An uncommon complication of a common injury: Acute foot compartment syndrome following an ankle sprain: A case report and review of the literature.

INTRODUCTION: Acute foot compartment syndrome (FCS) is a rare but potentially devastating complication that can occur following severe trauma of the limbs. In very are cases, such syndrome occurs following minor trauma. We present an exceptional case of acute FCS as a complication of an ankle sprain. CLINICAL FINDINGS: A 32-year-old male patient presented with excruciating foot pain and swelling 48 hours following an ankle sprain. Physical examination revealed severe swelling of the right foot, pale and swollen toes, and tense and pale dorsal skin and severe pain upon passive extension of the toes. DIAGNOSIS: An acute FCS was considered. INTERVENTION AND OUTCOMES: The patient underwent a fasciotomy using a double-dorsal incision technique. The patient's symptoms were controlled, and he was discharged from the hospital 2 days after the surgery. CONCLUSION: Acute FCS could occur following minor trauma such as an ankle sprain. Early recognition and timely surgical intervention are crucial to prevent severe complications. The diagnosis is primarily clinical and immediate fasciotomy is needed to reduce intracompartment pressure and prevent muscular necrosis and other complications.

Prevalence and risk factors for laminitis within the Norwegian pony breed Nordlandshest/Lyngshest.

BACKGROUND: Laminitis is a systemic condition resulting in debilitating pain and structural changes within the feet, and hence has major welfare implications. Causes include endocrine and systemic inflammatory conditions. Ponies are frequently affected, and observations in the field suggest that occurrence of laminitis is also common in Norwegian breeds. The aim of this study was to estimate the prevalence and risk factors for laminitis within the Norwegian pony breed Nordlandshest/Lyngshest. RESULTS: The study was a cross-sectional study based on questionnaires sent to members of the Norwegian Nordlandshest/Lyngshest breed association. Questionnaires were received for 504 animals, of which 464 records were eligible and included in analyses. The population comprised 71 stallions, 156 geldings, and 237 mares, with an age between 1 and 40 years (median and interquartile ranges: 12 (6-18) years). The estimated 3-year period prevalence of laminitis was 8.4% (95% confidence interval (CI95): 6.0-11.3%), whereas lifetime prevalence was 12.5% (CI95: 9.6-15.9%). Mares had a significantly higher period- and lifetime prevalence of laminitis than male horses, and horses 10 years and older had a significantly higher prevalence than younger horses. The lifetime prevalence of laminitis was 3.2% in horses 9 years and younger, whereas from 17.3-20.5% in older horses. Multivariable logistic regression analysis identified age, sex, and regional adiposity as significantly (P < 0.05) associated with the 3-year period outcome of laminitis: Horses older than 9 years had a three-fold increase in the likelihood of having laminitis compared to the younger horses (Odds Ratio (OR)10-14 years = 3.37 (CI95 = 1.19-9.50), OR15-19 years = 3.06 (CI95 = 1.04-9.05), and OR>20 years = 2.70 (CI95 = 0.90-8.02). Mares were more than twice as likely (OR = 2.44 (CI95 = 1.17-5.12) to have laminitis compared to male horses, and horses with regional adiposity had increased odds (OR = 2.35 (CI95 = 1.15-4.82) of laminitis compared to horses without regional adiposity. CONCLUSIONS: Laminitis appears to be a considerable welfare issue in the Norwegian pony breed Nordlandshest/Lyngshest. The identified risk factors age, sex, and regional adiposity highlight the need for improved owner education and awareness of strategies to reduce laminitis risk.

[Risk factors for infectious foot -disorders on two Swiss cattle -mountain pastures]. / Risikofaktoren für infektiöse Zehen­erkrankungen auf zwei Schweizer ­Rinderalpen.

INTRODUCTION: In the present study, risk groups for infectious foot disorders were identified on two large Swiss cattle mountain pastures by analyzing animal and treatment data of a total of 3256 animals of the bovine species. Both mountain pastures were part of the Federal Office for Agriculture (FOAG) consultancy project «Healthy animals, attractive herdsmen positions and less medication on large cattle mountain pastures¼. The project was launched in 2020 following the increased incidence of lameness on these mountain pastures. Bacteriological and histological analyses were to provide information as to whether the most common foot disorder was interdigital phlegmon (IP) or whether digital dermatitis also occurred. Further, the temporal distribution of cases over the mountain pasture season and the influence of mountain pasture and year were investigated and interpreted for the project years 2020 to 2022, and treatment incidences were compared between years. Multiple treatment cycles in the same individual were classified into persistent infections and new infections. Nineteen of 394 first-treated cattle were clinically examined, 12 of them were additionally sampled for bacteriological and histological analyses. All cases examined showed, both clinically and following laboratory analyses, typical characteristics for IP. In contrast, there was no specific evidence for the presence of digital dermatitis. No persistent infections occurred during treatment with benzylpenicillin. Multivariate logistic regression analyses identified > 365-730-day-old cattle (odds ratio OR 8,29), as well as inseminated (OR 5,30) and non-inseminated (OR 7,85) heifers as risk groups for the disease studied (p < 0,05). Association with the oestrus activity of non-inseminated heifers and a generally higher locomotor activity in heifers compared to cows - with a correspondingly increased risk of injury - is conceivable. Meat breeds had a reduced risk compared to dairy breeds (OR 0,29). Breed differences in behavior and/or the effectiveness of the local immune response might have an impact. Knowing about these risk groups can be put to use in the future when selecting animals to be taken to the mountain pastures and/or when planning pasture management in order to reduce the prevalence of infectious foot disorders and thereby the use of antibiotics.

