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Equine Final Year > Equine Foot > Flashcards

Equine Foot Flashcards

1
Q

Give some of the main causes of foot disease

A
  • Solar / white line infections
  • Thrush
  • Solar bruising / solar pain
  • Hoof wall lesions
  • Wounds
  • Laminitis
  • Foot imbalance / caudal foot pain
  • Navicular disease
  • DIP joint pain / DJD
  • Foot penetrations
  • Fractures
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2
Q

How can lameness be affected by work and surfaces?

A
  • Hard surfaces increase concussive forces and usually worsen foot lameness (worse when worked or lunged on hard ground) –majority of foot lameness’s are worse on a hard surface due to impact with hard ground
  • Circling with affected leg on inside increases weight through this limb (lunge with affected limb on inside to exacerbate lameness) –makes lameness worse
  • Arthritic conditions usually worsened by increases in work
  • Navicular pain may be triggered by periods of box rest – box rest doesn’t cure everything, and box rest can often trigger this
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3
Q

What kind of lamenesses can hard surfaces show up?

A

Hard surfaces increase concussive forces and usually worsen FOOT lameness (worse when worked or lunged on hard ground)

Majority of FOOT lameness’s are worse on a hard surface due to impact with the hard

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4
Q

How can circling show foot lameness?

A

Circling with affeced leg on the INSIDE increases weight through this limb (lunge with affeected limb on inside to exacerbate lameness)

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5
Q

What can navicular pain be triggered by?

A

Navicular pain may be triggered by periods of box rest - box rest doesn’t cure it and can show up the navicular problem

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6
Q

How can you use observation to start your diagnosis towards foot lameness?

A
  • Start physical exam by assessing stance, conformation and hoof / shoe wear
  • Weight-bearing
  • Foot balance
  • Uneven wear of hoof / shoe
  • Left foot vs right foot –is weight and balance even? Is it symmetrical
  • Shoeing (type of shoe, when shod) –if shoes falling off, cannot really do a good lameness evaluation! If weird type of shoe for a vetting –ask why its shod in this way! It may have a problem that needs these shoes!
  • Don’t dive in and palpate first –stand back and look how horse is standing and weight bearing etc.
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7
Q

How should you observe weight bearing when observing the horse for foot lameness?

A
  • Weight-bearing
    • Degree of lameness (PIF may be 10/10 th lame)
      • Severely lame–somethingmajor or PIF!
    • Severe lameness and some navicular disease may toe point because they don’t want to put weight on their heel area
    • Laminitis can have typical stance rocked back on heels
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8
Q

When looking for foot lameness, how should you compare the feet?

How can chronic lameness look?

A
  • Left foot vs right foot
    • Similar conformation, similar size feet between them
    • Chronic lameness can have contracted (smaller) affected foot (e.g. navicular disease)
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9
Q

How can looking at the foot balance and shoe give you an indication to foot lameness?

A
  • Foot balance
    • Assess from side
      • toe parallel to heel?
      • Where is the centre of weight-bearing?
    • Assess from front and from sole aspect
      • Mediolateral imbalance, sheared heels, valgus or varus
  • Uneven wear of hoof / shoe
    • Scuffing of toe or mediolateral imbalance
  • Shoeing (type of shoe, when shod)
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10
Q

How should you start your PHYSICAL exam when looking at foot lameness?

A

Palpation

  1. Feel for heat, pain, swelling and digital pulses
    • Inflammation can be a whole range of things!
    • Laminitis, infection, sole bruising, fractures, joint effusions
  2. Lift foot and check shoe and nail position, and sole surface
    • Slipped shoe, nail penetrations, sole bruising, white line disease, thrush and canker
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11
Q

When feeling for heat, pain, swelling or digital pulses in the foot - what would you feel with laminitis?

A

Laminitis

  • Hot feet, bounding digital pulses
  • Can be single limb, both forelimbs or all 4 limbs
  • Other systemic signs (tachycardia and sweating)
  • If bounding digital pulses in both forelimbs – pushing idea towards laminitis
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12
Q

When feeling for heat, pain, swelling or digital pulses in the foot, what would you feel with infection?

