Predictive factors for foot pain in the adult population.

BACKGROUND: Foot pain has been associated to factors like: fat, body mass index, age increased, female gender and the presence of pathologies. Although evidence is limited. The purpose is to determine the predictive factors for foot pain in the adult population. METHODS: From January to December 2021, 457 patients were > 18 years, gave signed informed consent to take part to this cross sectional study. All completed demographic data and various questionnaires related to pain: Foot Function Index, EuroQoL-5D and Visual Analogue Scale (foot pain). Anthropometric measurements were obtained using McPoil platform and foot posture was assessed by the Foot Posture Index (FPI). To determine whether a volume change is a predictive factor for foot pain, a parameter was established: the volumetric index for footwear (VIF). Factors linked to the presence of pain, including the considered VIF variables, were analyzed through multivariable logistic regression. RESULTS: Among the study population, 40.7% were male and 59.3% female. The mean age of 39.06 years and a body mass index of 25.58 Kg/cm2. The logistic regression model had a classification capability of 72.4%, a sensitivity of 72.3% and a specificity of 73%, in which, the predictors considered were the variables found to have a significant association with FFI-pain > 45 points,, showed that younger women, with a higher BMI, higher values of right FPI (pronation), poorer overall perceived health and with problems in walking were more likely to experience foot pain. CONCLUSION: Predictive factors for foot pain in the adult population include gender, age, Body Mass Index, FPI on the right foot, perceived health and mobility. Clinical implication, the presented measure aids physicians in assessing their patients´ foot pain likelihood.

Evaluation of field-testing protocols to diagnose insulin dysregulation in ponies using a Bayesian approach.

Field tests and their association with laminitis have not been evaluated in large cohorts. The objectives of this study were to evaluate the performance of basal insulin (BI), the oral sugar test (OST) and the insulin tolerance test (ITT) to diagnose ID and investigate their association with laminitis. Insulin dysregulation status was determined in 146 ponies using BI (insulin concentration >20 µIU/mL), an OST (insulin concentration >65 µIU/mL at 60 or 90 min after oral administration of 0.45 mL/kg corn syrup) and an ITT (< 50% reduction in glucose concentration 30 min after intravenous administration of 0.1 IU/kg insulin). Laminitis was identified using modified-Obel scores. A Bayesian approach was used to define the characteristics of the tests and receiver operating characteristic curves were used to assess their association with laminitis. All tests were well tolerated and laminitis was diagnosed in 9% of ponies. Insulin dysregulation was diagnosed in 15% of ponies using BI, 38% using the OST and 54% using the ITT with 11% of ponies positive for all three tests. The sensitivities and specificities of BI, the OST and the ITT to diagnose ID were 0.52 (95% confidence interval [CI], 0.35-0.79) and 0.97 (95% CI, 0.91 - 1.00), 0.84 (95% CI, 0.70 - 0.94) and 0.60 (95% CI, 0.49 - 0.71), and 0.85 (95% CI, 0.68-0.96) and 0.88 (95% CI, 0.75 - 0.97), respectively. Only BI and the OST were associated with laminitis (P = 0.003 and 0.015, respectively).

Broad-spectrum infrared thermography for detection of M2 digital dermatitis lesions on hind feet of standing dairy cattle.

Low-effort, reliable diagnostics of digital dermatitis (DD) are needed, especially for lesions warranting treatment, regardless of milking system or hygienic condition of the feet. The primary aim of this study was to test the association of infrared thermography (IRT) from unwashed hind feet with painful M2 lesions under farm conditions, with lesion detection as ultimate goal. Secondary objectives were to determine the association between IRT from washed feet and M2 lesions, and between IRT from unwashed and washed feet and the presence of any DD lesion. A total of 641 hind feet were given an M-score and IRT images of the plantar pastern were captured. Multivariable logistic regression analyses were done with DD status as dependent variable and maximum infrared temperature (IRTmax), lower leg cleanliness score and locomotion score as independent variables, and farm as fixed effect. To further our understanding of IRTmax within DD status, we divided IRTmax into two groups over the median value of IRTmax in the datasets of unwashed and washed feet, respectively, and repeated the multivariable logistic regression analyses. Higher IRTmax from unwashed hind feet were associated with M2 lesions or DD lesions, in comparison with feet without an M2 lesion or without DD, adjusted odds ratio 1.6 (95% CI 1.2-2.2) and 1.1 (95% CI 1.1-1.2), respectively. Washing of the feet resulted in similar associations. Dichotomization of IRTmax substantially enlarged the 95% CI for the association with feet with M2 lesions indicating that the association becomes less reliable. This makes it unlikely that IRTmax alone can be used for automated detection of feet with an M2 lesion. However, IRTmax can have a role in identifying feet at-risk for compromised foot health that need further examination, and could therefore function as a tool aiding in the automated monitoring of foot health on dairy herds.

