Translation, Cross-Cultural Adaptation, and Validation of the Foot Posture Index (FPI-6)-Italian Version.

Since foot posture is one of the main predictors of lower limb musculoskeletal injuries, it is crucial to use appropriate tools to define the foot's posture. The Foot Posture Index is, therefore, a reliable method to measure foot posture and is widely known and used in clinics and research. This study aimed to translate the Foot Posture Index 6 (FPI6) into Italian and to assess its psychometric properties. Translation and cross-cultural adaptation were obtained using a popular guideline. Two examinators assessed 68 subjects, and data were collected to test intra/inter-rater reliability, internal consistency and cross-cultural validity. The Italian version of FPI6 showed excellent inter- and intra-rater reliability (ICC 0.96 and 0.97), and Cronbach's alpha coefficient was 0.9, thus showing excellent internal consistency. The FPI-6 version has proved to be reliable in terms of inter- and intra-rater reliability and can, therefore, be used in clinical practice and scientific research.

Assessment of the Foot's Longitudinal Arch by Different Indicators and Their Correlation with the Foot Loading Paradigm in School-Aged Children: A Cross Sectional Study.

BACKGROUND: There are numerous studies assessing the morphological structure of the foot, but there is a notable scarcity of those focused on juxtaposing various longitudinal arch indices with foot loading paradigm. The present study aimed to determine the overall reliability, diagnostic accuracy of respective variables, and their correlation with the foot loading paradigm. METHODS: The study group consisted of 336 children, aged 10-15 years (girls 49.1% and boys 50.9%). The morphological structure of the plantar part of the foot in static conditions was assessed with the aid of a 2D podoscan. Individual foot loading paradigm in static conditions was assessed making use of the FreeMed platform. RESULTS: Staheli (SI), Chippaux-Smirak (CSI), and Sztriter-Godunow (KY) indices were strongly correlated with each other (ρ > 0.84, p < 0.001). Own research corroborated an increased pressure of hollow feet, as assessed by the SI, CSI, and KY indices, on the forefoot and the hindfoot, foot zones B, E, F; these correlations being statistically significant. The results yielded by the present study also indicate an increased pressure on the metatarsal, and foot zones C, D of the flat feet. CONCLUSIONS: Flatfootedness is not believed to be a common deformity among children and adolescents. The SI, CSI, and KY indices were found to be strongly correlated, as well as proved reliable in assessing the foot's longitudinal arch.

Alterações neoplásicas e não neoplásicas das mãos e dos pés de cães (2003-2016) / Neoplastic and non-neoplastic lesions of the hands and feet of dogs (2003-2016)

Mãos e pés de cães são comumente afetados por lesões neoplásicas e não neoplásicas. Estas alterações podem apresentar prognóstico histopatológico ou clínico ruim e a amputação tende a ser o tratamento de escolha. Estudos prévios avaliando a prevalência e os aspectos clínicopatológicos de alterações digitais em cães têm sido realizados em outros países, entretanto trabalhos similares não foram realizados no Brasil. O objetivo do presente estudo foi descrever e caracterizar histologicamente as lesões das mãos e pés de cães. Amostras de 105 lesões tumoriformes das mãos e pés de cães foram avaliadas. Essas amostras foram coletadas entre 2003 e 2016 e foram obtidas de três laboratórios brasileiros de diagnóstico veterinário. Todos espécimes foram fixados em formol tamponado 10%, processados rotineiramente e corados por hematoxilina-eosina. Adicionalmente, as colorações de azul de toluidina, Brown e Breen, periodic acid Schiff (PAS), Grocott Methenamine Silver (GMS) e Ziehl Neelsen foram utilizados em casos específicos. Imuno-histoquímica foi realizada usando os anticorpos anti-Leishmania spp., anti-CD117, anti-CD79, anti-CD3, anti-Melan A, anti-lisozima, anti-Pancytokeratin AE1/AE3 e anti-vimentina. Os neoplasmas (62,9%) foram as alterações mais frequentes, seguidas por inflamações (19%) e outras alterações (18,1%). Entre os neoplasmas, 40,9% foram mesenquimais, 39,4% epiteliais e 19,7% de células redondas. Todos os neoplasmas de células redondas e a maioria dos epiteliais e mesenquimais eram malignos. Não se observou predileção de prevalência dos neoplasmas em relação ao sexo. As raças Labrador Retriever, Schnauzer, Teckel, SRD, Pastor Alemão, Rottweiler e Pit Bull foram as mais afetadas. Fila Brasileiro, Pit Bull e Schnauzer tiveram alta incidência de neoplasmas mesenquimais, epiteliais e de células redondas, respectivamente. Inflamação foi mais comumente observada em cães Labrador Retriever e as outras alterações em Teckel, Labrador Retriever e SRD. A idade e o peso médio dos animais afetados foram de 8,4 anos e 28,5 kg, respectivamente. O diâmetro médio das lesões tumoriformes foi de 2,5 cm e as lesões neoplásicas apresentaram as maiores médias. As lesões ocorreram principalmente em animais de pelagem amarela. A maioria das biópsias incisionais (56,4%) e amputações (85,3%) consistiram de neoplasmas. O principal membro afetado foi o torácico direito e o dígito foi a estrutura anatômica acometida mais frequentemente. Carcinoma de células escamosas (14,2%) foi o neoplasma mais frequente, seguido do mastocitoma (7,6%), melanoma (7,6%) e sarcoma indiferenciado (7,6%). Em metade dos casos de inflamação, a lesão acometeu o folículo piloso e derme adjacente, e o infiltrado foi predominantemente piogranulomatoso ou lnfoplasmocítico. Cistos foliculares, calcinose circunscrita e acrocordoma foram as principais lesões não neoplásicas e não inflamatórias diagnosticadas.(AU)