A

Infection

  • Hot feet, bounding digital pulses
  • Usually unilateral (sole or white line infections)
  • Can be all around the white line or within the sole
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13
Q

n feeling for heat, pain, swelling or digital pulses in the foot, what would you feel with sole bruising?

A

Sole bruising

  • Hot foot, bounding digital pulse - means it has inflamed foot
  • Usually unilateral (can be bilateral)
  • Usually forelimb because it takes more weight
  • Can find with hoof testers
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14
Q

When feeling for heat, pain, swelling or digital pulses in the feet - what would you feel with fractures?

A

Fractures

  • Pedal bone and navicular –hot foot and bounding pulse
  • P2 +/-swelling and palpable crepitus
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15
Q

When feeling for heat, pain, swelling or digital pulses in and around the foot - what can swelling be due to?

A

Swelling

  • DIP joint (coffin joint) at coronary band –can palpate effusion here
  • New bone formation–lots of horses have new bone but it is around the joint that it becomes significant
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16
Q

When doing a physical exam of the foot - why should you lift the foot and check shoe and nail positon?

A

Check for a slipped shoe - shoe can move positions and the nail can sometimes go somewhere sensitive

Look for penetration wounds

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17
Q

When doing a physical exam of the foot - what should you look for on the sole surface?

A
  • Bruising/haemorrhage
  • Corns
  • Evidence of infection (pus, black marks, tracts)
  • Thrush or canker
  • Sometimes just need to use a hoof knife to scrape away a layer
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18
Q

What is equine canker?

A

Canker is an unusual condition of the horse’s foot that affects the frog, bars, and sole. The name comes from the early belief that the condition was of a cancerous nature. The microorganism associated with canker causes abnormal keratin production, or overgrowth of the horn

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19
Q

What are some contraindications for nerve blocks?

A
  • Unstable limbs
    • Suspected fractures
    • Severe soft tissue injuries such as DDFT ruptures)
  • Risk of infection
    • Current infection at injection sites, such as mud fever
    • Where you cannot perform technique in a safe and sterile manner
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20
Q

What is the problem with using distal interphalangeal joint block and the navicular bursa to look for a navicular problem?

A

A lot of overlap between some of the blocks:

  • Distal interphalangeal joint –up against navicular bursa, sometimes communicate, sometimes don’t –so can be complicated!
  • Navicular bursa –if you think it has a navicular problem, block the bursa! As sometimes this will interact with the DIP joint and sometimes wont –so cannot rely on a DIP nerve block to block it!
  • Digital flexor tendon sheath
  • Note there are issues about communication and overlap between different areas
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21
Q

What is radiography a first line diagnostic for?

A
  • First line of diagnostics in:
    • Suspected fracture
    • Laminitis
    • Suspected bone lesions / foot penetrations
    • Do not trot up or do nerve blocks in these –go straight to radiography!
  • Usually first line of diagnostics after nerve blocks
  • Standard views
    • LM, Upright pedal, upright navicular, flexor navicular
    • Left and Right fore
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22
Q

What should you not do if you suspect a fracture, laminitis or suspected bone lesion/foot penetration?

A

Do not trot up or do nerve blocks in these - go straight to radiography

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23
Q

What is a first line diagnostic for suspected synovial sepsis?

A

Arthrocentesis

(also known as joint aspiration, the procedure uses a sterile needle and syringe to drain fluid from a joint for further examination)

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24
Q

What is ultrasonography a first line diagnostic for?

A

Used for some soft tissue lesions, otherwise limited value due to problems accessing regions of the foot

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25
Q

What is gamma scintigraphy used for with regards to diagnosing foot lameness?

A

Used in non-displaced pedal bone fractures (no radiographic signs) - sometimes it take a while to see the fracture

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26
Q

Which diagnostic technqiue is one of the best for foot problems?

A

MRI

27
Q

Why is MRI useful for diagnosing and imaging foot problems?

A
  • Very useful for foot problems –very good for looking at all aspects of the foot!
  • Very good for soft tissue injuries that you cannot otherwise identify (DDFT lesions, collateral ligsof DIP joint)
  • Standing MRI units in a number of hospitals
  • Rapid developments in diagnosing new conditions
  • Navicular disease –x-ray will show it, but MRI will also show all other things associated and what else is involved. Can help a lot with prognosis
28
Q

What is the problem with using MRI for foot problems?

