Risk factors for development of acute laminitis in horses during hospitalization: 73 cases (1997–2004)

OBJECTIVE

To identify risk factors for development of acute laminitis in horses during hospitalization for illness or injury.

DESIGN

Retrospective case-control study.

ANIMALS

73 horses that developed laminitis (case horses) and 146 horses that did not develop laminitis (control horses) during hospitalization.

PROCEDURES

Case and control horses were matched in a 2:1 ratio by the date on which each horse was evaluated. Potential risk factors investigated included age, breed, and sex; highest and lowest values recorded during hospitalization for fibrinogen concentration, WBC count, PCV, and total solids concentration; and comorbid disease states, including pneumonia, endotoxemia, diarrhea, medically treated colic, surgically treated colic, pituitary adenoma, retained placenta or metritis, forelimb lameness, hind limb lameness, acute renal failure, and vascular abnormalities. A univariate screening of all potential risk factors was performed to determine which variables should be selected for further analysis. All factors found to be associated with development of laminitis were included in a multivariate conditional logistic regression model.

RESULTS

Development of laminitis was marginally associated with lowest and highest fibrinogen concentrations, highest PCV, and lowest total solids concentration and significantly associated with pneumonia, endotoxemia, diarrhea, abdominal surgery for colic, and vascular abnormalities. In the multivariate analysis, only endotoxemia was significantly associated with laminitis.

CONCLUSIONS AND CLINICAL RELEVANCE

Endotoxemia is an important risk factor for development of acute laminitis in horses during hospitalization for medical or surgical conditions. Early recognition of endotoxemia, or the potential for it to develop in certain disease states, and initiation of treatment directed at endotoxemia or its consequences may help prevent laminitis in horses during hospitalization.

Diabetes, hand and/or foot ulcers: a cross-sectional hospital-based study in Port Harcourt, Nigeria

OBJECTIVE

The study aimed to establish the prevalence of diabetes mellitus and the pattern of diabetic hand and foot ulcers in hospitalized adult patients in a teaching hospital in Port Harcourt, Nigeria.

RESEARCH DESIGN AND METHODS

All medical admission at the University of Port Harcourt Teaching Hospital between January 2000 and April 2001 were included in this cross-sectional study. Diabetes mellitus was diagnosed based on a fasting venous plasma glucose >or=7.0 mmol/l or a 2-h post-prandial venous plasma glucose level of >or=11.1 mmol/L using the glucose oxidase method. Data was processed for the 60 diabetic patients with limb ulcers excluding ulcers from major trauma.

RESULTS

The prevalence of diabetes mellitus was 38.1% (95% CI=34.8-41.4) among medical in-patients; while hand and foot ulcer was 19.1% among diabetic patients. The left lower limb ranked highest in ulcer involvement (32/60); hand ulcers were found in 5 cases (8.3%). Twenty (33.3%) of the patients had a previous limb ulcer. In 31 patients (51.7%) the ulcers evolved spontaneously without an identifiable cause (p-value=0.00). By Wagner's Grading System, Grade III lesions ranked highest (21/64).

CONCLUSIONS

A high prevalence of hand and foot ulcers was confirmed among patients with diabetics, which are common indications for hospitalization, and usually associated with long hospital stay with adverse outcomes including amputation and death. Diabetes education needs to be stepped-up, with emphasis on foot care and early presentation to hospital in the event of limb ulceration.

Evaluation of the efficacy of prophylactic hoof health examination and trimming during midlactation in reducing the incidence of lameness during late lactation in dairy cows

OBJECTIVE

To assess the efficacy of prophylactic hoof health examination and trimming during midlactation at reducing the incidence of lameness during late lactation in dairy cows.

DESIGN

Randomized field trial.

ANIMALS

333 Holstein cows.

PROCEDURES

Cows without apparent lameness were randomly allocated into 1 of 2 groups approximately 204 days after calving. Cows allocated to the treatment group (n = 161) were examined on a tilt table for diagnosis and underwent hoof-trimming procedures, if needed, for treatment of hoof disorders or lesions. Cows in the control group (n = 172) were not examined. Cows were assigned a locomotion score weekly for 28 weeks after allocation to a group. The number of cows classified as lame during late lactation (approx 205 to 400 days after calving) was compared between groups to assess the efficacy of prophylactic examination and trimming.

RESULTS

Incidence of lameness during late lactation was 24% in cows in the control group and 18% in cows in the treatment group.

