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CVS2 Musculoskeletal > Equine Acute and Chronic Foot Problems > Flashcards

Equine Acute and Chronic Foot Problems Flashcards

1
Q

Observations of the hoof.

A

Shod/unshod.
Substrate underfoot.
Hoof balance.
Hoof quality.
Visible lesions - bruising, cracks (grass cracks from bottom, sand cracks from top), swelling/depressions, discharge, widening of white line, divergence (growth lines should be parallel).
Paring the solar surface improves view here.

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2
Q

What might a farrier do to stop a crack propagating any further?

A

Avoid pressure up the centre of the hoof:
- avoid toe clip and use quarter clips instead to use the hoof as a single structure.
Interrupt line by rasping a horizontal line at the top of its current level.
Round off the top of the crack.
For cracks from coronary band, support hoof from the base.
- may be reducing load on a small area so it floats slightly above the shoe/ground and this does not move, allowing better new growth of the following horn.

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3
Q

Palpating the coronary band.

A

Dorsally to identify:
- sinking of the extensor process of P3 in the laminitic cases.
- effusion of the DIP joint.
Circumferentially:
- to identify if a foot abscess has tracked up under the dorsal hoof wall and is about to burst at the coronary band.

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4
Q

3 synovial structures in the equine hoof.

A

Navicular bursa.
Digital flexor tendon sheath.
DIP joint.

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5
Q

Navicular bursa injection.

A

Navicular bursa = small structure in the hoof which sits distal the to navicular bone.
Desensitisation of surrounding navicular bursa but may cross-react with DIP joint blocks.
Entry difficult buy may be US or radiographically guided.
Sepsis common following solar puncture wounds.

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6
Q

Prep for rads of hoof.

A

Remove mud from outside of hood and distal limb.
Pick out and brush hoof thoroughly.
Remove shoes if present.
Pare flaky sole away.
Pack frog with play doh.
Apply markers:
- dorsal hoof wall.
- coronary band.
- point of frog.

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7
Q

Foot block/tunnel options.

A

To elevate.
To angulate.
Variety of commercial and home made versions.

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8
Q
  1. P3 Lateromedial (LM) radiographs.
  2. Which condition may be commonly assessed by a single LM view of the affected limb(s)?
A
  1. Position: WB on blocks.
    Cassette: on ground, on medial aspect of limb, vertical, in sagittal plane.
    Generator: on floor.
    Beam: centre 1/3 palmar from dorsal coronary band, 1cm below coronary band, aim horizontally, w/ heel bulbs superimposed.
    Markers: dorsal hoof wall and point of frog.
  2. Laminitis.
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9
Q

Lateromedial view radiograph features to assess.

A

Centre of arc of DIP vertically over middle of hoof and point of frog.
Dorsal hoof wall, dorsal P3, back of heel and pastern all parallel to each other.
Coronary band and extensor process of P3 heights in comparison to marker.
- check symmetry between feet.
Shape of the extensor process can vary.
Assess solar thickness.
Angle of solar surface of P3 from hoof (5-10 degrees).
Wall thickness relative to P3 length (should be 1/3 of length of P3).
Tip of P3 is a point not a lip.

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10
Q
  1. P3 DP view.
  2. On a standard DP view, where should the L/R marker be placed?
A
  1. Position: WB on blocks, heel close to back.
    Cassette: on ground, on palmar aspect of limb, vertical, in frontal plane.
    Generator: on floor.
    Beam: centre axially at point mid way between sole and coronary band.
    Markers: left/right +/- lateral as symmetrical.
  2. Laterally (dorsally for LM).
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11
Q

DP features to assess on radiograph?

A

Mediolateral imbalance:
- difference between P3 and sole.
- REMEMBER WHOLE LIMB MUST BE SQUARE!
- joint spaces should look symmetrical.
Hoof wall flare.
Mineralisation of ungal cartilages (AKA sidebone).
VASCULAR CHANNELS ARE NOT PATHOLOGY!
Use other hoof as direct comparison.

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12
Q

P3 dorsoproximal palmarodistal oblique (DPr-PaDO) “upright pedal” or weight bearing on tunnel.

A

Position: toe on block, sole vertical (P3) or dorsal hoof wall vertical (nav).
Cassette: on ground, on palmar aspect of limb, vertical, in frontal plane.
Generator: on floor.
Beam: centre axially at coronary band.
Markers: L/R +/- lateral as symmetrical.
Can also be done with the horse stood on a tunnel housing the cassette using 55-65 degrees angled beam.
Can then rotate a=generator to add a lateral or medial 45 degrees obliques too.