INTRODUCTION: Dans la présente étude, nous avons identifié, grâce à l'analyse des données concernant les animaux et les traitements d'un total de 3256 animaux de l'espèce bovine, des groupes à risque pour les maladies infectieuses des onglons sur deux grands alpages bovins en Suisse. Les deux alpages faisaient partie du BLW-projet de conseil «Animaux sains, postes de bergers attractifs et moins de médicaments sur les grands alpages bovins¼. Le projet a débuté en 2020 suite à l'accumulation de problèmes de boiteries sur ces alpages. Des analyses bactériologiques et histologiques devaient fournir des indications afin de savoir si la maladie des onglons majoritaire était le phlegmon interdigité (PI) ou si la dermatite digitale était également présente. La répartition temporelle des cas de maladies durant la saison d'estivage et l'influence de l'alpage et de l'année pour les années de projet 2020 à 2022 ont été évaluées et interprétées, et les incidences des traitements comparées entre les années. Les cycles de traitement multiples chez le même individu ont été répartis en deux groupes: les infections persistantes et les nouvelles infections. Dix-neuf des 394 bovins primo-traités ont été évalués cliniquement. Douze de ces 19 animaux ont également été soumis à un échantillonnage bactériologique et histologique. Tous les cas étudiés présentaient, aussi bien cliniquement que suite à l'analyse technique en laboratoire, les caractéristiques typiques d'un PI. Par contre, il n'y a pas eu d'indication quant à la présence de dermatite digitale. Aucune infection persistante n'a été constatée après traitement avec de la Benzylpénicilline. Les bovins âgés > 365­730 jours (OR 8.29), ainsi que les génisses inséminées (odds ratio OR 5.30) et non inséminées (OR 7.85) ont été identifiés, suite à une analyse de régression logistique multivariée, comme faisant partie de groupes à risque pour la maladie étudiée (p < 0.05). Un lien avec l'activité en période de chaleurs des génisses non inséminées et une activité locomotrice généralement plus intensive des génisses par rapport aux vaches ­ avec par conséquent un risque accru de blessures ­ est concevable. Le risque était réduit pour les races à viande par rapport aux races laitières (OR 0.29). Des différences de comportement et/ou d'efficacité de l'immunité locale entre les races pourraient avoir une influence. Le fait de connaître ces groupes à risque pourrait être mis à profit à l'avenir lors de la sélection des animaux à monter à l'alpage et/ou lors de la planification de la gestion des prairies, afin de diminuer la prévalence des maladies infectieuses des onglons et ainsi l'utilisation d'antibiotiques.

Chopped straw and coffee husks affect bedding chemical composition and the performance and foot pad condition of broiler chickens.

Bedding material is a crucial environmental factor for chickens. Coffee husks are waste from the industry that could be reused. The study aimed to analyze the chemical composition of various bedding types and assess their impact on the performance characteristics of broiler chickens and the incidence of footpad dermatitis (FPD). Ross 308 broilers were used in the study. Birds were divided into 3 groups (216 chickens, 72 per group). Group 1 was kept on chopped straw (S). Group 2 was kept on coffee husks (CHs), and the 3rd group (PB) was kept on pellet bedding made from S and CHs in a 1:1 ratio. The dry matter (DM), crude fiber (CF), nitrogen (N), phosphorus (P), potassium (K) content, and the pH of the bedding were analyzed. Production results were examined during 42 days of rearing. FPD was assessed on a point scale. The tissue composition of the carcasses and qualitative physicochemical characteristics of the meat (pH, color, water holding capacity, drip loss) and bone-breaking strength were analyzed. Straw had a higher CF content. In total, the highest N content in CHs was noticed. P content was lower in the S, and K was the highest in the CHs group, followed by S and PB. The pH of the bedding was lower in the CHs group, higher in PB, and highest in S bedding. The DM was decreasing within the days of rearing. A significant interaction was demonstrated between the type of bedding and rearing days on the bedding (manure) composition. On days 1-14, FCR deteriorated in the PB group compared to the S group. The presence of FPD was significantly lower in the PB group than in the others. In the PB group, chickens had a higher slaughter yield than in the S group and a lower weight and liver share than in the CHs group. The weight and proportion of abdominal fat were higher in the group kept on S than on CHs. It can be concluded that coffee husks as a component of pellets had a beneficial effect on reducing FPD in chickens and their slaughter yield and enriched bedding with nutrients, which with poultry manure, could be a good fertilizer for agricultural soils after rearing. It could be recommended to use pelleted bedding.

