Population attributable risk for functional disability associated with chronic conditions in Canadian older adults

OBJECTIVES

to investigate the population impact on functional disability of chronic conditions individually and in combination.

METHODS

data from 9,008 community-dwelling individuals aged 65 and older from the Canadian Study of Health and Aging (CSHA) were used to estimate the population attributable risk (PAR) for chronic conditions after adjusting for confounding variables. Functional disability was measured using activity of daily living (ADL) and instrumental activity of daily living (IADL).

RESULTS

five chronic conditions (foot problems, arthritis, cognitive impairment, heart problems and vision) made the largest contribution to ADL- and IADL-related functional disabilities. There was variation in magnitude and ranking of population attributable risk (PAR) by age, sex and definition of disability. All chronic conditions taken simultaneously accounted for about 66% of the ADL-related disability and almost 50% of the IADL-related disability.

CONCLUSIONS

in community-dwelling older adults, foot problems, arthritis, cognitive impairment, heart problems and vision were the major determinants of disability. Attempts to reduce disability burden in older Canadians should target these chronic conditions; however, preventive interventions will be most efficient if they recognize the differences in the drivers of PAR by sex, age group and type of functional disability being targeted.

[Relationships between foot problems, fall experience and fear of falling among Japanese community-dwelling elderly]

PURPOSE

Although a foot care program for long-term care prevention has been launched in Japan, few studies have examined its effectiveness. The purpose of the present investigation was to examine the association of foot problems with fall experience and fear of falling among Japanese community-dwelling elderly people.

METHODS

The participants were 10,581 community-dwelling elderly people (75.2 +/- 5.6 years) and the study design was cross-sectional using a questionnaire. Self-reported tinea pedis, skin problems (inflammation, swelling, or discoloration), nail problems (thickening or deformities), impairment (in function or blood flow), regular foot care, and wearing of appropriate shoes were selected as parameters of foot problems and their care. Logistic regression analysis was conducted to examine whether these were related to fall experience (in the past 1 year) and fear of falling adjusted for age, the Tokyo Metropolitan institute of gerontology index of competence, medical conditions, and lower limb functions.

RESULTS

Forty-six percents of males and 39.0% of females reported at least one foot problem. After adjusting for covariates, tinea pedis (male: adjusted odds ratio = 1.37[95% confidence interval= 1.15-1.63], female: 1.29[1.08-1.53]), skin problems (male: 1.66[1.32-2.101, female: 1.37[1.13-1.66]), nail problems (male: 1.72[1.45-2.051, female: 1.48[1.26-1.74]), and functional impairment (male: 2.42[1.91-3.05], female: 1.66[1.36-2.04]) were significantly associated with fall experience. Also, each problem was negatively associated with fear of falling (tinea pedis[male: 1.37 [1.15-1.62], female: 1.25[1.07-1.47]], skin problems[male: 1.42[1.13-1.801, female: 1.62[1.34-2.00]], nail problems[male: 1.41[1.19-1.68], female: 1.46[1.25-1.70]], functional impairment [male: 2.05[1.61-2.60], female: 2.10[1.69-2.60]]). In addition, regular foot care (0.81[0.71-0.921) was a significant correlate of fear of falling in females.

CONCLUSIONS

These results imply that focusing on foot problems (i.e., tinea pedis, skin problems, nail problems, functional impairment) would be one of means for fall preventions. Well-designed prospective studies evaluating foot problems objectively are now needed to confirm the relationships indicated by this study.

[Pedicures and podiatry in psychiatry and social insecurity]

Practicing pedicures and podiatry in a psychiatric environment is a particular speciality. This specificity arises not only from the disorders and complications encountered, but also from the connection established between the patient and the healthcare worker during treatment.

The origin and foot condition of horses slaughtered in Australia for the human consumption market

REASONS FOR PERFORMING STUDY

There are ethical concerns regarding the loss of horses from various equine industries and their corresponding slaughter. However, to date, no empirical evidence regarding the extent of this loss, nor of the condition of horses involved, exists within Australia.

OBJECTIVES

To determine the approximate ages, brand type and condition of feet of horses relinquished to an export abattoir in Australia.

