Soya bean meal increases litter moisture and foot pad dermatitis in maize and wheat based diets for turkeys but maize and non-soya diets lower body weight

1. A 2 × 2 factorial experiment was conducted to compare the effects of wheat or maize based diets differing in dietary electrolyte balance (DEB) on litter moisture and foot pad dermatitis (FPD) at 4, 8 and 12 weeks of age in heavy-medium turkeys. A second objective was to investigate the effects on foot pad dermatitis of the interaction between dietary composition and artificially increasing litter moisture by adding water to the litter. 2. High DEB diets contained soya as the main protein source whereas low DEB diets did not contain soya bean meal. Diets were formulated to be iso-caloric and iso-nitrogenous in each of 3 successive 4-week phases following recommended dietary compositions. DEB concentrations were 330, 290 and 250 mEq/kg in high DEB diets and 230, 200 and 180 mEq/kg in low DEB diets. 3. Litter moisture and mean FPD score were higher in turkeys fed on high DEB diets compared with low DEB diets whereas there was no difference between maize and wheat. 4. Food intake was similar and body weight was lower after litter moisture was artificially raised in the wet compared with the dry litter treatment and there was no interaction with dietary composition. 5. Mean body weight and feed intake were higher in turkeys fed on wheat compared with maize and in high DEB compared with low DEB diets at 12 weeks of age. 6. Lowering dietary DEB for turkeys may improve litter moisture and lower the prevalence of FPD in commercial turkey flocks.

Foot health and quality of life among university students: cross-sectional study

BACKGROUND

Foot problems are believed to reduce quality of life and are increasingly present. Even among young adults of university age, untreated foot problems can lead to postural and mobility problems. Accordingly, our aim here was to determine the relationship between foot health and quality of life and general health among male and female university students.

DESIGN AND SETTING

Observational cross-sectional quantitative study conducted at the Podiatric Medicine and Surgery Clinic of the University of Coruña, Ferrol, Spain.

METHODS

A sample of 112 participants of median age 22 years came to a health center, where self-reported data were registered, including professional activity, and scores obtained through the Foot Health Status Questionnaire (FHSQ) were compared.

RESULTS

In Section One of the FHSQ, the university students recorded lower scores of 66.66 in the footwear domain and 60 in the general foot health domain and higher scores of 84.37 in the foot pain domain and 93.75 in the foot function domain. In Section Two, they obtained lower scores of 60 in the overall health domain and 62.50 in the vigor domain and higher scores of 100 in the physical activity and 87.50 in the social capacity domain. Differences between males and females were evaluated using the Wilcoxon rank-sum test, which showing statistical significance (P < 0.05) regarding the dimensions of footwear and general foot health.

CONCLUSIONS

These university students' quality of life relating to foot health was poor. This appears to be associated with the university period, regardless of gender.

Foot Problems in Older Adults Associations with Incident Falls, Frailty Syndrome, and Sensor-Derived Gait, Balance, and Physical Activity Measures

BACKGROUND

Research on foot problems and frailty is sparse and could advance using wearable sensor-based measures of gait, balance, and physical activity (PA). This study examined the effect of foot problems on the likelihood of falls, frailty syndrome, motor performance, and PA in community-dwelling older adults.

METHODS

Arizona Frailty Cohort Study participants (community-dwelling adults aged ≥65 years without baseline cognitive deficit, severe movement disorders, or recent stroke) underwent Fried frailty and foot assessment. Gait, balance (bipedal eyes open and eyes closed), and spontaneous PA over 48 hours were measured using validated wearable sensor technologies.

RESULTS

Of 117 participants, 41 (35%) were nonfrail, 56 (48%) prefrail, and 20 (17%) frail. Prevalence of foot problems (pain, peripheral neuropathy, or deformity) increased significantly as frailty category worsened (any problem: 63% in nonfrail, 80% in prefrail [odds ratio (OR) = 2.0], and 95% in frail [OR = 8.3]; P = .03 for trend) due to associations between foot problems and both weakness and exhaustion. Foot problems were associated with fear of falling but not with fall history or incident falls over 6 months. Foot pain and peripheral neuropathy were associated with lower gait speed and stride length; increased double support time; increased mediolateral sway of center of mass during walking, age adjusted; decreased eyes open sway of center of mass and ankle during quiet standing, age adjusted; and lower percentage walking, percentage standing, and total steps per day.

