Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.
Animals ; Congenital Abnormalities ; Foot ; Foot Orthoses ; Gait ; Hallux ; Hallux Limitus ; Hallux Rigidus ; Hallux Valgus ; Hammer Toe Syndrome ; Head ; Hoof and Claw ; Humans ; Joints ; Metatarsal Bones ; Metatarsalgia ; Metatarsophalangeal Joint ; Neuroma ; Orthotic Devices ; Quality of Life ; Shoes ; Splints ; Toes

PURPOSE: To compare the efficacy and complications of scleral fixation of posterior chamber intraocular lens (IOL) and retropupillary fixation of iris claw IOL for dislocated IOL or aphakia without sufficient capsular support. METHODS: This retrospective study was comprised of 17 eyes of 16 patients undergoing scleral fixation and 14 eyes of 13 patients undergoing retropupillary fixation from August 2013 to June 2018. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp examination, corneal topography, refractive indices, corneal curvatures, corneal endothelial cell density, and complications of both groups were examined preoperatively and 1 day, 1 week, 1 month, 2 months, and 6 months postoperatively. RESULTS: Six months after the operation, UCVA and BCVA improved in both groups; however, there were no significant differences between the two groups (UCVA, p = 0.162; BCVA, p = 0.418). IOP was temporarily higher in the scleral fixation group at one day postoperatively (p = 0.023). The mean absolute prediction error was smaller in the retropupillary iris fixation group at 6 months postoperatively (p = 0.034). Postoperative total astigmatism, corneal astigmatism, and corneal endothelial cell density were not significantly different between the two groups. CONCLUSIONS: The retropupillary iris fixation group did not show significant improvement in visual acuity compared with the scleral fixation group. However, the retropupillary iris fixation group provided better mean absolute prediction error and a low risk of postoperative increase in IOP compared with the scleral fixation group. Retropupillary fixation of iris claw IOL is a promising option for scleral fixation of posterior chamber IOL for dislocated IOL or aphakia without sufficient capsular support.
Animals ; Aphakia ; Astigmatism ; Corneal Topography ; Endothelial Cells ; Hoof and Claw ; Humans ; Intraocular Pressure ; Iris ; Lenses, Intraocular ; Refractometry ; Retrospective Studies ; Slit Lamp ; Visual Acuity

PURPOSE: Toe ulcers have been implicated as a causative factor in diabetic foot amputation. The aim of this study was to evaluate the outcomes of percutaneous needle flexor tenotomies of diabetic claw toes with ulcers or pending ulcers. MATERIALS AND METHODS: The authors undertook a retrospective chart review between January 2014 and June 2016 to identify those patients who underwent a percutaneous needle flexor tenotomy for diabetic claw toe deformities. We evaluated 54 toes in 42 patients. Twenty-four patients were female and the mean age at the time of operation was 57 years. The mean follow-up time was 11 months. Thirty-four patients (46 toes) had tip toe ulcers or pending ulcers and 8 patients (8 toes) had dorsal pending ulcers. All patients had palpable pulses and good capillary refill. RESULTS: Forty-three of 46 tip toe ulcers (93.5%) healed without significant complications and 8 dorsal ulcers showed no specific changes within 5 weeks. There were no recurrent ulcers at final follow-up. Four patients developed transfer lesion of the adjacent toe and needed subsequent tenotomy. CONCLUSION: Percutaneous needle tenotomy in an outpatient clinic was an effective and safe method for treating toe ulcers in neuropathic patients to offload the tip of the toe so that ulcer healing could occur.
Ambulatory Care Facilities ; Amputation ; Animals ; Capillaries ; Congenital Abnormalities* ; Diabetic Foot ; Female ; Follow-Up Studies ; Hammer Toe Syndrome* ; Hoof and Claw* ; Humans ; Methods ; Needles ; Outpatients* ; Retrospective Studies ; Tenotomy* ; Toes ; Ulcer*