CONCLUSIONS AND CLINICAL RELEVANCE

The 25% decrease in number of new cases of lameness in cows undergoing prophylactic hoof health examination and trimming during midlactation may be relevant for the well-being of dairy cows and should not represent a major economic burden to producers.

Acral lentiginous melanoma: a clinicoprognostic study of 126 cases

BACKGROUND

Although the histopathological subtype of melanoma has not been clearly proven to carry independent prognostic significance, acral lentiginous melanoma (ALM) seems to confer a poorer prognosis mainly because disease is often more advanced at the time of diagnosis.

OBJECTIVES

To investigate the distinctive epidemiological and clinical characteristics of ALM, a peculiar histological entity, and to identify prognostic factors.

METHODS

We performed a register-based review of cases from a single large referral centre, the University Hospital Department of Dermatology, Lyons, France. We reviewed patient demographics, the initial presentation of the lesion, and clinical outcome. ALM-specific and disease-free survival were estimated using the KaplanMeier method and compared using the log-rank test. A Cox model was used to identify prognostic factors.

RESULTS

One hundred and twenty-six patients were identified as having histopathology-proven ALM in our melanoma patient register from 1996 to 2004. There were 46 (37%) subungual ALM and 80 (63%) ALM on soles, palms and nonvolar sites. The mean age at diagnosis was 63 years. There were 44 (35%) men and 82 (65%) women, sex ratio M/F 1 : 1.86. The mean Breslow thickness was 2.51 mm (range: in situ to 20 mm). There was no evidence of overexposure to ultraviolet radiation, nor was there found a predisposing genetic trait. Only 16 (13%) patients recalled a history of trauma. Thirty-four ALM (28%) were unpigmented. The median ALM-specific and disease-free survival were 13.5 and 10.1 years, respectively. The 5-year survival rate was 76%. Multivariate analysis identified tumour thickness, male gender and amelanosis as independent clinical prognostic factors for both ALM-specific and disease-free survival.

CONCLUSIONS

Our study provides specific information on the clinical characteristics and outcome of this uncommon histological subtype of melanoma. However, the pathogenesis remains unknown. Breslow thickness, male gender and amelanosis were significantly associated with a poorer prognosis.

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

AIMS/HYPOTHESIS

Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries.

METHODS

The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October 2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection: A: PAD -, infection -; B: PAD -, infection +; C: PAD +, infection -; D: PAD +, infection +.

RESULTS

PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease. Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and more serious comorbidity.

CONCLUSIONS/INTERPRETATION

According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease. Further research is needed to obtain insight into the clinical outcome of these patients.

[Comparison of the effects of two walk-through footbaths on the prevalence of digital dermatitis and interdigital dermatitis on a commercial dairy farm]

This field trial was designed to evaluate the effect of treatment with copper chelate or formalin walk-through footbaths on the prevalence of digitalis dermatitis and interdigital dermatitis on a dairy farm. Although there was no difference in effect between the two types of footbath, the probability that interdigital dermatitis improved or remained stable was lower with the copper chelate footbath than with the formalin footbath.

The effect of trace mineral fortification level and source on performance of dairy cattle

Five hundred seventy-three cows, balanced by parity and 305-d mature equivalent at dry off, were assigned to 1 of 4 treatments: 1) 75% complexed trace minerals (CTM; 75C): Zn, Mn, Cu, and Co supplied at 75% of NRC (2001) guidelines by Zn-, Mn-, and Cu-specific AA complexes, and cobalt glucoheptonate; 2) 100% inorganic (100I): Zn, Mn, Cu, and Co supplied at 100% of NRC (2001) requirements by sulfate sources; 3) 100% complexed (100C): Zn, Mn, Cu, and Co supplied at 100% of NRC (2001) requirements by CTM; and 4) complexed/ inorganic (C/I): Zn and Cu supplied at 100% of NRC (2001) requirements using a combination of CTM and sulfates and Co and Mn supplied with sources at 9.1 and 3.3 times NRC (2001) requirements using a combination of CTM and sulfates. All percentages of Zn, Cu, Mn, and Co relative to NRC (2001) reflect supplemental contributions and do not include basal diet contributions. Experimental periods were dry period 1, full lactation 1, dry period 2, and 200 d into the subsequent lactation. Reproductive, health, and production information was collected during both lactations. Claw evaluations were conducted at trial start, 150 d into lactation 1, at the end of lactation 1, and 150 d into lactation 2. During lactation 1, C/I cows produced more milk, fat-corrected milk, energy-corrected milk, and fat than 100I cows. During lactation 2, yields of milk, fat-corrected milk, energy-corrected milk, fat, and protein were higher for 100C and C/I cows than for 75C or 100I cows. Fat percentage was highest for 100C cows with no treatment effect on protein content. During lactations 1 and 2, C/I cows had fewer days to first estrus than cows receiving the other treatments. During lactation 2, C/ I cows had fewer services per conception and days open. There were no significant effects of treatment on health. White line separation incidence was lower for 100I cows than 75C cows, whereas heel erosion was higher for the 100I cows than for the C/I cows. Fortification of trace elements with inorganic and complexed sources at or above NRC requirements improved reproductive and productive performance. In addition, cows can be supplemented with CTM at 75% of NRC requirements with no reduction in performance compared with supplementing at 100% of NRC requirements using only sulfate sources of Zn, Mn, Cu, and Co.