CONCLUSIONS

Foot problems were associated with frailty level and decreased motor performance and PA. Wearable technology is a practical way to screen for deterioration in gait, balance, and PA that may be associated with foot problems. Routine assessment and management of foot problems could promote earlier intervention to retain motor performance and manage fear of falling in older adults, which may ultimately improve healthy aging and reduce risk of frailty.

Clinical Aspects of Foot Health in Individuals with Alzheimer's Disease

Alzheimer's disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined the foot health status in older persons with AD, with a specific focus on the extent to which people with AD may be using inadequate footwear in old age. Seventy-three community-dwelling people with probable, mild to moderate AD aged 65-95 years were recruited from a center of excellence for AD. A single trained physician evaluated health status and foot conditions. Current shoe and foot length and width measurements were taken using a calibrated Brannock device. The results indicate that sixty-five participants (89.04%) suffered from feet problems. Also, only twenty-two subjects (30.14%) used the correct shoes in width and size related with the morphology of their feet. Fifty-one participants (69.86%) were using incorrect shoes in length or width. The present study revealed that peoples with AD had a high presence of foot health problems. Also, the use of inappropriate shoes revealed measurable differences of association between shoe size and the morphology of the foot.

Are underground coal miners satisfied with their work boots?

Dissatisfaction with work boot design is common in the mining industry. Many underground coal miners believe their work boots contribute to the high incidence of lower limb injuries they experience. Despite this, the most recent research to examine underground coal mining work boot satisfaction was conducted over a decade ago. This present study aimed to address this gap in the literature by assessing current mining work boot satisfaction in relation to the work-related requirements for underground coal mining. 358 underground coal miners (355 men; mean age = 39.1 ± 10.7 years) completed a 54-question survey regarding their job details, work footwear habits, foot problems, lower limb and lower back pain history, and work footwear fit and comfort. Results revealed that underground coal miners were not satisfied with their current mining work boots. This was evident in the high incidence of reported foot problems (55.3%), lower back pain (44.5%), knee pain (21.5%), ankle pain (24.9%) and foot pain (42.3%). Over half of the underground coal miners surveyed believed their work boots contributed to their lower limb pain and reported their work boots were uncomfortable. Different working roles and environments resulted in differences in the incidence of foot problems, lower limb pain and comfort scores, confirming that one boot design cannot meet all the work-related requirements of underground coal mining. Further research examining the interaction of a variety of boot designs across the different underground surfaces and the different tasks miners perform is paramount to identify key boot design features that affect the way underground coal miners perform. Enhanced work boot design could improve worker comfort and productivity by reducing the high rates of reported foot problems and pain amongst underground coal miners.

Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review

BACKGROUND

Research focusing on management of foot health has become more evident over the past decade, especially related to chronic conditions such as diabetes. The level of methodological rigour across this body of work however is varied and outputs do not appear to have been developed or translated into clinical practice. The aim of this systematic review was to assess the latest guidelines, standards of care and current recommendations relative to people with chronic conditions to ascertain the level of supporting evidence concerning the management of foot health.

METHODS

A systematic search of electronic databases (Medline, Embase, Cinahl, Web of Science, SCOPUS and The Cochrane Library) for literature on recommendations for foot health management for people with chronic conditions was performed between 2000 and 2016 using predefined criteria. Data from the included publications was synthesised via template analysis, employing a thematic organisation and structure. The methodological quality of all included publications was appraised using the Appraisal for Research and Evaluation (AGREE II) instrument. A more in-depth analysis was carried out that specifically considered the levels of evidence that underpinned the strength of their recommendations concerning management of foot health.