Hands and feet of dogs are commonly affected by neoplastic and non-neoplastic lesions. These lesions may commonly present poor clinical or histopathological prognosis and amputation tends to be the treatment of choice. Previous studies regarding the prevalence and the clinicopathological aspects of digital changes in dogs have been performed abroad, with no similar investigations in Brazil. The aim of this manuscript was to perform a histopathological study to characterize hands and feet lesions of dogs from Brazil.Tissue samples from 105 tumor-like lesions of dogs hands and feet were used in this study. The samples came from three Brazilian veterinary diagnostic laboratories and were collected between 2003 and 2016. All specimens were fixed in 10% buffered formalin, and routinely processed for paraffin embedding and hematoxylin-eosin staining. Additionally, toluidine blue, Brown and Breen, periodic acid Schiff (PAS), Grocott Methenamine Silver (GMS) and Ziehl Neelsen were used in selected cases. Immunohistochemistry using anti-Leishmania spp., anti-CD117, anti-CD79, anti-CD3, anti-Melan A, anti-lysozyme, anti-Pancytokeratin AE1/AE3, and anti-vimentin antibodies were also performed. Neoplasia (62.9%) was the most frequently found lesion, followed by inflammation (19%), and other changes (18.1%). Among the neoplasms, 40.9% were mesenchymal, 39.4% epithelial, and 19.7% round cells. All round cells and most of the epithelial and mesenchymal neoplasms were malignant. There was no difference between males and females regarding neoplasia prevalence. Labrador Retriever, Schnauzer, Teckel, mongrel, German Shepherd, Rottweiler, and Pit Bull were the most frequently affected breeds. Fila Brasileiro (aka Brazilian Mastiff), Pit Bull and Schnauzer had higher incidence of mesenchymal, epithelial, and round cells neoplasms, respectively. Inflammation was more commonly observed in the Labrador Retriever and other changes were more commonly in Teckel, Labrador Retriever, and mongrel dogs. Medium age and weight were 8.4 years and 28.5 kg, respectively. Medium diameter of the tumor-like lesions was 2.5 cm and the neoplastic lesions presented higher averages. Lesions were mainly in yellow-coated dogs. Incisional biopsy samples (56.4%) and amputations (85.3%) were mostly from neoplastic cases. Right forelimb was the most affected limb, and digits were the main injured anatomic structures. Squamous cell carcinoma was the most (14.2%) commonly diagnosed neoplasm, followed by mast cell tumor (7.6%), melanoma (7.6%), and undifferentiated sarcoma (7.6%). In half of the inflammatory cases, the lesion was centered in hair follicle and surrounding dermis. The inflammatory infiltrate was predominantly piogranulomatous or lymphoplasmacytic. Follicular cyst, calcinosis circumscripta, and acrochordons were the main non neoplastic and non-inflammatory changes.(AU)

Association of diabetic foot care and amputation rates in Germany.

Podologists are nurses who care for the diabetic foot (orthotics, offloading devices, blisters, calluses, treatment of fungus infection and patient education). In contrast to podiatrists, they are not qualified to perform any surgical treatment or wound care. We analysed whether there is an association between the decrease in major amputations and the number of podologic foot care (PFC) visits prescribed in Germany. Detailed list of all major lower limb amputations (OPS 5-864) performed from 2007 to 2011 was provided by the Federal Statistical Office. Data were separated for the 16 federal states in Germany. Detailed lists of the number of PFC treatments for each of the 5 years were derived from the federal report of the statutory health insurance. The total numbers of hospitalised cases per year having diabetes mellitus documented as an additional diagnosis were used to adjust for the different rates of people with diabetes in each federal state. Within a 5-year time period, population-based major amputations per 100 000 people dropped from 21·7 in 2007 to 17·5 in 2011 (-18·5%); whereas the number of PFC treatments per 1000 insured increased from 22 in 2007 to 60 in 2011 (+172·7%). The total number of major amputations divided by the total number of hospitalised cases with the additional diagnosis of diabetes mellitus (DM) shows an inverse correlation with the number of PFC treatments per 1000 insured (Pearson's correlation factor is -0·52049). The five countries with the highest increase in PFC compared with the five countries with the lowest increase (35·6 versus 15·4 per 1000 insured) will have only small differences in the decrease in major amputation rates in this period (-5·1 versus -3·4 per 100.000). There is a strong association between increasing utilisation PFC and decreasing major amputations in Germany. Further study is required to document the cost-effectiveness of this service.

