DOCSLIB.ORG

The Foot and Ankle

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Foot and Ankle 13 The Foot and Ankle Scott T. Sauer and Paul S. Cooper An overview of orthopedics would not be complete without an understand- ing of the foot and ankle. This area of the body is often forgotten in the scheme of things, and yet it is one of the most common sources of com- plaints in any physician’s office. Painful feet are seen in emergency rooms and family practitioners’ offices. Ankle discomfort is seen in medical clinics and on the sidelines of recreational sporting activities. This chapter is intended familiarize the student of medicine, whether an actual medical student, resident, or practitioner, with the anatomy, diagnostic tools, and some common conditions that affect the foot and ankle. Bones and Joints The bony anatomy of the foot and ankle consists of the distal tibia and fi bula in the leg and the 26 major bones that compose the foot. The tibia distally terminates into the metaphyseal plafond with its medial malleolus. The lateral surface of the distal tibia has a sulcus to accommodate the adjacent fibula, forming the distal tibiofibular joint. The distal fibula, which lies laterally and slightly posterior to the tibia, is held there by the inferior tibiofibular ligaments. The fibula forms the lateral malleolus of the ankle joint. The relationship of the fibula to the tibia is not static. With ankle dorsiflexion, the fibula laterally translates, proximally migrates, and exter- nally rotates. The ankle is a diarthrodial joint (Figs. 13-1, 13-2). It consists of an articulation between the talus and the mortise of the tibia and fibula. Dorsiflexion of the ankle joint is coupled with eversion of the foot, and plantarflexion is combined with inversion. The distal fibula provides a static buttress over the talus laterally and also bears one-sixth of the trans- mitted weight during the stance phase of gait. The foot is composed of 7 tarsals, 5 metatarsals, and 14 phalanges. Three anatomic groupings are defined for descriptive purposes: the hindfoot, the midfoot, and the forefoot (see Fig. 13-3). The hindfoot 472 13. The Foot and Ankle 473 AB C Figure 13-1. (A, B) Photographic, diagrammatic, and radiologic anatomy of the normal ankle in anteroposterior views. (C) Note equal width of cartilage spaces and alignment of lateral talus with posterior cortex (arrow) on mortise view. (From Weissman BNW, Sledge CB. Orthopedic Radiology. Philadelphia: Saunders, 1986. Reprinted with permission.) consists of the talus and calcaneus bones, and the talus consists of a body, neck, and head. Two-thirds of the talus is covered by articular cartilage. There are no muscle or tendon attachments on this bone. The talar dome is the superior portion of the body that forms the mortise with the tibia and fibula. The dome is wider anteriorly, which allows for stability in the mortise during dorsiflexion. Posteriorly, a sulcus is formed between the posterolateral and posteromedial tubercles to accommodate the flexor hal- lucis longus (FHL) tendon. The inferior surface of the talus articulates 474 S.T. Sauer and P.S. Cooper Figure 13-2. Photographic (A) and radiologic (B) anatomy of the normal ankle in lateral projection. (From Weissman BNW, Sledge CB. Orthopedic Radiology. Philadelphia: Saun- ders, 1986. Reprinted with permission.) Forefoot Midfoot Figure 13-3. Anatomic regions of the foot. Hindfoot (From Weissman BNW, Sledge CB. Orthopedic Radi- ology. Philadelphia: Saunders, 1986. Reprinted with permission.) 13. The Foot and Ankle 475 with the corresponding facet of the calcaneus to create a subtalar joint. The calcaneus is the largest bone in the foot, with its longitudinal axis directed dorsally and laterally. Its superior surface articulates with the talus and three facets—anterior, medial, and posterior—to form the sub- talar joint (Fig. 13-4). The large posterior facet articulates with the corre- sponding articular facet on the inferior surface of the talus. The middle facet overlies the sustentaculum tali (a dense, medial projection of the calcaneus that contains a groove to accommodate the FHL tendon sheath) and is often merged with the anterior facet. The middle and anterior facets articulate with the undersurface of the talar head. The midfoot consists of the navicular, cuboid, and three cuneiform bones. The tarsonavicular bone articulates with the talar head and lies medially to the cuboid bone. It functions as a keystone for the medial lon- gitudinal arch of the foot. The distal surface is composed of three facets that articulate with the medial, middle, and lateral cuneiform bones, respectively; this is also the insertion site for the posterior tibial tendon. In 10% of people, an unfused accessory navicular bone may be present. The cuboid bone forms an articulation with the calcaneus proximally and the fourth and fifth metatarsals distally. Laterally, a groove accommodates the peroneus longus tendon as it courses plantarly. Three cuneiform bones have distal articulations with the first, second, and third metatarsals and contribute to the formation of part of the tarsometatarsal, or Lisfranc’s Site of talocalcaneal ligament Talocalcaneo navicular joint Fifth metatarsal Sustentaculum tali Subtalar joint AB Figure 13-4. Photographic (A) and diagrammatic (B) anatomy of the normal ankle in tangential calcaneal (Harris) projection. (From Weissman BNW, Sledge CB. Orthopedic Radiology. Philadelphia: Saunders, 1986. Reprinted with permission.) 