Foot Diseases Research Articles

Evaluation of treatment plans using various treatment techniques for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of feet.

The purpose of this study was to investigate the plan qualities of various treatment modalities for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of the foot. A total of six virtual targets were generated on the skin of the foot in CT images. Five types of treatment plans were generated using photon beams (PB), electron beams (EB), high‐dose‐rate (HDR) brachytherapy with a Freiburg flap applicator, intensity‐modulated radiation therapy (IMRT), and volumetric‐modulated arc therapy (VMAT) techniques. Plans for each of the six targets (single‐target plans) and also for the combined target consisting of the six single targets combined (multitarget plans) were generated. Dose‐volumetric analysis was performed for the targets and normal tissues. The averaged conformity index (CI) and homogeneity index (HI) values for each single target using PB, EB, HDR, IMRT, and VMAT techniques were 1.97, 2.39, 1.60, 4.60, and 0.80 and 1.05, 1.11, 1.52, 1.04, and 1.04, respectively. For the multitarget, the CI values were 3.99, 5.08, 1.38, 1.95, and 0.84, and the values of HI were 1.10, 1.36, 1.43, 1.06, and 1.04, respectively. The averaged mean doses to normal tissue were 2.5, 2.7, 3.6, 1.7, and 2.9 Gy for single‐target plans, and 21.3, 14.6, 14.2, 14.3, and 13.0 Gy for the multitarget plans, respectively. The VMAT demonstrated dosimetric advantages and better treatment efficiency over other techniques for the radiotherapy of multifocal skin disease of the feet.PACS number: 87.55.dk

Retrospective Analysis of the Rate and Interval to Union for Joint Arthrodesis of the Foot and Ankle

Arthrodesis is a common procedure indicated for surgical treatment of end-stage degenerative joint disease of the foot and ankle. Many published studies have reviewed the union rate, focusing on specific technique or fixation. However, studies reporting on the average period required to achieve fusion, irrespective of the type of fixation or surgical method used, have been lacking. We report on the union rate and interval to fusion in patients who had undergone primary arthrodesis of various joints of the foot and ankle. A retrospective review of the medical records of 135 patients was performed. The specific joints studied were ankle, and the subtalar, triple, first tarsometatarsal, first metatarsophalangeal, and hallux interphalangeal joints. Our results showed that the average interval for complete fusion was significantly less for the joints in the forefoot, with the subtalar joint, ankle, and triple arthrodesis requiring a longer period to achieve complete fusion. The nonunion rate was also greater when the fusion involved the joints of the rearfoot. Our results have refuted the idea that 6 weeks is the minimum period required to achieve fusion in the foot and ankle. The results of our study support the need for additional education of the patients and surgeons that the interval required for recovery after foot and ankle fusion depends on the location and surface area that has been fused.

Critical Appraisal of Foot and Ankle Amputations in Diabetes

Diabetes is the leading cause of non-traumatic amputation in the world. Patients with diabetes have a 10-fold increased risk for lower extremity amputation compared with those who do not have diabetes. Amputees with diabetes are more likely to be severely disabled, to experience their initial amputation at a younger age, progress to higher-level amputations, and die at a younger age compared with patients without diabetes. Indications for amputation are chronic lower limb ulcers, infected or not infected, due to peripheral neuropathy, vascular disease or deformity of the feet. Foot ulcer precedes amputations in 84% of the cases. Amputation in diabetes is not a riskless treatment. The 5-year relative mortality rate is 48% after major limb loss. After a major limb loss, there is a 50% probability of developing a serious lesion on the contralateral limb within 2 years. In the present review and clinical appraisal, indications for determination of the level of amputation, the possible consequences of a specific amputation on stance, deambulation, necessity of using a specific footwear or prosthesis, technical problems and complications are discussed.

