Sonography of a case series of talar callosities.

Talar callosity is an uncommon condition characterized by asymptomatic hyperkeratotic plaques located on the dorsum of one or both feet. We have detected an increased number of children presenting with this condition after the COVID-19 lockdown. High-frequency ultrasound was performed in all patients who consulted because of talar callosity. All four cases shared similar ultrasound findings: thickening of the epidermis with effacement of the subepidermal low-echogenic band and diffuse thickening of the dermis and subcutaneous cellular tissue, with a diffuse decrease in echogenicity. The bone cortex was respected in all cases. No increase in vascularization was detected. Although it is a benign condition, it is important to recognize talar callosity to exclude worse conditions and to prevent unnecessary biopsies. To our knowledge, we are the first to describe ultrasonographic findings of talar callosity.

Hyperpigmentation and thickening of skin with callosity formation over dorsum of both feet and healed ulceration over left lateral malleolus in a patient with type 2 diabetes performing prolonged prayers.

Many types of skin lesions have been described in patients with diabetes, but prolonged prayer-induced hyperkeratosis and callous formation are rare. We describe such lesions in a 62-year-old Muslim patient with uncontrolled glycemia who practiced prolonged, repeated religious prayers in sitting position causing significant pressure over dorsum of both ankles. He developed prayer-induced callous formation on dorsum of both ankles, with more thickening and a healed ulcer on left. Prayer-induced skin lesions should be carefully managed in patients with diabetes, who are more vulnerable for infections and gangrene due to as venous/arterial insufficiency and peripheral neuropathy.

Foot callus thickness does not trade off protection for tactile sensitivity during walking.

Until relatively recently, humans, similar to other animals, were habitually barefoot. Therefore, the soles of our feet were the only direct contact between the body and the ground when walking. There is indirect evidence that footwear such as sandals and moccasins were first invented within the past 40 thousand years1, the oldest recovered footwear dates to eight thousand years ago2 and inexpensive shoes with cushioned heels were not developed until the Industrial Revolution3. Because calluses-thickened and hardened areas of the epidermal layer of the skin-are the evolutionary solution to protecting the foot, we wondered whether they differ from shoes in maintaining tactile sensitivity during walking, especially at initial foot contact, to improve safety on surfaces that can be slippery, abrasive or otherwise injurious or uncomfortable. Here we show that, as expected, people from Kenya and the United States who frequently walk barefoot have thicker and harder calluses than those who typically use footwear. However, in contrast to shoes, callus thickness does not trade-off protection, measured as hardness and stiffness, for the ability to perceive tactile stimuli at frequencies experienced during walking. Additionally, unlike cushioned footwear, callus thickness does not affect how hard the feet strike the ground during walking, as indicated by impact forces. Along with providing protection and comfort at the cost of tactile sensitivity, cushioned footwear also lowers rates of loading at impact but increases force impulses, with unknown effects on the skeleton that merit future study.

Milk-flow data collected routinely in an automatic milking system: an alternative to milking-time testing in the management of teat-end condition?

