Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost. An MRI-controlled investigation of a new method.
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Bone marrow oedema syndrome of the talus is a rare cause of pain in the foot, with limited options for treatment. We reviewed six patients who had been treated with five infusions of 50 microg of iloprost given over six hours on five consecutive days. Full weight-bearing was allowed as tolerated. The foot score as described by Mazur et al was used to assess function before and at one, three and six months after treatment. The mean score improved from 58 to 93 points. Plain radiographs were graded according to the Mont score and showed grade-I lesions before and after treatment, indicating that no subchondral fracture or collapse had occurred. MRI showed complete resolution of the oedema within three months. We conclude that the parenteral administration of iloprost may be used in the treatment of this syndrome. (+info)
Metastatic calcinosis circumscripta treated with an oral charcoal absorbent in a dog.
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A five-year-old West Highland white terrier dog was admitted to the teaching hospital of Nippon Veterinary and Animal Science University due to swelling and pain of the foot pads. Examinations revealed that the dog had renal failure and calcinosis circumscripta on its foot pads. The diagnosis was metastatic calcinosis circumscripta secondary to renal failure. An oral charcoal adsorbent (Kremezin) was used to treat this condition. Following this treatment, a significant decrease in the Ca x P value (the serum calcium level x the serum phosphorus level) was observed, and the dog's condition improved dramatically. This case suggests that charcoal adsorbent (Kremezin) may be useful for treating metastatic calcinosis circumscripta in dogs. (+info)
The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis.
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OBJECTIVE: To compare ultrasonography with bone scintigraphy in the diagnosis of plantar fasciitis and to compare ultrasound-guided injection with palpation-guided injection in the management of idiopathic plantar fasciitis. METHODS: Twenty-three patients with a clinical diagnosis of idiopathic plantar fasciitis in 28 heels underwent ultrasonography and bone scintigraphy of both heels at baseline. The patients were randomized to ultrasound- or palpation-guided injection of triamcinolone hexacetonide and xylocaine into the plantar fascia. The 100 mm visual analogue scale (VAS) of pain, the heel tenderness index (HTI), and ultrasonography were performed at baseline and follow-up (mean=13.4 weeks). RESULTS: The mean thickness (+/-standard error of the mean) of the plantar fascia, measured by ultrasonography, was 5.7+/-0.3 mm in symptomatic heels as compared with 3.8+/-0.2 mm in asymptomatic heels (P<0.001). Ultrasonography findings correlated with bone scintigraphic findings in the diagnosis of plantar fasciitis (P<0.001). Fourteen heels were randomized to ultrasound-guided injection, 10 heels were randomized to palpation-guided injection and four heels were not injected. Ultrasound- and palpation-guided injection resulted in significant mean improvements in VAS [39.6+/-9.2 (ultrasound) vs 41.5+/-8 (palpation)] and HTI [1.35+/-0.2 (ultrasound) vs 1.3+/-0.4 (palpation)]. There was no significant difference in the response rate following corticosteroid injection by either modality (ultrasound=13/14, palpation=8/10). Following injection, the mean thickness of the plantar fascia decreased from 5.7+/-0.3 mm to 4.65+/-0.4 mm (P<0.01). CONCLUSION: Ultrasonography and bone scintigraphy are equally effective in the diagnosis of plantar fasciitis. Ultrasound-guided injection is effective in the management of plantar fasciitis but is not more effective than palpation-guided injection. Ultrasonography may be used as an objective measure of response to treatment in plantar fasciitis. (+info)
Over-the-counter foot remedies.
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Several effective and inexpensive over-the-counter treatments are available for minor but troubling foot problems. In most cases, one week of therapy with topical terbinafine is effective for interdigital tinea pedis. Treatment of plantar warts with 17 percent salicylic acid with lactic acid in a collodion base is as effective as cryotherapy, but treatment must be sustained for several months. Toe sleeves and toe spacers can relieve pain from hard or soft corns. Metatarsal pads can relieve the pressure associated with plantar keratoses. Heel cups often can relieve pain caused by age-related thinning of the heel fat pad. Plantar fasciitis is a common cause of anteromedial heel pain caused by repetitive strain on the plantar fascia. Although the mainstay of therapy is stretching exercises, ready-made arch supports and insoles can be helpful adjuncts. (+info)
Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis.