RESULTS

The data collected revealed 166 publications in which the majority (102) were guidelines, standards of care or recommendations related to the treatment and management of diabetes. We noted a trend towards a systematic year on year increase in guidelines standards of care or recommendations related to the treatment and management of long term conditions other than diabetes over the past decade. The most common recommendation is for preventive care or assessments (e.g. vascular tests), followed by clinical interventions such as foot orthoses, foot ulcer care and foot health education. Methodological quality was spread across the range of AGREE II scores with 62 publications falling into the category of high quality (scores 6-7). The number of publications providing a recommendation in the context of a narrative but without an indication of the strength or quality of the underlying evidence was high (79 out of 166).

CONCLUSIONS

It is clear that evidence needs to be accelerated and in place to support the future of the Podiatry workforce. Whilst high level evidence for podiatry is currently low in quantity, the methodological quality is growing. Where levels of evidence have been given in in high quality guidelines, standards of care or recommendations, they also tend to be strong-moderate quality such that further strategically prioritised research, if performed, is likely to have an important impact in the field.

Predicting the hand, foot, and mouth disease incidence using search engine query data and climate variables: an ecological study in Guangdong, China

OBJECTIVES

Hand, foot, and mouth disease (HFMD) has caused a substantial burden in China, especially in Guangdong Province. Based on the enhanced surveillance system, we aimed to explore whether the addition of temperate and search engine query data improves the risk prediction of HFMD.

DESIGN

Ecological study.

SETTING AND PARTICIPANTS

Information on the confirmed cases of HFMD, climate parameters and search engine query logs was collected. A total of 1.36 million HFMD cases were identified from the surveillance system during 2011-2014. Analyses were conducted at aggregate level and no confidential information was involved.

OUTCOME MEASURES

A seasonal autoregressive integrated moving average (ARIMA) model with external variables (ARIMAX) was used to predict the HFMD incidence from 2011 to 2014, taking into account temperature and search engine query data (Baidu Index, BDI). Statistics of goodness-of-fit and precision of prediction were used to compare models (1) based on surveillance data only, and with the addition of (2) temperature, (3) BDI, and (4) both temperature and BDI.

RESULTS

A high correlation between HFMD incidence and BDI (r=0.794, p<0.001) or temperature (r=0.657, p<0.001) was observed using both time series plot and correlation matrix. A linear effect of BDI (without lag) and non-linear effect of temperature (1 week lag) on HFMD incidence were found in a distributed lag non-linear model. Compared with the model based on surveillance data only, the ARIMAX model including BDI reached the best goodness-of-fit with an Akaike information criterion (AIC) value of -345.332, whereas the model including both BDI and temperature had the most accurate prediction in terms of the mean absolute percentage error (MAPE) of 101.745%.

CONCLUSIONS

An ARIMAX model incorporating search engine query data significantly improved the prediction of HFMD. Further studies are warranted to examine whether including search engine query data also improves the prediction of other infectious diseases in other settings.

Associations between animal welfare indicators and Campylobacter spp. in broiler chickens under commercial settings: A case study

Few studies have previously investigated how poor animal welfare might be associated with infection of zoonotic pathogens in humans. This paper assesses the predictive value of the presence of Campylobacter spp. in broiler chicken flocks when animal-based measures related to footpad dermatitis, hock burns, body lesions and arthritis are identified under commercial conditions (high density). The study population included 32 flocks analysed on farm and at slaughter, slaughtered between April and August 2008 in six different slaughter plants in Brittany, France. Welfare and health indicators are those indicated by the European legislation and sampling was carried out in the framework of the European baseline survey on the prevalence of Campylobacter in broiler chicken. Caecal contents, sampled both on farm and at slaughter, and carcass skin samples from the neck and breast at slaughter, were investigated for the presence of Campylobacter spp. Logistic models/classification trees were used to estimate the probability of the presence (or absence) of a specific foodborne pathogen in a flock based on specific animal-based measures (or combinations of measures) in order to study the potential relationship between welfare indicators and foodborne pathogen prevalence/incidence levels. On farm, flocks with more than 25% animals with severe lesions on between 25 and 50% of the footpad are predicted to be Campylobacter-positive whereas flocks where less than 13 individuals have arthritis are predicted to be Campylobacter-negative. The error rate on farm and at slaughter was 10 and 4% respectively indicating good predicting abilities. A poor welfare environment may result in stress, which reduces chicken immunocompetence making them more susceptible to Campylobacter spp. An infection with Campylobacter spp may lead to impaired defence and susceptibility to other pathogens which may result in greater intestinal excretion. Poor welfare and high growing rate lead to digestive troubles that lead to litter humidity. Litter humidity that, among other things, causes footpad dermatitis may also influence the horizontal transmission of the Campylobacter spp. infection due to the normal coprophagic behaviour of poultry. Reducing welfare problems by a better management of rearing conditions would not only improve broiler welfare, but it would also decrease the risks of Campylobacter contamination, of carcass condemnations and of economic loss for the poultry industry.