From second webspace syndrome to second cross over toe: Clinical and radiological findings following Weil osteotomy with no soft tissue procedure.

BACKGROUND: The second webspace syndrome (SWS) refers to the progressive divergence between 2nd and 3rd toes associated with pain at the second intermetatarsal space that can be confused with Morton's neuroma and treated as such without considering the underlying deformity. There is yet no consensus regarding the best treatment, from isolated soft tissue or bony procedures or a combination of both. The objective of this study was to describe the clinical characteristics of the disease, as well as to evaluate the radiological outcomes of patients with SWS treated with open Weil's osteotomy or distal metatarsal minimal invasive osteotomy (DMMO) of the second metatarsal, with main emphasis on medialization of the head in the anteroposterior plane in either procedure. METHODS: A retrospective study of all patients with SWS treated with Weil's medializing osteotomy (open and percutaneous) associated or not with other forefoot procedures, treated between 2012 and 2019, was performed. Radiological variables such as metatarsal-phalangeal angle (MTPA), percentage of metatarsal uncoverage of M2 with respect to its phalanx, intermetatarsal angle (M1, M2 and M3), length of second metatarsal and intermetatarsal distance M2 - M3 were measured and compared before and after surgery. RESULTS: Twenty-six patients were included, with a mean follow-up of 26 months. All patients presented divergence between the 2nd and 3rd toes, 75 % associated pain at the level of the second intermetatarsal space and two patients presented neuropathic symptoms. After surgery (nineteen open and seven DMMO), all patients rated their results as good or excellent, and the two patients with neuropathic symptoms had improvement in their symptoms. Regarding the radiological results, the percentage of subluxation of the second MTP decreased in a large percentage of the operated patients (from 43.3 % to 3.9 %) with statistical significance as well as the length of M2, IM angle between M1 - M2, IM distance between M2-M3 and the percentage of uncoverage of the second MTP (p < 0.001). CONCLUSION: Medial translation associated with open Weil osteotomy or DMMO seems to correct the muscle-ligament imbalance of the second metatarsophalangeal joint and restore normal radiographic measurements, especially in the coronal and sagittal plane, without the need for soft tissue procedures, as well as the resolution of associated neuropathic symptoms in some patients. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Foot and Ankle Disorders in Nurses Exposed to Prolonged Standing Environments: A Scoping Review.

BACKGROUND: Prolonged standing environments constitute an occupational risk factor for nurses, particularly for developing foot and ankle disorders. The definitions and potential relationship to hours spent walking or standing are poorly understood. This scoping review aimed to synthesize the main disorders found on nurses' ankles and feet, their prevalence, the influence of hours spent walking or standing, and gender differences. METHODS: This review followed a previously published protocol. Primary and secondary studies were retrieved from relevant databases from December 2020 to March 2021. Potential articles were collated to Mendeley, and two independent reviewers assessed the title and abstracts. Studies meeting inclusion criteria were included. Two researchers retrieved and reviewed the full text of these studies independently. A predetermined extraction tool was used to retrieve relevant data, summarized in a tabular and narrative format. FINDINGS: The most common disorder was pain, followed by numbness, burning feet, bunions, structural deformities, and calluses. Prevalence differed among studies, depending on settings and specific local policies. Discussion: Various foot and ankle disorders and related variables have been found, with clear gaps that may be addressed in the future. CONCLUSION/APPLICATIONS TO PRACTICE:: Few studies have focused on nurses' foot and ankle disorders. Mapping signs and symptoms may contribute to the future development of preventive interventions for nurses' workplaces.

Predictors of laminitis development in a cohort of nonlaminitic ponies.