METHOD

Data were collected from 340 horses processed at an Australian abattoir from November 2007-January 2008. Foot abnormalities, injuries and hoof indicators of overgrown and untrimmed hooves were assessed together with a dental inspection. Observations of brand were used to determine horse origin.

RESULTS

The dental age of 60% of horses was 57 years, and 53% originated from the racing industry (40% Thoroughbred and 13% Standardbred). A total of 81% of the horses had overgrown or untrimmed hooves. Standardbred horses had fewer grass cracks and more injuries to the coronary band than Thoroughbreds, probably due to pacing and trotting activities.

CONCLUSIONS

Just over half of the horses slaughtered at an Australian abattoir on 3 working days were aged (7 years and emanated from the racing industry. Foot problems were common.

POTENTIAL RELEVANCE

Future research should identify means of reducing the number of horses slaughtered and preventative measures for foot disorders.

Magnitude of foot problems in diabetes in the developing world: a study of 1044 patients

AIM

To gain insight into the prevalence of peripheral neuropathy, foot care practices, foot at risk and foot ulcers in patients with diabetes mellitus at a tertiary care centre.

METHODS

A prospective case study involving 1044 patients with diabetes mellitus attending the diabetes clinic of a tertiary care centre in north India from January 2007 to May 2008. All subjects underwent a detailed clinical assessment including vibration perception threshold (VPT) and ankle brachial pressure index (ABI), along with metabolic parameters, and were categorized into ulcer, foot at risk and patients with no risk factors. Foot care practices were assessed with a questionnaire. Peripheral neuropathy was defined as VPT score > or = 25 V. Peripheral vascular disease (PVD) was defined as ABI < 0.9. One hundred and forty-nine patients with foot at risk were followed up for 9.0 +/- 2.3 months (range 5-13 months).

RESULTS

The prevalence of peripheral neuropathy was 34.9% and of PVD 12.6%. Two thirds of the patients were at risk for foot ulceration; 9% had an ulcer and 20.2% of them required amputation. Correct foot care practices were followed by 214 (20.5%) subjects of the whole study population and by only 135 (19.3%) of the patients with foot at risk. Improvement in glycaemic control in the patients on follow-up was associated with improvement or stabilization of VPT score. Five (3.4%) patients developed new ulcers on follow-up.

CONCLUSION

The high prevalence of neuropathy and PVD, coexisting with poor adherence to foot care practices predisposes to foot problems in people with diabetes in our study population.

A cross sectional study of prevalence, risk factors, population attributable fractions and pathology for foot and limb lesions in preweaning piglets on commercial farms in England

BACKGROUND

In a cross sectional study of 88 indoor and outdoor English pig farms, the prevalence of foot and limb lesions in 2843 preweaning piglets aged 1-4 weeks from 304 litters was recorded. The environmental risks for the prevalence of lesions and population attributable fractions were calculated. The risks for lesions in piglets were compared with those for limb and body lesions in their mothers. A small number of piglets with each type of lesion were examined post mortem to elucidate the pathology of the clinical lesions observed.

RESULTS

The prevalence of sole bruising, sole erosion, skin abrasion and swollen joints or claws in 2843 piglets was 49.4% (1404), 15.5% (441), 43.6% (1240) and 4.7% (143) respectively. The prevalence of all foot and limb lesions was higher in indoor housed piglets than in outdoor housed piglets. The prevalence of sole bruising (OR 0.3) and skin abrasion (OR 0.6) decreased with each week of age from 1-4 weeks, but there was no significant association between piglet age and the prevalence of sole erosion or swollen joints and claws. There was an increased prevalence of sole bruising (OR 3.0) and swollen joints or claws (OR 3.0) and a decreased prevalence of skin abrasion (OR 0.3, piglets

CONCLUSION

Piglets housed outdoors had a very low prevalence of foot and limb injuries. Indoors, no one floor type was ideal to minimise all piglet foot and limb injuries and the flooring requirements of sows differed from those of piglets.