Heel pain in psoriatic arthropathy: Analysis of a series of 291 patients

OBJECTIVE

To determine the prevalence of heel pain in a series of patients with psoriatic arthritis (PsA).

MATERIAL AND METHODS

Cross-sectional, observational and retrospective study of a series of 347 patients. All patients fulfilled the CASPAR criteria for PsA and 291 had a clinically significant history of heel pain. The statistical analysis was performed using chi-square test, ANOVA and binary logistic regression.

RESULTS

Thirty-five percent of the patients had clinically significant heel pain. A significant association was established between an early onset of skin and joint involvement in the disease and the development of heel pain. However, no significant correlation was found between disease duration and the presence of heel pain. History of dactylitis and PsA in first-degree family members was also statistically associated with this complication.

CONCLUSIONS

Clinically significant heel pain was recorded in one third of the patients in this series. There was a statistically significant association with dactylitis, PsA in first-degree family members and an earlier onset of joint and skin disease.

Impact of the quality of life related to foot health in a sample of pregnant women: A case control study

Pregnancy women coincide with numerous anatomical and physiological changes, which are believed to have a harmful effect on the quality of life related to foot health. The goal of this research was to identify and compare the impact foot health and overall health in a sample of pregnancy women and women without pregnancies with normalised reference values.A sample of 159 participants of a mean age of 30.13 ± 6.28 came to the area of midwifery center where self-reported data were registered, informants' with a 1 or various pregnancy was determined and the scores obtained were compared in the foot health status questionnaire (FHSQ). This has 13 questions that assess 4 health domains of the feet, namely pain, function, general health, and footwear.The pregnant women group showed a worse quality of life related to health in general and to foot health specifically at the following domains, foot function, footwear, general foot, health, physical activity, social capacity, and vigor (P < 0.05) and there were no differences at foot pain and general health (P > 0.05).Pregnant women present a negative impact on the quality of life related to foot health, which appears to be associated with the pregnancy period.

Prospective case-control study of toe tip necrosis syndrome (TTNS) in western Canadian feedlot cattle

A case-control study was conducted to investigate potential risk factors for toe tip necrosis syndrome (TTNS) in western Canadian feedlot cattle. Feedlot veterinarians provided hooves from 222 animals that died of either TTNS ("cases") or from all other causes ("controls"). The claws were sectioned by researchers to confirm the diagnoses; there was very good agreement between the practitioners' field diagnosis and that of the researchers (Cohen's kappa = 0.81; P < 0.001). The sole thickness of the apical white line region was thinner (P < 0.001) in the cases (3.74 mm) than the controls (4.72 mm). Claws from cases were 5.0 [95% confidence interval (CI): 1.5 to 8.6; P < 0.001] and 7.3 times (95% CI: 1.5 to 69.3; P < 0.01) more likely than those of controls to yield a heavy growth of Escherichia coli and Trueperella pyogenes, respectively. Cases were 4.4 times (95% CI: 4.4 to 22.9; P < 0.001) more likely to be acutely/transiently infected with bovine viral diarrhea virus than were controls. The findings support the hypothesis that TTNS is initiated by excessive wear along the white line, leading to separation and bacterial colonization of the 3rd phalangeal bone (P3) and associated soft tissues.