A

Not cheap (>£1000), must consider whether it would change what you do with that case (Matt Smith has published on this) –need to know if it will change what you are going to do as it is a lot of money!

29
Q

What would you feel in the feet with acute laminitis?

A

Hot feet

Bounding pulses

Abnormal stance

30
Q

In brief terms, what is the aetiology of laminitis?

A
  • Endotoxaemia, metabolic, endocrine, weight overload
    • Ischaemic necrosis –> vasconstriction
    • Damage to interlaminar bonds, loss of epidermal/dermal junction, separation of laminae
    • Separation of P3 from hoof wall
31
Q

Give some clinical signs in ACUTE laminitis?

A
  • Unilateral, bilateral or quadrilateral lameness –most are bilateral both forelimbs, forelimbs are biggest problem due to weight distribution
  • Hot feet, bounding pulses, abnormal stance
  • Systemic signs –tachycardia, hypertension, sweating
  • Can look like colics – always check feet in recumbent or reluctant to move horses –some of them are lying down, sweating with increased HR –so can look like colic!
  • Severe cases may have sinking of pedal bone (depression at coronary band, protrusion or haemorrhage of sole at toe region as pedal bone rotates through) –can feel this in the foot as a depression –sole bulges as pedal bone starts to come through and in the worst cases, the pedal bone can come through the sole
32
Q
A
33
Q

What are some systemic signs you see with acute laminitis?

A

Tachycardia

Hypertension

Sweating

34
Q

How can you use radiography to diagnose/assess laminitis?

A
  • Lateromedial views with markers on sole and coronary band, and dorsal hoof wall
  • Divergence of dorsal hoof wall and dorsal P3 (degree and speed of change related to prognosis)
  • <5 degree separation –good prognosis
  • >15 degree separation –poor prognosis –
  • Rapid deviation –poor prognosis
  • Slow deviation –better prognosis
  • Looking for divergence between dorsal hoof wall and P3–various ways can measure this
  • Also how quickly it has separated –might not start off bad, but can go bad really quickly –radiographic signs are helpful, but also see how horse is progressing and responding to treatment
35
Q

When using radiography to diagnoses/assess laminitis:

  1. is a rapid or slow deviation a better prognosis?
  2. Is >15degree separtion or <5 degree separation a better prognosis?
A
  1. Slow deviation is a better prognosis
  2. <5 degree separtion is a better prognosis - the less separated, the better
36
Q

Describe the following 2 radiographs

A
  • Top –about 3% degree of separation, good prognosis
  • Bottom –marked degree of separation. Block line is gas in dorsal area, due to separation so much!! P3 very close to sole–likely to have bulge and haemorrhage on sole of foot –poor prognosis!
37
Q

What are some radiographic signs of bad laminitis?

A
  • Gas between dorsal wall and pedal bone (infection and wall separation)
  • Sinking of pedal bone (from coronary band marker, and towards solar surface)
  • Chronic laminitis-remodelling of pedal bone, and new bone formation on dorsal surface P3 – with repeated tearing and healing
38
Q

What is the treatment for laminitis?

A
  • Treat the underlying cause (obesity, endocrine disease, grain overload, limb overload)
    • E.g.why does it hav elaminitis? Does it have cushings disease? Is itobese? Always addressanyunderlying causes
  • Break the pain / necrosis cycle
    • Vasodilators, NSAIDs –use any NSAID which will work with this horse. Some respond differently. Add in opioids if you cannot control it
    • If youdon’t get pain under control–pain necrosis cycle carries on!!
    • Throw everything at them (apart from steroids) and break the cycle ASAP
  • Support the foot
    • Frog supports, soft deep bed
  • Dorsal wall resection to stop rotation and release seroma fluid
  • Picture –drilled through to get rid of seromas – just do whatever you can to make them comfortable
39
Q

How can you break the pain/necrosis cycle in horses with laminitis? And why is it important?

