Surgery (b): Foot Ailments

A few accounts on foot problems and their treatments are noted in the Chapters on Medicine.

They are in relation to cracked feet, corns, and foot injury.

Theravāda:—“At that time a certain monk had a disease of corns on the feet.... ‘Monks, I allow one who has painful feet, or cracked feet, or a disease of corns on the feet to wear sandals.’”^[1]

“At that time the Venerable Pilindavaccha had cracked feet. ‘I allow, monks, [the use of] ointment for the feet.’ [The illness] was not becoming better. ‘I allow, monks, to prepare a medicine for the feet.’”^[2]

Dharmaguptaka:—“At that time the Exalted One went from Jiamoluo 迦摩羅 (Kālāma?) to Kapilavastu. Pilindavatsa lived in that country. [He] was afflicted with cracked feet. The physician instructed [him] to anoint the feet. [He] informed the Buddha [about this]. The Buddha said: ‘[I] allow anointing [the cracked feet].’ [Pilindavatsa] did not know what medicine to anoint with. [He] informed the Buddha. The Buddha said: ‘[I] allow using ghee, oil or fat for anointing.’ Hands became stinky by holding ghee [and] oil. The Buddha said: ‘[I] allow using a blade for anointing the medicine.’^{[3] [4]} Then the hands became greasy while anointing the feet. The Buddha said: ‘[I] allow anointing a foot by another foot.’ The medicine for anointing the feet being placed in a shallow container was not secure. The Buddha said: ‘[I] allow making a bottle [for it].’ If there was a trouble of dust strewing [onto the medicine], the Buddha said: ‘[I] allow making a lid.’ Then the place for putting aside the bottle [with] oil was not secure. The Buddha said: ‘[I] allow putting [it] under the bed or hanging [it] on an ivory peg on the wall.’”^[5]

Mahīśāsaka:—“There were monks whose heels were cracked. [They] informed the Buddha about this. The Buddha said: ‘[I] allow anointing [the heels] with bear grease and wrapping [them with] bear leather.’ Then Pilindavatsa always walked single-mindedly, [and he] was not aware of treading on [something] and injuring [his] toes. The Buddha saw that [and] addressed the monks: ‘From now [on], [I] allow the monks to wear short-legged boots^[6] .’”^[7]

“There was a monk afflicted with foot [disease]. [He had] a need of wearing boots [made of] bear leather and anointing with bear grease. Further, there was a need of using [a medicine made of] flour, snake skin, bear grease, [and] ghee, which were soaked in a bitter bottle gourd. [The monks] informed the Buddha about this [matter]. The Buddha said: ‘All [these] are allowed.’”^[8]

The records above show mild ailments of feet. The condition of cracked feet seems to have been a common problem for the monks in the past, probably due to prolonged walking during their wandering journeys. Such problems were treated by anointing with greasy substances such as animal fat, oil, or ghee. The Theravāda Bhesajjakkhandhaka mentions a particular medicine for the feet, but no detail is given. The Samantapāsādikā has briefly explained this medicine: “‘The meaning [of] ‘to prepare a medicine for the feet’ is: because of that cracked feet are natural, after putting in different medicines in coconut and so on, [it is] to prepare a medicine for the feet [and] to cook a medicine beneficial for the feet.”^[9] Again this information is not elaborate enough. Rather, the Mahīśāsaka Bhaiṣajyadharmaka has provided a recipe of certan ingredients for making such an ointment: flour, snake skin, bear grease, and ghee are soaked in a bitter bottle gourd. This may have been one of the ointments used for curing cracked feet in ancient India. Other foot problems like corns on the feet and foot injury mentioned in the Buddhist records were simply managed by footwear.

Cracked feet and corns on the feet are considered minor diseases in the classical Āyurvedic treatises, and there is only limited information for them in these texts. The condition of cracked feet (Pāli: pādaphālitā;Sanskrit: pādadārī) occurs when one walks a lot. Wind humour locates in the sole causing painful cracks in the rough feet (Suśruta Saṃhitā Nidānasthāna 13. 29). The Āyurvedic treatment for such a problem is: after bloodletting, lubrication and sudation therapies are carried out. The sole is then applied with medicated ghee or fat (Suśruta Saṃhitā Cikitsāsthāna 20. 19-20). The treatment mentioned in the Buddhist sources for this ailment is consistent with Āyurvedic therapies.

A corn on the foot (Pāli: pādakhīla; Sanskrit: kadara), according to Āyurveda, is “a nail-like hard knotty growth, [which is] depressed or raised in centre, of the size of jujube, painful and discharging” (Suśruta Saṃhitā Nidānasthāna 13. 30-31). It arises when the foot is pressed on a rough stone, or is injured by sharp object (e.g. thorn) (Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 31. 21). Āyurvedic cure for this problem includes complete excision of the corn, followed by burning the site with hot oil or fat (Suśruta Saṃhitā Cikitsāsthāna 20. 23; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 32. 11).