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MESH Headings

• Agriculture
• Animals
• Animals, Suckling/physiology
• Cross-Sectional Studies
• England
• Extremities/pathology
• Female
• Foot Diseases/epidemiology
• Foot Diseases/pathology
• Foot Diseases/veterinary
• Housing, Animal/standards
• Male
• Prevalence
• Risk Factors
• Swine
• Swine Diseases/epidemiology
• Swine Diseases/pathology
• Wounds and Injuries/epidemiology
• Wounds and Injuries/pathology
• Wounds and Injuries/veterinary

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An epidemiological survey of diabetic foot problems in the Stockholm County 1982

Diabetic foot disease is a severe complication to diabetes mellitus. Preventive measures can reduce its occurrence and consequences. The present study was performed in order to assess the prevalence of diabetic foot disease in an urbanized area with well developed medical facilities. The study was based on a mail questionnaire to a stratified, randomized sample of 742 diabetics living in the Stockholm county. Only one third of these patients were free of diabetic foot symptoms. Many patients with severe signs found it difficult to take care of their feet, were living alone and did not seek professional help for their foot problems. Only 66% of the patients with severe foot disease utilized hospitals for their diabetes care. Furthermore, only half of them relied on some type of professional care for their feet.

[Claw health in Dutch dairy herds, an update of some recent disorders]

The dairy practitioner can make an important contribution to animal welfare by preventing and treating painful claw disorders. Two relatively new claw disorders have been observed in Dutch dairy herds, namely, toe ulceration and non-healing white line disorder. This article provides an update of knowledge on these two disorders, the aetiology of which is not known yet.

A survey of foot problems in juvenile idiopathic arthritis

BACKGROUND

Evidence suggests that foot problems are common in juvenile idiopathic arthritis (JIA), with prevalence estimates over 90%. The aim of this survey was to describe foot-related impairment and disability associated with JIA and foot-care provision in patients managed under modern treatment paradigms, including disease-modifying anti-rheumatic drugs (DMARDs) and biologic therapies.

METHODS

The Juvenile Arthritis Foot Disability Index (JAFI), Child Health Assessment Questionnaire (CHAQ), and pain visual analogue scale (VAS) were recorded in 30 consecutive established JIA patients attending routine outpatient clinics. Foot deformity score, active/limited joint counts, walking speed, double-support time (s) (DS) and step length symmetry index % (SI) were also measured. Foot-care provision in the preceding 12 months was determined from medical records.

RESULTS

Sixty-three per cent of children reported some foot impairment, with a median (range) JAFI subscale score of 1 (0-3); 53% reported foot-related activity limitation, with a JAFI subscale score of 1 (0-4); and 60% reported participation restriction, with a JAFI subscale score of 1 (0-3). Other reported variables were CHAQ 0.38 (0-2), VAS pain 22 (0-79), foot deformity 6 (0-20), active joints 0 (0-7), limited joints 0 (0-31), walking speed 1.09 m/s (0.84-1.38 m/s), DS 0.22 s (0.08-0.26 s) and SI +/-4.0% (+/-0.2-+/-31.0%). A total of 23/30 medical records were reviewed and 15/23 children had received DMARDS, 8/23 biologic agents and 20/23 multiple intra-articular corticosteroid injections. Ten children received specialist podiatry care comprising footwear advice, orthotic therapy and silicone digital splints together with intrinsic muscle strengthening exercises.

CONCLUSION

Despite frequent use of DMARD/biologic therapy and specialist podiatry-led foot care, foot-related impairment and disability persists in some children with JIA.