BACKGROUND: Quantifying risk factors for laminitis development requires improvement. OBJECTIVES: To identify the most useful physical examination, metabolic and management factors to predict laminitis development in client-owned, nonlaminitic ponies. STUDY DESIGN: Prospective cohort study. METHODS: Physical examination, metabolic and management data were collected from a pony cohort 6 monthly for up to 4 years. Ponies were monitored for the development of laminitis. Metabolic data included basal plasma concentrations of ACTH ([ACTH]), adiponectin ([adiponectin]), triglycerides and glucose. Serum insulin concentrations ([insulin]) were measured in the unfasted basal state ([insulin]T0) and 60 minutes ([insulin]T60) after administration of corn syrup (0.3ml/kg). Separate multivariable Cox proportional-hazards models were developed for physical, management/signalment and metabolic data and later combined into two final models. Low-, medium- and high-laminitis risk categories were defined based on basal or T60 [insulin]. RESULTS: Overall, 374 ponies (age 5-32 years) and 891 pony-years were included in the main analysis. Laminitis incidence (95% confidence interval (CI)) was 4.8 (3.5-6.5) cases/100 pony-years. Laminitis development was associated with numerous univariable factors. Significant (P < .05) factors retained in the final multivariable models included [insulin]T0, [insulin]T60, [adiponectin] and divergent hoof growth. [ACTH] was not independently associated with laminitis. Based on [Insulin]T0, low- (<21.6 µIU/ml), medium- (21.6-45.2 µIU/ml) and high-risk (>45.2 µIU/ml) categories encompassed 70, 20 and 10% of the population and had estimated 4-year laminitis incidences (95%CI) of 6 (2-9)%, 22 (10-33)% and 69 (48-82)% respectively. Based on [Insulin]T60 the low- (<53.4 µIU/ml), medium- (53.4-153 µIU/ml) and high-risk (≥153 µIU/ml) categories comprised 60, 30 and 10% of the population and had estimated 4-year laminitis incidences (95%CI) of 3 (0-6)%, 20 (10-29)% and 73 (52-84)% respectively. MAIN LIMITATIONS: Results may not apply to different insulin assays, geographical regions, breeds or management types. CONCLUSIONS: [Insulin]T0 or [insulin]T60 best quantify the risk of future laminitis development in nonlaminitic ponies.

Evaluation of locking compression plate fixation of the distal phalanx to the hoof wall as a potential therapy for laminitis.

BACKGROUND: Surgical stabilisation of the distal phalanx (DP) is a potential therapeutic strategy for severe acute laminitis. OBJECTIVE: To evaluate the effects of locking compression plate (LCP) fixation of the DP to the dorsal hoof wall. STUDY DESIGN: Ex vivo and in vivo experiments. METHODS: A T-shaped LCP was applied to one limb per pair in six pairs of cadaver forelimbs subjected to a combination of thermally induced lamellar failure and vertical load to simulate severe acute laminitis. Standard radiographic measurements were used to compare DP displacement. The LCP was then applied to one forefoot in 12 healthy Standardbred horses either standing (n = 6) or under general anaesthesia (n = 6). Lameness was evaluated daily, then horses were euthanised (day 8) and lamellar tissue analysed using light microscopy, histomorphometery and molecular markers of apoptosis. RESULTS: In the cadaver limb model, LCP fixation prevented the significant changes in hoof-distal phalanx distance, coronary extensor process distance and sole depth that characterised DP displacement in untreated limbs (p < 0.05). Application of the construct in vivo was well tolerated with minimal lameness (10/12 horses were sound at the trot on day 8); however, histology revealed dorsal lamellar pathology consistent with laminitis, but with extensive keratinocyte apoptosis. Adjacent to the LCP, caspase-3 positive cell counts were approximately 20-fold higher than control (p < 0.001). MAIN LIMITATIONS: Pathology was evaluated at a single time point. Microvascular perfusion was not evaluated. CONCLUSIONS: Rigid fixation of the DP to the hoof capsule was achieved with the LCP construct in a cadaver limb laminitis model. In live horses, LCP fixation caused regional lamellar pathology with extensive apoptosis, likely due to disturbed lamellar microvascular perfusion and/or mechanostasis. Understanding these mechanisms is critical for refinement of the technique in order to avoid iatrogenic lamellar damage.

Lesiones de interés podológico en la práctica habitual de deportes de contacto / Podiatrically significant injuries in the regular practice of contact sports