476 S.T. Sauer and P.S. Cooper Phalanges Metatarsals Cuneiform bones Lisfranc’s joint Navicular Cuboid Talus Calcaneus A B Phalanges Metatarsals Cuneiform C1 bones C2 C3 Navicular Cuboid Talus Calcaneus D C Figure 13-5. Photographic, diagrammatic, and radiologic anatomy of the normal foot in posteroanterior (A, B) and internal oblique (C, D) projections. (From Weissman BNW, Sledge CB. Orthopedic Radiology. Philadelphia: Saunders, 1986. Reprinted with permission.) joint (Fig. 13-5). The middle cuneiform bone is shorter axially, adding to greater stability in the second tarsometatarsal joint; this is also known as the keystone. The forefoot consists of the metatarsal and phalangeal bones. Five meta- tarsals terminate distally with articulations to the proximal phalanges 13. The Foot and Ankle 477 creating metatarsal phalangeal (MTP) joints. The fifth metatarsal is a prominent styloid process proximally to which the peroneus brevis attaches. Each of the lesser toes, two through five, has three phalanges—a proximal, middle, and distal phalanx—and the hallux has only two phalanges, proxi- mal and distal. Each distal phalanx terminates in a tuft of bone and serves as an anchor for the toe pad. Underlying the first MTP joint are the two sesamoid bones. Tibial (medial) and fibular (lateral) sesamoid bones are encased by the flexor hallucis brevis tendon (FHB), which inserts at the base of the proximal phalanx. Ligaments The ligamentous structures of the ankle joint (Fig. 13-6) include the medial deltoid ligament complex and the lateral ankle ligament complex. The deltoid ligament medially has both superficial and deep components Interosseus membrane Anterior inferior tibiofibular lig. Deltoid lig. Anterior talofibular lig. A Interosseus membrane Inferior transverse lig. Posterior tibiofibular lig. Posterior Deltoid lig. talofibular lig. Calcaneofibular lig. Posterior talocalcaneal lig. Achilles tendon B Figure 13-6. The tibiofibular syndesmosis. The syndesmosis consists of the inter- osseous membrane, the anterior and the posterior inferior tibiofibular ligaments, and the inferior transverse ligament. (A) Anterior view; (B) posterior view. (From Weissman BNW, Sledge CB. Orthopedic Radiology. Philadelphia: Saunders, 1986. Reprinted with permission.) 478 S.T. Sauer and P.S. Cooper and is the primary contributor to medial stability of the ankle joint. The lateral ligament complex consists of three major ligaments including the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL); these contribute to lateral stability of the ankle joint. Ligaments of the ankle syndesmosis include the anterior tibiofibular, posterior tibiofi bular, and interosseous ligaments. Injuries to these liga- ments may occur with hyperdorsiflexion and external rotation, creating a “high-ankle sprain” that is seen especially in athletes. Ligamentous support of the subtalar joint is contributed by the CFL, the ligaments of the anterior capsule, the posterior subtalar joint capsule, the interosseous talocalcaneal ligaments, and the ligaments of the tarsal canal. The midfoot joints are stabilized by multiple ligaments as well as the intrinsic bony architecture of the wedge-shaped cuneiform bones. Little motion occurs through the midfoot. Stabilizing ligaments include the bifurcate ligament, a V-shaped structure composed of the lateral calcaneonavicular and medial calcaneo- cuboid ligaments, which insert on the anterior process of the calcaneus, navicular, and cuboid bones, respectively. Superficial and deep plantar ligaments span from the calcaneus to the cuboid bone and metatarsals; these serve as static stabilizers of the longitudinal arch. Another important structure is the plantar aponeurosis (or plantar fascia). This thick fibrous structure runs from the plantar surface of the calcaneus to distally insert into the metatarsals; it stabilizes the arch during gait (Fig. 13-7). There is Figure 13-7. Plantar aponeurosis and windlass mechanism provide stability to the longitudinal arch of the foot when the first metatarsophalangeal joint is forced into dorsiflexion and it secondarily plantarflexes the first metatarsal.