Treatment practices and quantification of antimicrobial drug usage in conventional and organic dairy farms in Wisconsin

The objective of this study was to develop a method to quantify antimicrobial drug usage and treatment practices on conventional and organic dairy farms that had been recruited to represent a broad spectrum of potential exposure to antimicrobial drugs. Data on disease prevalence and treatment practices of organic (n = 20) and conventional (n = 20) farms were obtained during a farm visit using a survey instrument. A standardized estimate of antimicrobial drug usage was developed using a defined daily dose (DDD) of selected compounds. Density of antimicrobial drug usage was expressed as the number of DDD per adult cow per year. Differences in prevalence and management of selected diseases between conventional and organic farms were identified. The overall estimated prevalence of selected diseases was greater for conventional farms compared with organic farms. Organic farmers reported use of a variety of nonantimicrobial compounds for treatment and prevention of disease. Conventional farmers reported that penicillin was the compound most commonly used for dry cow therapy and cephapirin was most commonly used for treatment of clinical mastitis. On conventional farms, the estimated overall exposure to antimicrobial drugs was 5.43 DDD per cow per year composed of 3.58 and 1.85 DDD of intramammary and parenteral antimicrobial drugs, respectively. Of total intramammary antimicrobial drug usage, treatment of clinical mastitis contributed 2.02 DDD compared with 1.56 DDD attributed to the use of dry cow therapy. Of total parenteral treatments, the distribution of exposure was 0.52 (dry cow therapy), 1.43 (clinical mastitis treatment), 0.39 (treatment of foot disease), 0.14 (treatment of respiratory disease), and 0.32 (treatment of metritis) DDD. For treatments of foot infections (0.33 DDD), respiratory infections (0.07 DDD), and metritis (0.19 DDD), the mean density of ceftiofur usage was significantly greater compared with other compounds.

[Foot health in the tropics]

The foot is particularly exposed to injury and infection in the tropical areas. This article provides a review of the main diseases affecting the foot in the tropics including leprosy, ainhum, ulceration due to Mycobacterium ulcerans, mycetoma, chromomycosis, Kaposi's sarcoma, elephantiasis, podoconiasis, dracunculosis, tungiasis, syphilis and endemic treponematosis, larva migrans, scytalidiosis, and envenomation. Prevention is essential.

Imported tungiasis: a report of 19 cases and review of the literature

Tungiasis is an infestation caused by penetration in the skin of the gravid female of the flea Tunga penetrans. In the period 1991-2006, 19 patients with imported tungiasis were observed at our Institute. All patients were subjected to general and dermatological examination, laboratory tests (including bacteriological examinations) and surgical excision of the lesions with histopathological examination. In all patients tetanus prophylaxis was made. All patients were followed up for at least six weeks. Thirteen patients were males (68.4%) and 6 females (31.6%). The age ranged from 3 to 71 years (average age: 37.8 years). Eleven patients (57.9%) contracted the infestation in Central and South America and 8 (42.1%) in Africa. In 17 patients (89.5%) tungiasis was localized to the feet, in one to the hands and in one to a thigh. In 13 patients (68.4%) the infestation was characterized by a single lesion; in the other 6 patients (31.6%) the lesions were two. In 15 patients (78.9%) tungiasis was characterized by a papular or nodular lesion. Crusted (2 patients), pustular (2 patients) and bullous (1 patient) lesions were also observed; furthermore, one patient presented with a plantar wart-like lesion. In only one patient bacteriological examinations showed the growth of Staphylococcus aureus and Escherichia coli. All patients healed without complications.

A cross-sectional study of the prevalence and associated risk factors for capped hock and the associations with bursitis in weaner, grower and finisher pigs from 93 commercial farms in England

The prevalence of capped hock in 5601 post-weaning pigs from 93 pig farms in England was 17.2%. The prevalence increased with age. Once adjusted for age, the lowest prevalence of capped hock was observed in pigs kept on soil floors (usually covered with deep straw bedding). There was no significant increase in the risk of capped hock in pigs kept on solid concrete floors with deep straw bedding. However, pigs kept on solid concrete with some, or the entire pen, sparsely bedded and pigs kept on partially or fully slatted floors had an approximately threefold increased risk of capped hock. This did not vary significantly between these four floor types. This was in contrast to the associated risks for bursitis in the same pigs, where as the floor went from highly resilient (straw and solid floors) to hard and perforated (fully slatted) the risk of bursitis increased in a similar way to a dose response. No other variables that were measured were associated with a change in risk for capped hock, while observation of pigs slipping or slip marks and wet, dirty and worn pens were also associated risks for bursitis. These results indicate that capped hock and bursitis are both affected by exposure to floors, but in different ways. The prevalence of capped hock was associated only with floor hardness, with deep straw protecting the pigs, while bursitis was associated with both changes in bedding depth (hardness), floor material (soil versus concrete) and floor construction (solid versus slatted floors) and in factors associated with locomotion (slipping and slip marks). These results indicate that the aetiology of capped hock and bursitis might differ.