Introducción: El auge en la práctica de deportes de contacto hace que sea necesario que el podólogo conozca las lesiones más comunes que sufren los deportistas que las practican para mejorar así la atención de estos pacientes. Debido a este motivo, nos planteamos como objetivo principal de este estudio analizar el perfil sociodemográfico del deportista de deportes de contacto y conocer las lesiones sufridas en diferentes deportes de contacto para hacer prevención primaria a nivel podológico. Pacientes y métodos: Se analizó una autoencuesta a través de Google Forms, donde se recabaron datos sobre los hábitos y las lesiones deportivas sufridas en la extremidad inferior de 100 deportistas que practican diversos deportes de contacto, además de otras variables como sexo, alimentación, horas de entrenamiento semanal, tiempo que lleva practicándolo, con el fin de conocer si en las diferentes modalidades de los deportes de contacto ocurren las mismas patologías podológicas o son diferentes. Los datos fueron tratados estadísticamente usando los programas Microsoft Office Excel 2013 y SPSS 22.0. Resultados: Las lesiones más comunes en la extremidad inferior en los deportistas de contacto analizados fueron lesiones en partes blandas, en concreto esguinces, contracturas y tendinitis, distensiones, fascitis, rotura de ligamentos pierna y pie, y también lesiones óseas, como fracturas de huesos (costillas, nariz, hombro, metatarsianos). A nivel dérmico se encontraron infecciones bacterianas y fúngicas.Conclusión: Conocer las lesiones y patologías que sufren los deportistas que practican deportes de contacto hace posible que, como profesionales de la salud, actuemos a nivel de prevención primaria, ya que las patologías sufridas pueden conllevar secuelas podológicas en el futuro y al empeoramiento de la calidad de vida del deportista (AU)

Objective: The boom in the practice of contact sports makes it necessary for the podiatrist to know the most common injuries suffered by athletes who practice them, to improve the care of these patients. Due to this reason, our main objective in this study is to analyze the sociodemographic profile of contact sports athletes and to understand the injuries suffered in different contact sports, in order to implement primary prevention measures at podiatry level. Patients and methods: Using a survey, we analyzed the sports injuries suffered in the lower extremity by 100 athletes who practice various contact sports. In addition to other variables such as sex, diet, hours of weekly training, and how long has been practicing it. To know if the same podiatric disorders occur in the different modalities or if they are different. The data was statistically treated using the Microsoft Office Excel 2013 and SPSS 22.0. Results: The most common injuries in the lower extremity in the contact athletes analyzed were soft tissue injuries, specifically: sprains, contractures and tendonitis, strains, fasciitis, leg and foot ligament tears, and also bone injuries: bone fractures (ribs, nose, shoulder, metatarsals) and at the dermal level bacterial infections and mycotites. Conclusion: Knowing the injuries and pathologies suffered by athletes who practice contact sports makes it possible for us as health professionals to act at the level of primary prevention, since the disorders described can lead to podiatric sequelae in the future and by worsening the quality of the life of the athlete (AU)

Light wavelength and its impact on broiler health.

Light is a powerful management tool in poultry production systems, affecting productivity, physiology, and behavior. The objective of this study was to understand the impacts of three light colors (blue, green, or white) on broiler health. Broilers (N = 14,256) were raised in floor pens with fresh litter from 0 to 35 d in 9 rooms (2 blocked trials). Additionally, 2 genotypes (Ross YPMx708 and EPMx708) and sex were studied (6 room replications per lighting treatment and 18 pen replicates per sex × genotype × lighting program). Blood samples and tissue samples from the retina and the pineal gland were collected from birds (16-18 d of age) 9 times in one 24-hr period per trial, then analyzed to determine melatonin levels (pg/mL). Mobility was assessed via gait scoring, using a 0 to 5 scale at 31 to 32 d of age. Footpad dermatitis was assessed using a 0 to 4 scale, and litter quality by a subjective scoring system (scores ranging from 0-4). Mortality and morbidity causes were identified through necropsies performed by pathologists. Data were analyzed as a 3 × 2 × 2 factorial design, with trial as a random variable block and lighting treatment nested within rooms (MIXED procedure, SAS). Birds raised under blue light had lower serum melatonin levels during one time-point during the scotophase, but no other differences were noted. No effect of light color was observed for melatonin produced in the tissues, nor mobility and footpad dermatitis. An interaction was noted for litter quality where a higher percentage of pens housing YPM-708 broilers had litter categorized into dry, but not easily moved with the foot (category 1). Males had higher incidence of infectious and metabolic deaths than females. Interactions were observed between light and sex, where males raised under white light had a higher incidence of skeletal causes of mortality. Overall, the results showed that light color had minor impacts only on melatonin levels, mobility, footpad dermatitis, litter quality, and cause of mortality.

A case-control study regarding factors associated with digital dermatitis in Norwegian dairy herds.