Navicular bone fracture and severe deep digital flexor tendinopathy after palmar digital neurectomy in two horses.

Background: Navicular syndrome is a common cause of forelimb lameness in horses. Beyond changes to the navicular bone itself, horses with a clinical diagnosis of navicular syndrome often have pathology associated with other components of the navicular apparatus, including the navicular bursa, deep digital flexor (DDF) tendon, collateral sesamoidean ligaments, and impar ligament. Palmar digital neurectomy (PDN) is often used as a salvage procedure for horses diagnosed with navicular syndrome that become unresponsive to medical management. There are many potential complications associated with PDN, some of which are debilitating. Case Description: This report describes two cases of navicular bone fracture with severe DDF tendinopathy and distal interphalangeal joint subluxation/hyperextension that occurred 12 and 19 weeks after bilateral forelimb PDN. Conclusion: These two cases highlight the importance of proper patient selection before PDN due to the high incidence of undiagnosed soft tissue pathology in conjunction with radiographic evidence of navicular syndrome. Advanced imaging of the digit is recommended to identify and characterize any soft tissue pathology associated with the navicular apparatus before pursuing PDN to avoid disease progression and catastrophic injury.

Plantar Vein Thrombosis in the Medial Branch of the Posterior Tibial Vein: A Case Report.

Plantar vein thrombosis (PVT) is an atypical cause of plantar heel pain and is seldom reported in the literature. We present a unique, rare case report of a patient exhibiting plantar heel and medial arch pain caused by thrombosis in the plantar medial branch of the posterior tibial vein. The diagnosis was made by means of magnetic resonance imaging, showing lobulated hypointensity in the medial plantar vein, consistent with a PVT. In this article, we provide an overview of the clinical signs of PVT, which is most commonly plantar heel pain. Furthermore, we discuss ultrasound and magnetic resonance imaging as diagnostic modalities, and conservative treatment options, including anti-inflammatory medications, anticoagulation therapy, and compression therapy. As with other types of venous thromboembolism, this condition must also be diagnosed without delay to avoid potential complications.

Integrated infrared thermography and accelerometer-based behavior logger as a hoof lesion identification tool in dairy cows with various foot diseases under subtropical climates.

Infrared thermography (IRT) can measure a temperature change on the surface of objects, and is widely used as an inflammation or fever detection tool. The objective of this longitudinal study was to investigate the feasibility of detecting hoof lesion cattle using IRT under subtropical climate conditions. The experiment was conducted in two free-stall commercial dairy farms and 502 dairy cows participated between August 2020 and March 2022. Before hoof trimming, the portable IRT was used to measure the maximum temperature of each hoof from three shooting directions, including anterior (hoof coronary band), lateral (hoof lateral coronary band), and posterior (skin between heel and bulbs). In order to evaluate the effect of hoof lesions on the behavior of dairy cows, we also collected behavior data by automated accelerometers. The results indicated that the temperature of hooves with lesions was significantly higher than that of sound hooves in hot environments regardless of the shooting directions (P < 0.0001). In all of three shooting directions, the maximum temperature of feet with severe lesion was significantly higher than those of feet with mild lesion and sound feet (P < 0.05). Cows with lesion feet had lower daily activity and feeding time than sound cows before clinical diagnosis (P < 0.05). Furthermore, we used thresholds of both anterior hoof temperature at 32.05 °C and average daily activity at 410.5 (arbitrary unit/d) as a lame cow detecting tool. The agreement of this integrated tool reached 75% with clinical diagnosis, indicating that this integrated approach may be feasible for practice in dairy farm. In conclusion, IRT has the potential to be used as a hoof lesion detecting tool under subtropical climate conditions when using sound hoof temperature as reference points, and detection precision can be improved when IRT integrated with automated accelerometers as a lame cow detecting tool.

Infrared thermography (IRT) has been considered as one of the most effective tools for identification of hoof lesions in dairy cows. However, ambient temperature had been proven to affect the measurement of the IRT. The purpose of this current study is to investigate whether IRT could detect changes in hoof temperature on the feet with lesions under subtropical climate conditions. The results indicated that the maximum temperature of affected hoof was significantly higher than that of nonaffected hoof even in hot environments. The diagnostic accuracy of the IRT could be above 70%. When combining daily activity value collected by accelerometer of each cow with hoof temperature as a hoof lesion detected criterion, the accuracy of this integrated diagnostic tool could elevate to 75%. This suggests that IRT can be used as a hoof lesion detecting tool under subtropical climate conditions.