A
  • Vasodilators, NSAIDs –use any NSAID which will work with this horse. Some respond differently. Add in opioids if you cannot control it
  • If you don’t get pain under control–pain necrosis cycle carries on!!
  • Throw everything at them (apart from steroids) and break the cycle ASAP
40
Q

Describe these horses feet in terms of foot balance

A
  • Left: broken forward HP axis
  • Top: Low sloping heels - mediolateral imbalance –loading all inside of the foot, other side is shorter. Dorsopalmar view –can affect all structures going up through the leg
  • Right pic: weight bearing in caudal region, whole load of long toe that isn’t contributing to weigh bearing Broken forward HP axis Low sloping heels Weight bearing in caudal region
41
Q

What can incorrect foot balance predispose the horse to?

A

Predisposes to other conditions e.g. navicular pain, palmar heel pain, DDFT lesions and DIP joint disease

42
Q

What is the treatment for incorrect foot balance?

A
  • Corrective farrier
    • Heels and tow parallel
    • Correct HP axis
    • Centre of DIP joint in middle 1/3rd of weight/bearing surface
43
Q

What is navicular disease?

A

navicular disease = pain in navicular region (navicular bone, navicular bursa, soft tissues) – doesn’t just mean bone. Bone has cartilage on it, there is also a bursa

44
Q

What is the aetiology of navicular disease?

A

Caused by biomechanical cause - where foot balance is important

45
Q

How can navicular disease cause a DDFT lesion?

A

DDFT inserts onto P3 - if you get erosion on the back of the bone, can also get a DDFT lesion - this is why MRI is really good for giving this imformation

46
Q

Where does DDFT insert?

A

Onto P3

47
Q

What are some clinical signs of naviuclar disease?

A
  • Predominantly middle aged horses (TB and Warmbloods)
  • Usually forelimbs
  • Unilateral or bilateral
  • Usually chronic, progressive lameness –doesn’t come on suddenly
  • Worsened by hard ground / concussion
  • Periods of box rest can trigger episodes –can make it worse!
  • Animals may toe point when resting –not always useful to use as a diagnostic
  • Chronic cases can have smaller, upright feet –‘boxy feet’
48
Q

What ground worsens navicular disease clinical signs?

A

Navicular disease is worsened by hard ground/concussion

49
Q

How can you diagnose navicuar disease?

A
  • Bilateral lameness may present as short striding, or only be obvious when lunged in a circle to exacerbate the main side of the lameness
  • Usually positive to flexion tests (and DIP extension test)
  • Nerve blocks
    • Positive to palmar digital nerve block
    • Sometimes positive to DIP joint block as sometimes it diffuses
    • Positive to navicular bursa block –the definitive way to diagnose! As DIP and bursa sometimes do or do not communicate
  • Lameness may ‘switch’ following nerve blocks (block left fore, right fore goes lame) –one is worse and then you take the pain away in one and then the lameness may change into other leg and appear
50
Q

Which block is navicular disease positive to?

Why not others?

A

Positive to navicular bursa block - the definitive way to diagnose

As the DIP and bursa do not always communicate - so doing a DIP block may not always block it!

51
Q

When taking radiography for naviuclar disease - what views should you take?

A

Lateromedial

Dorsoproximal palmarodistal 60degree oblique (upright view)

Palmarproximal palmarodistal oblique view (flexor view)

52
Q

What is the problem with navicular disease and radiography?

A
  • Can have radiographic signs without lameness
  • Can have disease without radiographic signs
  • So think in terms of the clinical pictures!
  • Can sometimes have sign, no lameness – clinically insignificant
53
Q

What are some radiographic signs you may see with navicular disease?

A
  • New bone formation (esp lateral and medial ‘wings’)
  • Loss of corticomedullary junction and normal radiographic appearance of either region
  • Irregular or cystic like radiolucencies (appearance and number of synovial fossae is NOT reliable)
  • Remodelling of distal border (upright pedal) or flexor surface (flexor view), including fractures
  • Calcification of soft tissues
54
Q

What are fossae?

Are fossae on the navicular bone normal or abnormal?

A

A shallow depression or hollow

Up to 6 fossae is fine

If there are any more or the fossae are all different shapes and sizes or if there is also soem sclerosis - can be signfiicant

55
Q

Other than radiography, what are some other methods of diagnosis for navicular disease?

