Palmar Foot Pain

Question 1

How can you correct poor foot balance due to a broken back hoof pastern axis?

Answer 1

Raise the heel

Shorten the toe

Question 2

Navicular syndrome

Answer 2

Middle aged
Hunter, jumper, eventer, dressage, western riding

Due to repetitive trauma to the navicular none and degeneration of the DDFT

Contributing factors:
Poor foot balance - long toe, low heel, repetitive concussion

Dx: positive response to palmar digital nerve block and navicular bursa block, MRI of damage to the navicular bone

Question 3

What radiographic abnormalities will you see with navicular syndrome?

Answer 3

Synovial fossae enlarged and abnormal 
Cyst formation 
Enthesiopathy - collateral sesamoidean ligament and impar lig
Osteophytes 
Poor corticomedullary distinction 
Flexor cortex abnormalities 
Medullary abnormalities

Question 4

How should you manage navicular disease?

Answer 4

Corrective farriery

• ease break over
• decrease the pressure on the heels
• maximise the weight bearing surface
• heart bar shoe

In hand walking to prevent stiffness
Phenylbutazone / suxibuzone

Salvage procedures

• palmar digital neurectomy
• desmotomy of the collateral sesamoidean ligament

Question 5

DDFT tears

Answer 5

Acute onset, unilateral forelimb lameness
Moderate to severe

Positive response to palmar digital, navicular bursa and DIPJ block
Us showing lesions in the DDFT
Gold standard MRI

Ddx: DDFT tendon lesion

Question 6

What is the most common cause of bilateral lameness in the foot?

Answer 6

Osteoarthritis

Dx: intra-articular anaesthesia

Question 7

DIPJ collateral ligament damage

Answer 7

Bulge over the collateral ligament
Variable blocking history
No radiographic abnormalities
Positive MRI