BACKGROUND: Having a poor teat-end condition is associated with increased mastitis risk, hence avoiding milking machine settings that have a negative effect on teat-end condition is important for successful dairy production. Milking-time testing (MTT) can be used in the evaluation of vacuum conditions during milking, but the method is less suited for herds using automatic milking systems (AMS) and relationships with teat end condition is poorly described. This study aimed to increase knowledge on interpretation of MTT in AMS and to assess whether milk-flow data obtained routinely by an AMS can be useful for the management of teat-end health. A cross-sectional study, including 251 teats of 79 Norwegian Red cows milked by AMS was performed in the research herd of the Norwegian University of Life Sciences. The following MTT variables were obtained at teat level: Average vacuum level in the short milk tube during main milking (MTVAC), average vacuum in the mouthpiece chamber during main milking and overmilking, teat compression intensity (COMPR) and overmilking time. Average and peak milk flow rates were obtained at quarter level from the AMS software. Teat-end callosity thickness and roughness was registered, and teat dimensions; length, and width at apex and base, were measured. Interrelationships among variables obtained by MTT, quarter milk flow variables, and teat dimensions were described. Associations between these variables and teat-end callosity thickness and roughness, were investigated. RESULTS: Principal component analysis showed clusters of strongly related variables. There was a strong negative relationship between MTVAC and average milk flow rate. The variables MTVAC, COMPR and average and peak milk flow rate were associated with both thickness and roughness of the callosity ring. CONCLUSIONS: Quarter milk flow rate obtained directly from the AMS software was useful in assessing associations between milking machine function and teat-end condition; low average milk flow rates were associated with a higher likelihood of the teat having a thickened or roughened teat-end callosity ring. Since information on milk flow rate is readily available from the herd management system, this information might be used when evaluating causes for impaired teat-end condition in AMS.

Clinical pearl: the squeeze maneuver.

Plantar warts can be distinguished from calluses using the squeeze maneuver, a quick and easy method to diagnose plantar warts. This technique negates the need for an expensive diagnostic tool.

Camptodactyly and knuckle pads coexisting in an adolescent boy: connection or coincidence?

Camptodactyly is a condition characterized by a nontraumatic, fixed flexion contracture at the proximal interphalangeal joint, typically involving the fifth finger. Most occurrences are sporadic, but autosomal dominant transmission and syndromic associations have been described in the literature. We describe the case of an adolescent boy who presented to our clinic with a 2-year history of bilateral, nonsyndromic camptodactyly and knuckle pads.

Abordagem cirúrgica de faixas constritivas em Síndrome de Vohwinkel / Surgical correction of constrictive bands in Vohwinkel syndrome

A Síndrome de Vohwinkel ou ceratodermia hereditária mutilante é uma ceratodermia palmoplantar rara, que se manifesta na infância e se torna mais evidente nas fases de adolescência e idade adulta. Doença de herança preferencialmente autossômica dominante, acomete mais mulheres e caucasianos. A hiperceratose palmoplantar difusa, com aparência de favo de mel; as faixas constritivas digitais conhecidas como pseudoainhum, e as placas ceratósicas em forma de estrela-do-mar no dorso de mãos e pés, podendo acometer cotovelos e joelhos, são os achados clínicos característicos da Síndrome. O presente trabalho trata de um relato de caso de uma paciente com Síndrome de Vohwinkel e a terapêutica cirúrgica realizada nas faixas constritivas.

Vohwinkel syndrome, also known as hereditary mutilating keratoderma, is a rare palmoplantar keratoderma that manifests in childhood and becomes more evident in adolescence and adulthood. This preferential autosomal dominant disease affects more women and Caucasians. Its clinical features are diffuse palmoplantar keratoderma with the appearance of honeycomblike constricting rings in the fingers and toes known as pseudo-ainhum, and starfish-shaped keratotic plaques on the dorsal aspect of the hands and feet that can affect the elbows and knees. The present report describes a case report of a patient with Vohwinkel syndrome and surgical correction of the constrictive bands.

In vitro differential diagnosis of clavus and verruca by a predictive model generated from electrical impedance.

