Secondary Foot Research Articles

Surgical Correction of Severe Secondary Anterior Foot Deformity

Clinical case of successful correction of severe iatrogenic foot deformity following several failed operations for transverse platypodia correction is presented. Application of several surgical techniques totality in combination with restoration of foot bones anatomical arrangement enabled to achieve positive result.

Nephroprotective potential of selenium and taurine against mercuric chloride induced nephropathy in rats

The study was aimed to estimate whether pre-treatment with sodium selenite or taurine would reverse kidney damage induced by intraperitoneal injection of mercuric chloride in rats. Animals were divided into six groups: (1) control group; (2) sodium selenite group; (3) taurine group; (4) HgCl2 group; (5) sodium selenite pretreated group; (6) taurine pretreated group. The results demonstrated that HgCl2 causes significant enhancement in serum malondialdehyde (MDA), creatinine, N-acetyl-beta-d-glucosaminidase (NAG), cystatin C, nephrin and interleukin 6 (IL-6) levels accompanied with significant reduction in serum nitric oxide (NO) level. Pretreatment with sodium selenite or taurine produces significant depletion in MDA, NAG, cystatin C, nephrin and IL-6 levels in concomitant with significant elevation in serum NO level as compared to HgCl2 group. HgCl2 induced pathological alterations in the kidney. The ultrastructural investigation of renal cortex of HgCl2-administered group revealed that the glomerular basement membrane is uniform, the fenestrations of endothelial cells are swollen, and the secondary foot processes appear also swollen even fused at some points. The proximal convoluted tubules showed apical short and few microvilli, while, some tubular cells showed relatively normal microvilli. In contrast, sodium selenite or taurine pretreatment could significantly reduce the pathological alterations in the kidney caused by HgCl2 intoxication. The current results suggested that selenium and taurine possess nephroprotective efficacy due to their antioxidative capacity and anti-inflammatory activity.

Avaliação das características do líquido ruminal, hemogasometria, atividade pedométrica e diagnóstico de laminite subclínica em vacas leiteiras

Este estudo objetivou avaliar as características do líquido ruminal, hemogasometria, atividade pedométrica e ocorrência laminite subclínica, por meio da presença de enfermidades podais secundárias, em vacas leiteiras de alta produção, provenientes de um rebanho comercial. Foram avaliadas 200 vacas holandesas, oriundas da mesma propriedade, localizada na região de Araçatuba, SP, divididas em quatro grupos, sendo estes estabelecidos a partir da produtividade diária. Inicialmente procedeu-se o exame clínico dos animais, seguido da colheita de amostras do líquido ruminal, por meio de sondagem esofágica, sendo este avaliado quanto ao pH, cor, odor, consistência, sedimentação, flutuação e prova de redução pelo azul de metileno. Também foram colhidas amostras de sangue venoso para hemogasometria, além da coleta dos dados da pedometria (número de passos) e produção de leite diária das vacas. Os dados obtidos foram tabulados e submetidos à análise de correlação. Nenhum animal avaliado apresentou alterações no pH ruminal, bem como não foram encontrados distúrbios do desequilíbrio ácido básico, pois os valores de pH sanguíneo, PCO2, TCO2, HCO3- e EB estavam dentro da normalidade, durante a análise hemogasométrica. A pedometria foi efetiva como método de triagem para as vacas acometidas de afecções podais, pois se observou a redução no número de passos devido à dor, correlacionada a menor produção leiteira. Contudo, a identificação destas afecções, somente foi possível mediante exame clínico específico dos dígitos. A ocorrência das afecções podais em 49,5% do rebanho deveu-se aos fatores de riscos presentes na propriedade, como o concreto abrasivo e instalações inadequadas, associados também a possível ocorrência de acidose ruminal subaguda, não diagnosticada pela metodologia utilizada. A correlação entre os valores do pH ruminal, pedometria e hemogasometria se mostrou eficiente para o diagnóstico precoce das afecções podais e também no estabelecimento da etiologia destas enfermidades. A laminite subclínica acometeu primariamente as vacas do rebanho, considerando a etiologia multifatorial desta afecção, ocorrência e distribuição das enfermidades podais diagnosticadas.