A
  • Gamma scintigraphy will show active bone remodelling which may not be apparent on radiography –but sometimes not that useful! MRI is definitely worth doing
  • MRI is the imaging tool of choice for soft tissue lesions, including lesions of the navicular fibrocartilage, navicular bursa and navicular ligaments
56
Q

What are some treatment options for navicular disease?

A
  1. Correct foot balance and farriery –see next session –if it had foot balance problem, there is something you can do about it!
  2. Get horse comfortable and moving (avoid rest) –NOT A BUTE AND BOX REST CASE! By all means give pain relief, but get it out and get it moving
    • Intra bursa lsteroid injections –short-lived effect (30-90 days)
    • Systemic NSAIDs
    • ?isoxuprine(vasodilator)
    • bisphosphonates
  3. Surgery
    • Endoscopy of navicular bursa, and DDFT
    • Suspensory ligament desmotomy
    • Neurectomy –cutting palmar digita lnerves and exercising–can be bad for the horse in future, as could get a penetration injury and they may not even know. Some competitions do not allow this
57
Q

What are some surgical options for treatment of navicular disease?

A

Surgery

  • Endoscopy of navicular bursa, and DDFT
  • Suspensory ligament desmotomy
  • Neurectomy –cutting palmar digita lnerves and exercising–can be bad for the horse in future, as could get a penetration injury and they may not even know. Some competitions do not allow this
58
Q

What can DIP joint pain arise from?

A
  • Synovitis
  • Degenerative joint disease
  • Trauma/fractures (not very common)
  • Infectious arthritis (joint infection)
59
Q

What are some clinical signs of DIP joint disease?

A
  • Acute onset with trauma / infection
  • Insidious onset with synovitis / DJD
  • Synovitis / DJD often related to foot balance, and can be unilateral or bilateral lameness
    • If you have wrong foot balance, will be causing stress and problems in these joints
  • Synovitis / DJD usually forelimbs
  • Lameness worsened by increase in workload, working on hard ground / increased concussion
  • Joint effusion often palpable (arthrocentesis site)
60
Q

What is the diagnosis for DIP joint disease?

A
  • Usually positive to flexion tests
  • Usually worse when lunged on hard ground with affected limb on inside –same as other stuff!
  • Nerve blocks
    • Full or partial response to PDNB (depending on how much of dorsal aspect blocked) –only get partial response because it ONLY DOES THE CAUDAL ASPECT. Usually improve to DIP joint but don’t usually go sound unless you do them really high. Will go sound with a abaxial sesamoid or a joint block
    • Positive response to abaxial sesamoid nerve block
    • Positive response to DIP joint anaesthesia
  • Suspected fractures / infection should not be nerve blocked –go to other diagnostic tests first
61
Q

Comment on these 2 radiographs

A
  • DIP is a high motion joint therefore radiographic changes can be subtle but significant. Osteophytes mainly seen on extensor process of distal phalanx and palmar aspect of second phalanx
  • Left –extensor process, see remodelling –DIP joint. Sometimes see changes on palmar aspect. Tends to just be some subtle remodelling
  • Right –canseesharpareaondorsalaspect. Also palmar aspect of P2 involvement.
  • Has ossification of collateral cartilage in the foot –usually incidental with older horses, but can be significant in some. Usually ignored
62
Q

What is the treatment of DIP joint disease?

A
  1. Identify and treat underlying cause
    • sepsis, fracture, cyst, foot imbalance
  2. Correct foot balance and farriery (next session)
  3. Treat inflammatory / degenerative cycle
    • Intra-articular medication (HA, PSGAGs, steroids) –try to improve health of the joint
    • If you have radiographic changes –will not fix it. Just thinking about long term management
  4. Treat pain
    • Systemic NSAIDs, intra-articular steroids –if radiographic changes, just trying to manage it
  5. Modify exercise
    • Work on soft ground, keep in regular, gentle exercise, weight loss if necessary
63
Q

What are some less common causes of foot lameness that should not be missed?

A

Foot penetrations

Fractures

64
Q

Which bones are you most likely to get bone cysts?

A

Pedal and naviuclar bone

Equine Final Year (102 decks)

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