A high prevalence of digital dermatitis (DD) and the benefits of early topical treatment highlight the need for simple tools for routine DD detection. The objective of this study was to determine the accuracy of scoring DD lesions using the 5 M-stage scoring system in the milking parlor compared with the trimming chute as the gold standard. Three observers inspected 3,585 cows and 6,991 hind feet from 9 farms in the milking parlor using a mirror (glued to a plastic kitchen spatula) and a headlamp, followed by inspection in a trimming chute within 5 d. Interobserver agreement for scoring DD in various settings was ≥82% (kappa >0.74; weighted kappa >0.76). At trimming chute inspections, 68% of cows had at least 1 DD lesion, 19% had 1 hind leg affected, and 49% had both hind legs affected. Within-herd DD prevalence ranged from 16 to 81% of cows affected. True within-herd prevalence was 2, 6, 0, 36, and 14% for M1, M2, M3, M4, and M4.1 lesions, respectively. At the foot level, DD prevalence was the same (58%) in the milking parlor and trimming chute inspection, but distribution of M-stages differed. Milking parlor inspection as a means of identifying the presence of DD lesions had a sensitivity of 92% and specificity of 88%, with positive and negative predictive values of 91 and 89%, respectively. Agreement between milking parlor and trimming chute inspections was 73% (kappa = 0.59, weighted kappa = 0.65) for the 5 M-stage scoring system and 90% (kappa = 0.80) if only the presence of a lesion was noted. Test characteristics varied greatly among M-stages, with the highest sensitivity for detecting M4 (82%) and M2 (62%) lesions, and the lowest for detecting M4.1 (20%), M1 (7%), and M3 (0%) lesions. In the milking parlor, 20% of M2 lesions were misclassified as M4.1, 8% of M4 lesions were misclassified as M0, and 68% of M4.1 lesions were misclassified as M4. The majority (87%) of DD lesions were located between the heel bulbs; 10 and 2% of DD lesions affected the interdigital space and the front of the foot, respectively. The sensitivity to detect the presence of a lesion when it occurred between the heel bulbs was 93%, but <67% if it occurred elsewhere on the foot. We concluded that inspection of the rear feet in the milking parlor was an inexpensive and simple method of detecting and scoring DD lesions. If the objective is to determine herd-level DD prevalence and routine monitoring, this method was adequately reliable. However, if the objective is to follow up DD in cows with history of interdigital hyperplasia or to detect M1 or M4.1 lesions, this method was not sufficiently reliable. Although DD scoring in the milking parlor as a routine practice should facilitate early detection, prompt treatment interventions, and herd monitoring, it was not sufficiently reliable to replace definitive identification of M-stages in the trimming chute.

To date, there have been very few randomized trials testing CDM interventions targeting primary care providers with the goal of improving care of people with CKD. Those conducted to date have shown minimal impact, suggesting that other strategies, or multifaceted interventions, may be required to enhance care for patients with CKD in the community.

Digital dermatitis (DD), an infectious bacterial foot lesion prevalent in dairy cattle worldwide, reduces both animal welfare and production. This disease was recently identified in replacement dairy heifers, with implications including increased risk of DD and decreased milk production in first lactation, poor reproductive performance, and altered hoof conformation. Therefore, a simple and effective method is needed to identify DD in young stock and to determine risk factors for DD in this group so that effective control strategies can be implemented. The objectives of this study were to (1) determine prevalence of DD in young stock (based on pen walks); and (2) identify potential risk factors for DD in young stock. A cross-sectional study was conducted on 28 dairy farms in Alberta, Canada; pen walks were used to identify DD (present/absent) on the hind feet of group-housed, young dairy stock. A subset of 583 young stock on 5 farms were selected for chute inspection of feet to determine the accuracy of pen walks for DD detection. Pen walks as a means of identifying DD lesions on the hind feet in young stock had sensitivity and specificity at the animal level of 65 and 98%, with positive and negative predictive values of 94 and 83%, respectively, at a prevalence of 37%. At the foot level, pen walks had sensitivity and specificity of 62 and 98%, respectively, with positive and negative predictive values of 92 and 88%, respectively, at a prevalence of 26%. Pen walks identified DD in 79 [2.9%; 95% confidence interval (95% CI): 2.3-3.6%] of 2,815 young stock on 11 (39%; 95% CI: 22-59%) of 28 farms, with all 79 DD-positive young stock ≥309 d of age. Apparent within-herd prevalence estimates ranged from 0 to 9.3%, with a mean of 1.4%. True within-herd prevalence of DD in young stock, calculated using the sensitivity and specificity of the pen walks, ranged from 0 to 12.6%, with a mean of 1.4%. On the 11 DD-positive farms, the proportion of young stock >12 mo of age with DD lesions was 9.9% (95% CI: 7.8-12.0%). Multilevel logistic regression was used to assess associations with potential risk factors for DD lesions, including age, leg cleanliness, and lactating herd DD prevalence. Presence of DD in young stock increased as their age increased and was associated with increased prevalence of DD in the lactating herd. Pen walks can be used to identify specific young stock with DD or groups where management practices can be implemented to prevent disease proliferation and transmission.

Digital dermatitis (DD), an infectious bacterial disease affecting the feet of dairy cattle, can cause lameness and decrease milk production, fertility, and animal welfare. Current DD treatment typically involves routine hoof trimming and topical antibiotics. Several nonantibiotic commercial topical products are used for controlling DD lesions; however, there is limited or no evidence regarding their effectiveness. The objectives of this study were to evaluate 2 commercially available topical applications on their ability to (1) clinically cure active DD lesions to nonactive lesions and (2) prevent recurrence of active DD lesions. Ten farms were visited weekly. In the milking parlor, the hind feet of lactating cattle were cleaned and scored (M-stage scoring system). Cattle with DD lesions at the first visit were randomly allocated to 1 of 4 treatment groups: positive control (tetracycline solution), HealMax (AgroChem Inc., Saratoga Springs, NY), HoofSol (Diamond Hoof Care Ltd., Intracare BV, Veghel, the Netherlands), and a negative control (saline). All products were applied to lesions using a spray bottle. Tetracycline, HealMax, and HoofSol had a higher probability of clinical cure for active lesions compared with saline 1 wk after the first treatment (wk 1), with 69, 52, and 79% clinical cure of active lesions, respectively, compared with 34% with saline. At wk 7, the probability of clinical cure for active lesions was 10, 33, 31, and 45% of lesions treated weekly with saline, tetracycline, HealMax, and HoofSol, respectively (no difference among treatments). The substantial clinical cure with saline highlighted the potential importance of cleaning feet. In wk 1, treatment with saline, tetracycline, HealMax, and HoofSol resulted in a probability of recurrence of active DD lesions of 9, 11, 11, and 8%, respectively, with no product being superior to saline. After 7 wk, the probability of recurrence of active lesions was 5, 7, 6, and 6% for saline, tetracycline, HealMax, and HoofSol respectively, with no difference among groups in wk 7. These results provide alternatives to antibiotics for treatment of DD lesions and highlight the potential importance of cleaning feet in the milking parlor.

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