Assessment of Carrier Materials to Formulate Trichoderma Harzianum Bio-Fungicide for Controlling Foot and Root Rot Disease of Brinjal in Seed Bed

Efficacy of eight different carrier materials and their combinations were tested to formulate a suitable Trichoderma harzianum based bio-fungicides for controlling foot and root rot diseases of brinjal caused by Sclerotium rolfsii in tray soil as well as seed bed soil under net house condition of Bangladesh Agricultural Research Institute (BARI). The results from a series of experiments revealed that four combination of carrier materials based T. harzianum bio-fungicides such as (1) wheat bran + rice bran, (2) wheat bran + mustard oil cake (MOC) + rice bran, (3) khesari bran + rice bran, and (4) khesari bran +MOC+ rice bran were suitable for controlling the soil borne foot and root rot disease (S. rolfsii) of brinjal in tray soil as well as seed bed soil conditions.

Infectious diseases of the feet

Chris Shepherd BVM&S, BSC (Hons), discusses the management of equine feet

Inflammatory Joint Disease of an Individual from St. Emmeram Cathedral, Nitra, Slovakia (14th – 18th Century AD)

The paper presents pathological findings of one individual from the St. Emmeram Cathedral, where osteological remains were excavated during archaeological examination of the site Nitra - Castle hill, especially Nitra - Cathedral in 2008 and where bishops, canons and children (probably from aristocratic families) were buried since 14th till 18th century AD. The purpose of this study was determining pathological finding of skeletal remains of an individual from grave no. 235. Skeletal remains consist of right and left tibia, part of the left fibula (diaphysis with distal epiphysis) and foot bones, making ankylosis. Skeletal remains were anthropological analysed and sex of the individual was confirmed by aDNA analysis for increasing accuracy and reliability in sex determining. Presented osteological remains were anthropomorphological and paleopathological determined and diagnosed by RTG and CT scans to establish inflammatory disease of feet. After anthropological examination and widespread carefully study of osteo-archaeological and paleopathological literature we conclude on fact, that ankylosis was likely caused by rheumatoid arthritis (RA). DOI: 10.5901/ajis.2013.v2n9p660

Risk factors for equine laminitis: A case-control study conducted in veterinary-registered horses and ponies in Great Britain between 2009 and 2011

Laminitis is a highly debilitating disease of the foot known to have a complex and multifactorial aetiology of metabolic, inflammatory, traumatic or vascular origin. The disease has major welfare implications due to unrelenting pain associated with degenerative changes, which often necessitate euthanasia on welfare grounds. Despite this, there have been few high-quality studies investigating risk factors for equine laminitis, and only a limited number of risk factors have been previously investigated. The aim of this study was to conduct a case-control study of risk factors for active episodes of veterinary-diagnosed laminitis in horses and ponies attended by veterinary practitioners in Great Britain, based on multivariable statistical analyses.Questionnaires were received for 1010 animals, comprising 191 laminitis cases and 819 controls. Factors associated with an increased risk of laminitis were weight gain in the previous 3months, summer and winter months compared to spring, new access to grass in the previous 4weeks, box rest in the previous week, owner-reported history of laminitis, lameness or foot-soreness after shoeing/trimming, existing endocrinopathic (pituitary pars intermedia dysfunction and equine metabolic syndrome) disease and increasing time since the last anthelmintic treatment. Factors associated with a decreased risk of laminitis were increasing height (cm), feeding of additional supplements in the previous week and transportation in the previous week. Novel associated factors were identified that may aid in the management and prevention of the disease in the veterinary-registered equine population.

Who was first to diagnose and report neuropathic arthropathy of the foot and ankle: Jean-Martin Charcot or Herbert William Page?

In November 1883, Jean-Martin Charcot and Charles Féré reported on bone and joint disease of the foot in cases of tabes dorsalis, and referred to the condition as 'pied tabétique'--a disabling neuropathic osteoarthropathy that we usually now refer to as the Charcot foot. Charcot had originally described neuropathic osteoarthropathy in more proximal joints in 1868, and in his 1883 paper with Féré stated that involvement of the short bones and small joints of the foot had not yet been described. They emphasised in the paper that one of their cases was the first ever observed, two years earlier, in 1881. It is relevant, however, that it was in this same year that involvement of the foot by tabetic arthropathy was presented to the International Medical Congress in London by an English surgeon, Herbert William Page. We believe that Page was the first to diagnose and to report a case of tabetic neuropathic osteoarthropathy in which the bones of the foot and ankle were involved. He was also the first to propose a link between the tabetic foot and disease of the peripheral nerves, as opposed to the central nervous system.