In terms of modern medicine, cracks on the foot usually occur at sites where the skin is under tension, and they can involve the superficial layer of the skin (epidermis) or the deeper part (dermis). They can be moist fissures which are found usually between the toes, or can be dry cracks around the heels. The lesions can become infected. Remedies include: removing any causative tension; hydrating the dry skin (by emollient creams or dressings) or dehydrating the moist skin (by astringent agents such as antiperspirant);application of keratolytic agents (e.g. salicylic acid) or debridement to reduce thick skin; use of tissue glues to close the cracks; strapping or utilising heel cups to redistribute the tension on foot; and wearing appropriate shoes. Further, infection should be treated if there is any (O’Sullivan, Fotinos, and St. Anna, 2012, 622-623; Springett and Johnson 2010, 28).

Calluses and corns are common foot problems in the elderly. A callus is a hard and thickened skin plague and a corn is a similar plague which is pushed into the skin. They are caused by pressure or friction at pressure points on the foot, leading to excessive thickening of the horny layer of the skin (hyperkeratinisation). Such mechanical stress may come from improper footwear, foot deformities, increased weight-bearing, or neuropathies. Tenderness and pain are usual symptoms. These skin lesions are also predisposing to ulcer formation. Treatments include correction of mechanical stress by using suitable footwear, wearing orthosis, or even orthopaedic operation; and removal of corns/calluses by keratolytic agents or by minor surgery (such as corn enucleation by scalpel, or electrodesiccation) (Berger 2012, 142; Springett and Johnson 2010, 28-30).

In short, cases of foot ailments are found in the Chapters on Medicine. These minor problems include cracked feet, corns, and injury. They were treated by ointments and footwear. In Āyurveda, cracked feet are chiefly cured by applying medicated ghee or fat, while corns by surgical excision. In modern medicine, treatements for these diseases aim at correcting any mechanical stress which causes these foot problems, and healing of lesions by means of medicinal agents, physical appliances, and/or surgical interventions.

Footnotes and references:

[1]:

Theravāda Vinaya Piṭaka I. 187-188: “tena kho pana samayena aññatarassa bhikkhuno pādakhīlābādho hoti... anujānāmi bhikkhave yassa pādā vā dikkhā pādā vā phālitā pādakhīlā vā ābādho upāhanaṃ dhāretun ti.” This information is not within the Theravāda Bhesajjakkhandhaka.

[2]:

Theravāda Vinaya Piṭaka I. 205: “tena kho pana samayena āyasmato Pilindacacchassa pādā phālitā honti. anujānāmi bhikkhave pādabbhañjanan ti. na kkhamanīyo hoti. anujānāmi bhikkhave pajjaṃ abhisaṃkharitun ti.”

[3]:

In Taishō Tripiṭaka (and CBETA), the character 篦 is given. In older editions of Chinese Buddhist canon, it is written as 錍, which refers to a kind of broad, thin, and long spear-head (Zhang et al.

[4]:

, 1237). Thus the instrument for anointing medicine probably is a blade which resembles that kind of spear-head.

[5]:

Taishō Tripiṭaka 1428. 874b3-11: “爾時世尊從迦摩羅至迦維羅衛國。畢陵伽婆蹉在彼國住，患脚劈破，醫教塗脚。白佛，佛言：「聽塗。」不知以何藥塗，白佛，佛言：「聽以酥油若脂塗。」手捉酥油臭，佛言：「聽用塗藥篦。」時手塗脚手膩，佛言：「聽脚脚相塗。」塗脚藥著淺器中不堅密，佛言：「聽作瓶。」若患坌塵，佛言：「聽作蓋。」時油瓶舉處不堅牢。佛言：「聽著床下、若懸著壁上龍牙杙上。」”

[6]:

富羅 is short-legged boot. See Digital Dictionary of Buddhism, s.v. “富羅” [accessed March 14, 2015, http://www.buddhism-dict.net/cgi-bin/xpr-ddb.pl?q=%E5%AF%8C%E7%BE%85].

[7]:

Taishō Tripiṭaka 1421. 146c11-14: “有諸比丘脚跟劈裂，以是白佛，佛言：「聽以熊膏塗，熊皮裹。」時畢陵伽婆蹉常一心行，不覺蹴脚指破。佛見之，告諸比丘：「從今聽諸比丘著富羅。」” This account is not within the Mahīśāsaka Bhaiṣajyadharmaka.

[8]:

Taishō Tripiṭaka 1421. 147c8-10: “有比丘患脚，須著熊皮鞾、熊膏塗；復須用麵、蛇皮、熊膏、酥，著苦瓠中漬。以是白佛，佛言：「皆聽。」”

[9]:

Samantapāsādikā V. 1092: “pajjaṃ abhisaṅkharitun ti yena phālitapādā pākatikā honti, taṃ nāḷikerādīsu nānābhesajjāni pakkhipitvā pajjaṃ abhisaṅkharituṃ, pādānaṃ sappāyabhesajjaṃ pacitun ti attho.”