Crosstalk: “Pag Ma Dukhe Che” (Gujarati for The Foot is Paining)

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A week ago, a friend called, “My Mom has pain in the left foot. The X-ray shows calcification. The doctor has said to do surgery. Is surgery needed?”

I was nonplussed, trying to figure out what kind of calcification in the foot of an 87-years old would merit surgery. Did she have severe Achilles tendinopathy? Or a bad calcaneal spur? Or was it a bad gout with calcific foci jutting out of the 1st MTP joint? As my brain kept churning, one part saying that surgery was not indicated for any of these conditions and perhaps she was being misled, I asked my friend, “Can you tell me exactly what the problem is?”

He said, “She has a lot of pain in the foot and which is quite unbearable.”

“Who has she shown?”, I asked.

“My usual orthopedic surgeon” and he named the surgeon. 

“Has he given a note?” I asked.

“I don’t know, but he has prescribed two heavy medicines for the pain. Should she take them?” I looked at the pictures he had sent on WhatsApp; one was a diclofenac based pain killer and the other I did not recognize.

“How can I say anything until I know what the problem is? And I can’t seem to understand what kind of surgery would be needed for foot calcification. Can you send me the X-ray film?”

A day later, the X-rays arrived. I removed three X-ray films from the envelope to find images only of the knee. I put my hand inside the X-ray envelope, fishing for any more that might be hiding in the crevices of the folder, but there was nothing else. The left knee X-ray showed diffuse calcification in the menisci and ligaments with degenerative changes, suggesting osteoarthritis (OA) with calcification. On the right, there were just OA changes. 

There was no doctor’s note. 

I kept wondering why there was no foot X-ray, until a dim light slowly brightened in my head (as they say in Hindi, “batti chal gayi”). 

I called him, “You have sent only knee X-rays. Are you sure the problem is in the foot?” He said, “Ha, pag ma dukhe che, par barabar, emne gothan ma dukhe che.” This was in Gujarati, which translates to “Yes, it is paining in the foot…but in the knee."

This was entirely on me. The first time he told me his mother had pain in the foot, I should have immediately asked, “Where exactly? Hip or knee or ankle?”

In Gujarati, “Pag ma dookhe che” and in Hindi, “pair mein dukhta hai”, can mean pain anywhere in the lower limb, from the hip to the toe. And “pag” or “pair” actually translates to “foot” in English. And literally translated, “foot”, therefore when used by Gujarati and Hindi speaking people/patients can also mean anything from the hip to the toe.

And so my thoughts of Achilles tendinopathy or gout or calcaneal spur morphed into a knee OA with some calcification. 

If you are wondering what happened next, it is still works in progress…there is still no doctor’s note…apparently the orthopod orally said surgery. I assume it is total knee replacement (TKR), but who knows…maybe it is arthroscopy with debridement, or maybe it is an intra-articular steroid injection…as is said in “The Good Wife”… nothing is confirmed or denied…

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