Foot Overuse Diseases in Rock Climbing

Literature examining the incidence of foot diseases in rock climbing is limited to traumatic injuries. We examined a large sample of climbers, assessed the chronic diseases of the foot, and correlated them with foot morphology, shoe type, and type of climbing practiced. Between May 1 and September 30, 2009, 144 climbers (mean age, 31.7 years) were examined to analyze the effect of rock climbing on the various foot diseases found at the time of the evaluation. Eighty-six percent of the climbers were affected by a pathologic condition. Nail disease was found in 65.3% of patients, followed by recurrent ankle sprains (27.8%), retrocalcaneal bursitis (19.4%), Achilles tendinitis (12.5%), metatarsalgia (12.5%), and plantar fasciitis (5.6%). Male sex, the use of high-type shoes, the high degree of climbing difficulty, and the competitive level were often related to the onset of foot diseases. Climbing shoes are usually smaller than common footwear. This "shoe-size reduction" averaged 2.3 sizes, forcing the foot into a supinated and cavus posture that favors lateral instability. The posterior edge of the shoe aperture produces increased pressure on the heel, with retrocalcaneal bursitis. Overuse foot diseases related to rock climbing are particularly frequent and debilitating. Detailed knowledge of these diseases and their predisposing factors may help us implement effective preventive or therapeutic measures, including changes in the type of climbing, correction of body weight, degree of difficulty, footwear, orthoses, and measures that maximize the support of the foot to the ground.

Black Bone Disease of the Foot: A Case Study and Review of Literature Demonstrating a Correlation of Long-term Minocycline Therapy and Bone Hyperpigmentation

The chronic use of minocycline and tetracycline has been widely reported in published studies to cause discoloration of skin and teeth. There are very few case reports with regard to discoloration of bone. Those cases reported have been termed black bone disease or blue bone disease because the resulting change to the bone is a blue, green, or brown discoloration that resembles necrotic bone. Documentation of the occurrence in bone, however, is rare, with very few studies noted and only 1 other case that reported changes to the bones of the foot. The mechanism responsible for bone discoloration is not clearly understood. We present a case of this condition encountered during cheilectomy of the first metatarsophalangeal joint in a patient who had required long-term usage of minocycline for adult acne.

Dermatologic Diseases of Foot that are Commonly Seen in Military Service and Leading Loss of Working Power

Skin diseases has been an important health concern in military medicine. The high frequency of dermatologic disease of the foot in facilities such as military services can lead loss of working power. Loss of working power and medical expenses may be decreased by preventive measures and educational studies. In this article we aimed to review dermatological diseases of the foot which seen frequently in military services.

The diagnostic value of single photon-emission computed tomography bone scans combined with CT (SPECT-CT) in diseases of the foot and ankle

A radionuclide bone scan with single photon-emission computed tomography and CT (SPECT-CT) is a new imaging modality which combines highly detailed CT with the functional information from a triple phase radionuclide bone scan. Little has been published about its diagnostic accuracy and usefulness in foot and ankle pathology. The aim of this study is to evaluate whether bone scans with SPECT-CT provide a useful contribution to the management of patients with foot and ankle pain, and whether it results in changes to clinical management. A retrospective study involving 50 patients was conducted between March 2010 and April 2011. SPECT-CT was requested in cases where definitive clinical diagnosis could not be achieved after clinical examination and plain radiography. Pathology as highlighted on SPECT-CT was taken as the definitive diagnosis in these patients and was treated accordingly. Patients were subsequently seen in the follow up clinic to evaluate the outcome of their treatment. In 11 patients (22%), the provisional clinical diagnosis matched with the findings of the SPECT-CT and no change in treatment was necessary. In 39 patients (78%) the findings of the SPECT-CT did not correlate exactly with the initial clinical diagnosis and led to a modified treatment plan. The accuracy, sensitivity, specificity, positive predictive and negative predictive value of SPECT-CT in this series was 94%, 95.45%, 83.3%, 97.6% and 71.43% respectively. SPECT-CT is a useful investigation tool in foot and ankle pathologies. The present study shows a high diagnostic accuracy and we recommend its use in cases with diagnostic uncertainty.