Influence of different digital diseases in lameness of dairy cows in southwest of the state of Goiás / Influência de diferentes enfermidades digitais na claudicação de vacas leiteiras no sudoeste de Goiás

The type of podal lesion varies according to the disease and several factors may be considered as determinants of high prevalence in breeding stocks. It severity is often attributed to the extension of the lesion and the impairment of structures that compose the hoof. However, clinically, it is noted that digital lesions that appear to a have mild or moderate tissue impairment area are identified as causing severe lameness in cattle. It is worth noting that the economic losses caused by this disease often go unnoticed by producers, a fact that is worrying, since the values are ​​ generally high. The objective with this paper was the analysis of epidemiological data of podal diseases in dairy cows, evaluating the influence of the different types and severity of those lesions, correlating them to the type and degree of lameness. The work was conducted in the Southwest of the State of Goiás in ten dairy farms and 190 Holstein, Jersey and mixed breed cows affected by different digital lesions were used. Scores for lameness and podal diseases were established. The data allowed to point out that digital dermatitis was the disease with higher incidence and the right pelvic limb, the most affected. In addition, digital lesions that are usually considered severe are not always responsible for severe lameness.

Os tipos de lesões podais variam de acordo com a enfermidade que está acometendo o animal e são considerados diversos os fatores que determinam sua a alta prevalência no rebanho. A severidade geralmente está atribuída ao grau de extensão da lesão e aos danos às estruturas do casco. Porém, verifica-se clinicamente que lesões digitais pouco profundas têm causado claudicações severas em bovinos. Ressalte-se, ainda, que os prejuízos econômicos causados por essa enfermidade muitas vezes passam despercebidas pelos produtores, fato esse preocupante, já que os valores geralmente são altos. Portanto, o objetivo com este estudo foi realizar uma análise epidemiológica das enfermidades podais em bovinos leiteiros, avaliando a influência dos diferentes tipos e severidade das lesões, correlacionando-os ao tipo e grau de claudicação. O estudo foi conduzido na região sudoeste do estado de Goiás, em dez granjas leiteiras, utilizando 190 animais das raças Holandesa, Jersey e animais mestiços portadores de diferentes lesões digitais. Foram estabelecidos escores para os graus de claudicação e enfermidades podais. Os resultados mostraram que a dermatite digital foi a enfermidade de maior incidência e o membro pélvico direito o mais acometido. Soma-se a isso, também, que lesões podais consideradas graves nem sempre são responsáveis por claudicações severas.

The importance of growth factors for the treatment of chronic wounds in the case of diabetic foot ulcers.

INTRODUCTION: Ulcers as a result of diabetes mellitus are a serious problem with an enormous impact on the overall global disease burden due to the increasing prevalence of diabetes. Because of long hospital stays, rehabilitation, often required home care and the use of social services diabetic foot complications are costly. Therapy with growth factors could be an effective and innovative add-on to standard wound care. RESEARCH QUESTIONS: What is the benefit of therapies with growth factors alone or in combination with other technologies in the treatment of diabetic foot ulcer assessed regarding medical, economical, social, ethical and juridical aspects? METHODS: We systematically searched relevant databases limited to English and German language and publications since 1990. Cost values were adjusted to the price level of 2008 and converted into Euro. A review and an assessment of the quality of publications were conducted following approved methodical standards conforming to evidence-based medicine and health economics. RESULTS: We identified 25 studies (14 randomized controlled trials (RCT), nine cost-effectiveness analyses, two meta-analyses). The RCT compared an add-on therapy to standard wound care with standard wound care/placebo alone or extracellular wound matrix: in six studies becaplermin, in two rhEGF, in one bFGF, and in five studies the metabolically active skin grafts Dermagraft and Apligraf. The study duration ranged from twelve to 20 weeks and the study population included between 17 to 382 patients, average 130 patients. The treatment with becaplermin, rhEGF and skin implants Dermagraft and Apligraf showed in eight out of 13 studies an advantage concerning complete wound closure and the time to complete wound healing. Evidence for a benefit of treatment with bFGF could not be found. In four out of 14 studies the proportion of adverse events was 30% per study group with no difference between the treatment groups. The methodological quality of the studies was affected by significant deficiencies. The results showed becaplermin being cost-effective whereas no obvious statement can be made regarding Dermagraft and Apligraf because of diverging cost bases and incremental cost-effectiveness ratios. DISCUSSION: Differences in standard wound care are complicating the comparison of study results. Taking into consideration the small to very small sample sizes and other methodological flaws with high potential of bias, the validity of the results with regard to effectiveness and cost-effectiveness has to be considered limited. The duration of treatment and follow-up examinations is not long enough to assess the sustainability of the intervention and the surveillance of ulcer recurrences or treatment related adverse events like the development of malignancy. CONCLUSIONS: There are indications of an advantage for the add-on therapy with growth factors in diabetic foot ulcers concerning complete wound closure and the time to complete wound healing. Further more studies of high methodological quality with adequate sample sizes and sufficient follow-up periods are necessary also investigating patient-relevant parameters like the health-related quality of life, the acceptance and tolerance of the intervention in addition to clinical outcomes.