The ADF/Cofilin-Pathway and Actin Dynamics in Podocyte Injury

ADF/cofilins are the major regulators of actin dynamics in mammalian cells. The activation of ADF/cofilins is controlled by a variety of regulatory mechanisms. Dysregulation of ADF/cofilin may result in loss of a precisely organized actin cytoskeletal architecture and can reduce podocyte migration and motility. Recent studies suggest that cofilin-1 can be regulated through several extracellular signals and slit diaphragm proteins. Cofilin knockdown and knockout animal models show dysfunction of glomerular barrier and filtration with foot process effacement and loss of secondary foot processes. This indicates that cofilin-1 is necessary for modulating actin dynamics in podocytes. Podocyte alterations in actin architecture may initiate or aid the progression of a large variety of glomerular diseases, and cofilin activity is required for reorganization of an intact filtration barrier. Since almost all proteinuric diseases result from a similar phenotype with effacement of the foot processes, we propose that cofilin-1 is at the centre stage of the development of proteinuria and thus may be an attractive drug target for antiproteinuric treatment strategies.

Clinical, Biological and Genetic Analysis of Anorchia in 26 Boys

BackgroundAnorchia is defined as the absence of testes in a 46,XY individual with a male phenotype. The cause is unknown.MethodsWe evaluated the clinical and biological presentation, and family histories of 26 boys with anorchia, and sequenced their SRY, NR5A1, INSL3, MAMLD1 genes and the T222P variant for LGR8.ResultsNo patient had any associated congenital anomaly. At birth, testes were palpable bilaterally or unilaterally in 13 cases and not in 7; one patient presented with bilateral testicular torsion immediately after birth. The basal plasma concentrations of anti-Müllerian hormone (AMH, n = 15), inhibin B (n = 7) and testosterone (n = 19) were very low or undetectable in all the patients evaluated, as were the increases in testosterone after human chorionic gonadotropin (hCG, n = 12). The basal plasma concentrations of follicle stimulating hormone (FSH) were increased in 20/25, as was that of luteinising hormone in 10/22 cases. Family members of 7/26 cases had histories of primary ovarian failure in the mother (n = 2), or sister 46,XX, together with fetal malformations of the only boy with microphallus and secondary foot edema (n = 1), secondary infertility in the father (n = 2), or cryptorchidism in first cousins (n = 2). The sequences of all the genes studied were normal.ConclusionUndetectable plasma concentrations of AMH and inhibin B and an elevated plasma FSH, together with 46,XY complement are sufficient for diagnosis of anorchia. The hCG test is unnecessary. NR5A1 and other genes implicated in gonadal development and testicle descent were not mutated, which suggests that other genes involved in these developments contribute to the phenotypes.

Elective and Emergency Surgery in Chronic Hemodialysis Patients

Purpose: Aim of this study was to report our experience in elective and emergency surgery on chronic hemodialysis (CH) patients for end-stage renal disease (ESRD). Methods: All patients on CH for ESRD who underwent various surgical procedures in our unit within the past 9-year period (2001–2010) were included in this study. These patients were divided into two groups according to the type of surgery performed: elective or emergency. Demographic data, indications for surgery, primary causes of ESRD, surgical procedures, postoperative complications, and mortality rates were studied. Results: Of 130 patients, 121 underwent elective surgery while 10 were addressed for emergency operation. In the elective surgery group, the most common diseases were secondary hyperparathyroidism, kidney diseases, cholelithiasis, and diabetic foot gangrene. Complications occurred in nine patients (morbidity rate, 7%) and only one patient died (mortality rate, 0.8%). In the emergency surgery group, the most common diseases were diabetic foot gangrene and obstructed sigmoid colon cancer. In this group, complications occurred in seven patients (total morbidity rate, 70%) and two patients died (mortality rate, 20%). Conclusions: Elective surgery in patients on CH for ESRD can be performed with acceptable surgical risks provided careful preoperative preparation, intraoperative, and postoperative precautions are taken.