BACKGROUND: Similar clinical appearances prevent accurate diagnosis of two common skin diseases, clavus and verruca. In this study, electrical impedance is employed as a novel tool to generate a predictive model for differentiating these two diseases. MATERIALS AND METHODS: We used 29 clavus and 28 verruca lesions. To obtain impedance parameters, a LCR-meter system was applied to measure capacitance (C), resistance (Re), impedance magnitude (Z), and phase angle (θ). These values were combined with lesion thickness (d) to characterize the tissue specimens. The results from clavus and verruca were then fitted to a univariate logistic regression model with the generalized estimating equations (GEE) method. In model generation, log ZSD and θSD were formulated as predictors by fitting a multiple logistic regression model with the same GEE method. The potential nonlinear effects of covariates were detected by fitting generalized additive models (GAM). Moreover, the model was validated by the goodness-of-fit (GOF) assessments. RESULTS: Significant mean differences of the index d, Re, Z, and θ are found between clavus and verruca (p<0.001). A final predictive model is established with Z and θ indices. The model fits the observed data quite well. In GOF evaluation, the area under the receiver operating characteristics (ROC) curve is 0.875 (>0.7), the adjusted generalized R2 is 0.512 (>0.3), and the p value of the Hosmer-Lemeshow GOF test is 0.350 (>0.05). CONCLUSIONS: This technique promises to provide an approved model for differential diagnosis of clavus and verruca. It could provide a rapid, relatively low-cost, safe and non-invasive screening tool in clinic use.

Subungual corn: a tender pigmented subungual lesion in older people.

BACKGROUND: Heloma durum occurs as a tender mass in the distal nail bed beneath the big toenail in older women. OBJECTIVES: To define and report a variant of heloma durum not referenced in the literature. METHODS: This was a retrospective study whereby records, including photographs, of all cases of subungual corn were reviewed. All patients were seen in an outpatient setting. RESULTS: The records of 16 patients [15 women, one man, mean age 68 years (range 49-87)] were examined; history was between 6 and 30 months, none of the patients had received effective treatment. Mycology was negative. All reported discomfort under the big toe nail; 12 had associated subungual haemorrhage. The right big toenail was involved in 10 of 16 patients. Shared clinical features were of a subungual focus of hyperkeratosis (100%) with haemorrhage admixed in 75% of cases. The lesion was in the midline third of the nail in 11 of 16 patients (69%). The affected distal margin of nail was the uppermost point in the lateral profile of the toe (100%). Hyperextension at the distal interphalangeal joint of the affected toe was demonstrated with the patient standing. Local excision was performed when diagnosis was unclear (eight patients); simple clearance of the keratin plug was performed in the other eight patients. There was no relapse in patients who were followed up for > 6 months (n = 7). CONCLUSIONS: Clinical explanation and paring down should be attempted in order to avoid surgery at this poor healing site in the elderly.

[Giant cornu cutaneum - a grotesque manifestation of squamosus cell carcinoma in the palm]. / Cornu cutaneum giganteum - groteske Manifestation eines Plattenepithelkarzinoms in der Hohlhand.

Squamous cell carcinoma is the most common maligne primary tumour of the hand. It is almost always located on the dorsum of the hand, an occurrence in the palm is very rare. Usually these tumours are recognised early because of their clinical presentation and visible location. We report on a case in which the patient presented in our hospital only due to a massive mechanical impairment of his hand function through an oversized squamous cell carcinoma. On the basis of this case the therapeutic algorithm for large squamous cell carcinoma in the palm is illustrated and discussed.

Reactive amyloidosis associated with ischial callosititis: a report with histology of ischial callosities in rhesus macaques (Macaca mulatta).

Ischial callosities have received little attention in veterinary medicine even though they are distinguishing anatomic organs. The organs are characterized by a pair of hairless pads of thickened epidermis, located bilaterally in the gluteal region, which overlay the tuberosities of the ischia of all Old World monkeys, gibbons, and siamangs. The current report describes a case of reactive amyloidosis associated with ischial callosititis in a rhesus macaque (Macaca mulatta). Amyloid A (AA) protein was found in the liver, spleen, small intestine, mesenteric lymph nodes, and ischial callosities by histology, Congo red stain, and immunohistochemistry. Confocal microscopy showed that many cluster of differentiation (CD)68-positive macrophages within the ischial callosities contained intracellular AA protein, which suggests that CD68-positive macrophages have an important role in the pathogenesis of reactive amyloidosis in nonhuman primates. The normal histology of ischial callosities of rhesus macaques is also documented in this report.

