Clinical photographic observation of plantar corns and callus associated with a nominal scale classification and inter- observer reliability study in a student population.

BACKGROUND: The management of plantar corns and callus has a low cost-benefit with reduced prioritisation in healthcare. The distinction between types of keratin lesions that forms corns and callus has attracted limited interest. Observation is imperative to improving diagnostic predictions and a number of studies point to some confusion as to how best to achieve this. The use of photographic observation has been proposed to improve our understanding of intractable keratin lesions. METHODS: Students from a podiatry school reviewed photographs where plantar keratin lesions were divided into four nominal groups; light callus (Grade 1), heavy defined callus (Grade 2), concentric keratin plugs (Grade 3) and callus with deeper density changes under the forefoot (Grade 4). A group of 'experts' assigned from qualified podiatrists validated the observer rated responses by the students. RESULTS: Cohen's weighted statistic (k) was used to measure inter-observer reliability. First year students (unskilled) performed less well when viewing photographs (k = 0.33) compared to third year students (semi-skilled, k = 0.62). The experts performed better than students (k = 0.88) providing consistency with wound care models in other studies. CONCLUSIONS: Improved clinical annotation of clinical features, supported by classification of keratin- based lesions, combined with patient outcome tools, could improve the scientific rationale to prioritise patient care. Problems associated with photographic assessment involves trying to differentiate similar lesions without the benefit of direct palpation. Direct observation of callus with and without debridement requires further investigation alongside the model proposed in this paper.

Operative repair of fourth and fifth toe corns.

METHODS: We report a retrospective review of 57 consecutive patients (72 feet) over a period of 20 years who had been treated operatively for either a lateral fifth toe corn or an interdigital corn of the fourth interdigital space more than two years previously. Of these, 51 patients (62 feet) returned for a follow-up evaluation at a minimum of two years (average of over seven years) which included a review of the interval history since the surgery, a physical examination, a radiographic evaluation, and assessment of the patient's satisfaction with the alignment and results of surgery. Treatment of 31 lateral fifth toe corns involved either a lateral condylectomy and flexor tenotomy or a complete condylectomy. Treatment of 31 interdigital corns comprised either a single condylectomy, double condylectomy of adjacent corns, or a complete condylectomy (hammertoe repair) of a symptomatic corn. Treatment in each case was dependent upon the severity of the deformity. RESULTS: There was found to be no significant difference in comparison of the two major groups (interdigital corns and lateral fifth toe corns) with the measurement of the relative length of the fourth and fifth metatarsals, toe malalignment, angulation of the fourth and fifth toes (MTP-4, MTP-5 angles), and the phalangeal-5 angle. Pain was relieved in 58 of 62 feet (93%) and subjective acceptable alignment was achieved in 54 of 62 feet (87%). At final follow-up 53 feet were rated by patients as excellent, seven as good, one as fair, and one as poor. Complications included numbness of the involved digit (six feet). There were two superficial infections. There were two cases of joint instability due to excessive bone resection. Joint stiffness was commonly observed (34/62 feet, 55%), but was not associated with diminished satisfaction at final follow-up. Mild asymptomatic recurrence of a callosity was noted in 10 feet and moderate or severe recurrence was noted in two feet. Dissatisfaction was associated with moderate or severe recurrence. CONCLUSION: In this retrospective study at an average of more than seven years, we achieved a high level of patient satisfaction treating both lateral fifth toe corns and interdigital corns with a partial and/or complete condylectomy, the choice depending upon the magnitude of the deformity and the callus, and the fixed nature of the lesser toe deformity.

Relationship between teat-end callosity and occurrence of clinical mastitis.