Load more

Recommended publications
  • Onychomycosis Treatment with “Fungus Clinic” IPL Device ‏Roma Agostino (DPM), Ponti Valerio (DPM), Montesi Mauro (DPM) University of Rome “La Sapienza” - Italy
    Onychomycosis Treatment with “Fungus Clinic” IPL Device Roma Agostino (DPM), Ponti Valerio (DPM), Montesi Mauro (DPM) University of Rome “La Sapienza” - Italy nychomycosis Treatment with “Fungus Clinic” especially in those categories of people that fit athletic shoes that OIPL Device avoid adequate ventilation. Going to gyms and swimming pools is a major risk factor; consider the promiscuity of the people and Roma Agostino (DPM), Ponti Valerio (DPM), Montesi the warm and moist environment. Not rarely it originate from Mauro (DPM) University of Rome “La Sapienza” - pre-existing skin outbreaks, in fact, can often be caused by fun- Italy gal infection between the toes, where the fungus, or by contigu- ity or indirectly through shoes and socks, get into the nail. So, it Introduction: in a research conducted in the second is possible to have a contagion indirectly through contaminated semester of 2011 by the Italian institute of podiatry objects or clothing. This is the most common mode of transmis- (IPI) in association with the degree course in podiatry of sion of dermatophyte Onychomycosis. Moreover, the infection Rome University “La Sapienza”, an innovative IPL de- can occur by: vice “Fungus Clinic”™ produced by Formatk Systems Ltd. - Israel, has been tested as an alternative therapeutic Autoinoculation, even at a distance through scratching as in the method for nail fungus (Onychomycosis). This research case of Candida albicans, responsible for onychomycosis more was subject of a thesis as part of the degree course in frequently in females, because of Candida perionyxis. This podiatry in the academic year 2011-2012. Twenty five disease affects mostly housewives, as they are subjected to a patients suspected of Onychomycosis attended the study prolonged contact with water and rubber gloves.
    [Show full text]
  • Partial Plantar Fasciotomy Using Endoscope with Inner Two-Channel
    Partial Plantar Fasciotomy Using Endoscope with Inner Two-Channel Portals Produced Better Functional Outcomes Than Mini-Open Procedures for The Treatment of Refractory Plantar Fasciitis Shi-Ming Feng ( [email protected] ) Xuzhou Central Hospital https://orcid.org/0000-0002-0815-2426 Ai-Guo Wang Xuzhou Central Hospital Zai-Yi Zhang Xuzhou Central Hospital Technical advance Keywords: Endoscopic Partial Plantar Fasciotomy, Refractory Plantar Fasciitis, Inner Two-Channel Portals, Mini-Open Plantar Fasciotomy Posted Date: October 9th, 2019 DOI: https://doi.org/10.21203/rs.2.15786/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/12 Abstract Objective: To evaluate the clinical ecacy of partial fasciotomy using two-channel arthroscope in the treatment of refractory plantar fasciitis, and to compare it with the clinical effects of partial fasciotomy using minimally invasive open. Methods: Sixty-two patients with refractory fasciitis admitted from January 2015 to July 2017 were randomly assigned to the arthroscopic group and the open surgery group. Arthroscopic partial section was performed using endoscope with inner two-channel portals. The open surgery group underwent partial sacral fascia resection with minimally invasive medial incision. Then compare the pain visual analogue scale (VAS), the American foot and ankle surgery association score (AOFAS), the calcaneodynia score (CS), and the medical outcomes short form 36-item (SF-36) health survey between the two groups. Results: All patients were followed up for at least 24 months, and there was no difference in follow-up between two groups. At the last follow-up, the patient's plantar pain symptoms completely disappeared.
