Surgical treatment for forefoot deformities in patients with rheumatoid arthritis has recently shifted toward joint-preserving procedures for all toes. In contrast, resection arthroplasty was previously more commonly performed for the lesser toes. Advances in drug therapy have improved life expectancy, resulting in an increased number of long-term survivors who had previously underwent resection arthroplasty. With increased activity levels, the recurrence of plantar callosities in the forefoot has become more frequent, often leading to gait disturbances. In general, revision surgery for such cases often involves additional bone resection; however, this approach may result in further shortening of the metatarsals and increase the risk of further recurrence. Therefore, we applied a metatarsal-shortening offset osteotomy, which we typically perform as a primary procedure, as a salvage procedure to reduce the risk of recurrence. We report three cases treated using this strategy. In all cases, the second to fifth metatarsal heads had been resected, but the resection stumps were covered with pseudo-cartilaginous tissue. This allowed a metatarsal-shortening offset osteotomy to be performed as a procedure similar to that used in primary surgery, achieving the planned correction. Consequently, both radiographic and clinical improvements were observed. These findings suggest that a metatarsal-shortening offset osteotomy may be a possible salvage option after primary resection arthroplasty for forefoot deformities in patients with rheumatoid arthritis.

Background: Caregivers often seek medical assistance when their child experiences podiatric medical ailments. Podiatric medical diseases such as ingrown toenails, callosities, warts, metatarsus varus, and hallux valgus frequently occur in children and adolescents. However, treatment, prevention, and rehabilitation are often based on empirical experiences; thus, as a first endeavor, clinical and epidemiologic mapping of podiatric medical diseases in children is warranted. We describe the prevalence of common foot conditions-callosities, ingrown toenails, hallux valgus, metatarsus varus, and warts-among Danish schoolchildren aged 6 to 16 years. Methods: In this cross-sectional study, we evaluated foot conditions in children in first (aged 6-8 years), fifth (aged 10-12 years), and ninth (aged 14-16 years) grades. The clinical status of the feet was examined by teams of two podiatric physicians each. Specifically, we evaluated deformities of the foot, foot pathologies, and their anatomical localization. Results: Of 501 children (1002 extremities) evaluated, 417 had one or more of the investigated foot deformities or pathologies. We found 266 various foot pathologies among Danish schoolchildren. Metatarsus varus (53%) and callosities (46%) were the most frequently occurring foot conditions. The prevalence of foot pathologies of ingrown toenails and warts was 14% and 12%, respectively. The prevalence of ingrown toenails, metatarsus varus, and hallux valgus increased with age. Conclusions: This study found that foot pathologies such as warts and ingrown toenails and conditions such as metatarsus varus and callosities are common in Danish primary school students. These findings of high prevalences of foot pathologies and conditions motivate future research projects to clarify how this affects general health and subsequently the relation to pain, health challenges, socioeconomics, and quality of life.

Neglected congenital clubfoot in adults is difficult to manage. Multi-joint arthrodesis is often required but is invasive and associated with complications. We report an adult case treated with ankle arthrodesis and midfoot derotational osteotomy. A 59-year-old man with untreated idiopathic clubfoot since birth presented with severe hindfoot varus and rigid midfoot inversion, leading to wheelchair dependence. Imaging showed correctable hindfoot deformities but rigid midfoot inversion with talonavicular subluxation. Surgery consisted of Achilles tendon lengthening, ankle and subtalar arthrodesis with a retrograde intramedullary nail, and midfoot derotational osteotomy, resulting plantigrade. Bony union was confirmed at one year. At 3 years, plantigrade alignment remained without recurrence. Callosities resolved, and the patient regained pain-free walking. Clinical scores improved: Japanese Society for Surgery of the Foot ankle/hindfoot (4.0 to 66.0), Japanese Society for Surgery of the Foot midfoot (0.0 to 73.0), self-administered foot evaluation questionnaire (89.2 to 366.0). This is the first report of midfoot derotational osteotomy for neglected congenital clubfoot, offering a less invasive option for selected adults.