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OBJECTIVE: To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) in calcaneal enthesophytosis. METHODS: 60 patients (43 women, 17 men) were examined who had talalgia associated with heel spur. A single blind randomised study was performed in which 30 patients underwent a regular treatment (group 1) and 30 a simulated one (shocks of 0 mJ/mm(2) energy were applied) (group 2). Variations in symptoms were evaluated by visual analogue scale (VAS). Variations in the dimension of enthesophytosis were evaluated by x ray examination. Variations in the grade of enthesitis were evaluated by sonography. RESULTS: A significant decrease of VAS was seen in group 1. Examination by x ray showed morphological modifications (reduction of the larger diameter >1 mm) of the enthesophytosis in nine (30%) patients. Sonography did not show significant changes in the grade of enthesitis just after the end of the treatment, but a significant reduction was seen after one month. In the control group no significant decrease of VAS was seen. No modification was observed by x ray examination or sonography. CONCLUSION: ESWT is safe and improves the symptoms of most patients with a painful heel, it can also structurally modify enthesophytosis, and reduce inflammatory oedema. (+info)
Charcot foot: the diagnostic dilemma.
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Primary care physicians involved in the management of patients with diabetes are likely to encounter the diagnostic and treatment challenges of pedal neuropathic joint disease, also known as Charcot foot. The acute Charcot foot is characterized by erythema, edema and elevated temperature of the foot that can clinically mimic cellulitis or gout. Plain film radiographic findings can be normal in the acute phase of Charcot foot. A diagnosis of Charcot syndrome should be considered in any neuropathic patient, even those with a minor increase of heat and swelling of the foot or ankle, especially after any injury. Early recognition of Charcot syndrome and immobilization (often with a total contact cast), even in the presence of normal radiographs, can minimize potential foot deformity, ulceration and loss of function. Orthopedic or podiatric foot and ankle specialists should be consulted when the disease process does not respond to treatment. (+info)
Variation in diagnosis and management of common foot problems by GPs.
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BACKGROUND: There are indications that the diagnosis and management of common foot problems vary widely in general practice. OBJECTIVES: Our aim was to explore the variation of GPs' diagnosis and management of common foot problems and the possible correlation between GPs' characteristics and their competence to diagnose correctly. METHODS: In a cross-sectional design, 90 GPs in The Netherlands were invited to complete a questionnaire regarding seven vignettes with common foot problems (hallux valgus, hallux rigidus, fasciitis plantaris, tarsal tunnel syndrome, metatarsalgia, corns and calluses, and rheumatoid arthritis), combined with questions covering diagnoses, management options and some GP characteristics. RESULTS: A total of 72 GPs responded (80%). They most often diagnosed hallux valgus (79%) and rheumatoid arthritis (86%) correctly, and most often hallux rigidus (37%) and tarsal tunnel syndrome (74%) incorrectly. GP characteristics did not correlate with their competence in diagnosing. The most frequently suggested management was referral to a podiatrist. The referral rate to medical specialists was low, except in the case of rheumatoid arthritis (79%). CONCLUSIONS: More than half of the GPs were competent in diagnosing vignettes of common foot problems. This diagnostic competence showed great variation and was not associated independently with GP characteristics. Educational programmes are recommended. Management showed less variation and often included referral to podiatrists. Further research into the effectiveness of specific treatments for different foot problems is recommended. (+info)
Isolation and characterisation of a novel spirochaete from severe virulent ovine foot rot.
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A novel spirochaete was isolated from a case of severe virulent ovine foot rot (SVOFR) by immunomagnetic separation with beads coated with polyclonal anti-treponemal antisera and prolonged anaerobic broth culture. The as yet unnamed treponeme differs considerably from the only other spirochaete isolated from ovine foot rot as regards morphology, enzymic profile and 16S rDNA sequence. On the basis of 16S rDNA, it was most closely related to another unnamed spirochaete isolated from cases of bovine digital dermatitis in the USA, raising the possibility of cross-species transmission. Further information is required to establish this novel ovine spirochaete as the cause of SVOFR. (+info)