Impact of COVID-19 pandemic on foot care services in Ontario, Canada.

BACKGROUND: The COVID-19 pandemic has directly affected the delivery of health care services in Canada, including foot care. The goal of this descriptive study was to understand the impact of the early COVID-19 pandemic (March 2020 to April 2021) on chiropodists' and podiatrists' clinical practices and foot care service delivery in Ontario, Canada. METHODS: A web-survey was completed by participating chiropodists and podiatrists registered with the College of Chiropodists of Ontario. The survey consisted of 31 multiple choice and open-ended items on clinical practice characteristics, foot care service delivery changes, perceived barriers during the pandemic, and its impact on clinicians. Descriptive statistics were used to characterize the sample and examine clinicians' responses, and qualitative content analysis was used to explore opened-ended items. RESULTS: Of the 773 eligible clinicians, 279 participated for a response rate of 36.1%. Most respondents reported a decline in patient volume, an increase in urgent foot health problems, a financial impact on their clinical practices, an emotional impact, and substantial changes to how they provided foot care services, such as incorporating telehealth/virtual care into patient care. Factors that impact clinicians' perception of future pandemic preparedness are identified. CONCLUSION: This study describes foot care service delivery in Ontario, Canada during the COVID-19 pandemic. The COVID-19 pandemic saw an increase in urgent foot health problems, decline in patient volume, and impacted clinicians' mental health and emotional well-being. Future studies should examine patients' experiences of foot care service delivery and maintaining their foot health during the pandemic, and further examination of factors that impact clinicians' perception of pandemic preparedness.

A Rare Case of Myxochondroid Metaplasia of the Plantar Foot With Review of Histopathological Mimics.

ABSTRACT: Chondromyxoid metaplasia can rarely lead to the formation of a distinctive tumor-like proliferation in the plantar foot. This is thought to represent a reactive or reparative process, possibly due to chronic trauma. For the unwary dermatopathologist, this could represent a diagnostic challenge. Herein, we review the clinical, histopathological, and molecular presentation of an athletic 17-year-old boy with a soft tissue mass arising in the right plantar foot. Microscopic examination showed a relatively circumscribed proliferation of spindle cells with abundant chondromyxoid stroma, hyalinization, and diffuse ERG reactivity. We also review characteristics of this entity that help differentiate it from clinical and histopathologic mimics and postulate possible links with soft tissue chondromas and immature chondroid choristoma.

Evaluation and optimisation of a footwear assessment tool for use within a clinical environment.

Footwear has been documented as a significant factor in the aetiology of foot pain in the general population. Assessing footwear in a clinical setting continues to be practitioner specific and there is limited guidance to direct advice. Health professionals must have access to clinically appropriate and reliable footwear assessment tools to educate patients on healthier footwear choices. The primary aim of this study was to critique what elements should be in a footwear assessment tool with a secondary aim of testing the agreed tool for validity.A combined Nominal Group Technique and then a Delphi technique from purposively sampled experts of foot health professions were employed to critique elements of footwear assessment. The agreed tool was then tested by practising podiatrists on 5 different shoes to assess the validity and reliability of the measures.Twelve test evaluation criteria were identified receiving significant ratings to form the final footwear assessment tool consisting of five footwear themes. Application of the tool in a clinical setting validated the themes of footwear characteristics, footwear structure, motion control and wear patterns. However, the assessment of footwear fit was not reliable.The footwear tool was refined based on the collective consensus achieved from the rounds creating a more clinically appropriate tool. The validity of this tool was assessed as high in some of the themes but for those that were lower, a training need was identified.

Translation, Cultural Adaptation, and Psychometric Evaluation of the Manchester Foot Pain and Disability Index in Persian-Speaking Iranians With Foot Disorders.

Foot pain has a significantly detrimental effect on mobility, function, and health status. Researchers have developed a number of measurement tools to assess foot health and its impact on quality of life. This study was conducted to translate the original English Manchester Foot Pain and Disability Index (MFPDI) into Persian and to examine the psychometric properties of the Persian version. A total of 206 patients with a range of foot disorders filled out the Persian version of the MFPDI and the Short-Form 36 Health Survey. The Persian version of the MFPDI was re-completed by the participants at an interval of 5 to 7 days. The analyses performed included internal consistency, test-retest reliability, construct validity, and floor and ceiling effect analysis. The Persian MFPDI had a good internal consistency (Cronbach's α ≥ 0.70) and test-retest reliability (intraclass correlation coefficient = 0.84). The construct validity of the Persian MFPDI was demonstrated to be acceptable as a result of its significantly strong negative correlations with the Short-Form 36 Health Survey. The results of this study showed that the Persian version of the MFPDI is a valid and reliable measure to assess foot-related disability.