Comparison of Claw Health and Milk Yield in Dairy Cows on Elastic or Concrete Flooring

This article reports on the effects of elastic (rubber) flooring compared with concrete flooring on claw health and milk yield in dairy cows. Milk yield and activity data of 53 complete lactations from 49 cows were recorded by an automatic milking system in the University of Munich Livestock Center dairy herd. Cows were kept in a loose housing system on concrete-slatted or rubber-matted slatted flooring. Claws were trimmed and measured linearly in combination with claw lesion diagnosis 3 times during one lactation period (including the transition phase). An automatic milking system recorded milk yield and activity. The net horn growth of the claws increased on elastic flooring. Therefore, correct and frequent claw trimming is at least as important for claw health in dairy herds kept on rubber flooring as for those on concrete-slatted flooring. Cows housed on rubber had an increased incidence of sole ulcers. Sole hemorrhages (except for hemorrhages associated with sole ulcers) occurred less frequently on rubber than on concrete. Results concerning digital dermatitis were difficult to assess, because manual manure scraping on rubber required sprinkling the flooring twice daily, which additionally moistened the digital skin of the cows. This might explain the greater incidence of digital dermatitis on elastic flooring. The incidence of clinically lame cows did not differ between flooring types. Cows showed greater activity on rubber, most likely caused by the more comfortable walking surface compared with the concrete-slatted flooring. The greater activity may indicate better overall health of high-yielding dairy cows on rubber flooring. Milk yield, however, did not differ between flooring types.

Claw and limb disorders in 12 Norwegian beef-cow herds

Background

The main aim of the study was to assess the prevalence of claw and limb disorders in Norwegian beef-cow herds.

Methods

Twenty-six herds with ≥15 cow-years were selected by computerized systematic assignment from the three most beef cattle-dense regions of Norway. The study population consisted of 12 herds with 28 heifers and 334 cows. The animals were trimmed and examined once by claw trimmers during the late winter and spring of 2003. The seven claw trimmers had been taught diagnosing and recording of claw lesions. Environment, feeding and management routines, age and breed, culling and carcass characteristics were also recorded.

Results

Lameness was recorded in 1.1% of the animals, and only in hind claws. Pericarpal swellings were recorded in one animal and peritarsal lesions in none. In total, claw and limb disorders including lameness were recorded in 29.6% of the animals, 4.1% with front and 28.2% with hind limb disorders, respectively. Most lesions were mild. Laminitis-related claw lesions were recorded in 18.0% of the animals and infectious lesions in 16.6%. The average claw length was 84 mm in front claws and 89 mm in hind claw. Both laminitis-related and infectious claw lesions were more prevalent with increasing age. Carcasses from animals with claw and limb disorders were on average 34 kg heavier than carcasses from animals without such disorders (p = 0.02). Our results also indicate association between some management factors and claw lesions.

Conclusion

The study shows that the prevalence of lameness was low in 12 Norwegian beef-cow herds compared to beef-cattle herds in other countries and also that there were less claw and limb disorders in these herds compared to foreign dairy-cattle herds. The prevalence of lameness and white-line fissures was approximately the same as in Norwegian dairy herds whereas less dermatitis, heel-horn erosions, haemorrhages of the sole and the white line and sole ulcers were recorded.

Agreement among surgical pathologists evaluating routine histologic sections of digits amputated from cats and dogs

Agreement among pathologists interpreting histologic specimens is an area of interest within human pathology, but little work in this area has been reported in the veterinary literature. Agreement among pathologists evaluating routine histologic sections of amputated digits from cats and dogs submitted to multiple diagnostic centers was examined. Histologic sections from surgical specimens were reviewed in a blinded fashion by two pathologists, and a comparison to the original diagnosis, as stated in the diagnostic report, was recorded. A total of 513 cases were reviewed, and complete agreement was reached in 409 (79.7%). Of the 104 instances of disagreement, 77 (74.0%) were considered to be of clinical significance. The diagnosis of keratoacanthoma was disagreed with in 19 of 21 diagnoses (90.4%). No other individual diagnosis was similarly disputed. The overall level of disagreement is large and is similar to that reported in human pathology and suggests that further study of this issue would be useful in veterinary pathology.

