Healthcare Sector Skills Council (HSSC) are eager to leverage for the larger good.

Skill India, over the last few years have adopted a multi-pronged approach in Healthcare targeting unemployed youth, school children, recognition of prior learning, college youth etc. Industry has participated enthusiastically in these activities, but we have a long way to go in order to develop a robust system and acceptance of the skilled individuals in the mainstream and established systems of care. Not only the industry but general public also needs to accept the importance of skill development in building careers.

A common thread in the ever burgeoning cost of health care is the cost of manpower. However if we were to look at it from the perspective of not seeing health workers as an expense  to contain, but from a lens of an investment for better health outcomes and job creation the world  perhaps would be in a better place . A contextualized skills mix accompanied by adequate recognition and reward systems by way of career progression will result in improved retention an enhanced quality and performance of health workers. Encouraging an  inter sectoral movement of skilled manpower will further add to the success of the initiative as many a time ability to exit from “A” particular course and transfer credits to another are not possible  . Case in example would be an IT professional who transcends all sectors and are embedded in the “big picture” trends of AI, VR and Big Data.

The India Skills competition is a unique platform which helps raise the profile and recognition of skilled people. Competing  in various skills starting from local state level to zonal level to National level and finally at the World skills competition and pitted against the best encourages students as well as training providers to strive for highest level of performance in their individual areas. The Healthcare sector is participating in this event for the first time this year and we hope to be able to make a mark at the International arena much like our Doctors and Nurses have. The competition will help give necessary visibility and insight into the complex world of healthcare delivery as well as raise the acceptability levels of people who are not Doctors and Nurses yet, are vital parts of the delivery ecosystem. Hopefully this will boost a much needed interest in this space. 

* Dr Shubnum Singh, Chairperson, HSSC & Director-Medical Education & Research, Max Healthcare Institute Ltd.