03072nas a2200349   4500000000100000008004100001260001300042653001000055653001500065653002800080653002200108653002800130653001400158653001100172653001500183653002000198653001100218653001200229653000900241653001600250653001800266653002600284653002500310653001100335100001900346700001300365245012600378300001100504490000700515520218600522022001402708       2005                            d  c2005 Feb10aAdult10aAlcoholism10aArthropathy, Neurogenic10aDiabetes Mellitus10aDiagnosis, Differential10aDiaphyses10aFemale10aFoot Bones10aFractures, Bone10aHumans10aleprosy10aMale10aMiddle Aged10aNeurosyphilis10aScleroderma, Systemic10aSpondylarthropathies10aStroke1 aRothschild B M1 aBehnam S00aThe often overlooked digital tuft: clues to diagnosis and pathophysiology of neuropathic disease and spondyloarthropathy.  a286-900 v643 a<p><b>OBJECTIVE: </b>To assess diagnostic implications of abnormalities of the pedal digital tufts and to identify features to facilitate distinguishing of spondyloarthropathy and leprosy.</p><p><b>BACKGROUND: </b>Better criteria for distinguishing between these disorders are necessary if their character, natural history, and evolution are to be understood.</p><p><b>METHODS: </b>Pedal x rays of 91 consecutive patients with diabetes, 21 alcoholic patients, 100 with spondyloarthropathy, 8 with scleroderma, and 137 with leprosy, and 188 defleshed skeletons of individuals with alcoholism, syphilis, cerebrovascular disease, and paraplegia from the Terry and Hamman-Todd collections were examined for evidence of osseous and articular pathologies. Digital tuft abnormalities were divided into irregularity, divot, flattening, resorption, whittling, and fragmentation.</p><p><b>RESULTS: </b>Tuft divots were more common in alcoholics than in diabetic, and were more common in both than in the other groups studied. Tuft flattening was limited to alcoholic and neurosyphilis groups. Tuft whittling was especially prominent among individuals with spondyloarthropathy, contrasted with leprosy and diabetes. Aligned fractures were more common in diabetics than individuals with leprosy. Misaligned fractures were limited to individuals with leprosy and neurosyphilis. Leprosy and spondyloarthropathy were complicated by phalangeal and metatarsal whittling more commonly than other diseases studied. Background pedal abnormalities, derived from individuals with cardiovascular syphilis, cerebrovascular accidents, and paraplegia, was limited to abnormal divots only.</p><p><b>CONCLUSIONS: </b>Pedal digital tufts undergo a variety of pathological alterations useful in the recognition of disorders traditionally considered neuropathic in aetiology and in distinguishing differential considerations. Tuft flattening appears specific for alcoholism and neurosyphilis, and misaligned fractures seem specific for neurosyphilis and leprosy, providing differential assistance related to spondyloarthropathy. Conversely, periosteal reaction distinguishes spondyloarthropathy from leprosy.</p>  a0003-4967