Detection the pathogens and analysis the clinical characteristics in children with hand, foot and mouth disease in Shanghai during 2009-2011

To investigate the epidemic characteristics of etiological agents and analyze the clinic differences in children with hand, foot and mouth diseases in Shanghai. Collection 551 specimens including vesicle fluid, stool and throat swabs to detect the pathogens. The positive rates were tested by RT-PCR assay with Enterovirus consensus primer and specific primer for Enterovirus 71 (EV71) and Coxsackie A16 (CoxA16), respectively. Out of 357 patients, the overall positive rate was 79.7%. CoxA16 infection was mainly popular in 2009, EV71 was mainly popular in 2011. The epidemic characteristics of enterovirus infection within 2009-2011 had significant differences (P = 0.005). The positive rate of vesicle fluid was highest. The concurrent rate of fever and tendency to be frightened had significant differences in three patients' groups. The count of the peripheral white blood cells and the ratio of the neutrophil in the patients with EV71 infection was higher than that in the patients with CoxA16 or PE infection. HFMD showed alternant epidemic characteristics at different times of enterovirus infection in Shanghai. Analyzing the differences of clinic characteristic of EV71 and CoxA16 infection is helpful to prevent and control EV71 infection.

Relationship between histopathological lesions and magnetic resonance imaging (MRI) in diseases of the foot of the horse

The increasing number of available pathological studies on the various tissues of the foot has helped validate the significance of Magnetic Resonance Imaging (MRI) signal variations documented with various clinical MRI systems used in equine practice. In particular MRI has helped elucidate the different grades of histological abnormalities and possibly also different stages of disease progression in the deep digital flexor tendon and the navicular bone. However, further work is needed to continue to improve our understanding of the different causes of foot lameness and their pathogenesis.

Frequency of equine laminitis: A systematic review with quality appraisal of published evidence

Equine laminitis is a highly debilitating disease of the foot. Despite its perceived importance, epidemiological characteristics are poorly understood and the true frequency of the disease remains unclear. The objective of this study was to retrospectively assess previous research to identify publications which provide the best evidence of the frequency of naturally-occurring equine laminitis. A systematic review of English language publications was conducted using MEDLINE (1950-2010), CAB Direct (1910-2010) and IVIS (1997-2010). Additional publications were included by searching bibliographies. Search terms included laminitis, equine, frequency, prevalence and incidence. Studies that allowed frequency estimations to be made for naturally-occurring equine laminitis were included. Information was extracted using predefined data fields, including 13 study quality indicators. Sixty-nine publications were appraised. Ten were considered to provide the most reliable information, estimating the frequency of equine laminitis ranging from 1.5% to 34%. Previous publications estimating laminitis frequency were generally poor quality. Laminitis frequency varied across publications however the publications included in this review focussed on many of the different underlying laminitis aetiologies and comparison of the frequencies between groups would be inappropriate. High-quality evidence-based studies are needed to estimate the true disease frequency in different equine populations.

Foot Rot- An Emerging Issue in Sheep Husbandry

Foot rot is a highly contagious and economically important disease of the feet of ruminants especially sheep and goats and is characterized by the separation of keratinous hoof from the underlying epidermal tissue resulting in severe lameness, loss of body condition and reduced wool production. Although foot rot infection has been reported in cattle, horses, pigs, deer and mouflon, the infection is specific to sheep and goats. The main predisposing factors to foot rot infection include muddy pastures, frequent rains and injury to feet. Other factors include lowland farms, high stocking densities, winter housing, routine foot trimming, and inadequate treatment and failure to isolate the affected sheep. Outbreak of diseases affects the sheep population in a huge way. Among the diseases, this may be bacterial, viral or parasitic origin in J&K. The foot rot is the emerging disease which affects the sheep population in a big way.

