The silent musculoskeletal burden: orthopaedic manifestations and management challenges of neglected tropical diseases in India

Abstract

Neglected tropical diseases (NTDs) represent a heterogeneous group of 20 chronic, debilitating infections that disproportionately plague poor populations within the endemic regions of India. Despite the systemic and dermal manifestations of these diseases being well characterized, the severe and often delayed orthopedic and musculoskeletal (MSK) sequelae remain poorly appreciated and result in late diagnosis, loss of function, and permanent disability. The article provides a review of the specific orthopedic pathology associated with four key NTDs endemic to India, namely LF, Leprosy, OATB, and Mycetoma. It synthesizes data on the clinical presentation, pathology, functional outcomes, and the surgical challenges presented by such complex infections in resource-constrained settings. Orthopedic manifestations vary from acute infective arthritis and osteomyelitis (Mycetoma, OATB) to chronic, secondary deformities resulting from nerve damage, chronic lymphedema, and muscle paralysis. These often necessitate complex, multistage reconstructive surgery, including arthrodesis, tendon transfers, and extensive soft-tissue management, which push the limits of the available surgical infrastructure. The NTDs pose a significant, yet "neglected" orthopedic burden in India, and need early diagnosis, robust primary care integration, and the development of specialized orthopedic-plastic surgery protocols to mitigate the severe long-term disability and restore function in these affected patients.