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13
Q

Acquiring the DPr-PaDO view radiograph.

A

Focus on either P3 or navicular bone.
If complete P3 first, then alter setup for navicular bone by:
- increase exposure.
- reduce collimation.
- centre 1cm more proximal.
– to reduce angle by 5 degrees when FFD is 75-100cm.

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14
Q

DPr-PaDO features to assess.

A

Margins of P3.
Wings of P3.
DIP joint congruity.
Crena (midline distal P3 margin) variable appearance.
Vascular channels similar size and shape on P3.
Several small radiolucent zones on distal border of navicular bone normal.

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15
Q

Dorso-proximal lateral-palmarodistomedial and dorso-proximal medial-palmarodistolateral views features to assess.

A

Symmetry between medial and lateral sides and L and R feet.
Useful for pedal wings and abaxial navicular fractures.
DIP joint.

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16
Q

P3 palmaroproximal-palmarodistal oblique (skyline) view.

A

Position:
WB on tunnel, heel close to back and extend caudally +/or lift heel.
Cassette: in tunnel on ground.
Generator: on floor.
Beam: centre axially between heel bulbs angling 45-55 degrees distally.
Markers: L/R +/- lateral as symmetrical.

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17
Q

Skyline features to assess.

A

Limb extended caudally.
Change appearance with angle:
- corticomedullary definition.
- flexor margin shape.
- overlap with p2/p3 (want minimal).
Note: appearance changes with conformation and angle used.

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18
Q

What other modality is most commonly used in practice for investigation of foot lameness?

A

MRI.

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19
Q

U/S of the foot.

A

Effectively obsolete now there is MRI.
Transcutaneous:
- collateral ligament of DIP (proximal portion).
- DIP joint effusion (dorsally).
- DDFT between heel bulbs.
Solar view - through the frog, takes LOTS of prep.
– DDFT, navicular bone and bursa.
– P3.

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20
Q

Equine distal limb MRI.

A

Gold standard to evaluate soft tissues due to superior contrast details.
Early detection of injuries from biochemical changes in tissue.
Standing low field MRI developed in 2001 readily available in UK
- only for distal limb.
Currently few high field scanners in UK, used for proximal and distal limbs, head and neck.

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21
Q

CT of equine limbs.

A

Few standing units available in UK.
Allows accurate assessment of bony structures e.g. fractures and facilitates surgical approaches UNDER STANDING SEDATION.
Much quicker than MRI (5mins vs couple hrs per distal limb).

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22
Q

Specialist skills involved in image viewing of the equine foot.

A

Knowledge of normal anatomy.
Understanding of MRI/CT science.
Knowledge of normal appearance for each structure on each sequence.
Years of practice.

23
Q

Name common causes of acute onset lameness associated w/ foot pathology.

A

Infection:
- nail prick, foot abscess, penetration, FB.
Trauma:
- bruising and corns, fractures.
Other:
- laminitis.

24
Q

Nail bind/pricked hoof…
1. aetiology.
2. presentation.
3. dx.
4. tx.

A
  1. nail placed in or axial to white line during farriery.
  2. Shortly after farriery - <few days.
    Acute severe lameness.
  3. Hoof testers and paring.
  4. Remove nail/shoe.
    Poultice.
    Rest <1w.
25
Q

Solar bruising…
1. aetiology.
2. presentation.
3. dx.
4. tx

A
  1. Rough ground.
    Unshod.
    (laminitis)
  2. mild-moderate lameness.
  3. Pain on hoof testers.
    Visible bruising after paring.
  4. Rest. Unshod? Poultice?
    Reshoe after paring?
    Avoid stony ground.
26
Q

Corns…
1. aetiology.
2. presentation.
3. dx.
4. tx.

A
  1. Collapsed bars.
    Too long shoeing interval.
  2. mild-moderate lameness.
  3. pain on hoof testers.
    visible.
  4. Rest. Unshod? Poultice?
    Reshoe after paring.
    For future, decrease shoeing interval.
27
Q

Hoof (subsolar) abscess = pus in foot…
1. aetiology.
2. clinical signs.
3. dx.
4. tx.