The association between teat end hyperkeratosis and teat canal microbial load in lactating dairy cattle.

Most pathogens that cause bovine mastitis invade the udder lumen through the teat canal. Amino acids and intercellular lipids may support microbial colonisation of the teat canal epithelium by pathogenic microorganisms. The aim of this study was to investigate the association between teat end hyperkeratosis, which is induced by machine milking, and teat canal microbial load. Contralateral teats, which differed in teat end hyperkeratosis scores, were identified in a split-udder experiment. The teat canal's microbial load was evaluated using the wet and dry swab technique. Staphylococcus (S.) aureus, Streptococcus (Sc.) uberis, Escherichia (E.) coli and other coliforms were detected by agar plate cultures. The positive detection of E. coli and the log(10)-transformed E. coli load of a teat canal were significantly associated with the teat end hyperkeratosis score (P<0.05). There were significant differences with respect to positive findings for E. coli, as well as the microbial load of E. coli and Sc. uberis, between the less-calloused and the more-calloused teat of a pair. For S. aureus, no significant associations between hyperkeratosis score and teat canal microbial load were detected. In general, a teat with a highly calloused teat end had an increased teat canal microbial load compared with the contralateral teat, characterised by a lower callosity. The results of the present study indicate that the environmental pathogen load is associated with teat end hyperkeratosis. Further research is needed to identify factors that may affect teat canal microbial load in lactating dairy cattle.

[Non traumatic lesions of the foot, calluses and nails: socioeconomic impact of an unexplored issue]. / Lésions non traumatiques du pied, cors et ongles: impact socio-écono- mique d'un problème méconnu.

Up to 20% of the general population, especially women and old people, suffer from non traumatic lesions of the foot. These lesions have repercussions on a person's health and wellbeing. Nevertheless, the clinical examination of the foot rarely forms part of routine medical consultations. Using questionnaires and individual interviews, this pilot study investigated the foot problems of 96 patients attending a podiatrist's practice, as well as the level of communication between the patients and their doctor. 85% of the participants said they never talked about calluses and nails with their doctor. The results were confirmed by fifteen individual interviews. Clinicians have an important role to play in the early detection of these lesions, allowing an efficient management of this issue.

Granuloma annulare mimicking dorsal knuckle pads.

A 37-year-old man underwent excision of what was presumed to be knuckle pads associated with Dupuytren disease. The histology revealed granuloma annulare, which is typically treated nonsurgically. This report includes a discussion of granuloma annulare and its differentiation from knuckle pads.

Beneficial effects of foot care nursing for people with diabetes mellitus: an uncontrolled before and after intervention study.

AIM: The aim of this study was to assess the effectiveness of a preventative foot care nursing programme for diabetic patients. BACKGROUND: Foot complications are common in diabetic patients and prevention of such complications requires foot care. However, there is little information on the effectiveness of foot care nursing on the incidence and recurrence of diabetic foot. METHODS: We developed a diabetic foot care programme based on the International Working Group on the Diabetic Foot. We studied 88 patients who attended our foot care programme for 2 years, and collected data from April 2005 to March 2009. Patients were divided into four groups according to the risk classification, and received foot care. We evaluated the incidence of foot ulceration or recurrence and non-ulcerated foot condition. Characteristics of the patients were analysed using the paired t-test and McNemar's test, and changes in severity of tinea pedis and grade of callus were analysed using Wilcoxon's signed rank sum test. RESULTS: The programme reduced the severity score of tinea pedis (P < 0·001) and improved callus grade (P < 0·001). All these were evaluated by Wilcoxon's signed rank sum test. None of the patients of risk-group-3 (history of foot ulceration) showed recurrence of callus-related foot ulcers. Six high-risk patients developed foot ulceration during the programme because of minor injury, but the ulcers healed without development of gangrene. CONCLUSION: A nurse-based foot care programme is effective in preventing diabetic foot in diabetic patients.