[Skin lesions and other foot problems associated with safety footwear]

OBJECTIVES

The principal purpose of this epidemiological cross-sectional study was to evaluate the frequency of foot problems associated with the wearing of safety footwear (SFW).

METHODS

We examined 509 workers from 12 separate metal-working factories, representing all workers employed in these factories. All subjects wore SFW on a daily basis. The study was based on an interviewer-administered questionnaire and a clinical examination of the feet, with particular attention to skin lesions.

RESULTS

81% of the workers had at least one foot problem. The most frequently reported shoe concern was the hot/wet conditions inside the SFW (42%), followed by weight (27.5%), fit (22.9%) with narrowness (19%) and poor sole flexibility (16.3%).

CONCLUSIONS

Preventive measures should be implemented to reduce the risk associated with SFW. To achieve this goal, it is necessary on one hand to improve the comfort of SFW from a physiological and ergonomic point of view and, on the other hand, to make an appropriate choice of this personal protective device from the various brands and models available on the market.

Association between arsenic and different-sized dissolved organic matter in the groundwater of black-foot disease area, Taiwan

The formation of an arsenic (As)-dissolved organic matter (DOM) complex is important in driving the release of arsenic in groundwater. This study collected groundwater samples from a 20 m deep well throughout 2014 and separated each into three subsamples by ultrafiltration: high molecular weight-DOM (HDOM, 0.45 μm-10 kDa), medium molecular weight-DOM (MDOM, 10-1 kDa), and low molecular weight-DOM (LDOM, <1 kDa) solutions. The fractional DOM was measured with a three-dimensional excitation-emission matrix (EEM) via fluorescence spectroscopy. A fluorescence quenching method was used to calculate the apparent stability constant (Ks) between arsenic and the fractional DOM. Based on the EEM records, three fluorescence indicators were further calculated to characterize the DOM sources, including the fluorescence index (FI), the biological index (BI), and the humification index (HI). The experimental results indicated that arsenic in the groundwater was mainly partitioned into the MDOM and LDOM fractions. All fractional DOMs contained humic acid-like substances and were considered as microbial sources. LDOM had the highest humification degree and aromaticity, followed by MDOM and HDOM. The As and DOM association could be formed by a Fe-bridge, which was demonstrated by the Ks values and fourier transform infrared (FTIR) spectra of the DOM. The formation of AsFe-DOM complex was only significant in the MDOM and LDOM.

Prevalence and awareness of functional and structural foot abnormalities in children and adolescents with type 1 diabetes

BACKGROUND

The ISPAD guideline 2011/2014 advises annual podiatric screening to detect foot complications and identify other possible risk factors such as functional and structural foot abnormalities. The aim of this study was to assess the prevalence and awareness of neurovascular, functional and structural foot abnormalities in children and adolescents with type 1 diabetes mellitus (T1DM).

METHODS

All patients aged 0-18 years with T1DM were invited for a foot examination and structured questionnaire by a certified podiatrist.

RESULTS

Three of the examined patients (n=128) showed signs of possible long-term complications. Structural and functional foot problems were observed in 71.9% (n=92). Of all patients, 38.3% (n=49) required further treatment by a podiatrist.

CONCLUSIONS

Functional and structural foot abnormalities are a frequent problem in children with T1DM in the southern part of the Netherlands. These abnormalities are an additional risk factor for developing long-term foot complications. Education in and implementation of the guideline are necessary.