Appropriate hoof preparation and symmetry are linked to the well-being of the horse. Previous studies have shown the efficacy of pressure plates (PPs) in delivering objective biomechanical analysis. We aimed to assess the effect of hoof trimming on hoof biomechanics using a PP. Nine clinically sound Arabian horses were walked across a PP while foot strike was recorded by a digital camera. Kinetic and kinematic parameters were recorded before and after trimming. Changes were considered significant when p < 0.05. Vertical force (p = 0.026) and contact pressure (p = 0.006) increased after trimming. Stance-phase duration (p = 0.006), swing-phase duration (p = 0.023), and gait-cycle duration (p = 0.007) decreased significantly post-trimming. The observed changes in kinetic and kinematic parameters were related to hoof trimming. The reported results underline the importance of farriery practice and its effect on hoof biomechanics, which should be considered by both farriers and veterinarians.
Animals ; Biomechanical Phenomena ; Foot ; Hoof and Claw ; Horses ; Humans ; Kinetics ; Strikes, Employee ; Veterinarians

PURPOSE: To report three cases of severe endothelial cell density loss after iris claw phakic intraocular lens (Artisan® lens) implantation. CASE SUMMARY: A 32-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 2,556 cells/mm² in the right eye and 2,674 cells/mm² in the left eye. After 4 years, the corneal endothelial cell count was 1,968 cells/mm² in the right eye and 1,997 cells/mm² in the left eye. A 27-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 3,222 cells/mm² in the right eye and 3,122 cells/mm² in the left eye. After 4 years 8 months, the corneal endothelial cell count was 2,729 cells/mm² in the right eye and 2,488 cells/mm² in the left eye. A 39-year-old woman underwent phakic intraocular lens implantation in other clinic, and the lens of left eye was removed the same day because of elevated intraocular pressure. She underwent iris claw intraocular lens implantation in the left eye. Preoperative corneal endothelial cell count was 2,500 cells/mm² in the left eye, which decreased to 1,873 cells/mm² after 8 years. Six months after intraocular lens removal and cataract surgery, her cornea endothelial cell count was 1,412 cells/mm². CONCLUSIONS: Although iris-fixed intraocular lens implantation is safe and effective for correcting myopia, at least 4 years of long-term observation for evaluating corneal endothelial cell density maybe necessary.
Adult ; Animals ; Cataract ; Cornea ; Endothelial Cells* ; Female ; Hoof and Claw ; Humans ; Intraocular Pressure ; Iris ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Myopia ; Phakic Intraocular Lenses*

Head lice, Pediculus humanus capitis, infestation is an important public health problem in Egypt. Inadequate application of topical pediculicides and the increasing resistance to the commonly used pediculicides made the urgent need for the development of new agents able to induce irreversible changes in the exposed lice leading to their mortality. The aim of the present work is to evaluate pediculicidal efficacy of some natural products such as olive oil, tea tree oil, lemon juice, and ivermectin separately in comparison with tetramethrin-piperonyl butoxide (licid), as a standard pediculicide commonly used in Egypt. The effects of these products were evaluated by direct observation using dissecting and scanning electron microscopes (SEM). Results showed that after 1 hr exposure time in vitro, absolute (100%) mortalities were recorded after exposure to 1% ivermectin and fresh concentrate lemon juice. The mortalities were decreased to 96.7% after exposure to tea tree oil. Very low percentage of mortality (23.3%) was recorded after 1 hr of exposure to extra virgin olive oil. On the other hand, the reference pediculicide (licid) revealed only mortality rate of 93.3%. On the contrary, no mortalities were recorded in the control group exposed to distilled water. By SEM examination, control lice preserved outer smooth architecture, eyes, antenna, respiratory spiracles, sensory hairs, and legs with hook-like claws. In contrast, dead lice which had been exposed to pediculicidal products showed damage of outer smooth architecture, sensory hairs, respiratory spiracles and/or clinching claws according to pediculicidal products used.
Animals ; Biological Products ; Egypt ; Hair ; Hand ; Hoof and Claw ; In Vitro Techniques ; Ivermectin ; Leg ; Mortality ; Olive Oil ; Pediculus* ; Phthiraptera ; Plant Extracts* ; Plants* ; Public Health ; Tea Tree Oil ; Water

