[Is there a lasting effect of functional claw-trimming on claw conditions?]

The influence of regular claw-trimming on the occurrence and prevalence of claw disorders was examined on a total of 164 dairy cows (Simmental, Red Friesian, Holstein Friesian). Ten dairy farms in the Austrian province of Salzburg were used for this study. Three examinations of the claws were carried out with an interval of six months in between to find out claw disorders. The results were recorded according to a claw scoring system. The claw scores were in the range of other studies using the same scoring system. The median of the claw scores at the beginning of the study was 27 in the tied stall group compared with 37 in the loose housing group, remaining at that level in the first group and falling to 25 in the second group. All in all, the positive effect of regular claw trimming was more pronounced in the loose housing group than in the tethered housing group.

Foot problems in older patients: a focused podogeriatric assessment study in ambulatory care

This study sought to demonstrate the prevalence of foot conditions in older individuals and their association with chronic risk diseases such as diabetes mellitus, peripheral arterial disease, and arthritis, and to develop care plans to reduce complications from local foot problems and chronic diseases. One thousand individuals older than 65 years who were ambulatory and not institutionalized underwent a standardized and validated podogeriatric examination assessment protocol or index. Overall, 74.6% of all patients had a history of pain, 57.2% were receiving current care for diabetes mellitus, 22.9% indicated current care for peripheral vascular disease, 94.2% had onychodystrophy, 64.2% had one or more foot deformities, 64.0% demonstrated some loss of protective sensation, and 81.7% had one or more symptoms and signs of peripheral arterial insufficiency. These findings demonstrate that foot problems in the older population result from disease, disability, and deformity related to multiple chronic diseases as well as changes associated with repetitive use and trauma. Older people are at a high risk of developing foot-related disease and should receive continuing foot assessment, education, surveillance, and care.

Distal lower extremity sarcomas: frequency of occurrence and patient survival rate

BACKGROUND

Primary sarcomas in the distal leg, tibia, fibula, ankle, and foot are uncommon and are believed to be less malignant than those that arise in other sites, but only limited information is available to support this contention.

METHODS

Using a computerized system containing extensive information regarding over 14,000 patients, mostly with tumors treated by our center over a 25-year period, 175 sarcomatous lesions with MSTS stage I, II, and III were located in the distal lower extremity. These were compared with 2367 lesions of similar diagnoses in other body parts. The principal studies included diagnostic distribution and outcome (recorded as death as a result of disease). Data were compared for diagnosis, gender, age, Musculoskeletal Tumor Society (MSTS) stage, anatomic site, and treatment methods and evaluated statistically by chi-square methods.

RESULTS

The most frequent distal lower limb tumors were synovial cell sarcoma, osteosarcoma, and Ewing's tumor and the percentage distribution of the various tumors for that site as compared with the rest of the body was quite different. Of even more importance was the remarkable difference in outcome with the death rate for the lower limb tumors set at 10%, while the same tumors at other sites had a death rate of 27% (p <.000002). Furthermore, gender, stage, age, and the type of operative procedure showed highly significant differences between the tumors of the lower leg and those of the remainder of the body.

CONCLUSIONS

On the basis of these data, it is evident that far fewer sarcomas occur in the lower leg, tibia, fibula, ankle, and foot than in other body sites and that their diagnostic distribution is different. Of perhaps greater interest is the fact that the rate of metastasis and death is markedly reduced for this site as compared with others. The authors speculate on the causes of this remarkable alteration in numbers and outcome.

Podiatric problems are associated with worse health status in persons with severe mental illness

The objective of this study was to determine the prevalence of self-reported podiatric impairments and their effect on health status in persons with severe mental illness. A sample of psychiatric outpatients (N=309) underwent interviews assessing medical conditions and health status with the Medical Outcomes Study Short Form-36 (SF-36). Podiatric health was assessed using nine items from the National Health Interview Survey (NHIS). Eighty percent of patients reported at least one podiatric problem. The most common problems were foot pain (48%), nail disorders (35%) and corns/calluses (28%). Prevalence rates were 4-11 times higher than those reported by the general population in the 1990 NHIS. The total number of podiatric problems was inversely related to eight self-reported health status domains and both summary SF-36 scores (all P<==.0001). After controlling for sociodemographic factors, psychiatric illness and medical conditions, the total number of podiatric limitations remained significantly associated with lower patient ratings in four of the eight SF-36 domains and both summary scores. We concluded that persons with severe and persistent mental illness have markedly elevated rates of podiatric problems when compared to the general population group. These problems are associated with worsened self-perceived health status. Addressing podiatric health may be a successful way to improve the overall health of this population.

