Lame - therapeutic foot trimming, digit amputation

Question 1

What is the technique used for therapeutic foot trimming?

Answer 1

Dutch 5 step technique

Question 2

What are the steps once lesion is identified?

Answer 2

Isolate lesion
Remove underrun and diseased horn
Decrease weight bearing on diseased claw
Foot block and bandage

Question 3

What are the different techniques of administering local anaesthesia when doing therapeutic foot trimming?

Answer 3

Local infiltration - ring block
Nerve block
Intravenous regional anaesthesia (IVRA) - most common

Question 4

What local anaesthetic is used when doing therapeutic foot trimming?

Answer 4

Procaine and adrenaline

Question 5

How do you do an Intravenous regional anaesthesia (IVRA)?

Answer 5

Apply tourniquet just below hock
Identify vein - above accessory digit
Clip and prep
Give 15-20ml of procaine

Question 6

What is the onset of action of procaine?

Answer 6

5 to 10 mins - quick

Question 7

What do you have to be careful of when using a tourniquet?

Answer 7

Ischaemic necrosis if left on too long
Care when removing - procaine shooting round system

Question 8

How long is the max time a foot block should be on?

Answer 8

4-6 weeks

Question 9

What is the block of choice?

Answer 9

Wooden demotec block
Cow slips are a bit far forward on the hoof, not used as much anymore

Question 10

What 2 NSAIDs can you give to lame cows?

Answer 10

Ketoprofen
Meloxicam

Question 11

What are the benefits of the two different types of NSAIDs?

Answer 11

Ketoprofen - 0 day milk withdrawals
Meloxicam - longer analgesic effect

Question 12

What are the disadvantages of bandaging?

Answer 12

If dirty then they trap infection in there in anaerobic environment
If walking on bandage then mroe weight on affected claw

Question 13

When are bandages used?

Answer 13

For applying topical treatments/antibiotics
For digit amputations/surgery

Question 14

When are digit amputations needed?

Answer 14

Deep digital sepsis
Toe necrosis
Non healing white line disease/sole ulcers
Trauma - degloving/disarticulation

Question 15

What are contraindications of digit amputation?

Answer 15

Imperfect contralateral claw
Severe ascending tenosynovitis
Lameness affecting other limb

Question 16

What do you use for anaesthetising the limb in digit amputation?

Answer 16

IVRA with tourniquet
Poke with needle 5 mins after to test feeling

Question 17

Where do you cut the soft tissues for a digit amputation?

Answer 17

1cm about coronary band through soft tissues down to bone
Second longitudinal incision in interdigital space

Question 18

What do you use to cut through P2 for a digit amputation?

Answer 18

Clean embryotomy wire

Question 19

What do you use to dress the foot after digit amputation?

Answer 19

A pressure bandage - before taking tourniquet off

Question 20

What post op care is needed for digit amputation?

Answer 20

Change pressure bandage every 48 hours
Keep environment clean, easy access to food and water
Systemic antibiotics for minimum 5 days
NSAIDs

Question 21

What are the complications of digit amputation?

Answer 21

Haemorrhage
Ascending infection, osteomyelitis
Ischaemia, sloughing
Premature culling

Question 22

What is the prognosis of digit amputation?

Answer 22

If surgery and post op care go well then they can do very well with one claw
If anything goes wrong with remaining claw - very bad