Комплексное лечение детей старшей возрастной группы с врожденной косолапостью

The results of treatment of 100 patients in age from 13 to 18 years who were in the institution for reconstruction of foot deformities were analyzed. The complex treatment of children with recurrent clubfoot and secondary foot deformities in adolescence consists in reconstruction of tendon-ligamentous and bony structures of the foot with the use, if it is indicated, of external fixation devices with simultaneous intensive physiotherapy aimed at improving of microcirculation and bone formation as well as correction of mineral metabolism.

Cytotoxic effect of ochratoxin A on the renal corpuscles of rat kidney: could ochratoxin A cause kidney failure?

To demonstrate that Ochratoxin A can cause kidney failure as the kidney is the primary target for OTA cytotoxicity. Ochratoxin A (OTA) is a mycotoxin found in our food. The cytotoxic effect of a low cumulative dose of OTA on the renal corpuscles of the kidney tissue has been investigated in this report. This study was based on two groups in which weaning albino rats were used: (1) control; (2) OTA-treated rats (289 µg/kg/day). After 28 days of treatment, a significant decrease in body weight, kidney weight and relative weight were detected in OTA treated rats. Serum creatinine and urea level were slightly elevated. These results revealed significant histological as well as ultrastructral lesions in the OTA treated group. The lesions included global congestion in the renal tissue and loss of demarcation between the cortex and medulla. The normal architecture of the renal corpuscles was destroyed and most of the corpuscles lost their ordinary look. The most apparent histopathological changes were urinary space disappearance and hypercellularity. In addition, congested, undifferentiated, atrophied, hypertrophied, fragmented, sclerotic, degenerated, and obliterated renal corpuscles were distinct. The ultrastructural lesions observed in the renal corpuscles in OTA on treated rats included; proliferation and swelling of the endothelial cells with occasional loss of fenestrae; narrowing of the capillary lumen; damaged podocytes with deteriorated secondary foot processes, hypertrophied and proliferated mesangial cells with expanded mesangial matrix. The endothelium was clearly defected and vacuolated, and lost its fenestrations in many glomerular capillaries. In addition, the glomerular basement membrane (GBM) became visibly thickened and tortuous. Necrotic glomerular cells were frequently observed. Pre-apoptotic cells were also seen. It was concluded that the exposure to relatively low OTA concentrations induced significant lesions to the renal corpuscles. Moreover, it activated oxidative damage and necrosis which can cause extensive damage to the kidney and ultimately kidney failure.

Can Curcumin Prevent Gentamicin-Induced Nephrotoxicity in Rats? A Histological Study

Background: Free oxygen radicals play an important role in the pathogenesis of gentamicin (GEN) nephrotoxicity and curcumin (CMN) has a strong antioxidant activity. Aim of the Work: The possible protective role of CMN on GEN-induced nephrotoxicity was investigated in albino rats by histological and morphometric methods. Materials and Methods: Thirty-six adult male albino rats were randomly divided into six equal groups. Group I: Control group received intraperitoneal (i.p.) injection of 0.9% saline, Group II received 1 ml corn oil orally for 21 days, Group III received 200 mg/kg CMN dissolved in corn oil orally for 21 days. Group IV received 100 mg/kg GEN dissolved in 0.9% saline i.p. for seven days from day 14, Group V received corn oil for 21 days and GEN for seven days from day 14 and lastly Group VI received CMN for 21 days and GEN from day 14 for seven days. At the end of the experiment, animals were weighed, sacrificed and the kidneys were dissected out, then processed for light and electron microscopic studies. Morphometric and statistical analysis were also performed. Results: Treatment with GEN led to significant limitation of weight gain, hyaline degeneration and nuclear pyknosis in the renal proximal tubules, shrinking of glomeruli and weak PAS reaction. Ultrastructurally, the proximal tubules exhibited loss of microvilli, thickened tubular basement membrane, condensed nuclei, rarefied cytoplasm with dark bodies and reduced number of mitochondria. Podocytes displayed fusion of secondary foot processes and thickening of the glomerular basement membrane with focal loss of its trilamellar structure. Concomitant administration of CMN with GEN revealed an observable protection against these changes. Conclusion: CMN showed a protective effect against nephrotoxicity induced by GEN in albino rats.

Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

we sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. data regarding patients' diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients' toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A(1c) and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus.

Cofilin-1 Inactivation Leads to Proteinuria – Studies in Zebrafish, Mice and Humans

BackgroundPodocytes are highly specialized epithelial cells on the visceral side of the glomerulus. Their interdigitating primary and secondary foot processes contain an actin based contractile apparatus that can adjust to changes in the glomerular perfusion pressure. Thus, the dynamic regulation of actin bundles in the foot processes is critical for maintenance of a well functioning glomerular filtration barrier. Since the actin binding protein, cofilin-1, plays a significant role in the regulation of actin dynamics, we examined its role in podocytes to determine the impact of cofilin-1 dysfunction on glomerular filtration.Methods and FindingsWe evaluated zebrafish pronephros function by dextran clearance and structure by TEM in cofilin-1 morphant and mutant zebrafish and we found that cofilin-1 deficiency led to foot process effacement and proteinuria. In vitro studies in murine and human podocytes revealed that PMA stimulation induced activation of cofilin-1, whereas treatment with TGF-β resulted in cofilin-1 inactivation. Silencing of cofilin-1 led to an accumulation of F-actin fibers and significantly decreased podocyte migration ability. When we analyzed normal and diseased murine and human glomerular tissues to determine cofilin-1 localization and activity in podocytes, we found that in normal kidney tissues unphosphorylated, active cofilin-1 was distributed throughout the cell. However, in glomerular diseases that affect podocytes, cofilin-1 was inactivated by phosphorylation and observed in the nucleus.ConclusionsBased on these in vitro and in vivo studies we concluded cofilin-1 is an essential regulator for actin filament recycling that is required for the dynamic nature of podocyte foot processes. Therefore, we describe a novel pathomechanism of proteinuria development.