Lameness and fertility of sows and gilts in randomly selected loose-housed herds in Finland

The prevalence of lameness among 646 sows and gilts in 21 selected herds was determined; 8.8 per cent of the animals were lame and the most common clinical diagnoses were osteochondrosis, infected skin lesions and claw lesions. The lame animals had higher serum concentrations of haptoglobin and C-reactive protein than the sound animals. Animals housed on slatted floors had twice the odds of being lame and 3.7 times the odds of being severely lame than animals housed on solid floors. Yorkshire pigs had 2.7 times the odds of being lame than Landrace or crossbred animals. Higher parity and the use of roughage decreased the odds of the sows not becoming pregnant; however, lameness was not a risk factor for non-pregnancy.

The effect of pre-calving environment on the development of digital dermatitis in first lactation heifers

Digital dermatitis is commonly reported to be most severe in first lactation heifers. It has been suggested that this initial infection is followed by the development of a limited immunity to the organisms which cause digital dermatitis. If this is the case then exposure to digital dermatitis prior to calving should reduce its severity after calving. A study was undertaken to examine whether such exposure significantly affected the development of digital dermatitis post-partum. Twelve weeks prior to calving, 60 Holstein heifers were blocked on the basis of their antibody titre to Borrelia burgdorferi and randomly allocated to one of three pre-calving environments: clean straw, used straw or cubicles. There was no significant effect of pre-calving environment on the development of digital dermatitis after calving indicating that "exposure" pre-calving did not reduce the development of digital dermatitis after calving. The most important factors determining the development of digital dermatitis after calving were presence of absence of visible lesions of digital dermatitis at Week-12 and at calving.

Interdigital skin lesions of the lower limbs among patients with lymphoedema in an area endemic for bancroftian filariasis

OBJECTIVES

An estimated 15 million persons suffer from lymphoedema of the leg in filariasis-endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces ('interdigital skin lesions'). Little is known about the epidemiology of these skin lesions or about patients' awareness of them.

METHODS

We interviewed and examined 119 patients (89% women) with lymphoedema of the leg in Recife, Brazil, an area endemic for bancroftian filariasis.

RESULTS

We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5 lesions per patient, range 0-8). The number of interdigital skin lesions was significantly associated with lymphoedema stage (P<0.001) and frequency of ADLA (P<0.0001). Only 20 (16.8%) patients detected their own interdigital skin lesions or considered them abnormal. Patients reported a mean of 3.6 ADLA episodes during the previous 12 months (range, 0-20); reported ADLA incidence was associated with lymphoedema stage (P<0.0001) and the number of interdigital skin lesions detected by the examining physician (P<0.0001).

CONCLUSIONS

These data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas are unaware of their presence or importance. Prevention of ADLA through prompt recognition and treatment of interdigital skin lesions will require that patients be taught to identify lesions, especially between the toes and to recognize them as abnormal.

[Disease monitoring in European mouflon (Ovis gmelini musimon) populations by clinical blood tests--aspects of epidemiology and treatment control of claw diseases]

European mouflon are in the focus of research since they were brought from the Tyrrhenic islands to the European mainland a hundred years ago. From the beginning many populations on European mainland suffer from different claw diseases which are unknown in their original habitats. Foot rot, the ovine purulent laminitis, whose existence im wild ruminants was negotiated some years before, furthermore claw alterations caused by primary or secondary lack of trace elements similar to the copper deficiency syndrome of the boreal deer species moose and reindeer and finally horn hyperplasia with a genetic background are found as main claw diseases in Central Europe. Object of this study was the acquiring of clinical parameters from blood for the installation of a mouflon-specific diagnostic profile "claw diseases". Count of leucocytes (WBC), activity of Alkaline phosphatase, serum contents of phosphorus, iron, copper and zinc were found to be parameters for successful differential diagnosis and control of progress in cure programs.