Immobilization of human joints for extended periods, often lasting weeks or longer, can lead to stiffness and contracture. In recent years, various modern treatment modalities have been developed to address joint stiffness and soft tissue contracture. However, in many developing countries, traditional treatments involving plants and animal products remain popular due to their accessibility and affordability. The present study aims to assess the indigenous knowledge and treatment practices for post-traumatic joint stiffness and soft tissue contracture, using the ischial callosities of Papio hamadryas, among residents in both rural and urban communities of Tigray. A survey was conducted across two zonal areas between October 1 and January 30, 2023. A total of 34 male traditional healers, selected based on their expertise in treating musculoskeletal disorders with Papio hamadryas's ischial callosities, were interviewed using a structured questionnaire. The questionnaire collected information on the preparation process, dosage, efficacy, duration of treatment, and any adverse side effects experienced by patients. According to the survey responses, the age distribution of the traditional healers was as follows: 2.9% were aged 41–50, 67.6% were aged 51–60, and 29.4% were over 60 years old. Educationally, 50% of the healers had no formal education, 35.3% had completed primary school, 11.8% had secondary education, and 2.9% had post-secondary qualifications. In terms of the treatment methods used, 8.8% of the healers applied the ischial callosities as a defined ointment, 32.4% used the whole material along with its skin, and 58.8% applied pieces of the callosities along with the skin, securing them with available coverings. Regarding monitoring the progress of treatment, 58.8% of the healers checked the range of motion twice a week, 26.5% checked three times a week, and 14.7% checked daily until the maximum range of motion restored. Based on the responses, 76.5% of the healers reported that patients showed significant improvement (near-complete healing) within one month, while 23.5% noted progress within two months. Regarding the potential adverse effects associated with the use of the material, 28.6% of respondents replied 'yes,' providing some form of justification, while 71.4% responded 'no,' opposing any adverse side effects (absence of significant observable harm) from the material. These data show that a system of indigenous knowledge in a particular traditional culture, may disprove or potentially utilized as an alternative for managing post-traumatic joint stiffness and soft tissue contracture, Therefore, it is crucial to conduct further scientific research to validate these traditional claims.

A retrograde ankle nail combined with corrected talar osteotomy is indicated for severe ankle joint deformities owing to rheumatoid arthritis. However, the usefulness of this procedure in improving gait function remains unclear. We treated a 78-year-old woman with rheumatoid arthritis (RA) who experienced significant gait pain owing to a severe varus deformity of the ankle. She underwent corrected closed-wedge talus osteotomy and retrograde intramedullary ankle nail insertion. Preoperative analysis showed Japanese Society for Surgery of the Foot RA foot ankle scale of 44, with limited range of motion and impaired gait. Six months postoperatively, her scale improved to 69, indicating enhanced functional outcomes. Gait analysis at 6 months revealed a notable increase in stride length, gait speed, and cadence, along with a reduction in stance phase and double support duration. In addition, the swing phase increased. The painful lateral callosity of the foot disappeared postoperatively. This report emphasises the effectiveness of surgical intervention in improving gait function in patients with severe ankle deformities owing to RA. However, limitations include the absence of clubfoot correction and a relatively short follow-up period. Overall, these findings suggest that the surgical approach is beneficial for restoring mobility and alleviating pain in patients with complex ankle conditions.

Talar neck osteotomy (TNO) has been reported as one of the surgical options for cavovarus foot caused by residual congenital clubfoot and neurologic disease in children, or talar neck fracture. However, TNO is rarely reported to correct the neurologic cavovarus foot in adults. We present the case of a 29-year-old male with spina bifida who exhibited a flexible cavovarus deformity of the foot, associated pain during ambulation, and plantar callosities. Preoperative weight-bearing foot radiographs showed cavovarus alignment, and three-dimensional computed tomography demonstrated increased varus/plantarflexion of the talar neck. We performed joint-preserving reconstruction comprising TNO, anterolateral transfer of the tibialis posterior tendon, dorsiflexion of the first‑metatarsal osteotomy, and Achilles tendon lengthening. At 24 months, radiographs and clinical examination confirmed a reduction of cavovarus deformity and plantar callosities. Bony union was achieved at all osteotomy sites without signs of talar avascular necrosis. The Japanese Society for Surgery of the Foot hindfoot score improved from 55 to 90, the visual analog scale for pain also improved from 7 to 0, and the‑Self-Administered Foot Evaluation Questionnaire scores improved in all domains. TNO combined with tendon transfer and first‑ray and gastrosoleus procedures can be a useful option within a comprehensive, deformity-specific strategy for adult neurologic cavovarus feet.