Inter-observer agreement for clinical examinations of foot lesions of sheep

In sheep, the diagnosis of foot lesions is routinely based on physical examination of the hoof. Correct diagnosis is important for the effective treatment, prevention and control of both infectious and non-infectious causes of lameness. Therefore, the aim of this study was to evaluate the level of inter-observer agreement for clinical examination of ovine foot lesions. Eight observers of varying experience, training and occupation performed foot examinations on a total of 1158 sheep from 38 farms across North England and Wales. On each farm, a group of two to four observers independently examined a sample of 24 to 30 sheep to diagnose the presence or absence of specific foot lesions including white line lesions (WL), contagious ovine digital dermatitis (CODD), footrot (FR), inter-digital dermatitis (ID) and toe granuloma (TG). The inter-observer agreement of foot lesion assessments was examined using Fleiss kappa (κ), and Cohen's κ examined the paired agreement between the test standard observer (TSO) and each observer. Scoring differences with the TSO were examined as the percentage of scoring errors and assessed for evidence of systematic scoring bias. With the exception of WL (maximum error rate 33.3%), few scoring differences with the TSO occurred (maximum error rate 3.3%). This suggests that observers can achieve good levels of reliability when diagnosing most of the commonly observed foot conditions associated with lameness in sheep.

Predictors of foot pain in the community: the North West Adelaide health study

BACKGROUND

Foot pain has been shown to be prevalent across all age groups. The presence of foot pain may reduce mobility and impact on the ability to undertake activities of daily living. The aim of this study was to determine factors that are predictive of foot pain in a community based sample of the general population.

METHODS

This study analysed data from the North West Adelaide Health Study, a cohort study located in the northwestern suburbs of Adelaide, South Australia. Data were obtained between 2004-2006 and 2008-2010, using a self-completed questionnaire, computer assisted telephone interviewing, and a clinical assessment. The sensitivity, specificity and positive predictive values of variables were determined and generalised linear models ascertained the variables associated with the highest relative risk of self-reporting foot pain in 2008-2010 based on the data obtained in 2004-2006.

RESULTS

The prevalence of foot pain in 2004-2006 was 14.9 % (95 % CI 13.6-16.4) and in 2008-2010, 29.9 % (95 % CI 27.5-32.5). Variables with the highest sensitivity were: female sex, ever having back pain, self-reported arthritis, body mass index (BMI) classified as obese and having foot pain in 2004-2006, while most variables demonstrated high specificity. Those with the highest risk of reporting foot pain in 2008-2010 were those with depressive symptoms, self-reported arthritis, high BMI, self-reported upper limb pain and foot pain (in general or in specific regions of the foot) in 2004-2006.

CONCLUSION

Foot pain is common in the general population and those with the greatest risk of foot pain potentially represent a high level of chronicity and potential burden on the health system. Addressing the factors that predict foot pain, as well as the provision of targeted messages to highlight the importance of managing foot pain, may help reduce the impact on the population.

Direct inpatient burden caused by foot-related conditions: a multisite point-prevalence study

OBJECTIVE

The aims of this point-prevalence study were to investigate a representative inpatient population to determine the prevalence of people admitted to hospital for the reason of a foot-related condition, and identify associated independent factors.

METHODS

Participants were adult inpatients in 5 different representative hospitals, admitted for any reason on the day of data collection. Maternity, mental health and cognitively impaired inpatients were excluded. Participants were surveyed on a range of self-reported demographic, social determinant, medical history, foot disease history, self-care, footwear, past foot treatment prior to hospitalisation and reason for admission variables. Physical examinations were performed to clinically diagnose a range of foot disease and foot risk factor variables. Independent factors associated with being admitted to hospital for the primary or secondary reason of a foot-related condition were analysed using multivariate logistic regression.

RESULTS

Overall, 733 participants were included; mean (SD) age 62 (19) years, male 55.8%. Foot-related conditions were the primary reason for admission in 54 participants (7.4% (95% CI 5.7% to 9.5%)); 36 for foot disease (4.9%), 15 foot trauma (2.1%). Being admitted for the primary reason of a foot-related condition was independently associated with foot infection, critical peripheral arterial disease, foot trauma and past foot treatment by a general practitioner and surgeon (p<0.01). Foot-related conditions were a secondary reason for admission in 28 participants (3.8% (2.6% to 5.6%)), and were independently associated with diabetes and current foot ulcer (p<0.01).