Intra- and inter-observer agreement of a protocol for clinical examination of dairy cows

In 2004,five veterinarians examined 283 dairy cows from four Danish dairy herds and independently assigned scores for the clinical signs lameness, hock lesions and other cutaneous lesions to each cow using a clinical protocol. We evaluated the inter-observer and the intra-observer agreement using prevalence-adjusted, bias-adjusted kappa (PABAK). We chose two different cut-offs between the ordinal scores for classifying cows as healthy or diseased for each of the clinical signs, and we compared the ability of the observers to discriminate between healthy and diseased cows for the two cut-offs. Without any formal training of the observers we found PABAK in the range 0.36-0.88 and we concluded that the choice of cut-off had an effect on the observed agreement among the observers.

Herd- and cow-level prevalence of digital dermatitis in the Netherlands and associated risk factors

The objective of this cross-sectional study was to reevaluate the prevalence of digital dermatitis (DD) and associated risk factors in The Netherlands. Between May 2002 and December 2003, information about the presence or absence of DD lesions and other claw disorders on the hind claws of dairy cows in The Netherlands was collected by 20 hoof trimmers during trimming of all dairy cows in 383 herds. A questionnaire was used to acquire information regarding management and housing. Additional information, such as parity, breed, and stage of lactation of the cows, was provided by the Dutch Herd Book Organization. Digital dermatitis was present in 21.2% (SE = 0.3) of the study population (n = 22,454 cows). The herd prevalence varied from 0% (9.1% of the herds) to 83.0%. Most common was herd prevalence between 5 and 10%. The Holstein-Friesian breed was at higher risk for DD [odds ratio (OR) = 1.7] than was the Meuse Rhine IJssel breed (dual purpose breed). The risk for DD decreased with increasing parity. Cows at the peak of their lactation (30 to 60 d in milk) and in the third parity had higher odds for DD in comparison with cows that were later than 60 DIM. The presence of other claw disorders, such as interdigital dermatitis/heel horn erosion (IDHE), interdigital hyperplasia (HYP), and interdigital phlegmon, appeared to be predisposing for DD. Based on estimation of the population-attributable fraction, it was concluded that if IDHE, HYP, and interdigital phlegmon were not present among the study population, respectively, 32.2, 9.0, and 1.1% of the DD cases could have been prevented. The risk for DD slightly decreased when cows affected by IDHE had access to pasture. Because of the interrelation between infectious claw disorders, an effective intervention strategy against DD should focus on an integrated approach to the control of all infectious claw diseases. Cows trimmed >12 mo before the study (during regular trimming of the entire herd) were at lower risk for DD than were cows that were trimmed at shorter intervals. Animals that had >8 h of access to pasture were at higher risk for DD (OR = 1.6) compared with no access to pasture. Finally, cows in small-sized herds (<45 cows) affected with HYP were at lower risk (OR = 0.6) for DD than were cows affected with HYP in medium- and large-sized herds (60 to 85 cows per herd).

Effects of frequency and duration of outdoor exercise on the prevalence of hock lesions in tied Swiss dairy cows

Injuries around the tarsal joint are common in dairy cows kept in tie stalls. This study investigated the influence of the frequency and duration of outdoor exercise on the prevalence of hock lesions in tied Swiss dairy cows. Over a 1-year period (from January to December), cows on 66 farms were examined a total of six times (once every 2 months) for the number and severity of hock lesions (hairless patches, scabs and open wounds, swellings). The prevalence of scabs and wounds (mean 2.1 scabs per cow and farm, range 0.3-4.1) was negatively associated with the duration of outdoor exercise, and positively associated with its frequency. It was also significantly affected by the time of visit and the type of bedding (straw being better than other materials). With increasing length of the lying area, the prevalence of scabs and wounds decreased. Based on the interpretation of the final model, it is suggested that a minimum of 50h spent outdoors over a 4-week period is necessary to have a marked result on the prevalence of hock lesions.

