Foot Diseases

The book features increased coverage of ultrasound, PET, and the diabetic foot and upgraded MR and CT images. New syndromes such as impingement have been added to the chapter on soft tissue trauma and overuse. The fractures and dislocations chapter includes OTA classifications and additional MR and CT scans of complications. Other highlights include up-to-date information on new fixation devices and prostheses and state-of-the-art interventional and vascular techniques including use of MRA.

The aim of this study was to evaluate the use of Doppler ultrasonography to monitor vascular blood flow dynamics in defined diseases of the equine digit in a noninvasive way. Doppler sonography was used to evaluate medial digital artery blood flow in eight horses with septic pododermatitis and four horses with laminitis in comparison with 10 horses of a control group. Doppler sonographic measurement and lameness examinations were performed in lame horses before treatment (day 0) and at 3, 6, and 9 days following treatment. Before treatment, blood flow velocities, arterial diameter, and flow volume were significantly higher in the lame horses, while pulsatility indices (PIs) were significantly lower (P < 0.05). Compared with the control group, there was no significant difference of resistive indices (RI) in the septic pododermatitis group, but these indices were significantly lower in the laminitis group. No significant difference between the two lame groups was recorded. After tr...

Squamous cell carcinoma (SCC) is a rare but well-documented complication of chronic osteomyelitis. Between February 1991 and March 1999, 13 cases (12 men and one woman) of SCC arising in chronic osteomyelitis were diagnosed and treated in our clinic. Mean age was 56.5 (38–70) years. Twelve patients underwent amputation and one underwent limb salvage. Average follow-up was 56 (24–121) months. Among the 13 patients two died of the disease. Treatment of choice for these tumours has been amputation. Carcinome cellulaire squameux est une complication d'ostéomyélite, peu fréquente, mais bien connue. Entre le février 91–mars 99, dans notre clinique, nous ont constate 13 malades (12 hommes et 1 femme) a qui nous ont vu la maladie développe a la base d'ostéomyélite chronique. L'age moyen était 56.5. (38–70) 12 malades ont subi une amputation et dans l'autre l'extrémité a été gardée. La surveillance a duré à peu près 56 (24–121) mois. Parmi ces 13 malades seulement deux sont morts. Pour ces tumeurs on peut dire que l'amputation est la méthode la plus efficace.

Generalized edema has been reported to be a rare side effect of systemic retinoids. We report a patient who developed localized bipedal edema from acitretin. Other causes of bipedal edema were excluded and withdrawal of acitretin led to resolution of the edema.

The medical records of 57 horses that had palmar digital neurectomy performed between 1984 and 1990 were reviewed. Neurectomies were performed either by transection and elec-trocoagulation (47 horses) or by the guillotine technique (10 horses). Middle-aged geldings, Quarter Horses, and Thoroughbreds were significantly over-represented when compared with the hospital population. Horses used as hunter/jumpers also appeared to be over-represented. Complications occurred in 17 (34%) of the 50 horses for which follow-up information was obtained. Recurrence of heel pain was the most common complication (14 horses). Palpable painful neuromas were detected in three horses. One year after neurectomy, 74% of the horses were sound; this decreased to 63% after 2 years.

To assess the clinimetric value of the Dutch version of the Foot Function Index (FFI) in comparison with the original FFI using verbal rating scales (FFI-5pt) rather than visual analog scales (VAS). A prospective study was performed on 206 patients with nontraumatic forefoot complaints. Scoring, internal consistency, and construct validity of the FFI-5pt were compared with those of the original FFI, which rates all items on VAS. We also studied agreement between the scores at baseline and after one and 8 weeks and the scale scores with regard to sex, age, presence of osteoarthritis, limitation of mobility, bodily pain, and poor physical functioning (using SF-36). Some items were not applicable; removal of these items left 2 scales (Pain and Disability) with high internal consistency (alpha = 0.88 to 0.94) and good agreement between both versions (intraclass correlation coefficient 0.64 to 0.79). Principal component analysis with varimax rotation using a forced 2 factor model fitted ...

To report outcome of horses treated for navicular syndrome using a pull-through (PT) technique for palmar digital neurectomy (PDN). Retrospective study. Horses (n=41) with navicular syndrome (NS). Medical records (1998-2002) for horses that had NS and failed to respond to conservative management that had unilateral or bilateral forelimb, biaxial PDN were reviewed. Outcome for up to 6 years was obtained by telephone questionnaire or lameness examination. Survival analysis was used to assess time to recurrence of lameness. One year after PDN, 36 horses (88%) were free of lameness. Mean survival with no lameness after surgery was estimated at 4.14+/-0.33 years (median, 5 years). PT-PDN technique resulted in soundness for 88% of horses for at least 1 year. PT-PDN was easily and quickly performed without specialized equipment, and had a low incidence of complications. The PT technique is an effective and viable alternative surgical method for PDN.

During a pre-purchase examination (PPE) there is always a debate about how clinical findings of the hoof different from ideal should be interpreted in relation to future lameness risk and/or unsuitability of the horse for the potential purchaser. The objectives of this study were to describe and compare external angular measurements, linear ratios and hoof capsule characteristics of non-lame and lame feet. Photographs of feet from 300 horses with foot pain and 25 non-lame horses were analysed. Hoof wall, heel and coronary band angles and hoof wall length and height, weight-bearing length, coronary band length and height of the coronary band at dorsal and palmar locations were measured and expressed as linear ratios. Mean hoof wall, heel and coronary band angles were larger in lame compared with non-lame feet; only the ratio of dorsal to palmar coronary band heights and the shape of the coronary band were significantly different between lame and non-lame horses. Growth rings were divergent and horn tubules were non-parallel in lameness of >3 months. At a PPE, a larger ratio of dorsal to palmar coronary band heights in one limb may be indicative of previous lameness in that foot. Changes in coronary band shape and divergent growth rings and horn tubules would suggest a longer duration.

Background: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. Methods: A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King's classification respectively. Results: The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King's classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Conclusion: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot.