Lecture 23 3/31/25 Flashcards
Which ailments of the foot can be treated with surgery?
-pedal osteitis
-distal interphalangeal joint septic arthritis
-digital tenosynovitis
-corn removal
What are the indications for local anesthesia of the foot?
-rule out distal limb lameness
-perform uncomfortable procedures, including aggressive corrective trims, corn removals, and claw amputations/other surgeries
What is a bier block/RLP?
use of a tourniquet to keep anesthetics injected into the vein within the limb region of interest
Which vein is most commonly used in a bier block?
dorsal-pedal vein
What are the characteristics of a four point nerve block for the foot?
-lidocaine inhibits sodium channels to prevent action potentials
-needle is inserted into the dorsal aspect of the pastern, in the groove between the proximal phalanges, just distal to the fetlock for injection
-injections are also done on the palmar/plantar aspect of the pastern and at the medial and lateral aspects of the fetlock
-for each injection, 5 mL of anesthetic is injected deep and another 5 mL is injected more superficially
What is pedal osteitis?
septic inflammation of the 3rd phalanx following an underlying cause
What are the three major locations of pedal osteitis?
-apex of P3
-flexor tuberosity of P3
-ventral surface of P3
What are the potential underlying problems that lead to pedal osteitis?
-toe ulcer
-white line disease
-screw claw
What finding on radiographs is consistent with pedal osteitis?
radiolucent area with sclerosis/radiopacity around it
What re the possible treatment options for pedal osteitis?
-apical amputation: removal of 1/3 to 1/2 of claw
-bone curettage: removal of just damaged bone
What are the clinical signs of DIP septic arthritis?
-unilateral swelling of foot (single digit)
-swelling above the skin/horn junction +/- a draining tract
-swelling of the heel
-persistent lameness
-upward pointing of the toe from flexor tendon rupture
What is the main differential for DIP septic arthritis, and how are the conditions distinguished?
main differential is foot rot; foot rot causes bilateral swelling/swelling in both digits
How is DIP septic arthritis diagnosed?
-clinical signs
-radiography
What are the treatment options for DIP septic arthritis?
-amputation
-facilitated ankylosis
What are the benefits to choosing amputation as a treatment for DIP septic arthritis?
-gets rid of the infection
-cost effective
-rapid recovery; can save a lactation
What is the prognosis for DIP septic arthritis following amputation?
-better outcome if medial claw is the one needing amputated; hindlimb and forelimb
-retention in production for 1, maybe 2 more cycles
What are the 3 surgical approaches to amputation in DIP septic arthritis cases?
-distal P1
-proximal half of P2
-P1/P2 disarticulation
What are the complications that can occur with the different amputation approaches in DIP septic arthritis?
-proximal half of P2: closer to ground and close toa synovial structure that can get infected
-P1/P2 disarticulation: must remove all of P1 cartilage to ensure granulation tissue can grow over the site
What are the aftercare steps for amputation in DIP septic arthritis cases?
-use a compression bandage for hemostasis; change as needed
-place a block on the remaining claw to keep surgical site up of the ground/clean
-maintain animal in dry and clean environment
What are the characteristics of skin flaps as a part of claw amputation surgery?
-can do an inverted T with partial suture closure or a true flap and primary closure
-requires complete sterile field
-expensive
-beneficial if owner can afford it due to faster healing
What are the possible complications of claw amputation?
-severe post-op hemorrhage
-persistent infection
-bone necrosis
-extension of infection
-breakdown of remaining digit
What are the characteristics of facilitated ankylosis?
-allows animal to keep digit
-prolonged process requiring several bandage changes and long-term antibiotics
-will require lots of pain management
What are the preparation steps for facilitated ankylosis?
-place animal in lateral recumbency with affected claw uppermost
-apply regional limb anesthesia
-lower the heel/caudal sole thickness
-surgically prep entire distal limb
What are the characteristics of the facilitated ankylosis procedure?
-involves resection of the joint
-goal is to remove as much cartilage as possible while sparing unaffected structures
-diminish ROM in the joint without placing hardware
-drill, lavage, and antibiotics are used to remove cartilage between P2 and P3 and clear infection from the joint
What are the characteristics of the modified abaxial approach to facilitated ankylosis?
-most common; used when palmar/plantar aspect is not infected
-hoof wall fenestration
-3/4” x 3/4” square made just dorsal to abaxial groove
-allows exposition of distal sesamoid bone
What are the characteristics of the bulbar approach to facilitated ankylosis?
-vertical incision made over heel bulb
-necrotic DDFT and distal sesamoid bone are removed
-cartilage removed with 1/2” drill bit
What are the aftercare steps for facilitated ankylosis?
-flushing of wound with weak povidone iodine daily for 5 to 7 days
-regional limb perfusion
-possible penrose drain
-pain management with NSAIDs and/or opioids
-claw block on opposite claw
-foot cast to prevent motion
What is the prognosis for DIP septic arthritis with facilitated ankylosis?
-the 3 to 4 weeks after procedure will be very challenging
-25% of patients will not make a recovery
What are the possible origins of digital tenosynovitis?
-sole ulcer
-white line dz
What is the presentation of digital tenosynovitis?
-swelling of distal portion of limb
-non-weightbearing lameness
-pain upon palpation
What are the imaging modalities used to diagnose digital tenosynovitis?
-radiography
-ultrasonography
What are the treatment steps for digital tenosynovitis?
-establish drainage
-resection of affected tendon
What happens when the infection cannot be controlled in digital tenosynovitis?
-persistence of lameness
-presence of exuberant granulation tissue
What is the prognosis for digital tenosynovitis?
treatment can provide cow with 1 additional repro. cycle
What are the characteristics of interdigital hyperplasia?
-acanthosis of interdigital skin
-increased amount of stratum granulosum and stratum spinosum of the epidermis
-associated with interdigital dermatitis, foot rot, and heredity
-more common in heavy animals
Why is surgical resection the only true treatment option for corn removal?
cryosurgery and electrocautery do not work well
Why should surgical resection of corns be reserved for problem-causing lesions when possible?
removal of corns simply for cosmetic reasons creates a potential for sepsis while providing no benefit to the cow
What are the common pathologies that affect the ligaments and tendons?
-flexural limb deformities
-spastic paresis
-trauma (rare)
What are the characteristics of flexural limb deformities?
-most common ligament/tendon defect
-painful due to the strain on tendons
-want to sedate animals and try to manipulate affected joints as part of exam
-typically seen in larger calves that grow really fast
-etiology unknown
How can the angle between the hoof and the floor be useful in determining treatment options for flexural limb deformities?
-if the angle between the point of the toe and the ground is less than 90 degrees, medical management can be tried first; move on to surgery if no improvement in 10 days
-animals with angles of 90 degrees or greater between the point of the toe and the ground will need surgery; medical management will not be sufficient
What are the components of medical management for flexural limb deformities?
-manage pain
-attempt elongation of the toe with splints
What is the surgical management for flexural limb deformity?
tenotomy; can cut SDF first and then cut DDF if needed or cut both at same time
What is important regarding splints in flexural limb deformity cases?
the feet must touch the ground to allow the animal to bear weight on the tendons
What are the characteristics of spastic paralysis?
-legs are completely extended
-genetic tibial nerve issue
-can do a tenectomy or neurectomy
What are the characteristics of osteochondrosis?
-rare
-seen in growing animals
-predisposing factors include high energy/protein diets, low calcium, inheritance, and hard flooring
-clinical signs include joint distention and progressive reluctance to ambulate
-stifle and tarsus are predisposed
What are the characteristics of osteochondrosis treatment?
-conservative treatment takes 1 to 3 months and has a guarded prognosis
-surgical treatment via arthroscopy can be done, especially if animal has value
What are the characteristics of angular limb deformity?
-rare
-dysfunction of growth plate
-occurs secondary to fracture
What are the treatment options for angular limb deformity?
-stall rest
-periosteal elevation
-transphyseal bridge
-ostectomy
-osteotomy and external skeletal fixation