Associations of sole ulcer at claw trimming with reproductive performance, udder health, milk yield, and culling in Swedish dairy cattle

The association between sole ulcer found at routine claw trimming 2-6 months after calving and reproductive, health and productive traits in the same lactation, was investigated in an observational study of 2368 dairy cows in 102 Swedish herds. The data were analysed by mixed multivariable linear-, logistic- and Poisson-regression modelling at the cow level, accounting for clustering within herd. Associations were found between sole ulcer and first-service conception risk in the first study year (OR 0.59), calving interval (2% longer), treatment for anoestrus (OR 1.61), and 305-day milk yield (479 kg ECM higher). No associations could be shown between sole ulcer and first-service conception risk in the second study year, the number of services per conception, clinical mastitis, high milk somatic-cell counts or culling.

Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis

OBJECTIVE

To determine prevalence and clinical features of pituitary pars intermedia dysfunction (PPID) in horses with laminitis.

DESIGN

Case series.

ANIMALS

40 horses with laminitis.

PROCEDURES

Horses with laminitis that survived an initial episode of pain and were not receiving medications known to alter the hypothalamic-pituitary-adrenal axis were tested for PPID by evaluation of endogenous plasma ACTH concentration. Signalment, suspected cause, month of onset and duration of laminitis, Obel grade of lameness, pedal bone rotation, physical examination findings, results of endocrine function tests, treatment, outcome, and postmortem examination findings were recorded.

RESULTS

Prevalence of PPID as defined by a single high plasma ACTH concentration was 70%. Median age of horses suspected of having PPID (n = 28) was 15.5 years, and median age of horses without PPID (12) was 14.5 years. Laminitis occurred most frequently in horses with and without suspected PPID during September and May, respectively. Chronic laminitis was significantly more common in horses suspected of having PPID. In horses suspected of having PPID, the most common physical examination findings included abnormal body fat distribution, bulging supraorbital fossae, and hirsutism. Five horses suspected of having PPID had no clinical abnormalities other than laminitis. Seventeen horses suspected of having PPID that were treated with pergolide survived, and 3 horses that were not treated survived.

CONCLUSIONS AND CLINICAL RELEVANCE

Evidence of PPID is common among horses with laminitis in a primary-care ambulatory setting. Horses with laminitis may have PPID without other clinical signs commonly associated with the disease.

Prevalence of foot and ankle conditions in a multiethnic community sample of older adults

The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.

[Analysis of the prevalence of pastern dermatitis in German Coldblood horse breeds]

The prevalence of pastern dermatitis was investigated in 917 German Coldblood horses aged 2.5 to 26 years. Pastern dermatitis was prevalent in Black Forest Draught horses with 47.5% and in South German Draught horses with 58.5%. High prevalences were found in Mecklenburg (76.4%), Saxon-Thuringa (84.3%), Schleswig (86.0%), and Rhenisch German Coldblood (96.1%) horses. All four legs or both hind legs were affected most frequently. The most prevalent forms of pastern dermatitis were crusted and hyperkeratotic-hyperplastic. The occurrence of pastern dermatitis was dependent of age. The statistical analysis using a generalized linear model and a probit function showed the significant influence of the breed, age at examination, sex, position of the leg, interaction of breed by age at examination, and breed by position of the leg. So the analysis indicated that pastern dermatitis is a serious problem in all German Coldblood breeds investigated here.

High prevalence of foot diseases in Europe: results of the Achilles Project

OBJECTIVE

To provide an insight into the prevalence of foot disease in Europe, and to include an assessment of the prevalence of predisposing factors and their correlation with foot disease.

DESIGN

Large population-based survey conducted in 16 European countries.