    [Show full text]
  • Septic Superficial Thrombophlebitis: a Major Threat from a Minor Lesion
    Septic superficial thrombophlebitis: a major threat from a minor lesion Bernard J. Mezon, md; Andrus J. Voitk, md Sites of insertion of peripheral intra¬ mon, its incidence correlates imper- fossa. CVP monitoring was discontinued venous catheters remain an important fectly with that of local infection with after 2 days and the established line used to administer fluids but often overlooked source of or without septicemia.3,4 Not only is no intravenous and and the obtained from culture of mate¬ medication. When drainage failed to oc¬ hospital-acquired septicemia growth cur the anastomosis be¬ most source of rial from at through biliary important staphylococcal many catheter tips sites cause of an de¬ thrombo¬ with unrecognized anomaly, septicemia. Septic superficial phlebitis, but culture of material scribed elsewhere,10 an end-to-side chole- phlebitis is characterized by severe from the tip at many clinically normal dochoenterostomy was fashioned 4 days local pain and is readily evident intravenous sites yields pathogenic or¬ after the first operation. The night after clinically. Care of the intravenous line ganisms, thus proving these sites to be the second operation the patient com¬ can prevent this complication. To be the source of septicemia. Staphylococcus plained of pain in his left arm and the it must be aureus is the cultured in more next morning his temperature was 39.2°C. diagnosed, suspected. pathogen Acute and Treatment consists of removal of the than 50% of instances; the others are superficial thrombophlebitis intravenous line and administration cellulitis surrounding the left cephalic mostly gram-negative bacilli,3'4 among vein were noted.
    [Show full text]
  • Musculoskeletal Foot Health Problems
    Standards of Care for people with Musculoskeletal Foot Health Problems A document setting out standards of care for foot health services for people with musculoskeletal and rheumatological conditions managed in community and hospital settings Generic foot health Inflammatory arthritis Osteoarthritis Back pain Metabolic bone diseases Connective tissue diseases Project carried out on behalf of the Podiatry Rheumatic Care Association PRCA Funded by the Arthritis Research Campaign (arc) Contents The background 1 About these Standards 3 Section 1. Generic Foot Health Standards 5 Standards to improve access to effective services 6 Standards to improve access to services that enable early diagnosis 12 Standards to improve access to services that enable ongoing management 16 Standards to improve access to services that enable ongoing support 20 Section 2. Disease-Specific Foot Health Standards 22 Standards of care for people with foot problems and inflammatory arthritis 23 Standards of care for people with foot problems and osteoarthritis 29 Standards of care for people with foot problems and back pain 31 Standards of care for people with foot problems and metabolic bone diseases 33 Standards of care for people with foot problems and connective tissue diseases 35 Appendix 1: Standard Statements 39 Glossary 43 References 46 Contributors 48 Information Boxes Information Box 1: Public Health Information 8 Information Box 2: User Involvement in Service Organisation 11 Information Box 3: Guidelines for Imaging Referral 15 Information Box 4: The Trinity of Signs 15 Information Box 5. Self Management Initiatives 18 Information Box 6: Red Flags for Urgent Referral for Back Pain 32 Information Box 7: Disease Specific Public Health Information 38 Good Practice Examples Good Practice Example A: Innovative Triage 7 Good Practice Example B: Education and Training 11 Good Practice Example C: Formal Referral Criteria for Podiatry 13 Good Practice Example D.