Lameness and claw lesions of the Norwegian red dairy cattle housed in free stalls in relation to environment, parity and stage of lactation

Approximately 88% of Norwegian dairy cattle are housed in tie stalls. Free stall housing for all dairy cattle will be implemented within 20 years. This means that the majority of existing stalls will be rebuilt in the near future. Fifty-seven free stall herds of the Norwegian Red breed were randomly selected and 1547 cows and 403 heifers were trimmed by 13 claw trimmers during the late winter and spring of 2002. The claw trimmers had been taught diagnosing and recording of claw lesions. Environment, management- and feeding routines were also recorded. Fifty-three herds had concrete slatted alleys while 4 had solid concrete. Thirty-five herds had concrete as a stall base, while 17 had rubber mats, 2 had wood and 3 had deep litter straw beds. The prevalence of lameness was 1.6% in hind claws. Models for lameness and claw lesions were designed to estimate the influence of different risk factors and to account for the cluster effects within herd and claw trimmer. Detected risk factors for lameness were: parity three and above and narrow cubicles; for heel horn erosions: lactation stage around 5–7 months after calving and solid concrete alleys; for haemorrhages of the white line: lactation stage around 3–5 months after calving and solid concrete alleys; for haemorrhages of the sole: parity one, lactation stage around 5–7 months after calving and short cubicles, for white line fissures: slatted concrete alleys; for asymmetrical claws: parities two and above and for corkscrewed claws: solid concrete alleys. The prevalence of lameness in heifers was low, however 29% had one or more claw lesions. Heifers that were housed in pens or free stalls had more heel-horn erosions, haemorrhages of the sole and white-line fissures than heifers in tie stalls. As new free stalls are being built, it is important to optimise the conditions for claw health.

Claw trimming routines in relation to claw lesions, claw shape and lameness in Norwegian dairy herds housed in tie stalls and free stalls

We assessed the prevalence of claw lesions, abnormal claw shapes and lameness in relation to most-recent claw-trimming routines in Norwegian dairy herds housed in tie stalls and free stalls. Equal-sized groups were randomly sampled from both tie and free stalls in each of the three most animal-dense regions in Norway. The study population consisted of 2551 cows of the Norwegian Red breed housed in 54 tie stalls and 52 free stalls. Fourteen educated claw trimmers performed claw trimming and recording of claw lesions once during the spring of 2002. A multivariable model including cluster effects and individual-cow factors was fit for each claw lesion and abnormal claw shape. In tie-stall herds with routine trimming 39.9% of the cows had one or more lesions or abnormal shapes in front or hind claws versus 52.8% in herds with no routine trimming. Hind-claw results in tie stalls with concrete stall base: herds trimmed occasionally had more haemorrhages of the white line (OR=2.8) and corkscrewed hind claws (OR=3.6) versus herds trimmed routinely; herds never trimmed had more heel-horn erosions (OR=2.6) versus herds trimmed routinely and less haemorrhages of the white line (OR=0.3) and the sole (OR=0.2) versus herds trimmed occasionally. In free-stall herds with routine trimming 76.8% of the cows had one or more lesions or abnormal shapes in front or hind claws versus 68.9% in herds with no routine trimming. Hind-claw results in free stalls with concrete stall base: herds never trimmed had less haemorrhages of the white line (OR=0.3) and the sole (OR=0.3) versus herds trimmed routinely; and also less haemorrhages of the white line (OR=0.3) and white-line fissures (OR=0.3) versus herds trimmed occasionally. Hind-claw results in free stalls with rubber-mat stall base: herds trimmed occasionally had less heel-horn erosions (OR=0.5) and more dermatitis (OR=5.4) versus herds trimmed routinely. The routine claw trimming performed in Norwegian free stalls has not had the desired effects on claw lesions and abnormal claw shapes. Routine trimming in tie stalls, however, seems to have prevented claw disorders.