BACKGROUND: Digital dermatitis (DD) is a contagious bovine foot disease causing painful lesions, lameness, and reduced animal welfare. Previous studies indicate a complex aetiology of the disease. The aim of this study was to compare DD negative and DD positive herds to identify factors associated with DD in Norwegian dairy herds by analysing data obtained in a questionnaire and data recorded in the Norwegian Dairy Herd Recording System (NDHRS). The questionnaire was e-mailed to the owners of all 380 herds recorded with DD in 2019 and to 1530 randomly selected herds with no recordings of DD. Altogether 559 dairy herds were included in the final study population, of which 113 was classified as DD positive (≥ one cow recorded with DD in NDHRS) and 446 as DD negative. When stratified by housing system, the ratio between DD positive and negative herds was 108/281 in free stalls and 5/165 in tie stalls. Multilevel logistic regression was used to model the association between potential risk factors and variables related to the detection and diagnosis of DD, and the outcome in the free-stall population. Geographical area (county) was included in the model as a random effect. RESULTS: In the final study population 108/113 (96%) of the DD positive herds were housed in free stalls versus 5/113 (4%) in tie stalls. The free-stall herds' DD status was associated with purchase of cattle during the last 5 years (baseline: 0 animals, OR = 2.30 for category 12-27 animals, OR = 4.34 for 28-52 animals, and OR = 5.39 for ≥ 53 animals). The DD status was also associated with claw trimming frequency (Baseline: 1 < 2/year, OR = 0.41 for category < 1/year, and OR = 4.09 for ≥ 3/year), whether the claw trimming was done by a certified professional trimmer or not (baseline: ≤ 90% of the cows, OR = 3.98 for category ≥ 90% of the cows), cleaning of feet in the chute before trimming (baseline: no cleaning, OR = 1.98 for category cleaning), and alley flooring (baseline: slatted floor, OR = 2.36 for category solid floor). CONCLUSIONS: Digital dermatitis was far more frequent in Norwegian dairy herds housed in free stalls versus those housed in tie stalls. In the free-stall herds purchase of cattle, increasing trimming frequency, use of certified professional trimmer, cleaning of the feet in the chute, and solid flooring in the alleys were associated with increased odds of recorded DD.

Foot pain and inflammatory markers: a cross sectional study in older adults.

BACKGROUND: Foot disorders may limit independence and reduce quality of life for older adults. Obesity is a risk factor for foot conditions; both mechanical load and metabolic effects may contribute to these conditions. This study determined cross-sectional associations between inflammatory markers and foot disorders. METHODS: Participants were drawn from the Framingham Foot Study (2002-2008). C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were each examined for associations with foot pain, forefoot pain, hindfoot pain, hallux valgus, hallux rigidus, and toe deformities (claw, hammer, or overlapping toes). Unadjusted and adjusted (age, body mass index, physical activity, smoking status) sex-specific logistic regression was performed. RESULTS: Of 909 participants, 54% were women (mean age 65 [Formula: see text] 9 years), 20% had foot pain, 29% had hallux valgus, 3% had hallux rigidus, and 27% had toe deformities. In unadjusted models, higher CRP (OR [95% CI] = 1.5 [1.1, 2.0]) and IL-6 (OR [95% CI] = 1.8 [1.2, 2.6]) were associated with foot pain among men; higher CRP was associated with foot pain (OR [95% CI] = 1.3 [1.0, 1.5]) among women. Higher CRP (OR [95% CI] = 1.9 [1.1, 3.2]) and IL-6 (OR [95% CI] = 2.4 [1.2, 4.7]) were associated with forefoot pain in men. Higher CRP was associated with hindfoot pain ([95% CI] = 1.8 [1.2, 2.6]) in women. After adjustment, CRP ([95% CI] = 1.5 [1.1, 2.0]) and IL-6 ([95% CI] = 1.8 [1.2, 2.6]) remained associated with foot pain in men, and IL-6 with forefoot pain ([95% CI] = 2.9 [1.4, 6.1]) in men. No associations with structural foot disorders were observed. CONCLUSIONS: Inflammation may impact foot pain. Future work assessing whether inflammation is part of the mechanism linking obesity to foot pain may identify areas for intervention and prevention.

The Use of Confined Housing in Sand Bedding and Trimming to Manage Phalangeal Rotation and Hoof Malconformation Over a 20-Week Period in Two Laminitic Stallions.

Chronic laminitis is a late stage of laminitis in horses characterised by distal phalangeal rotation and foot pain. Various trimming and shoeing methods have been implemented; however, they sometimes aggravate lameness, particularly in laminitic horses with poor hoof quality. Sand bedding confinement has alternatively been employed to relieve foot pain in laminitic horses; however, the impact of long-term confined sand bed accommodation on hoof conditions is unknown. Moreover, the time course of sand bedding housing for managing chronic laminitis has yet to be described. We report the outcome of long-term housing in sand bedding confinement on hoof architectures and the time required for appropriate management of hoof malconformation. Two stallions, diagnosed with bilateral chronic laminitis and showing severe lameness following therapeutic shoeing, were assigned barefoot to confined sand bedding accommodations. Sole depth increased starting at 8 weeks; however, heel depth did not change throughout the housing period. A decrease in hoof angles was detected at 20 weeks of housing. An increase in sole depth/heel depth ratios was strongly correlated with the reduction in hoof angles. Therefore, long-term housing in sand bedding confinement for at least 20 weeks corrected phalangeal rotation and improved hoof conformation in two stallions with bilateral chronic laminitis. Further validation with a larger sample size is needed to determine whether this strategic housing management provides an alternative approach to treating hoof problems in laminitic horses that respond poorly to shoeing management.