    [Show full text]
  • An Investigation on the Prevalence of Different Foot Skin Diseases and Their Risk Factors Among University Students
    eISSN 1307-394X Research An Investigation on the Prevalence of Different Foot Skin Diseases and Their Risk Factors Among University Students Yeşim Kaymak,1* MD, Ercan Göçgeldi,2 MD, Işıl Şimşek,3 MD Address: 1Dermatologist, Gazi University, Medical Health Center, Ankara, Turkey; 2Assistant Professor, Gülhane Military Medical Academy, Department of Public Health, Ankara, Turkey; 3Professor, Gazi University, Vocational Educa- tion Faculty, Ankara, Turkey. E-mail: [email protected] * Corresponding author: Yeşim Kaymak, MD, Hoşdere Cad. Şair Baki Sok. 2/5 Yukarı Ayrancı, Ankara 06540 Turkey Published: J Turk Acad Dermatol 2007;1 (2): 71202a This article is available from: http://www.jtad.org/2007/2/jtad71202a.pdf Key Words: Skin diseases, foot health, university students Abstract Objectives: Skin diseases seen on the feet increase in the university environment due to factors such as shared living conditions, failing to provide adequate hygiene, lower economic status, length of daily walking and wearing shoes continuously. Our aim in this study was to determine the skin dis- eases seen on the feet of university students, to specify the students' knowledge, attitudes and be- haviors regarding foot health and foot care, and to reveal the risk factors playing a role in the de- velopment of these diseases. Methods: A total of 302 university students who consulted the dermatology specialist in the Medico– Social Health Center due to any disease on their feet and agreed to participate in the research were included in the study. Subjects were requested to respond to a questionnaire. Results: The most common foot diseases of the participants were tinea pedis (24.8%), sweaty feet (24.2%), and foot callosities (23.2%).
    [Show full text]
  • The Elephant's Hoof
    Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2005 The elephant’s hoof: macroscopic and microscopic morphology of defined locations under consideration of pathological changes Benz, Andreas Abstract: Die Arbeit erfasst die normale makroskopische und mikroskopische Morphologie des Ze- henendorgans vom Elefanten unter Berücksichtigung von pathologischen Veränderungen. Weiter wurden Biotin-Plasmakonzentrationen untersucht, um Werte als Basis für allfällige Behandlungen zu erhalten. 86 Füsse von 24 asiatischen (Elephas maximus) und 9 afrikanischen (Loxodonta africana) Elefanten wurden makroskopisch erfasst und 727 Gewebeproben von definierten Stellen des Zehendenorgans histologisch un- tersucht. Die makroskopische Anatomie zeigt einige Unterschiede zwischen den zwei Arten sowie zwischen Wildtieren und den in Gefangenschaft gehaltenen Elefanten. Dabei bestehen aber einige Parallelen zu anderen Huf- und Klauentieren. Ein wichtiger Befund ist die vergleichsweise dünne Hornschicht an Sohle und Ballen der Zooelefanten (ca. 10mm). Die Hornwand wächst zwischen 5-8 mm / 28 Tage, mit gerin- geren Wachstumsraten an den Hinterfüssen im Vergleich zu den Vorderfüssen und bei den afrikanischen gegenüber den asiatischen Elefanten. Die histologischen Befunde zeigen an verschiedenen Lokalisationen und zwischen den beiden Spezies ebenfalls relativ geringe Unterschiede und vielfach ähnliche Strukturen wie bei anderen Huf- und Klauentieren. Pathologische Veränderungen wurden auch mikroskopisch erfasst. Am Zehenendorgan werden schlechte Hornqualität mit Vakuolen im Stratum spinosum und erweiterten Markräumen von Hornröhrchen sowie Schwachstellen, wie Mikrorisse nahe der Papillen im Ballensegment, bei den in Gefangenschaft gehaltenen Elefanten und den Wildtieren beschrieben. Nach ersten Biotin- plasmaproben wurde 500 ng Biotin pro Liter Plasma als Grenzwert zwischen Elefanten mit und ohne Biotinbehandlung angenommen.
    [Show full text]
  • Sever's Disease
    ORIGINAL ARTICLES Sever’s Disease: What Does the Literature Really Tell Us? Rolf W. Scharfbillig, PhD* Sara Jones, PhD† Sheila D. Scutter, PhD‡ Background: Sever’s disease is typical of many musculoskeletal conditions where ob- servational annotations have slowly been accepted as fact with the passing of years. Ac- ceptance of these nontested observations means that health professionals seeking in- formation on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series. Methods: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever’s disease. This information was then re- viewed to present what is actually known about this condition. Results: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition. Conclusion: The level of evidence for most of what we purport to know about Sever’s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment. (J Am Podiatr Med Assoc 98(3): 212-223, 2008) Sever’s disease, also known as calcaneal apophysitis growth center onto which the Achilles tendon in- or calcaneoapophysitis, was first described by Hag- serts.3-5 Kvist and Heinonen6 and Kim et al7 refine this lund1 in 1907, although Sever2 has received more definition, adding that Sever’s disease is a traction credit for describing the condition. Sever’s disease epiphysitis as opposed to other forms of inflamma- has been described in various ways and attributed to tion at this site, such as bruising or infection.