SETTING

The project consisted of two parts (study I and study II), in which all patients presenting to general practitioners and dermatologists over a defined time period were invited to participate. Patients. In study I, 70,497 patients presenting to dermatologists or general practitioners were recruited, and in study II 19,588 patients presenting to dermatologists were recruited.

MAIN OUTCOME MEASURE

The feet of all participants were examined for signs of foot disease. The assessors also recorded relevant details such as the age and sex of patients, and the presence of predisposing factors for foot disease. In addition, patients in study II were offered a free mycological examination of the toenails and skin on the feet.

RESULTS

In study I, 57.0% of patients had at least one foot disease. In study II, 61.3% had at least one foot disease. The proportions of patients with fungal foot disease and non-fungal foot disease in study I were 34.9% and 38.4%, respectively, and in study II were 40.6% and 41.7%, respectively. Orthopedic conditions and metatarsal corns were the most frequently reported non-fungal foot diseases, and onychomycosis and tinea pedis were the most frequently observed fungal infections.

CONCLUSIONS

This large-scale survey suggests that the prevalence of fungal and non-fungal foot disease is higher than previously estimated.

Feeding regimen and enzyme supplementation to rye-based diets for broilers

A trial was conducted to study the influence of feeding regimen [ad libitum, (AL) vs. feed restriction, (FR)] and supplementation of the diet with a combination of xylanase and beta-glucanase on physiological parameters and performance of broilers fed rye-based diets. There were 4 dietary treatments arranged factorially with 2 feeding regimens (0 vs. 30% FR from 4 to 14 d), 2 enzyme doses (0 vs. 500 ppm), and an additional corn control diet. Each treatment was replicated 9 times from 4 to 25 d (15 chicks caged together) and 6 times from 25 to 46 d. From 4 to 46 d of age, FR did not affect weight gain and improved feed conversion of broilers (P < 0.05). Also, FR reduced the incidence of leg disorders, digesta viscosity, and pasted vents (P < 0.01) and increased relative weight of gizzard (P < 0.001). Enzyme supplementation (ES) improved average daily gain and feed conversion at all ages (P < 0.01), and the beneficial effects were greater for AL than for FR birds (P < 0.10). Also, ES reduced digesta viscosity (P < 0.001), relative weights of gizzard (P < 0.05) and crop (P < 0.01), and jejunum length (P < 0.05). Compared with feeding corn, feeding rye AL with or without ES impaired growth and feed conversion from 4 to 46 d (P < 0.01) and increased incidence of leg disorders (P < 0.05), viscosity of jejunum content (P < 0.01), and jejunum length (P < 0.05). We concluded that rye in feed impaired broiler performance and increased digesta viscosity and incidence of leg disorders and that FR and ES reduced the magnitude of the problem. The beneficial effects of ES on bird performance were more evident when birds were fed AL.

The prevalence of symptoms of sensorimotor and autonomic neuropathy in Type 1 and Type 2 diabetic subjects

The aim of this study was to analyze the prevalence and severity of sensorimotor and autonomic neuropathic symptoms within an outpatients diabetic population. A total of 350 consecutive Type 1 (26.9%) and Type 2 diabetic subjects were investigated using the Michigan Neuropathy Screening Instrument (MNSI). The original questionnaire was extended with questions on autonomic neuropathy and to include a six-point scale to rate the severity of symptoms, which were recorded accurately in order to avoid overrating. More than one half of Type 2 and nearly a third of Type 1 diabetic subjects suffer from at least one neuropathic symptom; the former suffered significantly more often from paresthesia (P<.05) and burning pain (P=.05). Less than 10% of the study population had autonomic symptoms. The prevalence of symptomatic polyneuropathy (PNP), diagnosed by an abnormal MNSI together with the presence of any symptom, was 16.0% in Type 1 and 37.5% (P<.001) in Type 2 diabetic subjects. Subjects with an abnormal ankle reflex (54.6%) had in 48.2% any sensorimotor, in 35.1% any autonomic, and in 25.7% any sensorimotor plus autonomic symptoms. The corresponding percentages for subjects with an abnormal vibration perception threshold (VPT; 28.9%) were 59.4%, 46.5%, and 34.7%, respectively. An abnormal ankle reflex was significantly correlated to numbness, and to the the sum of sensorimotor and autonomic symptoms. An abnormal vibration perception was significantly correlated to numbness, to paresthesia pain, and to the sum of sensorimotor and autonomic symptoms. A higher percentage of Type 2 diabetic subjects had symptoms of neuropathy and the most frequent symptoms were numbness, muscle cramps and postural hypotension.