The multi-talented podocyte

The podocyte has long been viewed as a fascinating cell. It was first appreciated for its exquisite anatomy with primary, secondary and tertiary foot processes enveloping the glomerular capillary loops in a complex meshwork. Karnovsky described the highly specialized cell junctions at the glomerular basement membrane, the slit diaphragm, further highlighting its complex and highly specialized anatomy [1]. The podocyte was recognized as a key element of the capillary wall barrier to maintain normal permeability, and podocyte abnormalities, i.e. foot process effacement, were recognized early on to be key corollaries of proteinuria. The next era of interest in the podocyte began with the discovery by Tryggvason et al. that a key slit diaphragm structural molecule, i.e. nephrin, was mutated in congenital nephrotic syndrome of Finnish type [2]. This discovery launched an explosion of interest in many structural molecules of the podocyte that when affected by mutations or polymorphisms are linked to nephrotic syndrome and sclerosis. Examples include podocin, αactinin4, phospholipase C e, CD2-AP and more recently the transient receptor potential channel-6 (TRPC-6) [3]. Thus, we now have an example of a podocyte channel that responds to alterations in angiotensin II by altering calcium signalling that profoundly affects the podocyte’s cytoskeleton [4]. In parallel, the slit diaphragm is now recognized not merely as a mechanical barrier to filtration, but also as a sensing device [5] that responds dynamically to alterations in the ultrafiltrate that passes through it, with changes in signalling cascades that also affect the cytoskeleton. Injurious and pro-fibrotic events are also recognized to directly affect the podocyte. Thus, the podocyte expresses key components of the renin–angiotensin system and also responds to transforming growth factor-β (TGF-β) [6,7]. Importantly, the podocyte is not isolated, as it sits on the urinary aspect of the GBM. Through complex mechanisms, podocyte-specific production of vascular endothelial growth factor-A (VEGF-A) reaches the endothelium, which is key for maintenance of the glomerular endothelial cell [8]. Autocrine effects of VEGF, involving direct actions of VEGF-A via a podocyte receptor, have also been suggested [9]. The loss of the podocyte is thought to be a key event in progressive sclerotic injury in many diseases [10–12]. The podocyte has very limited regeneration capacity [13]. Although regeneration may be possible from niche stem cells, such as specialized parietal-like epithelial cells [14], podocyte detachment and/or apoptosis are closely correlated with loss of normal permeability function and ultimately, sclerosis. In recent years, the podocyte has also been shown to be capable of responding to insulin, transporting glucose via the glucose transporters GLUT1 and GLUT4 [15]. This action was found to be dependent on nephrin expression. The current studies by Lennon et al. reveal the expanded talents and responsiveness of the podocyte [16]. The authors show that free fatty acids induce profound changes in cultured podocytes, including decreased insulin receptor IRS1, PKB and lesser translocation of GLUT4 to the cytoplasmic membrane. In the absence of cytotoxicity, there was a corresponding downregulation of VEGF-A and of key insulin receptor signalling pathways, investigated by the focused gene array and protein signalling and trafficking. The authors previously showed that the response of podocytes to insulin and glucose transport was dependent on nephrin expression [15]. The authors suggest that the NCK adaptor protein may mediate the linkage of nephrin to actin and thus play a role in glucose transporter translocation. Of key importance therefore is the downregulation of the adaptor protein NCK1 by palmitate, suggesting a direct free fatty acid effect on glucose transport. In related studies, Ijaz et al. [17] showed that podocytes from db/db diabetic mice lost their ability to respond to insulin as albuminuria developed, in association with increased phosphorylation of C-jun N-terminal kinase (JNK). However, when phosphorylation of JNK was inhibited in db/db mice in vivo, although insulin sensitivity improved and glucose levels were lower, there was no improvement in albuminuria. Similarly, knockout of either JNK1 or JNK2 did not improve the streptozotocin-induced diabetic phenotype, and albuminuria was actually worse in JNK2 knockout mice. However, whether JNK phosphorylation was specifically altered in podocytes, or whether podocyte differentiation and insulin sensitivity were altered in response to JNK inhibition, was not specifically investigated. The above studies indicate that there may be complex interrelationships between events of insulin signalling and other components of podocyte injury and ultimate diabetic nephropathy. In vivo multiple mechanisms are

Investigation of standing balance in patients with diabetic neuropathy at different stages of foot complications

Background Diabetic peripheral neuropathy is known to cause postural instability. This study investigated standing balance in patients with diabetic neuropathy with secondary foot complications: foot ulceration, partial foot amputation and trans-tibial amputation, which are expected to pose further challenge to balance control. Methods In this cross-sectional study, 23 patients with diabetic neuropathy alone (controls) were compared with 23 patients with diabetic foot ulceration, 16 patients with partial foot amputation and 22 patients with trans-tibial amputation. Posturography was used to determine the centre of pressure excursion during quiet standing. Differences between the 4 groups were tested using ANOVA and post-hoc comparisons. Findings The 4 groups varied in neuropathy score ( P = 0.001) and demonstrated significant decline in balance from neuropathy alone to foot ulceration, to partial foot amputation and trans-tibial amputation based on total excursion of centre of pressure ( P < 0.001) and centre of pressure excursion in antero-posterior direction ( P < 0.001). The excursion of centre of pressure in medio-lateral direction varied between 4 groups ( P < 0.05) however, there was no significant trend. The distance between ankles increased significantly from neuropathy to trans-tibial amputee group ( P = 0.001). Post-hoc comparison with controls revealed that each of three study groups demonstrated decreased balance (diabetic neuropathy vs. foot ulceration, P = 0.001, diabetic neuropathy vs. partial foot amputation, P = 0.002 and diabetic neuropathy vs. trans-tibial amputation, P = 0.009). Interpretation Balance deterioration among patient groups from diabetic neuropathy alone to trans-tibial amputation appears to result from bio-mechanical impairment caused by progression of foot complications in addition to postural instability caused by diabetic neuropathy.

