Foot Pain

Question 1

How can you diagnose foot pain?

Answer 1

• History + clinical exam - acute/chronic, resting stance, foot balance, wounds
• Dynamic lameness examination
• Local anaesthesia
• Imaging - radiography / MRI

Question 2

How would you prepare the foot for radiography?

Answer 2

• Clean foot - mud/stones will show on radiograph
• Remove shoe
• Pare foot - remove any loose horn / overgrown frog
• Use Play-doh on lateral/central sulcus
• Stand on blocks - square + evenly
• Markers - L/R + dorsal hoof wall marker from coronary band

Question 3

What are your most common radiographs?

Answer 3

• Lateromedial
• Horizontal dorsopalmar
• Dorsoproximal-palmarodistal oblique - P3
• Dorsoproximal-palmarodistal oblique - navicular bone
• Palmaroproximal-palmarodistal oblique - skyline

Question 4

What can be assessed with the lateromedial projection?

Answer 4

• Phalangeal/solar angle
• Relationship to dorsal hoof wall and sole/shoe
• P3/P2/NB/DIP joint (P1/PIPJ)
• P3 extensor process – Variation
• Navicular bone

Question 5

What can you assess on the dorsopalmar projection?

Answer 5

• P3 margins - relationship to hoof wall / sidebone
• DIPJ + PIPJ space
• PIPJ margins
• Navicular bone margins

Question 6

What are benefits of the dorsoproximal-palmarodistal oblique - P3?

Answer 6

• Can see whole of P3 body, solar margin + wings

Question 7

What are benefits of the dorsoproximal-palmarodistal oblique - Navicular bone?

Answer 7

• Navicular bone =
  -proximal + distal borders
  -lateral + medial wings
  -DIPJ margins

Question 8

What can you assess with the palmaroproximal-palmarodistal oblique?

Answer 8

• Articular surface of the navicular bone
• Synovial fossae
• Endosteal surface
• Corticomedullary definition

Question 9

What can cause primary pain in the distal interphalangeal joint + associated structures?

Answer 9

• Joint disease - OA
• Joint trauma / subchondral bone pain
• Collateral ligament desmitis
• Osseous cyst-like lesion

Question 10

How can you diagnosed primary pain of the DIPJ?

Answer 10

• Uni/bilateral lameness
• DIPJ effusion
• Diagnostic anaesthesia
• Imaging - radiography, US, MRI

Question 11

How do you manage conditions of the distal interphalangeal joint?

Answer 11

• Rest / controlled exercise - ligament/joint injuries
• Systemic NSAIDs - bute
• Joint medication - corticosteroids
• Other - foot balance/shoeing

Question 12

What can cause pedal bone fractures? What are signs?

Answer 12

• Kicking wall / blunt trauma
• CS = Acute foot pain,
  -increase digital pulse,
• Hoof tester +ve,
  -percussion +ve,
  -DIPJ effusion

Question 13

How are pedal bone fractures diagnosed?

Answer 13

• CS
• Local Anaesthesia
• Radiography - should always describe the fracture

Question 14

How do you manage pedal bone fracture?

Answer 14

• Conservative managements = immobilisation + rest using bar shoe + hoof/foot cast
• Surgical = remove fragments, internal fixation, PD neurectomy

Question 15

What is pedal osteitis? What should be done?

Answer 15

• Chronic foot soreness - often associated w foot imbalance
• Tx = correct foot imbalance, reduce abnormal stresses through foot

Question 16

What is navicular disease?

Answer 16

• Chronic bilateral forelimb lameness - worse on hard surface + exacerbated in a circle
• Low heel/ long toe conformation

Question 17

What is pathology of navicular disease?

Answer 17

• Age related = thinning of fibrocartilage + roughening of DDFT
• Defects in palmar surface fibrocartilage
• DDFT damage
• Defects in palmar cortical bone
• New bone formation
• Degenerative changes around DIP/NB articulation

Question 18

How is navicular disease diagnosed?

Answer 18

• Clinical evaluation - Hx, foot conformation, hoof testers
• Dynamic evaluation - land toe first (worse on hard circle)
• Local anaesthesia

Question 19

What are radiographic abnormalities (in order of importance)?

Answer 19

• Medullary cyst formation
• Flexor cortex erosion / irregularities
• Loss of corticomedullary definition - endosteal sclerosis
• Distal border fragmentation
• Entheseophytes on lateral border
• Enlarged / increased number of synovial fossae

Question 20

How do you treat navicular disease?

Answer 20

• Farriery = balance foot, reduce breakover, engage frog + heel support
• Medical Tx = NSAIDs, intra-articular / intra-bursal medication, bisphonates
• Surgical Tx = Neurectomy

Question 21

What is diagnosis + management of primary DDFT lesions?

Answer 21

• Dx = mild-severe acute unilateral lameness, diagnostic analgesia, MRI
• Management =
  -conservative = rest / shoeing
  -surgical = debridement of lesion via navicular bursa