Demographic, morphologic, hormonal and metabolic factors associated with the rate of improvement from equine hyperinsulinaemia-associated laminitis.

BACKGROUND: Although several studies have investigated factors associated with the onset and occurrence of hyperinsulinaemia-associated laminitis (HAL), few have examined the factors associated with the rate of improvement during recovery from an acute bout of the disease. This observational study sought to discover if a range of demographic, morphologic, hormonal and metabolic variables are associated with the improvement rate from HAL in 37 naturally-occurring cases identified by 16 clinics across Germany. Each case was evaluated for laminitis severity on the day of inclusion in the trial (d 0), then after 4, 9, 14, 25 and 42 d. The horses were managed according to best clinical practice including restricting exercise and prescribing a diet of hay-only, for a minimum of 9 d. Blood samples were also collected during each evaluation, except on d 9, and analysed for glucose, insulin, ACTH and leptin. RESULTS: Based on individual clinical laminitis scores plotted against time, most horses improved markedly within 2 weeks, with a 'fast group' (n = 27) having a median (interquartile range) score on a 12-point scale of 0 (0-2) by d 14. However, there was a clear disparity within the total cohort, as ~ 1 in 4 horses demonstrated much slower improvement, with a median score of 5 (4-7) by d 14, or a marked relapse thereafter ('slow group', n = 10). Horses in the slow improvement group were younger (12.5 (8.8-16.3) vs 17 (14-24) yr; P = 0.008), but were not more likely to be heavier, male, very fat, to have presented with a previous history of laminitis or elevated ACTH concentrations, or to be receiving pergolide treatment. Of the hormonal and metabolic parameters measured, glucose and insulin concentrations were within the normal range following transition to the hay-only diet, but were higher in the group that failed to improve quickly, with a small but significant difference being evident on d 4, 14 and 25 for glucose (11 to 16%; P < 0.05), and a larger difference for insulin on d 14 and 25 (51 to 55%; P < 0.05). There was no difference between the groups in ACTH or leptin concentrations throughout the study. The main limitations of this study were the small number of slow-improvement horses and an inability to control or measure certain variables, such as feed quality. CONCLUSIONS: Young age and a modest increase in blood glucose and insulin concentrations are associated with delayed laminitis improvement.

Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton's neuroma and correlation with intraoperative anatomical variations.

BACKGROUND: Morton's neuroma (MN) is a common cause of forefoot pain. After failure of conservative management, surgical procedures include neurectomy or neuroma preserving procedures; resection of deep transverse intermetatarsal ligament only (DTIML), dorsal neurolysis, dorsal nerve transposition (DNT). OBJECTIVES: This retrospective study evaluates the long-term results of open DNT, and it also reports anatomical variants in the plantar interdigital nerve. MATERIAL AND METHODS: The study included 39 patients (30 females and 9 males) who were treated for MN between 2002 and 2016. RESULTS: The mean pre-operative Giannini score of 13 (0-30) improved to 61 (20-80) (p < .0001), with only 6 patients scoring less than 50 (poor). Using Coughlin's criterion for overall satisfaction, 9 patients (23%) reported excellent, 18 patients (46%) good, 6 patients (15%) fair and 6 patients (15%) reported poor results. In the long term, 25 patients (64%) had no pain, 8 patients (20%) had mild pain, and 6 patients (16%) had severe pain. Ten patients (26%) reported normal sensitivity in their toes, 26 patients (66%) had numbness, and 3 patients (8%) reported dysesthesia in their toes. Twenty-two patients (56%) could wear fashionable shoes, 11 patients (28%) comfortable shoes, and 6 patients (16%) modified shoes. Regarding walking distance, 30 patients (77%) had no limitation, and 9 patients (23%) reported some limitation. Nineteen per cent regretted having surgery. Around 40% (17 out of 43 web spaces) showed anatomical variations in either the nerve or in the web space and we could not identify any specific risk factors in relation to the outcome. CONCLUSION: Dividing the DTIML or dorsal neurolysis should be considered as the primary surgical treatment and, if this fails, neurectomy would be an option. DNT can be considered if one is concerned about stump neuroma, but this may be technically demanding and in some patients it may not be possible. LEVEL OF EVIDENCE: Level IV - Case Control Retrospective study.