Microsporum(M.) gypseum, a geophilic dermatophyte, causes dermatophytosis that is characterized by rapid development and resolution. M. gypseum infection is rare due to its low infectivity, and there have been no previous case reports of infection with this dermatophyte after scratch injury by a dog. Here, we report a case of annular, scaly, erythematous plaques on the right ankle of a 5-year-old female patient after being scratched on the leg by a dog. Histopathological examination showed fungal hyphae on the stratum corneum. M. gypseum was identified by tissue culture and polymerase chain reaction. She was treated with sertaconazole cream. In this case, M. gypseum may have been transferred to the scratched area from contaminated soil or from the claws of the dog.
Animals ; Ankle ; Arthrodermataceae ; Child, Preschool ; Dogs* ; Female ; Hoof and Claw ; Humans ; Hyphae ; Leg ; Microsporum* ; Polymerase Chain Reaction ; Soil ; Tinea*

To evaluate the effects of chelated Zn/Cu/Mn on redox status, immune responses and hoof health in lactating Holstein cows, 48 head in early lactation were divided into healthy or lame groups according to their gait score. Cows were fed the same amount of Zn/Cu/Mn as sulfate salts or in chelated forms for 180 days, and foot-and-mouth disease (FMD) vaccine was injected at day 90. The results showed that lame cows had lower antioxidant function, serum Zn/Mn levels, hair Cu levels, and hoof hardness. Moreover, increased antioxidant status, FMD antibody titers, serum and hair levels of Zn/Cu/Mn, and hoof hardness and decreased milk fat percent and arthritis biomarkers were observed in cows fed chelated Zn/Cu/Mn. In summary, supplementation with chelated Zn/Cu/Mn improved antioxidant status and immune responses, reduced arthritis biomarkers, and increased accumulation of Zn/Cu/Mn in the body and hoof hardness in dairy cows.
Animals ; Arthritis ; Biological Markers ; Female ; Foot-and-Mouth Disease ; Gait ; Hair ; Hardness ; Head ; Hoof and Claw* ; Lactation ; Milk ; Oxidation-Reduction* ; Salts

We report the case of 57-year-old woman diagnosed with Charcot-Marie-Tooth (CMT) disease and lumbar disk herniation (LDH). She had left leg weakness and foot numbness, foot deformity (muscle atrophy, high arch, and clawed toes). The lumbar spine MRI showed LDH at L4-5. Additionally, electrophysiology results were consistent with chronic peripheral motor-sensory polyneuropathy (axonopathy). In genetic testing, 17p11.2-p12 duplication/deletions characteristic of CMT disease were observed. We confirmed the patient's diagnosis as CMT disease and used conservative treatment.
Animals ; Atrophy ; Charcot-Marie-Tooth Disease* ; Diagnosis ; Electrophysiology ; Female ; Foot Deformities ; Foot* ; Genetic Testing ; Hoof and Claw ; Humans ; Hypesthesia ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Polyneuropathies ; Spine

This study aimed to compare thickness of the capsule, corium, and soft tissues measured ultrasonographically and macroscopically in selected regions of bovine claws. A hundred and twenty claws (n = 120) of 15 healthy Holstein bovines were obtained. After cleaning the claws, ultrasonographic measurement of the capsule, corium, and soft tissues was performed while submerging the claws in a water bath. Macroscopic measurements were taken after cutting of the claws axially. These values were compared statistically. According to the macroscopic measurements, the mean thickness +/- standard deviation (SD) of the capsule for dorsal wall and sole was 6.2 +/- 0.1 and 9.5 +/- 0.4 mm, respectively. The thickness of the corium and soft tissues for dorsal wall and sole was 4.5 +/- 0.1 and 5.3 +/- 0.1 mm, respectively. Ultrasonographically, the mean thickness +/- SD of the capsule for dorsal wall and sole was 4.7 +/- 0.1 and 7.8 +/- 0.3 mm, respectively. The thickness of the corium and soft tissues for dorsal wall and sole was 4.3 +/- 0.1 and 5.9 +/- 0.2 mm, respectively. Findings demonstrated that ultrasonography can be reliably to measure of the thickness of the hoof capsule, corium, and soft tissue in bovine claw.
Animals ; Cadaver ; Cattle/*anatomy & histology ; Hoof and Claw/*anatomy & histology/ultrasonography