Naming and recognition of six foot lesions of sheep using written and pictorial information: a study of 809 English sheep farmers

In 2005, 3000 questionnaires were sent to a random sample of English sheep farmers from a list kept by the English Beef and Lamb Executive (EBLEX) to investigate whether farmers could correctly name six common foot lesions in sheep from a characteristic picture and a written description. The lesions were interdigital dermatitis (ID), footrot (FR), contagious ovine digital dermatitis (CODD), shelly hoof, foot abscess and toe granuloma. In addition, farmers were asked to report the total percent of lame sheep in their flock in 2004 and the percent of this lameness attributable to each of the six lesions listed above. The overall response percentage was 44 with a useable response of 32%. Fifty-nine farmers out of 262 (23%) who answered all six questions named all six lesions correctly. This was greater than expected by chance. The same questionnaire of six lesions was presented at a meeting of specialist sheep advisors, primarily veterinarians, 37/47 (79%) responders named all six lesions correctly. From the six lesions listed above, the percent correctly named by farmers was approximately 83%, 85%, 36%, 28%, 65% and 43% and the percent incorrectly attributed to another lesion was 5%, 47%, 10%, 13%, 35% and 7%, respectively. The most commonly used incorrect name was FR, with farmers tending to name any hoof horn lesion as FR. A comparison of the distribution of sheep lame by a lesion correctly named compared with the same lesion incorrectly named as FR suggested that farmers recognised lesions but did not name them correctly; the distribution of lameness fitted the pattern for the correctly named lesion rather than the pattern of lameness attributed to FR. The results were validated with farm visits and a repeatability study of the questionnaire. The mean farmer-estimated prevalence for all lameness was 10.4%; with 6.9%, 3.7%, 2.4%, 1.9%, 0.9% and 0.8% of the sheep lame with ID, FR, CODD, shelly hoof, foot abscess and toe granuloma respectively from respondents who correctly named these lesions. Whilst ID and FR were the most prevalent causes of lameness in most flocks it is possible that in up to 17% flocks the primary cause of lameness was a different lesion.

Economic aspects of diabetic foot care in a multidisciplinary setting: a review

BACKGROUND

To evaluate the economic aspects of diabetic foot care in a multidisciplinary setting.

METHOD

A review of the English language literature, published from 1966 to November 2005.

RESULTS

The results of available studies on the cost-of-illness of diabetic foot problems are difficult to compare. Nevertheless trends concerning excess of costs, protraction in time of costs, positive correlation to severity of ulcer and/or peripheral vascular disease, contribution of in-hospital stay and length of stay, and the patient's own contribution to total costs, are obvious. Only a few cost-effectiveness and cost-utility studies are available. Most use a Markov based model to predict outcome and show an acceptable result on long-term.

CONCLUSIONS

Diabetic foot problems are frequent and are associated with high costs. A multidisciplinary approach to diabetic foot problems has proved to be cost saving with regard to cost of treatment itself. Nevertheless, it remained unclear if these savings could offset the overall costs involved in implementing this kind of approach. The few studies that address this issue specifically all show an acceptable cost-effectiveness, but often the profit will be evident after some years only, because long-term costs are involved. Based on these data, policymakers should foresee sufficient reimbursement for preventive and early curative measures, and not only for 'salvage manoeuvres'.

The differential diagnosis of foot lumps: 101 cases treated surgically in North Glasgow over 4 years

INTRODUCTION

There are a wide variety of different lesions which present as lumps of the foot. There have been very few studies which look at the presenting characteristics or the differential diagnosis of such lesions.