Incidence and treatment of recurrent plantar fibromatosis by surgery and postoperative radiotherapy

BACKGROUND

The incidence of plantar fibromatosis (PF) is unknown. Sometimes PF tends to recur repetitively after surgical treatment. In our institute we have used postoperative radiotherapy in an attempt to diminish the change on recurrence.

METHODS

The Dutch Network and National Database for Pathology (PALGA) was consulted to establish the incidence of plantar fibromatosis (PF). Data from 9 patients (11 feet) with PF referred to our institute for recurrent disease were analyzed and the role of postoperative radiotherapy in prevention of recurrence was studied.

RESULTS

An average of 1.2 operations for PF was performed per 100,000 citizens yearly in the Netherlands. Twenty-six operations were performed and postoperative radiotherapy was used in 6 cases. Plantar fasciectomy was associated with the lowest recurrence rate. After microscopically incomplete excision or excision of early recurrence (< or =6 months) alone all tumors recurred, while recurrence was rarely observed after adjuvant radiotherapy. However, radiotherapy was associated with significantly impaired functional outcome in 3 cases.

CONCLUSIONS

Plantar fibromatosis is relatively rare. Plantar fasciectomy seems to be the operation of choice. Although effective in decreasing the recurrence rate, adjuvant radiotherapy should be used very selectively because of its serious side effects.

Influence of Transition Diets on Occurrence of Subclinical Laminitis in Holstein Dairy Cows

Pre- and postpartum diets varying in energy and fiber were studied for effects on subclinical laminitis in Holstein cows. Also, ruminal acidosis was examined relative to sole hemorrhages and ulcers. Cows (n = 98) were assigned to a 2 x 2 factorial arrangement of treatments in a randomized complete block. Diets high in net energy of lactation (NE(L)) and low fiber were classified as high NE(L), whereas low NE(L) and higher fiber were defined as low NE(L). Two diets were fed for 3 wk before calving and 2 others fed for 3 wk postpartum resulting in 4 treatment combinations: high NE(L), low NE(L); high NE(L), high NE(L); low NE(L), low NE(L); and low NE(L), high NE(L). Levels of NE(L) (Mcal/kg DM), percentage of acid detergent fiber, and percentage of neutral detergent fiber for low NE(L) vs. high NE(L) prepartum diets, were 1.51, 30.2, 47.2 vs. 1.65, 23.4, 39.8, respectively, and 1.70, 22.4, 36.8 vs. 1.77, 17.5, 31.4 for low NE(L) vs. high NE(L) lactating diets, respectively. A single diet was fed after 21 d in milk (DIM). Measures of hoof discoloration, hemorrhage, and/or ulcer formation were done at about 45 d before calving, and near 28 and 70 DIM. Rumenocentesis was performed 14 d before calving and at 8, 22, and 70 DIM. Hoof scores among treatments were similar at 28 DIM. The low NE(L), high NE(L) group had less desirable hoof scores than high NE(L), high NE(L), or low NE(L), low NE(L) groups from 55 to 75 DIM. Rumen pH did not differ by treatment before calving. The lowest postpartum rumen pH was significantly lower and rates of ruminal acidosis (pH < or = 5.8) at 8 and 22 DIM were higher for groups fed high NE(L) after calving. No direct relationship between low postpartum rumen pH and hoof scores on individual cows was found. Low NE(L) before calving and high NE(L) right after calving may increase risk of subclinical laminitis if not carefully managed.