Intra-class correlation attributable to claw trimmers scoring common hind-claw disorders in Dutch dairy herds

Data of a cross-sectional study on prevalence of seven common bovine-claw disorders were used to calculate the intra-class correlation coefficients (ICCs) for claw trimmers. Fifteen professional claw trimmers were trained in diagnosing claw disorders uniformly. During regular trimming of all dairy cows in a herd, they recorded the presence (yes/no) of hind-claw disorders for digital dermatitis (DD), chronic laminitis (CL), sole ulcer (SU), white-line disease (WLD) and interdigital hyperplasia (HYP). For the claw disorders interdigital dermatitis/heel-horn erosion (IDHE) and sole haemorrhage (SH), claw trimmers also recorded (using graduated scores 1-3) the extent of the lesion. Complete information of 21,153 animals from 361 herds in The Netherlands was recorded between July 2002 and December 2003. To assure objective recording of claw disorders, ideally there would not be any correlation between observations. However, quantified ICCs from claw-trimmers observations ranged from 4.9% for DD to 38.0% for CL, while ICCs for herd ranged from 7.9% for SU to 26.7% for DD. Changes in the cut-off values for the diagnosis of IDHE and SH did not result in any relevant changes of the ICCs from claw-trimmers observations and these remained larger than the ICC explained by the herd. Based on these results, we conclude that for estimating measures of frequencies for different claw disorders, uniformity in recording certain diagnoses becomes an issue to consider when involving more than one observer.

Foot pain in community-dwelling older people: an evaluation of the Manchester Foot Pain and Disability Index

OBJECTIVES

The objectives of this study were (i) to examine the psychometric properties of the Manchester Foot Pain and Disability Index (MFPDI) in community-dwelling older people, and (ii) to determine the correlates of disabling foot pain in this age-group.

METHODS

A questionnaire consisting of medical history, the MFPDI, the Goldberg Anxiety and Depression Scale (GADS) and the Medical Outcomes Study Short Form 36 (SF-36) was administered to a sample of 301 community-dwelling people (117 men, 184 women) aged between 70 and 95 yr (mean 77.2, s.d. 4.9), who also underwent a clinical assessment of foot problems.

RESULTS

Using the MFPDI case definition, 108 people (36%) were found to have disabling foot pain. Within this subgroup, the MFPDI had high internal consistency (Cronbach's alpha=0.89). Principal components analysis revealed a four-factor structure representing the constructs of functional limitation, pain intensity, concern about appearance, and activity restriction, which explained 62% of the variance in the original items. Participants with disabling foot pain were more likely to report pain in the back, hips, knees and hands or wrists, and exhibited flatter feet and less range of motion in the ankle joint. The MFPDI and its subscales were significantly associated with scores on the GADS depression subscale and the general health and mental health components of the SF-36.

CONCLUSIONS

These findings confirm the high prevalence of disabling foot pain in older people, and suggest that the MFPDI is a suitable tool for assessing foot pain in this population.

Prevalence of claw lesions in Norwegian dairy cattle housed in tie stalls and free stalls

Approximately 88% of Norwegian dairy cattle are housed in tie stalls. Free-stall housing will be implemented for all cattle within 20 years. This means that most existing barns have to be rebuilt in the near future. We designed our study to estimate the prevalence of claw lesions in Norway and to reveal possible differences between tie stalls and free stalls. Fifty-five tie-stall herds and 57 free-stall herds were sampled by computerized systematic selection and 2665 cows were trimmed by 13 claw trimmers, during the late winter and spring of 2002. The claw trimmers had been taught diagnosing and recording of claw lesions. Environmental factors, management and feeding routines also were recorded. Forty-eight percent of cows housed in tie stalls had one or more claw lesions versus 71.8% in free stalls. Prevalences recorded in the hind claws were: 4.2% of the animals had dermatitis in tie stalls versus 5.7% in free stalls; 7.9% versus 38.0% had heel-horn erosions; 7.3% versus 13.6% had haemorrhages of the white line; 11.7% versus 20.4% had haemorrhages of the sole; 2.8% versus 3.2% had sole ulcers and 5.5% versus 9.7% had white-line fissures. Most lesions were mild. A model was designed to estimate cluster effects within herd and within claw trimmer. The cluster effect within herd was significant for all lesions. The cluster effect within claw trimmer was only significant for heel-horn erosions in front and hind claws and for white-line fissures in front claws. Agreements between some of the claw lesions were revealed. The study confirms that in Norwegian dairy cattle, most claw lesions are more prevalent in free stalls than in tie stalls.