Impact of Secondary Foot Complications on the Inpatient Department of the Diabetes Unit of Yaoundé Central Hospital

Diabetic foot ulceration and gangrene are preventable long-term complications of diabetes mellitus. This cross-sectional study was conducted to evaluate the impact of secondary foot complications on hospital admission and activities of the diabetes service of Yaoundé Central Hospital (YCH). A total of 207 patient files were included in this study, the period of which was from November 1999 to October 2000, 1 year of activity of the inpatient department of the Diabetes and Endocrine Unit of YCH. General characteristics of the patients were considered, the reason for their admission, the duration of their hospitalization in the service, and the outcome. The diabetic foot problem was the second most common cause of hospital admission in 27 (13%) patients. Secondary foot complication was the associated cause of mortality in 19.3% of cases of death (6 out of 31) in this study. The highest duration of hospitalization was recorded in patients with foot problems (29.4+/-5.4 days), the finding being statistically significant. Foot problems accounted for 0.25% of bed occupancy for the selected period. Five patients underwent amputation because of foot problems. A high rate of hospital discharge upon request was recorded among patients with foot problems (25% of the cases). This study suggests that diabetic foot is the second biggest cause of hospital admission in this setting; however, it is the main cause of prolonged hospital stay and bed occupancy.

Does infection affect amputation rate in chronic critical leg ischemia?

Aim was to analyze the association between local infection and amputation rate in patients with chronic critical limb ischemia (CLI) with or without successful revascularization. We performed a retrospective analysis of 56 consecutive patients with 57 critically ischemic legs seen at the University Hospital Bern. Patients with CLI were selected if ischemic lesions and follow-up of more than 2 months were documented. Infection was suggested when 2 of the following criterion were present: temperature > 37 degrees C, C-reactive protein > 50 mg/L, leukocytes > 10 x 10(3)/microliter ("2 of 3" criterion), or a putrid secretion was documented ("secretion" criterion). In patients with successful revascularization (n = 39), there was a significant shift from 10.3% major to 33.3% minor amputations (Chi Square p value = 0.014) as compared to patients without or with failed revascularization (n = 18) with 44.4% and 11.1% (Chi Square p value = 0.008), respectively. An infection was suggested in 22 of 53 limbs (41.5%) according to the "2 of 3" criterion, and 30 of 57 limbs (52.6%) satisfying the "secretion" criterion. Both criteria, were significantly more common in patients undergoing amputation as compared to patients without amputation (p = 0.001). Multiple lesions were more common in patients with major amputations (p = 0.026). Successful revascularization effectively reduces major amputations and leads to healing of ischemic ulcers. Secondary foot infections are frequent. Infections are associated with a significantly higher rate of minor and major amputations, also in patients with successful revascularization, and should be treated adequately as well as in time with antibiotics.

Wojnowicia hirta . [Descriptions of Fungi and Bacteria

Abstract A description is provided for Wojnowicia hirta . Information is included on the disease caused by the organism, its transmission, geographical distribution, and hosts. HOSTS: Cereals and grasses ( Agropyron, Avena, Bromus, Calamagrostis, Calamovilfa, Dacrylis, Distichlis, Elymus, Festuca, Hordeum, Koeleria, Phleum, Poa, Secale, Sorghastrum, Sorghum, Spartina, Stipa, Triticum ). DISEASE: Secondary foot rot or root rot of cereals and grasses. Also referred to as rot of mature straw. Rot of cereals and grasses is very common (5, 223; 6, 272; 7, 370; 11, 503; 12, 685; 16, 242; 48, 120; 1602) and considered to be of definite economic importance (Sprague, 1950). In France infected wheat plants have been reported to become etiolated and progressively shrivelled without producing lesions (4, 662). As the disease progresses, cells at the base of the culms were claimed to collapse resulting in the breaking of the stems and general lodging of plants in infected areas (5, 223; 12, 685). Subsequently pycnidia were reported appearing on lower leaf-sheaths above and below the soil line (1, 288). Sometimes affected wheat plants have been found to show discolouration of culm bases and roots (5, 223), or dark brown to black spots and streaks on the stem which are partly superficial (7, 370, Sprague, 1935). GEOGRAPHICAL DISTRIBUTION: Africa (Morocco, South Africa, Tunisia); Asia (Turkey); Australasia and Oceania (Australia, New South Wales, South Australia, Victoria, Western Australia); Europe (Belgium, Bulgaria, Czechoslovakia, Finland, France, Germany, Irish Republic, Italy, Netherlands, Poland, Rumania, Spain, Switzerland, UK, USSR); North America (Canada, Alberta, Saskatchewan; USA, Arkansas, California, Colorado, Dakota, Idaho, Kansas, Montana, Oregon, Washington, Wyoming). TRANSMISSION: Infected soil has been found to be the chief mode of transmission where stubble has been ploughed under (3, 191). It has also been reported that W. hirta occurs on culms overwintered in the field usually at the 2nd node (9, 639-641).