Social determinants of diabetes-related foot disease among older adults in New South Wales, Australia: evidence from a population-based study.

BACKGROUND: Diabetes-related foot is the largest burden to the health sector compared to other diabetes-related complications in Australia, including New South Wales (NSW). Understanding of social determinants of diabetes-related foot disease has not been definitive in Australian studies. This study aimed to investigate the social determinants of diabetes-related foot disease in NSW. METHODOLOGY: The first wave of the 45 and Up Study survey data was linked with NSW Admitted Patient Data Collection, Emergency Department Data Collection, and Pharmaceutical Benefits Scheme data resulting in 28,210 individuals with diabetes aged 45 years and older in NSW, Australia. Three outcome variables were used: diabetes-related foot disease (DFD), diabetic foot ulcer (DFU), and diabetic foot infection (DFI). They were classified as binary, and survey logistic regression was used to determine the association between each outcome measure and associated factors after adjusting for sampling weights. RESULTS: The prevalence of DFD, DFU and DFI were 10.8%, 5.4% and 5.2%, respectively, among people with diabetes. Multivariate analyses revealed that the common factors associated with DFD, DFU and DFI were older age (75 years or more), male, single status, background in English speaking countries, and coming from lower-income households (less than AUD 20,000 per year). Furthermore, common lifestyle and health factors associated with DFD, DFU, and DFI were low physical activity (< 150 min of moderate-to-vigorous physical activity per week), history of diabetes for over 15 years, and having cardiovascular disease. CONCLUSION: Our study showed that about 1 in 10 adults with diabetes aged 45 years and older in NSW reported DFD. Interventions, including the provision of related health services aimed at reducing all forms of DFD in NSW, are recommended to target older individuals with a long history of diabetes, and coming from lower-income households.

Cloves (Syzygium aromaticum) fluid gel on healing of pododermatitis in rabbits.

Wounds are damaging to quality life of confined animals, causing dysfunction in spinal, members injuries, and reduction in productive performance. This research investigated the clove antimicrobial and antioxidant activity on the healing of decubitus wounds (pododermatitis) of rabbits (Oryctolagus cuniculus). Adult animals were treated for 21 days every three days with a fluid gel spray in the wound region: control fluid gel without addition of clove (FGC0), fluid gel with addition of 1% clove powder (FGC1), and fluid gel with 2% clove powder (FGC2). Microbiological analysis for Escherichia coli and Pseudomonas spp. were performed during 21 days of experimental period. After this period, samples from treated skin were evaluated for histological analysis and evaluation of the healing process by spectroscopy (FTIR-ATR). Rabbits treated with FGC2 showed advanced healing and decreased tissue inflammation similar to healthy rabbits, while FGC0 rabbits showed a decrease in bacterial contamination without signs of healing. Both FGC1 and FGC2 rabbits demonstrated antimicrobial and antioxidant action against both bacteria tested, favoring the wound healing process. Considering the results, the use of fluid gel with 2% of clove powder (Syzigium aromaticum) based on the best antimicrobial, antioxidant and anti-inflammatory activities on healing of decubitus wounds (pododermatitis) of rabbits in commercial farming system.

Apoptosis in epithelial cells and its correlation with leukocyte accumulation in lamellar tissue from horses subjected to experimental sepsis-associated laminitis.

Inflammation and apoptosis in the hoof lamellar interface both contribute to the early stages of sepsis-associated laminitis, but it is not clear whether apoptosis is occurring before the onset of inflammation or is being provoked by inflammation. Apoptosis and inflammation were therefore measured in lamellar tissues obtained at different time points throughout the early stages of experimentally induced laminitis. Apoptotic cells and leukocyte were enumerated in archived paraffin embedded lamellar tissue samples from previous experiments in which acute laminitis was induced using Black Walnut Extract (BWE) or starch (CHO). BWE-derived samples from 20 horses were allocated into four groups: Control (CON = 5); Early Time Point (ETP, 1.5 h after induction, n = 5); Developmental Time Point (DTP, 3-4 h after induction, n = 5); Obel Grade 1 (OG1, Onset of Lameness, n = 5). CHO-derived samples from 25 horses were allocated into four groups: CON (n = 8); DTP (10-12 h after induction, n = 6); OG 1 (n = 6); Obel 3 (OG3, lameness progression, n = 5). Apoptotic cells were enumerated using a horse validated TUNEL technique. Compared to controls, significant increases in apoptotic cell counts were not detected in lamellar epithelial cells during the developmental phase or at the onset of lameness during laminitis induction. A negative correlation between apoptosis and leukocyte infiltration was detected in the BWE model (P < 0.05). In conclusion, apoptosis does not play an important role in the initial stages of sepsis-related laminitis.