Prevalence of foot diseases in outpatients attending the Institute of Dermatology, Bangkok, Thailand

Two thousand patients who visited the outpatient department at the Institute of Dermatology, Bangkok, were assessed for the presence of foot diseases by questionnaire and physical examination. Abnormalities were detected in 741 individuals (37.1%). Nonfungal conditions were more prevalent (31.4%), mainly consisting of eczema (254 cases, 12.7%) and psoriasis (176 cases, 8.8%). Fungal disease was observed in 119 cases (6.0%). There were 76 cases (3.8%) with tinea pedis and 33 cases (1.7%) with onychomycosis. The identified organisms causing tinea pedis were 57.9% nondermatophyte moulds, 36.8% dermatophytes, and 2.6%Candida spp. The corresponding organisms causing onychomycosis were 51.6% nondermatophyte moulds, 36.3% dermatophytes, and 6.0%Candida spp. Among nondermatophytes, Scytalidium dimidiatum was the leading pathogen while Trichophyton rubrum and T. mentagrophytes were the predominant dermatophytes identified. Diabetes mellitus, peripheral vascular disease and activities related to foot trauma were noted to be predisposing factors for onychomycosis. Footwear, particularly sandals and cut shoes, was the only factor relevant to individuals with tinea pedis (P < or = 0.05). In contrast with other published data on fungal foot infections, this study disclosed a higher prevalence of nondermatophyte organisms, predominantly S. dimidiatum, as the major cause of tinea pedis and onychomycosis. An increase in awareness is necessary to identify such cases, prevent misdiagnosis and initiate appropriate treatment.

Effects of Biotin Supplementation on Performance and Claw Lesions on a Commercial Dairy Farm

A controlled 14-mo field trial was conducted to evaluate the effect of biotin supplementation on hoof lesions, milk production, and reproductive performance in a commercial dairy herd. One hundred seventy cows were studied and supplemented with either 0 or 20 mg/d of biotin by computer feeder. All were housed in the same free-stall facility with the same environment, base diet, and management. The feet of 99 cows were trimmed three times at 6-mo intervals, and hoof health was evaluated. Milk production and fertility data were captured monthly by the Dairy Herd Improvement Association. At the final hoof trimming, sole hemorrhages were significantly higher in control (50%) vs. biotin-supplemented animals (24%). The incidents of cows affected with double soles, hoof wall grooves, and heel horn erosion did not differ between control and biotin-supplemented animals. Biotin supplementation of trimmed cows resulted in 878 kg more milk than control cows when compared with previous lactation yield (n = 46 biotin supplemented, n = 48 control cows). At the end of the study, for both trimmed and untrimmed animals, biotin supplemented cows (n = 81) produced 481 kg more milk and 25 kg more fat than the controls (n = 81). There was no interaction between biotin supplementation and hoof trimming on milk production. There were variations in the response of fertility to biotin between age groups. First lactation heifers fed supplemental biotin had significantly fewer days from calving to conception and required fewer inseminations per pregnancy than controls of the same parity.

["Epidemic" of plantar dermatitis during military maneuvers in the rain forest of Guyana]

The purpose of this report is to describe an "epidemic" outbreak of plantar dermatitis that occurred in 30 soldiers on mission in the rain forest of Guyana. The contingent was forced to stop twice and operational readiness was seriously reduced. The first episode affecting 43% (13/30) of the contingent occurred after 4 days of march. In the second episode 70% (21/30) of the contingent was affected. Manifestations were characterized by the appearance of distinct, dry, nonpruriginus, erythematous papules followed a few hours later by quasi-exfoliating, noncoalescing, nonoozing, nonmalodorous lesions measuring several centimeters in diameter. Symptoms regressed quickly within 48 to 72 hours with only symptomatic treatment. A combination of microtrauma and maceration is the most likely mechanism. However identification of an offending microbial, viral or fungal agent or of a cause in the environment, clothing or products could not be made. A tempting hypothesis involves an inflammatory reaction caused by an organism in ground water or the soil. A prospective study could be undertaken at the Rain Forest Training Camp in Regina where similar clinical manifestation have been observed.