Tie-Stall Design and its Relationship to Lameness, Injury, and Cleanliness on 317 Ontario Dairy Farms

The objective of this study was to identify relationships between tie-stall design and selected cow-based injury, lameness, and cleanliness measurements. All lactating dairy cows (n = 17,893) from 317 Ontario tie-stall dairy farms were evaluated once between March and September 2003. Stall dimensions were recorded and cows were scored for neck and hock lesions, broken tails, back arch, hind claw rotation, and udder and hind limb cleanliness. Neck lesions were significantly associated with tie-rail height. Hock lesions were positively associated with presence of an electric trainer and hind limb and udder cleanliness and negatively associated with tie-chain length. A negative association was found between broken tails and tie-rail height and a positive association between broken tails and udder and hind limb cleanliness. As mean stall length increased, fewer cows had hind-claw rotation. Having more dirty cows was associated negatively with stall length and chain length, and positively associated with the presence of an electric trainer. Proportion of cows with clean udders increased with the percentage of cows with clean hind limbs and with tie-rail height. As the prevalence of clean udders increased the prevalence of broken tails decreased. This study provides insight into how tie-stall dimensions may influence aspects of dairy cow welfare. Application of these principles could improve tie-stall design.

Foot musculoskeletal disorders, pain, and foot-related functional limitation in older persons

OBJECTIVES

To examine whether common musculoskeletal disorders of feet are associated with pain and foot-related functional limitation.

DESIGN

A cross-sectional study using stratified random sampling.

SETTING

A residential community.

PARTICIPANTS

Ethnically diverse sample of elderly persons (n=784).

MEASUREMENTS

Foot disorders (hallux valgus/bunion, pes planus (flat foot), pes cavus (high arch), hammertoe, mallet toe, claw toe, overlapping toes, bunionette, and plantar fasciitis), foot pain, the foot health functional status (FHFS, range 0-100, 100=no problems) scale, and walk time score (range 0-4, 4=fastest).

RESULTS

Most commonly assessed musculoskeletal disorders, including hallux valgus and toe deformities, were not associated with pain or function limitation. Plantar fasciitis and, to a lesser extent, pes cavus were associated with worse FHFS scores; foot pain partially explained this association. Neither foot disorders nor foot pain were significantly associated with slower walk times.

CONCLUSION

Many foot disorders had little relationship with foot pain or function and may not require clinical attention when asymptomatic. Risk factors and preventive and therapeutic interventions for plantar fasciitis require further longitudinal investigation.

Osteomyelitis of the foot and toe in adults is a surgical disease: conservative management worsens lower extremity salvage

OBJECTIVE

To characterize the national epidemiology of adult osteomyelitis (OM) and, using a single institutions' experience, test the hypothesis that early surgical therapy as compared with antibiotics alone results in an improved chance of wound healing and limb salvage.

BACKGROUND

Foot and digit OM is a very common problem for which management is variable and for which few guidelines exist.

METHODS

The Nationwide Inpatient Sample (NIS) and a single institution review from 1993 to 2000 form the basis of this study, using ICD-9CM codes for lower extremity foot and digit OM. Demographics, risk factors, and treatments were analyzed against the outcomes of a healed wound, limb salvage, and death.

RESULTS

The NIS included 51,875 patients (incidence = 9/10,000 patients per year) with a mean age of 60 years, and 59% were men. The median length of stay decreased from 9 to 6 days (P < 0.001), but the average admission charge of 19,000 dollars did not significantly decrease over 7 years. Of these patients, 23% underwent a digit amputation and 8.5% suffered proximal limb loss. Single-institution analysis of 237 consecutive patients with OM confirmed a similar mean age (58 years), gender (67% men), and most presented with a foot or digit ulcer (56%). Wound healing was achieved in 56% and overall limb salvage was 80%. Decreased wound healing was associated with peripheral vascular occlusive disease (odds ratio, 0.4; 95% confidence interval, 0.2-0.8, P = 0.006) and preadmission antibiotic use (odds ratio, 0.2; 95% confidence interval, 0.05-1.1, P=0.07), while surgical debridement (odds ratio, 2.2; 95% confidence interval, 1.2-4.2, P = 0.02) was associated with increased healing. Limb salvage was improved with an arterial bypass (odds ratio, 3.9; 95% confidence interval, 1.1-14, P = 0.04), while preadmission solid organ transplant (odds ratio, 0.37; 95% confidence interval, 0.14-0.96, P = 0.04), peripheral vascular occlusive disease (odds ratio, 0.25; 95% confidence interval, 0.12-0.5, P = 0.001), and preadmission antibiotic use (odds ratio, 0.34; 95% confidence interval, 0.15-0.77, P = 0.009) were associated with greater limb loss.