PATIENTS AND METHODS

All patients who underwent excision or biopsy of a foot lump over a period of 4 years were studied in order to determine patient demographics, presenting characteristics, diagnoses encountered and to assess the diagnostic accuracy of the surgeon.

RESULTS

In total, 101 patients were identified. Average age was 47.3 years (range, 14-79 years); there was a marked female preponderance with 73 females and 28 males. Thirty different histological types were identified; ganglion cysts were the most commonly encountered lesions and there was only one malignant lesion encountered in this study. Only 58 out of the 101 lumps were correctly diagnosed prior to surgery. Certain lesions were more commonly encountered in specific zones of the foot.

CONCLUSIONS

We have shown that there are a wide variety of potential diagnoses which have to be considered when examining a patient with a foot lump. There is a low diagnostic accuracy for foot lumps and, therefore, surgical excision and histological diagnosis should be sought if there is any uncertainty.

[Epidemiology of bone and soft-part tumors of the foot and knee]

DESIGN

Report of cases.

OBJECTIVE

Review of the cases in a period of 10 years with bone and soft tumors in foot and ankle, to knowing epidemilogical, clinic and patologic anatomy parameters to describe the behavior.

MATERIALS AND METHODS

Review of 166 cases from 1991 to 2000 and been analyze with descriptive statistic, association measurment for inside stratum, with odds ratio, hipótesis test with chi square for qualitative date and t to Student for quantitative date.

RESULTS

166 patients within 2 years to 78 years old, 81 with bone tumors and 79 with soft tumors, mostly benign, the most frequent was in the soft tissue ganglion and oseal benign exostosis in bone, 6 different malignant tumors, the principal affected zone were the toes, as a difference to literature, the most affected age group was 10 to 20 years followed to the 30 to 40 years old, we report 42 different patological diagnostics results to soft tissue and osseous tissue.

CONCLUSION

clinical features is not a useful parameter to differentiate between malign or benign tumors and does not allow to establish the biological behavior, we propose the diagnostic algorithm that includes the intentional clinical probe, comparative X-ray in three projections with soft technique, in suspicion to malignant lesion may require CT scan, MRI, osseous scan and finally biopsy which will improve the final outcome.

Designing a podiatry service to meet the needs of the population: a service simulation

A model of a podiatry service has been developed which takes into consideration the effect of changing access criteria, skill mix and staffing levels (among others) given fixed local staffing budgets and the foot-health characteristics of the local community. A spreadsheet-based deterministic model was chosen to allow maximum transparency of programming. This work models a podiatry service in England, but could be adapted for other settings and, with some modification, for other community-based services. This model enables individual services to see the effect on outcome parameters such as number of patients treated, number discharged and size of waiting lists of various service configurations, given their individual local data profile. The process of designing the model has also had spin-off benefits for the participants in making explicit many of the implicit rules used in managing their services.

Estimation de la fréquence des atteintes plantaires à dermatophytes

BACKGROUND

Plantar dermatophytosis frequently goes unnoticed and can cause relapse or re-infestation at other sites. The purpose of this study was to evaluate the incidence of plantar dermatophytosis in association with onyxis and intertrigo involving dermatophytes.

PATIENTS AND METHODS

This was a retrospective study in patients seen at mycology consultations between January 2002 and December 2003 and for whom culture revealed dermatophytes on the soles, interdigital spaces and/or toe nails. Gender, age and culture data were record from the laboratory workbooks.

RESULTS

716 patients were included, giving 1291 samples. The sex ratio M/F was 1.5 with a mean age of 48 years. Samples of toe nail were obtained from 591 patients, with plantar samples from 433 patients and intertrigo samples from 267 patients. Plantar dermatophytosis was seen in 66.6% of patients with interdigital-plantar signs, in 75.1% of those with ungual involvement and in 73.9% of cases involving both. T. rubrum was the most frequently isolated dermatophyte.

DISCUSSION

Combine involvement of the sole, nail and/or interdigital space was seen in more than 2/3 of cases. Despite the retrospective nature of our study and the evident bias, our results suggest that plantar dermatophytosis is common and should be sought. The sensitivity and specificity of clinical screening methods merit investigation in a prospective study.