A
  1. Penetrating injury to solar surface.
    Bacteria tracking up white line.
    May follow nail bind / solar bruising / corns.
  2. Acute NWB lameness.
    Increased digital pulses.
    Pain on hoof testers.
    May burst spontaneously.
  3. Pus released during paring.
  4. Poultice / tubbing.
    Rest.
28
Q

Foot abscesses - progression.

A

Most abscesses drain at the white line.
Occasionally these may track and exit elsewhere:
- coronary band.
- frog.
-penetration site.
Some have multiple pockets.
Some are very deep - donkey!

29
Q

Deep puncture wounds…
1. aetiology.
2. presentation.
3. investigation.

A
  1. Usually FB.
    If in situ, image before removal.
  2. Acute lameness NWB.
  3. Hoof testers and paring.
    Rads +/- contrast.
    - orthogonal.
    MRI.
    - remove metal FB beforehand!
  4. If DIP, NB, DFTS affected, carry out arthroscopic lavage or euthanasia.
    If DIP, NB, DFTS not affected, poultice, rest, analgesia, maybe antimicrobials.
30
Q

Pedal osteitis…
1. aetiology.
2. presentation.
3. dx.
4. tx.

A
  1. Septic focus in P3.
    Often following PIF/puncture.
  2. Acute severe lameness which persists.
    Increased digital pulses.
    Pain on hoof testers.
  3. Imaging.
  4. Curettage back to healthy bone, remove any sequestrate which have formed.
    Manage open wound.
    Hospitalised?
    Plate or bandaging.
31
Q

Consideration for obtaining rads for a suspected hoof fracture.

A

Leave shod.
- removing shoes requires levering and pulling on the foot to remove the shoe.
- painful.

32
Q

P3 fractures…
1. aetiology.
2. presentation.
3. dx.

A
  1. Trauma.
    Kick wall - esp. HLs.
  2. Acute onset severe lameness.
  3. Rads - may need to wait for lysis to visualise.
    - orthogonal views.
    MRI.
    CT?
33
Q

P3 fracture configuration.

A

Type I fractures involve the palmar/plantar process and do not enter the DIP joint.
Type II fractures are oblique or parasagittal fractures that are articular but not on the midline.
Type III fractures are midline articular fractures that bisect the pedal bone into 2 equal halves.
Type IV fractures involve the extensor (pyramidal) process of the pedal bone.
Type V fractures are comminuted and split the pedal bone into multiple fragments.
Type VI fractures are solar margin fractures.
Type VII fractures are exclusive to foals and are also fractures of the solar margin.

34
Q

P3 fracture tx options.

A

Depends on configuration.
Sx lag screw.
Conservative bar shoe and rest.
Assessment of healing must be based on soundness, not radiography.
- heal by fibrosis.

35
Q

Navicular bone fracture…
1. aetiology.
2. presentation.
3. investigation.
4. configuration.
5. tx.

A
  1. Trauma.
  2. Acute severe lameness.
    Increased digital pulses.
  3. Radiographs - PaPr-PaDiO.
    MRI.
  4. Usually parasagittal and slightly oblique.
  5. Sx lag screw.
    Conservative - bar shoe with quarter clips and rest.
36
Q

Fracture of ossified ungual cartilages…
1. aetiology.
2. presentation.
3. tx.
4. care w/ dx.

A
  1. Ossification of ungual cartilages is usually an asymptomatic condition but they are predisposed to trauma e.g. overreach.
  2. Acute severe lameness.
    Increased digital pulses.
    Pain on palpation of heel bulbs.
  3. Bar shoes w/ quarter clips and rest.
  4. As separate centres of ossification, this may be a misdiagnosis!
37
Q

Conditions that predispose a pony to laminitis?

A

EMS.
PPID.
Being a pony.

38
Q

Phases, presentation and timeline of laminitis.

A

Developmental stage.
- causal event until clinical signs.
– good to act now if you cab!
- ice boots are protective.
Acute.
- from onset of signs to 72hrs, may include structural failure.
Sub-acute.
- repair over 2-3m.
Chronic.
- structural failure develops over indefinite period.

39
Q

Laminitis aetiology.

A

Endocrinopathies:
- PPID.
- EMS.
- Corticosteroid administration (in cases of unidentified or uncontrolled PPID or EMS).
Excess carbohydrate intake.
Toxaemia.
Contralateral limb lameness (heavier horses).
At risk:
- Hx of laminitis - ~30% recurrence rate.
- obese.
- crest neck.
- breeds.
– ponies.
– heavy horses.
Pathogenesis.
- dermal-epidermal separation of lamellae.
- basement membrane lysis.