    [Show full text]
  • Diagnosis and Treatment of Ankle Arthritis
    The Journal of Foot & Ankle Surgery 59 (2020) 1019−1031 Contents lists available at ScienceDirect The Journal of Foot & Ankle Surgery journal homepage: www.jfas.org ACFAS Clinical Consensus Statement Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis Naohiro Shibuya, DPM, MS, FACFAS1, Jeffery E. McAlister, DPM, FACFAS2, Mark A. Prissel, DPM, FACFAS3, Jason A. Piraino, DPM, MS, FACFAS4, Robert M. Joseph, DPM, PhD, FACFAS5, Michael H. Theodoulou, DPM, FACFAS6, Daniel C. Jupiter, PhD7 1 Professor, College of Medicine, Texas A&M University, Temple, TX 2 Podiatrist, Arcadia Orthopedics and Sports Medicine, Phoenix, AZ 3 Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH 4 Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL 5 Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL 6 Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA 7 Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX Executive Summary S15: Open arthrodesis is a viable option for treatment of ankle arthritis. The American College of Foot and Ankle Surgeons has developed a S16: Arthroscopic arthrodesis is a viable option for treatment of consensus statement on diagnosis and treatment of ankle arthritis. A ankle arthritis. modified Delphi method was sed in an attempt to develop consensus S17: Total ankle arthroplasty is a viable option for treatment of on a series of 18 statements using the best available evidence, clinical ankle arthritis.
    [Show full text]
  • 1813 Vet Proceedings Inside
    H51062 Autumn 08 Cover:H51062 Autumn Cover 28/8/08 10:29 Page 1 AUTUMN MEETING, SEPTEMBER 2008 EAST MIDLANDS AUTUMN BRITISH VETERINARY DERMATOLOGY STUDY GROUP AUTUMN MEETING 13th and 14th SEPTEMBER 2008 EAST MIDLANDS AIRPORT THISTLE HOTEL SPONSORS Principal Sponsor: VIRBAC Major Sponsors: DECHRA VETERINARY PRODUCTS HILLS PET NUTRITION JANSSEN ANIMAL HEALTH PFIZER Main Sponsors: ARTU BIOLOGICALS BAYER MERIAL ANIMAL HEALTH NATIONWIDE VETERINARY LABORATORIES NOVARTIS ANIMAL HEALTH ROYAL CANIN The B.V.D.S.G. committee and members would like to thank our sponsors for their generosity and support of this meeting Proceedings published for the British Veterinary Dermatology Study Group by Affiniti, Adventis Health Limited, Adventis House, Post Office Lane, Beaconsfield HP9 1FN Proceedings editor: Paul S Coward. Anthills, 25 Moneyfly Road, Verwood, Dorset BH31 6BL [email protected] 1 PROGRAMME DISEASES OF THE FACE AND FEET SATURDAY 13 TH September 2008 9.00 - 9.45am REGISTRATION Morning session 9.45 - 10.15 Anatomy and Surgery of Foot and Claw Structures Prue Neath 10.15 - 10.45 Surgery of Foot and Claw Structures Prue Neath 10.45 - 11.30 COFFEE AND COMMERCIAL EXHIBITION 11.30 - 12.15 Lymphocytic-Plasmacytic Pododermatitis in the Dog Rory Breathnach 12.15 - 1.00 The Canine Foot as a Predilection Site for Disease Rory Breathnach 1.00 - 2.00 LUNCH 1.30 - 2.00 ESVD AGM 2.00 - 2.30 COFFEE AND COMMERCIAL EXHIBITION Afternoon session 2.30 - 3.15 Symmetrical Lupoid Onychodystrophy Rory Breathnach 3.15 - 4.15 Uveodermatological Syndrome – an Ophthalmologist’s
    [Show full text]
  • The Elephant's Hoof
    Veterinär-Anatomisches Institut der Vetsuisse-Fakultät Universität Zürich Direktor: Prof. Dr. H. Geyer The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes Inaugural-Dissertation zur Erlangung der Doktorwürde der Vetsuisse-Fakultät Universität Zürich vorgelegt von Andreas Benz Tierarzt von Schübelbach, SZ genehmigt auf Antrag von Prof. Dr. Hans Geyer, Referent Prof. Dr. Klaus Eulenberger, Korreferent Zürich 2005 Druck: RoNexus Services AG, Basel “The feet of elephants, both in captivity and in work camps, are probably the single greatest source of medical problems, which confront veterinarians working with elephants” (M.J. Schmidt, 1986) Meiner Familie und insbesondere meiner Mutter für Ihre immerwährende Unterstützung jeglicher Art in grosser Dankbarkeit gewidmet Content 1 Summary............................................................................................... 1 2 Zusammenfassung .............................................................................. 2 3 Introduction and aim of the study ...................................................... 3 4 Review of the literature........................................................................ 5 4.1 Definition of elephants’ hooves...................................................... 5 4.2 General facts about Asian and African elephants.......................... 5 4.2.1 Classification ................................................................................................... 5 4.2.2 Natural