The impact of parity and duration of biotin supplementation on white line disease lameness in dairy cattle

A field study was conducted to examine effects of oral biotin supplementation for up to 18 mo on risks of lameness in dairy cows. The study included a total of 900 cattle from five dairy farms in Gloucestershire, southwest U.K., in a within-herd randomized control trial. The data from this trial were used in this paper to investigate the impact of parity and duration of supplementation with oral biotin at 20 mg/d on white line disease (WLD) lameness. Analysis of the data indicated that WLD increased with increasing parity independent of biotin supplementation from approximately two cases per 100 cow years in primiparous cows to 15.5 cases per 100 cow years in all multiparous cows, but up to 47.7 cases per 100 cow years for cows in parities > or = 5. Supplementation with biotin reduced WLD lameness by 45% in multiparous cows down to 8.5 cases per 100 cow years, whereas the effect of biotin supplementation in primiparous cows was not significant. Although numerical reductions in WLD lameness were observed for shorter periods of supplementation, a supplementation length of at least 6 mo was required to significantly reduce the risk of WLD lameness in multiparous cows. The effect of biotin supplementation in reducing lameness has potential impact for both animal welfare and farm economics.

[Tumors of the footbones- a report from the Hamburg Bone Tumor Registry]

Aim of the present study was a systematic examination of the tumors of the foot registered in the Hamburg Bone Tumor Registry regarding age, sex, location, diagnosis and morphological characteristics. The registry files and histological specimens of 367 tumors and tumor-like lesions of the foot were reviewed. Males were more frequently affected (ratio 4 : 3). Some 20.4 % of all mass forming tumors were malignant. Cartilage tumors (146 cases), cystic (132 cases) and osteoblastic lesions (33 cases) were most common. Several tumors showed a strong predilection for certain parts of the foot. In the calcaneus a solitary bone cyst was the most common lesion. Lesions in the talus and metatarsals with a similar morphology mostly represented intraosseous ganglion cysts. Other tumors in the calcaneus were mainly cartilaginous. Besides chondroblastoma, chondrosarcoma was regularly diagnosed. Chondroma was extremely rare at this site. Contrary to that chondroma was regularly found at the metatarsal and phalangeal bones, it was 4 times more common than chondrosarcoma. An even distribution showed aneurysmal bone cysts and osteoidosteoma. Very rare lesions were fibrous dysplasia, eosinophilic granuloma and intraosseous lipoma. The knowledge of the distribution of tumors in the foot is important for an exact differential diagnosis and thereby for biopsy planning, diagnosis and therapy.

Prevalence of claw disorders in Dutch dairy cows exposed to several floor systems

Claw health was examined in an observational study on Dutch dairy farms with either a slatted floor (SL), slatted floor with manure scraper (SL-SCR), solid concrete floor (SCF), a straw yard (SY), or a zero-grazing feeding system (ZG). Hooves of cows' hind legs were examined for the presence and severity of claw disorders during hoof trimming events at the end of the pasture (P-study) and housing period (H-study). The number of cows in each study was 3078 (49 herds) and 3190 (47 herds), respectively. Due to a different hoof trimming strategy, data collected during both observation periods in SY herds (638 cows; 16 herds) were combined. Cows in straw yards (SY) had by far the lowest numbers of claw disorders. Over 80% of cows exposed to concrete flooring had at least one claw disorder at the time of observation, whereas on SY surfaces, this percentage was between 55 and 60. Cows on SL-SCR were less frequently affected by interdigital dermatitis/heel erosion (IDHE) and digital dermatitis (DD) than cows on SL (reference floor system). Little difference in claw health was found between SF and SL. The ZG cows were at higher risk (OR > 2) for most claw disorders in the P-study, whereas in the H-study, ZG cows showed less IDHE, sole hemorrhage, and sole ulcer. All herds on concrete flooring (SL, SL-SCR, SCF, ZG) were infected by DD, resulting in an average cow level prevalence of 30%. This indicates that the level of DD infection has increased considerably over the last 10 yr in The Netherlands.