40
Q

Clinical signs of laminitis.

A

Typical stance = weight on heels.
Reluctant to move / pick up foot,
Increased digital pulses.
Warm feet.
Pain on hoof testers,
Change in solar surface - flatter.
Coronary band depression.
Solar bruising.
Divergent growth rings
Change in hoof shape.

41
Q

Dx of laminitis?

A

Clinical signs.
Imaging:
- may not see pathology immediately.
- often 2w after onset.
Rotation.
Sinking.
Gas.
- subsolar.
- inflammation, haemorrhage, haemorrhage resorption, gas-filled pocket, prone to abscessation.
Remodelling/lysis.

42
Q
  1. Tx aims of laminitis.
  2. Tx of laminitis in the developmental phase.
A
  1. Manage primary cause.
    Alter laminar perfusion.
    Reduce inflammation.
    Mechanical support.
    Pain relief.
  2. Treat primary cause:
    - PPID/EMS.
    - feed room gorge.
    - endotoxaemia.
    – polymixin, NSAIDs, ice.
    Alter laminar perfusion:
    - cold to decrease flow, isoxsuprine, ACP.
    Prevent inflammation and analgesia - NSAIDs.
    Mechanical support:
    - rest on deep bed.
    - Styrofoam pads, lily pads, frog bandages, plaster of paris,
43
Q

Tx of laminitis in the acute phase.

A

Alter laminar perfusion:
- increase perfusion.
- ACP? / Isoxsuprine? / glyceryl trinitrate?
Prevent inflammation and analgesia:
- NSAIDs.
Mechanical support:
- rest on deep bed.
- frog supports.
- Styrofoam pads / lily pads / plaster of paris sole casts / sole putty.
- remove toe.
- elevate heel? – reduces DDFT pull.

44
Q

Tx of laminitis in sub-acute to chronic phases.

A

Gradually withdraw acute Tx.
Normalise anatomy w/ trimming.
- shorten toe.
- REMOVE heel height.
- takes months-years.
Support from heart bar shoes / silicone filler.

45
Q

Prognostication in the acute laminitis case is difficult as there are many factors. What are these?

A

Disease severity:
- sinking?
- degree of rotation?
- clinical severity / level of pain.
- response to initial tx.
Number of feet affected.
Weight of horse?
Breed of horse?
Cause?
Underlying foot conformation.
Need to warn owners 1/3 cases recur.

46
Q

Laminitis types and descriptions.

A

Type A = Acute Founder = anatomically correct.
Type B = Founder = depression at D coronary band.
Type C = Chronic Founder = depression all coronary band.
Type D = Sinker = chronic remodelling signs.

47
Q

Causes of chronic lameness.

A

Soft tissue lesions within the foot.
Osteoarthritis.
Navicular disease/syndrome.
Chronic infections (thrush, canker, quittor).
Keratoma.

48
Q

Soft tissue lesions.

A

Strain or sprain injuries to:
- collateral ligaments of the DIP joint.
- distal DDFT.
- impar ligament of the navicular bone.

49
Q
  1. Osteoarthritis of DIP joint.
  2. What is the cheapest IA med for DIP OA.
A
  1. Enthesiophytes:
    - mid-distal P2.
    - remember large DIP joint capsule dorsally.
    Osteophytes:
    - proximal P3.
    - NB variable appearance of extensor process and separate centre of ossification mimics fragments.
    - palmar P3.
    - navicular.
  2. Corticosteroids.
50
Q

OA of PIP joint.

A

Osteophytes:
- distal P1.
- proximal P2.
Common in heavy horses.
Small joint motion so arthrodesis possible.

51
Q

Subchondral bone cyst in P3.

A

Clinical signs:
- lameness.
- effusion of DIP.
Tx:
- translesional screw used from dorsal aspect.

52
Q
  1. Navicular disease aetiology.
  2. …clinical signs.
A
  1. Unclear, likely degenerative predisposed by poor foot conformation.
  2. Bilateral, thoroughbred horse.
    Chronic, often bilateral, low grade FL lameness.
    Worse when lunged on hard circle.
    Positive response to palmar digital nerve block.
    Large vascular channels, bone inflammation.
52
Q
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53
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CVS2 Musculoskeletal (21 decks)

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