The objectives were to investigate the association between machine milking-induced teat tissue changes and the occurrence of clinical mastitis in Holstein dairy cows. We conducted 2 separate prospective cohort studies at 1 commercial dairy farm in New York State to study the association of machine milking-induced short-term changes (STC, trial 1) and machine milking-induced long-term changes (LTC, trial 2) with clinical mastitis occurrence. Each trial consisted of four 3-wk periods. On d 1 of each period, STC and LTC were assessed through visual inspection and manual palpation. Short-term teat tissue changes were assessed based on teat discoloration, the condition of the teat base, and the consistency of the teat end and categorized into a binary variable (STC present or absent). Long-term teat tissue changes were categorized into 4 groups as follows: no callosity present (score 1), callosity ring present with no or only mild roughness (score 2); callosity ring and roughness present with keratin fronds extending 1 to 3 mm from the teat orifice (score 3); and callosity ring present with excessive keratin fronds extending ≥4 mm from the teat orifice (score 4). Data on clinical mastitis occurrence was extracted from the herd management software. We used the first clinical mastitis event of a quarter for each 3-wk trial period and applied a 14-d gap to define a new mastitis case within a quarter between 2 trial periods. In trial 1, STC was documented in 6,110 of 66,702 cases (9.2%) over the four 3-wk periods, The frequency distribution of LTC in trial 2 was as follows: score 1 in 7,348 of 61,624 cases (11.9%), score 2 in 48,553 cases (78.8%), score 3 in 5,514 cases (8.9%), and score 4 in 209 cases (0.3%). We documented 944/66,702 (1.4%) clinical mastitis cases at the quarter level during trial 1 and 866/61,624 (1.4%) cases during trial 2. Generalized linear mixed models with a logit link and a binomial distribution were used to test if machine milking-induced teat tissue changes were associated with clinical mastitis occurrence. In trial 1, we analyzed 66,702 quarter-level observations from 5,094 cows. We found no significant association between STC and clinical mastitis occurrence. Compared with a quarter with a teat without STC, the odds (95% CI) of clinical mastitis were 1.22 (0.95-1.59). In trial 2, we used 61,624 quarter-level observations from 4,998 cows. We found no significant association between LTC and clinical mastitis occurrence. Compared with a quarter with a teat with a smooth end (score 1), the odds of a clinical mastitis case were 1.02 (0.77-1.36) for score 2, 1.19 (0.84-1.69) for score 3, and 2.14 (0.80-5.71) for score 4. We concluded that in the study cohort presented here, machine milking-induced teat tissue changes were not associated with the occurrence of clinical mastitis.

Objective Diabetes mellitus is a disease that can affect various organs, and so all the symptoms should be investigated. Nonetheless, skin symptoms have received less attention than others. The duration of diabetes plays a critical role in the development and progression of systemic and dermatological complications. Existing evidence suggests that many cutaneous complications, such as diabetic dermopathy, xerosis, and infections, tend to increase in frequency and severity with longer disease duration. Therefore, this study assessed and compared the demographic, clinical, lifestyle, and dermatological features of patients with type 2 diabetes mellitus (T2DM) based on the duration of the disease. Methodology This cross-sectional study was performed at multiple secondary care hospitals and primary care centers. The time period of the study was from December 1, 2024, to May 30, 2025. This study included 290 patients with confirmed T2DM, categorized into three groups based on diabetes duration: Group A (less than one year), Group B (one to five years), and Group C (more than five years). Data were collected through clinical examination and structured questionnaires covering demographic details, lifestyle factors, treatment modalities, physiological parameters, and dermatological findings. Statistical analysis was applied using the chi-square test and a Kruskal-Wallis test, with p < 0.05 reflecting statistically significant. Results The comparison of three groups showed significant differences in gender, socioeconomic status, dyslipidemia, smoking history, and diabetes treatment. Group A had more individuals from a high socioeconomic background, while Group C had the most from the middle class. Dermatological conditions such as acanthosis nigricans (p < 0.001), callosities (p = 0.020), and bullae (p = 0.027) were significantly associated with longer diabetes duration. Conclusion This study concluded that the duration of T2DM patients with a longer diabetes duration was linked to lower BMI, better glycemic control, and more lifestyle-based treatments, while shorter duration was associated with higher age, BMI, dyslipidemia, and smoking. Dermatological manifestations such as acanthosis nigricans, callosities, and bullae indicated a significant association with diabetes duration.

Objectives Type 2 diabetes mellitus (T2DM) is frequently related with various cutaneous manifestations, which may be influenced by comorbid conditions such as dyslipidemia. Hence, this study compared the demographic to match clinical and dermatological profiles of T2DM patients with and without dyslipidemia. Methodology This cross-sectional study was conducted at a secondary care hospital using a non-probability convenient sampling technique over six months. A total of 280 T2DM patients aged 40-65 years were included in this study. Patients were distributed into two equal groups: Group A (with dyslipidemia) and Group B (without dyslipidemia). Data on demographics, clinical history, lifestyle factors, treatment regimens, and dermatological findings were collected using structured questionnaires, physical examinations, and laboratory tests. A Chi-square test and a Mann-Whitney test were applied to examine the association of dermatological symptoms in T2DM. A p-value < 0.05 was reflected as statistically significant. Results The study findings showed that a significant gender disparity was observed: all patients in Group A were male subjects at 140 (100%), while Group B were predominantly female subjects at 88.6% (p<0.001). A larger proportion of Group A had diabetes for more than five years, 47 (33.6%) compared to Group B at 14 (10.0%), (p<0.001), and more frequent use of insulin and oral hypoglycemic agents (p=0.001). Xerosis with fissured skin was significantly more common in Group B at 109(77.9%), (p<0.001). The presence of bullae was also significantly greater in Group B at 54(38.6%) as compared to Group A at 25 (17.9%) (p<0.001). Although acanthosis nigricans showed no significant difference, it was slightly more prevalent in Group B. Conclusion This study concluded that the dermatological manifestations were common among T2DM patients, with notable differences based on dyslipidemia status. Patients without dyslipidemia showed a higher prevalence of xerosis, ichthyosis, callosities, and bullae, whereas paresthesias were more frequently observed in those with dyslipidemia.