    [Show full text]
  • Brown County Foot Care Options Phone (920) 448-4300
    300 S. Adams St, Green Bay, WI 54301 Brown County Foot Care Options Phone (920) 448-4300 www.ADRCofbrowncounty.org Foot Care in a Clinic Setting Agency Hours Payment Options Notes Aging and Disability Resource Center ON HOLD DUE TO COVID-19 $20 donation requested at time of All services performed by NWTC students under the 300 S. Adams St. Vary during the month. registration (covers cost of supervision of an instructor. Please bring own towel. Green Bay, WI 54301 Call for dates, times, and to set-up supplies). Diabetic Assistance www.adrcofbrowncounty.org appointments. Cash, credit cards, and checks 920-448-4300 accepted. De Pere Community Center FALL EVENT Free but donations accepted. Cash All services performed by NWTC students under the 600 Grant St. THURSDAY NOVEMBER. 4TH 2021 & checks accepted supervision of an instructor. De Pere, WI 54115 Call to Register: 920-339-4097 *Soak feet prior & bring own towel. Reservations are being taken at this time Bellin Home Health Care ONLY BELLIN REFERRED PATIENT $40 Thick toenails, nails with fungus, corns/calluses, treat in- 704 S. Webster Ave. Friday, 8:00 am - 2:00 pm Cash & checks accepted grown toenails & other foot problems. Soak feet prior to Green Bay, WI 54301 Call to schedule an appointment. appointment if possible. www.bellin.org 920-445-7272 Diabetic Assistance Clarity Care Foot Care First & Third Thursdays, $30 Provided by nurses. Includes foot massage, toenail 2649 Manitowoc Rd. alternating mornings & afternoons. Cash & checks accepted. trimming, foot & nail soak, callus care and foot care Green Bay, WI 54311 Call to schedule an appointment.
    [Show full text]
  • Using Compression Therapy in Complex Situations
    Clinical PRACTICE DEVELOPMENT Clinical PRACTICE DEVELOPMENT Using compression therapy in complex situations Patients presenting with ulceration will often have other chronic illnesses such as diabetes mellitus and osteoarthritis. Compression therapy remains the mainstay of treatment for the majority of these patients, although in some it will be contraindicated. This article stresses the importance of assessment of ulcer aetiology and will discuss the treatment of patients with ulceration who have complex health needs, including those with diabetes, rheumatoid arthritis, haematological problems such as sickle cell anaemia, cardiac problems, and wounds caused by trauma. Christine Moffatt Patients with diabetes KEY WORDS Many textbooks state that Table 1 Compression therapy compression therapy should not be Factors affecting wound healing Ulceration used in patients with diabetes. This Diabetes is because of the risk of concurrent Rheumatoid arthritis peripheral arterial occlusive disease 8 Peripheral arterial occlusive disease that leads to reduced perfusion and low oxygen levels Sickle cell anaemia and the concern that sensory neuropathy will prevent a patient from that result in tissue breakdown and gangrene Pre-tibial crest injuries detecting whether the compression is (Kite and Powell, 2007) causing trauma. However, patients with 8 Smoking is a major risk factor for peripheral diabetes are just as likely to suffer vascular disease (PVD) (Burns et al, 2003). In here is increasing evidence that from a venous ulcer as those without. addition to its role in accelerating arterial the proportion of patients with disease, it is also a potent vasoconstrictor, complex ulceration is increasing Such patients with venous further reducing local tissue oxygen perfusion T 8 (Moffatt et al, 2004).
    [Show full text]