Regional musculoskeletal conditions: foot and ankle disorders

Foot pain is very common, especially in women, owing to inappropriate footwear. Overuse, repetitive strain and minor, easily forgettable injuries may result in chronic foot and ankle pain. Rheumatoid arthritis, spondyloarthropathies and gout frequently affect the foot, often as a first presentation. Charcot's joints and foot infections are not rare in diabetes. The rheumatologist should be familiar with foot disorders, either localized or as manifestations of generalized disease. History taking, physical examination, identification of the source of pain by intra-articularly given local anaesthetics and imaging methods should be used to reveal the underlying disorder. Correct diagnosis and efficient therapy-including local steroid injections, physiotherapy, orthoses, surgery-are necessary not only for treatment but also for preventing biomechanical chain reactions. This chapter gives an overview of the epidemiology, diagnosis and treatment of foot pain and foot disorders caused by both local and generalized diseases.

[Prevalence of herd specific factors and limb disorders, and their associations in intensive swine production]

A longitudinal observational study in 180 pig breeding herds was performed to calculate prevalences of herd specific factors as well as typical limb disorders and to estimate their associations in a 2-step regression analysis. Regarding herd size, genetics, feeding and weight gain herds were distributed almost equal. The population density and the hygiene status were considered proper in most herds. In the farrowing units partially slatted floors of metal or plastic with slats > 9 mm, in the weaning units fully slatted floors of plastic, and in the rearing units fully slatted floors of concrete were most common. Less than 6% of the farms housed their pigs on solid concrete with straw bedding. Herd prevalences of fault floors varied between 18 and 43%. As a herd health problem (morbidity > 25%) claw hematomas and limb abrasions in just 1-week old piglets, overgrown claws and bursa swellings in weaned pigs, and bursa swellings in rearing pigs were wide spread. Leg deformations by osteopathy or arthritis occurred only sporadically. In the risk analysis claw hematomas of piglets were associated with slatted floors, particulary with slats < 10 mm. Abrasions were associated with concrete and rough floor surfaces at all. Overgrown claws and bursa swellings in weaned and in rearing pigs were associated with damaged, slippery or rough floor surfaces. Other associations were not detected. The quality of floor might be more important than the type of housing.

Comorbidities associated with diabetic foot complications among Asian Americans in southern California

The comorbidities of diabetes mellitus were evaluated in an Asian American population with podiatric symptoms living in southern California. The three most common nonpedal complaints in men were blurred vision (73.6%), hypertension (64.1%), and erectile dysfunction (52.3%) and in women were blurred vision (84.5%), incontinence (71.5%), and low-back pain with radiculopathy-like symptoms (56.5%). The most significant finding was that only 3.2% of all patients had any previous knowledge or understanding of the risks of foot infection, ulceration, and amputation secondary to diabetes mellitus. The prevalence of diabetes mellitus in ethnic populations once considered practically exempt continues to rise steadily, and Asians living in the United States are becoming casualties of diabetes mellitus and its complications.

Bone and soft tissue tumours of the foot: review of 83 cases

PURPOSE

To review cases of bone and soft tissue tumours of the feet managed at the Hyogo College of Medicine, Nishinomiya and Takarazuka Municipal Hospital, Takarazuka, Japan.

METHODS

Retrospective analysis of 83 patient records treated for bone and soft tissue tumours of the feet between 1974 and 2000.

RESULTS

There were 33 benign bone tumours, one primary malignant bone tumour, and 2 metastatic bone cancer. Marginal resection was performed in cases of osteochondroma and curettage in cases of other benign bone tumour. Despite below-knee amputation in the case of chondrosarcoma, the patient died because of pulmonary metastasis. Two patients with metastatic cancer also died, and 2 cases of osteochondroma and one of benign chondroblastoma recurred. There were 47 cases of soft tissue tumour. Treatment for benign soft tissue tumours was marginal resection; no cases recurred. In contrast, all patients with soft tissue sarcoma died after surgery. The majority of bone tumours were located in the toe and hindfoot areas, in the first and second decades of life, whereas soft tissue tumours occurred mainly in the midfoot area and in patients aged between 20 and 50 years. The sex distribution was almost even for bone tumours (male: female ratio, 19:17), whereas about half as many males as females had soft tissue tumours (14:33).

CONCLUSION

Bone and soft tissue tumours of the feet are uncommon. Most bone tumours are chondrogenic, but differential diagnosis of malignant from benign disease is difficult and prognosis is poor. Management of benign tumours by marginal resection has good prognosis, whereas prognosis of soft tissue sarcomas is very poor.