Approaches to endocrinopathic laminitis in the field: Results of a survey of veterinary practitioners in North America.

Endocrinopathic laminitis is the most common cause of laminitis in the field. Insulin has recently been implicated as a key factor in development of endocrinopathic laminitis; however, it is unclear whether diagnostic, and treatment approaches reflect insights derived from recent research. This study sought to evaluate North American veterinary practitioners' approach to endocrinopathic laminitis in the field. Demographic information, approach to diagnosis, management, and prognosis of endocrinopathic laminitis, as well as factors influencing changes in approach to laminitis were collected. To compare regional differences in approach to laminitis, results were compared to a recently published study from the United Kingdom. Findings of the present study suggest that North American practitioners have changed their approach to laminitis to more readily incorporate diagnostic testing for endocrine disease.

Benign and Malignant Tumors in Child Foot.

Bone tumors affecting pediatric foot are a rare occurrence. Most lesions are benign, but a thorough diagnostic evaluation must always be performed to rule out malignant tumors. Approach to benign lesions is conservative, from observation follow-up to curettage or mininvasive techniques. In malignant lesions, a wide resection must be performed and same protocols applied as in tumors affecting other skeletal sites. Reconstructive procedures should aim to mechanical stability and long-lasting results; joint motion restoring can be attempted when not negatively affecting stability. Amputation procedures should be considered as a still viable choice because of their good functional result in the foot.

Mechanical Principles of the Equine Foot.

A healthy foot requires a well-balanced foot capable of shock absorption, traction, and normal proprioception. Radiographs and venograms are helpful in assessing health of the external and internal structures of the foot and in early diagnosis. Other techniques to assess foot mechanics include force plate and inertial sensors. When foot pathology ensues, early recognition and emergency mechanical treatment can improve prognosis and overall outcome. Sheared heels, under-run heels, and clubfeet are common problems that need to be corrected early. Successful management and results require he veterinarians and farriers establishing a professional, collaborative, and respectful relationship.

Epithelioma cuniculatum of the sole of the foot mimicking an infection.

Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in advanced cases. We report a case a 76-year-old patient with a 5-year-old lesion on the sole of the foot, which was originally treated as a wart without improvement while the lesion slowly evolved. The patient was referred to our center with a diagnosis of chronic osteomyelitis. An excisional biopsy revealed an invasive keratinizing squamous carcinoma. In this advanced phase of the disease the only possible treatment was a Syme amputation.

El epitelioma cuniculatum se caracteriza por una lesión de crecimiento lento en la planta del pie cuyo diagnóstico suele retrasarse por la baja sospecha clínica y por su similitud con una infección. Este tumor raramente metastatiza, pero es común que produzca una invasión local a los tejidos blandos adyacentes, requiriendo una amplia resección quirúrgica o incluso una amputación en casos avanzados. Presentamos un caso de un paciente de 76 años con una lesión de 5 años de edad en la planta del pie, que originalmente fue tratada como una verruga plantar común sin mejoría, mientras que la lesión evolucionó lentamente. El paciente fue remitido a nuestro centro con un diagnóstico de osteomielitis crónica. Una biopsia excisional reveló un carcinoma escamoso queratinizante invasivo. En esta fase avanzada de la enfermedad el único tratamiento posible fue una amputación de Syme.

Rabdomiosarcoma alveolar con metástasis cardíaca en un paciente pediátrico / Alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient

El rabdomiosarcoma es el tumor maligno de partes blandas más frecuente en la edad pediátrica. Puede afectar cualquier localización anatómica. El subtipo histológico alveolar suele causar lesiones en las extremidades en niños de mayor edad. Los sitios metástasicos más frecuentes son el pulmón, la médula ósea, el hueso y los ganglios linfáticos. Describimos el caso de un paciente con rabdomiosarcoma alveolar (RA) con metástasis cardíaca, una presentación poco frecuente de la patología.

Rhabdomyosarcoma is the most common malignant soft tissue tumor in pediatric age. It can affect any anatomical location. Alveolar histological subtype usually presents lesions on the extremities in older children. The most common metastatic sites are the lung, bone marrow, bone and lymph node. We describe a case of alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient, a rare presentation of the pathology.