Radiological Studies on Changes in Calcaneus Trabecula in Leprosy

The important factors closely relating to the structure of calcaneus trabecula are generally considered the static conditions, namely the charged pressure imposed by standing and/or walking and the traction force by muscle movement of lower half of the body at that time.As frequently, leprosy accompanies with peroneal palsy (so-called as drop foot), calcaneus fracture, deformity in foot joint (Charcot's joint in particular), secondary foot joint union (triple-or pantalar-arthrodesis), secondary amputation of metatarsal part or their combinations. (or above combinations)All of the above mentioned static conditions are considered to have a close relation with the structure of calcaneus trabecula.Therefore, radiological studies on changes in calcaneus trabecula have been carried out on the deformed feet in leprosy.The results are as follows :(1) Even in the old peroneal palsy cases, if the form of longitudinal arch is slightly decomposed, no effects are observed on the trabecula a, C1 and/or C2 due to steppage gait. The pressure by standing and/or walking which goes through the longitudinal axis of the tibia, further through the center of the foot joint, is ramified (spreaded) to each condition in the metatarsal part and tuber calcanei and, as the trabecula a, C1 and C2 coincide with their own routes respectively, the pressure in the stance phase with the greatest pressure imposed by standing and/or walking is considered to show normal ramification, even in the case of steppage gait.Even if the joint condition is normal in the stance phase, the trabecula b and/or C2 tends to become coarser when the foot joint is fixed. This seems as the fact of the pressure imposed by standing and/or walking, which goes through the longitudinal axes of the tibia, is not ramified toward the metatarsal part but perpendicularly to the bottom of the calcaneus.(2) Excepting for the peroneal palsy cases (the majority of the cases) and calcaneus fracture cases with normal Bohler angle, the trabecula d1 and d2 have been found to be weakened or disappearing in almost all studied cases. This seems as these trabeculae have relations with the traction force of the sole muscles. Also, as the calcaeus frequently occurs in leprosy patients, these trabeculae cross the tabecula b, C1 and C2 to make the skeletal structure strong.(3) As the contructure of calcaneus tendon or loss of its function, the trabecula e markedly increased its disappearing tendency, As the above, this trabecula is considered to have a closed correlation with the traction force of the calcaneus tendon.

A Two-Stage Stabilization Procedure for Correction of Calcaneocavus

1. Advanced calcaneocavus includes structural bone changes in the calcaneus, as evidenced by an increase in the tuber angle. 2. The objective in the treatment of calcaneocavus is to obtain a corrected, stable foot which is as nearly normal in appearance as possible and which will afford a good weight-bearing surface when fitted with a normal shoe. 3. Shifting the foot posteriorly in order to obtain a long posterior lever arm is felt to be unsound and undesirable if a secondary foot deformity is thereby produced. 4. The two-stage operative procedure for stabilization of the calcaneocavus foot which has been presented facilitates the removal of a posterior bone wedge from the subtalar joint, allowing rotation of the calcaneus to a horizontal position and restoring heel length. 5. Immediate postoperative care is nsecessary in order to minimize complications due to pressure within the cast. 6. In a preliminary survey it was found that the objectives of the operation were obtained in twenty-one of the twenty-four feet available for evaluation. 7. A major complication occurred in only one case. There were no infections.