CONCLUSIONS

This study, the first in a representative inpatient population, suggests the direct inpatient burden caused by foot-related conditions is significantly higher than previously appreciated. Findings indicate 1 in every 13 inpatients was primarily admitted because of a foot-related condition with most due to foot disease or foot trauma. Future strategies are recommended to investigate and intervene in the considerable inpatient burden caused by foot-related conditions.

Assessment of foot health and animal welfare: clinical findings in 229 dairy Mediterranean Buffaloes (Bubalus bubalis) affected by foot disorders

BACKGROUND

Lameness represents the third most important health-related cause of economic loss in the dairy industry after fertility and mastitis. Although, dairy Mediterranean Buffaloes (MB) and dairy cows share similar breeding systems predisposing to similar herd problems, published studies exploring its relevance and role in these ruminants are still rare and incomplete. The aims of this study were to describe the clinical findings of foot disorders (FDs) in dairy MB and their influence on animal welfare, determined by assessment of locomotion score (LS), body condition score (BCS) and cleanliness score (CS).

RESULTS

Of 1297 multiparous MB submitted to routine trimming procedures, 229 buffaloes showed at least one FD. The prevalence of buffaloes affected by FDs was 17.7 %, while motility and lameness indexes were 84.1 % (1091/1297) and 15.9 % (206/1297), respectively. Overgrowth was present in 17.0 % (220/1297), corkscrew claw in 15.8 % (205/1297), interdigital phlegmon in 0.9 % (12/1297), white line abscess in 0.8 % (11/1297), digital dermatitis in 0.1 % (1/1297) and interdigital hyperplasia in 0.1 % (1/1297). Simultaneous presence of FDs was recorded in 17.0 % of MB (221/1297): overgrowth and corkscrew claw occurred together in 15.8 % of cases (205/1297), overgrowth and interdigital phlegmon in 0.3 % (4/1297), overgrowth and white line abscess in 0.8 % (11/1297), digital dermatitis and interdigital hyperplasia in 0.1 % (1/1297). The presence of FDs was always associated with lameness (LS > 2), except from 23 MB with simultaneous overgrowth and interdigital phlegmon occurrence. The majority of MB within the under-conditioned group (95.5 %, 43/45) and all those with CS > 2 (122/122) had a locomotion score above the threshold of normality (LS > 2). Furthermore, foot diseases such as interdigital hyperplasia, white line abscess and digital dermatitis or interdigital hyperplasia seemed to occur more frequently associated with decreased BCS and increased CS scores.

CONCLUSIONS

This study describes for the first time the involvement of white line disease, interdigital phlegmona, digital dermatitis and interdigital hyperplasia in foot disorders of dairy Mediterranean buffalo and shows their association with an impairment of animal welfare.

Infectious lameness among migratory sheep and goats in north-west India, with particular focus on anaerobes

Various bacterial species, particularly Dichelobacter nodosus, Fusobacterium necrophorum, Trueperella pyogenes (previously Arcanobacterium pyogenes) and Treponema spp., have been implicated in infectious conditions manifesting in lameness in sheep and goat populations. The current study reports the causes of infectious lameness in the north-western Himalayan region, particularly Himachal Pradesh (HP), where no such study has been conducted in the past. Among a total surveyed population of 27,586 animals, comprised of 15,006 sheep and 12,580 goats, 216 samples were collected from foot lesions. A total of 6.48% (14/216) samples were positive for D. nodosus, 20.83% (45/216) for F. necrophorum and 20.37% (44/216) for T pyogenes. In three instances, all of the three aforementioned bacteria were present in a single foot lesion. Most of the positive samples were from areas in the state of HP adjoining the state of Jammu and Kashmir (J&K), where footrot is endemic. The confirmation of footrot in HP and the fact that F. necrophorum and T pyogenes were detected from cases of foot/hoof infection in high numbers emphasises thatthese organisms play an important role in inducing morbidity in migratory sheep and goats. The present investigation also confirms the detection of D. nodosus from cases of footrot for the first time from HP. With new reports identifying F. necrophorum as a pathogen with a potential role in aggravating infection caused by footrot, the development of a combined vaccine to prevent lameness in sheep and goats in the north-western Himalayan region has been suggested.