A longitudinal study in 15 herds, with a total of 2157 cows, was conducted to examine the relationship between teat-end callosity (TEC) and the incidence of clinical mastitis. During the 1.5-yr study period, clinical mastitis was diagnosed by the farmers based on clinical signs. Teat-end callosity was scored every month according to a teat-end callosity classification system, which discriminates between teat-end callosity thickness (TECT) and roughness (TECR). Differences in TECT between healthy and clinical mastitis quarters within infected cows were small but significant 3 mo before (0.13 higher), in the month during which the clinical mastitis occurred (0.08 higher), and in the following 2 mo (0.06 and 0.05 higher). To compare TECT and TECR between cows with and without clinical mastitis, 199 cows with clinical mastitis were paired with control cows based on herd, days in milk, and parity. Clinical mastitis cows had more TEC than their healthy herd mates, particularly when clinical mastitis occurred between the second and fifth months of lactation. Clinical Escherichia coli mastitis in the second or third month of lactation occurred in cows with less TEC than in cows with clinical mastitis caused by other pathogens. Clinical culture-negative, yeast, Klebsiella pneumoniae, and Enterobacter aerogenes mastitis cows had more TECT and TECR than other cows with clinical mastitis in the same month of lactation. Pointed teat ends had higher TECT and TECR than flat or inverted teat ends. Teat-end callosity thickness increased with a higher milk yield at peak production.

Classification and longitudinal examination of callused teat ends in dairy cows.

To examine the development of teat end callosity thickness and roughness in early lactation and to quantify cow factors of interest, a system to classify teat end condition was developed. A distinction was made between rough and smooth rings around the teat orifice. In addition, a classification of the degree of callosity was developed. Kappa coefficients for the repeatability of scoring by this classification system by different workers were 0.71 for teat end callosity thickness and 0.86 for teat end callosity roughness. The teat end callosity classification system was used for a longitudinal study with 40 cows during the first 14 wk of lactation. Models were built to predict teat end callosity thickness and roughness, machine-on time, and milk yield. For the response variables, teat end callosity thickness, machine-on time, and milk yield, the consecutive measurements appeared to follow a lactation curve model with a subject-specific general slope and intercept. Teat end callosity increased rapidly the first 8 wk. Cow factors such as days in milk, parity, machine-on time, and teat end shape were associated with the degree of teat end callosity, and the probability of the callosity ring to become rough. Teat end callosity thickness did not decrease within the 14-wk trial period for most teats. Pointed or round teat ends showed more callus than inverted teat ends. Longer machine-on time resulted in a higher probability of the callosity ring to become rough. Rear teats showed less callosity than front teats in this study.

The use of orthotic devices to correct plantar callus in people with diabetes.

Foot problems are a major cause of morbidity in people with diabetes. Plantar callus is common and is a sign of abnormal foot pressures. Shear stresses at these areas of high foot pressures may ultimately result in ulcer formation. This study compared the effect on plantar callus of the use of rigid orthotic devices and conventional podiatric care. Twenty diabetic subjects participated in the study and were randomly allocated to conventional treatment (n = 11) or orthotic device treatment (n = 9). After 12 months the patients in the orthotic group showed a significant reduction in callus grade, whereas the conventionally treated group showed no significant change. There were no adverse effects from wearing the orthotic device. Rigid orthoses have a beneficial effect on plantar callus presumably through the lowering and redistribution of abnormal foot pressures.

Callosidades dolorosas constitucionales: tratamiento con etritinato / Constitutional painful callosities: treatment with etretinate

Se describe un caso de queratodermia palmoplantar circunscripta, bilateral, con paquioniquia e hiperhidrosis, en una paciente de sexo femenino, de 32 años de edad, sin antecedentes heredofamiliares de la afección. Se la trató con etretinato durante 3 meses , obteniéndose la remisión de las lesiones y su sintomalogía hasta la actualidad. Proponemos, de acuerdo a la revisión realizada, la clasificación de los cuadros de callosidades dolorosas en constitucionales o hereditarias. Nuestro caso constituye la segunda observación en la bibliografía de callosidades dolorosas constitucionales (CDC). (AU)

Callosidades dolorosas constitucionales: tratamiento con etritinato / Constitutional painful callosities: treatment with etretinate

Se describe un caso de queratodermia palmoplantar circunscripta, bilateral, con paquioniquia e hiperhidrosis, en una paciente de sexo femenino, de 32 años de edad, sin antecedentes heredofamiliares de la afección. Se la trató con etretinato durante 3 meses , obteniéndose la remisión de las lesiones y su sintomalogía hasta la actualidad. Proponemos, de acuerdo a la revisión realizada, la clasificación de los cuadros de callosidades dolorosas en constitucionales o hereditarias. Nuestro caso constituye la segunda observación en la bibliografía de callosidades dolorosas constitucionales (CDC).