Degenerative joint disease and tendinopathy of the foot and ankle: A biomechanical and manual therapy approach

In this workshop participants will gain an understanding of the mechanical basis to joint and tendon disease of the foot and ankle, and be able to adapt their treatment protocols for these conditions accordingly. Intervention will be outlined relevant to influencing factors intrinsic and extrinsic to the individual. Manual therapy that influences these biomechanical factors will also be presented. Participants will, at completion, be able to recognise and remediate the key mechanical influences on foot and ankle tendon and joint diseases.

Prevalence of diabetic foot syndrome and its risk factors in the UK

To determine the prevalence of diabetic foot syndrome (DFS) and its risk factors (diabetic neuropathy, peripheral vascular disease, open wounds and mycoses of the feet) at GP practices in the UK in 2008. We searched the IMS Disease Analyzer database, which stores representative information on approximately 4.2 million patients. All documented diagnoses of diabetes mellitus in 2008, based on either ICD-10 (international classification of diseases) codes or free text comments from doctors, were analysed. Data from 34,198 patients with type 2 diabetes (47.1% female, mean age 66.1 years [SD 15.1], mean diabetes duration 7.4 years [SD 5.1]) and 2,576 patients with type 1 diabetes (43.2% female, mean age 39.2 years [SD: 18.0], diabetes duration 11.0 years [SD: 6.1]) were analysed. DFS was registered in 7.6% (95% CI: 6.6-8.6) of patients with type 1 diabetes and 8.5% (95% CI: 8.2-8.8) with type 2 diabetes. Many more patients were at high risk of developing DFS, with diabetic neuropathy, diabetic angiopathy, foot mycoses and/or open wounds of the feet. Results from this analysis of one of the large representative databases show that even though the prevalence of DFS among patients with diabetes mellitus is relatively low, the prevalence of its main risk factors is high. Preventive efforts should target these risk factors.

Feet and footwear: a cultural encyclopedia

Take a walk in someone else's shoes in this fascinating examination of shoes and feet around the world! This one-of-a-kind A-Z reference work contains over 150 fascinating entries and intriguing sidebars that look at feet and adornment of feet across the many cultures of the world throughout time. A wide range of international and multicultural topics are covered, including foot binding, fetishes, diseases of the foot, customs and beliefs related to the foot, shoe construction, myths and folktales featuring feet or shoes, the history of footwear, iconic brands and types of shoes, important celebrities associated with shoes, and the types of footwear worn around the world. This exhaustive compilation is ideal for students and general readers interested in the human body, fashion, and medicine, and even scholars looking for more in-depth coverage on the social and cultural uses of the body will find it as a useful starting point in their research. Cross-references, suggestions for further reading, and a full bibliography of print and electronic resources are valuable tools for all readers. Students can use this reference work to draw cross-cultural comparisons, as well as study the evolution of footwear in terms of social, religious, and ethnic parameters. Aside from iconic American brands and types of shoes, this volume will also look at how feet are treated and viewed around the globe: removing shoes upon entering a house, washing feet for religious purposes, giving feet the spa treatment, and covering feet up for social customs. Perfect for undergraduate and high school students studying anthropology and world culture.

V 47 Added Value of SPECT-CT imaging in localizing degenerative joint disease of the foot and ankle

Introduction Precise localisation of osteoarthritis is crucial for selective surgical treatment. Single photon emission computed tomography – computer tomography (SPECT-CT) fuses morphologic and biologic information. We hypothesized that SPECT-CT increase intra- and interobserver reliability to localise increased uptake compared to traditional side-by-side evaluation of CT and bone-scans. Material and Methods 20 consecutive patients with pain of uncertain origin at foot and ankle where evaluated with X-rays and SPECT-CT, available as fused SPECT-CT and separate bone-scan and CT images. Five observers evaluated for presence or absence of arthritis. Images were blinded and randomly ordered and evaluated twice with a six weeks interval. Kappa and multi-rater kappa values were calculated. Results Average intraobserver reliability for SPECT-CT was perfect (κ=0.86; CI 0.81 to 0.88) and significant higher as CT & bone-scan. SPECT-CT had significant higher interobserver agreements, especially evaluating naviculocuneiforme and tarsometatarsal joints. Conclusions Our data suggest that SPECT-CT has added value in localizing active arthritis especially in areas where number and configuration of joints is complex.