I read with interest the article titled "Toilet seat injury of the Achilles tendon: a series of twelve cases" authored by Dar et al. in the December 2011 edition of your esteemed journal. I must compliment the authors and the journal for a lucid feature. Earlier as a general surgeon and now a plastic surgeon, my experience with the toilet seat injury has been similar. Only, I have had another culprit to blame for it. As described by Dar et al., the Indian toilet system requires the patient to squat and this makes it possible for the foot to slip into the toilet causing the injury [1]. In some toilets, especially in the low socio-economic strata, the seats are cut into the tiles on the floor without any formal squatting plate to place the feet on. Invariably, the edge of the seat is the sharp edge of the cut tiles and is not smoothened as shown in Fig. 1. As most of these toilets are housed in the same chamber as the bathing facility, the tiles are often wet and slippery. In such a situation, following slipping while usually getting up from the squatting position, the sharp edge can injure the Achilles tendon.
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