CONCLUSION

Digit OM is an expensive and morbid disease. Aggressive surgical debridement/digit amputation and selected use of arterial bypass should improve wound healing and limb salvage, respectively. In contrast, antibiotic therapy alone is associated with decreased wound healing and limb salvage.

[The development of verrucous pastern dermatitis syndrome in heavy draught horses. Part I: Review of the literature]

Verrucous pastern dermatitis is a chronic hyperplastic dermatopathy of the feet of horses which is characterized by a greasy, odorous coating of the skin and, in advanced stages, by clearly demarcated calluses and wart-like proliferations. The disease occurs almost exclusively in cold-blooded and other heavy horses, with certain breeds affected most frequently. It is considered a distinct disease entity within the framework of pastern dermatitis syndrome. There is no consensus in the literature about relationship of the disease to the sex and age of the horse. Horses with a high cannon circumference and pronounced fetlock tufts of hair seem to be affected most severely. In chiefly anecdotal reports the cause of the disease or its aggravation has been ascribed to housing conditions and environmental influences, chemicals, mechanical insults, feeding, or infections with Chorioptes skin mites. It thus seems likely that the disease is affected by a variety of factors. Although verrucous pastern dermatitis has been known for hundreds of years, its etiology and pathogenesis remain unclear.

The effects of foot disease on quality of life: results of the Achilles Project

BACKGROUND

Foot diseases have a high prevalence in the general population, but their impact on quality of life has not been assessed in large-scale studies. The Achilles Project surveyed foot disease in patients visiting their primary care physician or dermatologist.

METHODS

A total of 43 593 patients were asked about the impact of their condition on their quality of life: pain, discomfort in walking, limitations in daily activities, and embarrassment.

RESULTS

Overall, 52.5% of patients had some aspect of their quality of life affected by their foot disease. More specifically, 30.7% of patients experienced pain, 40.3% had discomfort in walking, 19.6% had their daily activities limited, and 27.3% were embarrassed. The survey indicated a larger impact of foot disease on the quality of life of women vs. men in all categories, except for daily activities. Similarly, the elderly (> or = 65 years) were more affected by their foot disease, although they suffered no more embarrassment than other age groups. Participation in sports seemed to lower the proportion of patients who had their quality of life adversely affected. Non-fungal foot diseases, particularly ulcer and gangrene, are more likely to cause pain, discomfort in walking and limit daily activities, than fungal diseases.

CONCLUSIONS

In general, non-fungal foot diseases caused pain, discomfort in walking and limitations in daily activities in more patients than fungal foot diseases, but a higher proportion of patients with fungal foot diseases were embarrassed by their condition than patients with non-fungal foot diseases. The study found that the impact of foot disease on quality of life may be greater than previously suggested. Given that effective treatments are available, routine examination of patients' feet by dermatologists and primary care physicians may help to reduce the burden of these foot conditions.

The association of radiographic foot osteoarthritis and radiographic osteoarthritis at other sites

OBJECTIVE

To quantify the association between radiographic foot osteoarthritis (OA) and radiographic OA at four joints: second distal interphalangeal (DIP), third proximal interphalangeal (PIP), first carpometacarpal (CMC), and the knee.

METHODS

Data collected for the Clearwater Osteoarthritis Study (COS) were analyzed (N=3436). The study outcome was first metatarso-phalangeal joint (first MTP) OA status. The predictor variables were second DIP, third PIP, first CMC, and knee OA. The Kellgren and Lawrence scale determined OA status. The strength of the association between foot OA and other sites was further explored by unilateral and bilateral categories.

RESULTS

For both genders, we found a significant, positive relationship between grade 2+ foot OA and second DIP, third PIP, first CMC, and knee OA. This relationship maintained its significance after adjustment for age, body mass index, and occupational history. Adjusted odds ratios ranged from 3.2 for the second DIP joint (P<0.0001) to 3.7 for the knee joint (P<0.0001). Relative to unilateral joint disease, co-existing bilateral disease yielded a significantly elevated risk for foot OA for all joints examined. While other studies have not specifically examined co-occurrence with foot OA, our findings are consistent with results from related studies.

CONCLUSIONS

There is a dearth of studies exploring foot OA. Our findings support the theory of a systemic etiology involved in the development of OA. Future epidemiological studies that further distinguish the relationship between OA at differing sites will provide an enhanced ability to describe the respective influences of mechanical and systemic factors in the development of this disease.