Charcot Neuroarthropathy of the Foot and Ankle

Charcot neuropathy is a painless, progressive, degeneration most notably of the ankle or midfoot joints, seen in patients with diabetes and neuropathy. This article will describe the etiology, diagnosis, and treatment of this potentially debilitating joint disease and provide implications for home care clinicians.

The incidence and prevention of foot problems among male Phase One British Army recruits at an Army Training Regiment

INTRODUCTION

Studies have demonstrated that there is an excessive number of foot problems among personnel entering the military, which leads to disruption to training resulting in an increase in both costs and wastage. Days are lost in training due to foot problems, most commonly blisters, causing a loss of working/training days with a resultant low morale and a financial loss to the army.

METHODS

A cohort of Phase One British Army recruits completed a questionnaire in week 3 of training to identify previous and current foot problems and assess what education on the topic they received during their training. Also, 43 foot risk assessment tools were used by the medical staff to identify incidence, severity and working days lost. Questionnaires were completed by 31 instructors to gain data on prevention and management of foot problems. Focus groups were conducted among instructors to investigate their knowledge of prevention and management, and problems identified among recruits.

RESULTS

A lack of formal training on foot care exists among recruits and instructors. Blisters were reported to be the main foot problem, and army-issue boots were reported to be the main cause of problems. Sizing of boots was inconsistent, and manufacturers can vary in their sizings. There were no policies available, and only one lesson on foot care was given.

CONCLUSIONS

Currently, no policies exist on foot care at the Army Training Regiment (ATR). Foot clinics were available daily, and blisters and foot problems were already present; therefore, foot education is required in the early stages of training. The field craft exercise resulted in half of the recruits reporting blisters. Poor foot hygiene remained a problem when recruits arrived at the ATR for their training. Foot care instruction included in the training would reduce days and hours lost in training.

Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis

OBJECTIVE

To systematically review studies reporting the prevalence in general adult inpatient populations of foot disease disorders (foot wounds, foot infections, collective 'foot disease') and risk factors (peripheral arterial disease (PAD), peripheral neuropathy (PN), foot deformity).

METHODS

A systematic review of studies published between 1980 and 2013 was undertaken using electronic databases (MEDLINE, EMBASE and CINAHL). Keywords and synonyms relating to prevalence, inpatients, foot disease disorders and risk factors were used. Studies reporting foot disease or risk factor prevalence data in general inpatient populations were included. Included study's reference lists and citations were searched and experts consulted to identify additional relevant studies. 2 authors, blinded to each other, assessed the methodological quality of included studies. Applicable data were extracted by 1 author and checked by a second author. Prevalence proportions and SEs were calculated for all included studies. Pooled prevalence estimates were calculated using random-effects models where 3 eligible studies were available.

RESULTS

Of the 4972 studies initially identified, 78 studies reporting 84 different cohorts (total 60 231 517 participants) were included. Foot disease prevalence included: foot wounds 0.01-13.5% (70 cohorts), foot infections 0.05-6.4% (7 cohorts), collective foot disease 0.2-11.9% (12 cohorts). Risk factor prevalence included: PAD 0.01-36.0% (10 cohorts), PN 0.003-2.8% (6 cohorts), foot deformity was not reported. Pooled prevalence estimates were only able to be calculated for pressure ulcer-related foot wounds 4.6% (95% CI 3.7% to 5.4%)), diabetes-related foot wounds 2.4% (1.5% to 3.4%), diabetes-related foot infections 3.4% (0.2% to 6.5%), diabetes-related foot disease 4.7% (0.3% to 9.2%). Heterogeneity was high in all pooled estimates (I(2)=94.2-97.8%, p<0.001).

CONCLUSIONS

This review found high heterogeneity, yet suggests foot disease was present in 1 in every 20 inpatients and a major risk factor in 1 in 3 inpatients. These findings are likely an underestimate and more robust studies are required to provide more precise estimates.