Septic pedal osteitis

Question 1

Pathogenesis

Answer 1

§ Follows a solar penetration which penetrates distal phalanx
– Usually a nail
§ Bacteria enter bone and
cause osteomyelitis
§ Sequestrum formation follows

Question 2

History and examination

Answer 2

§ Nail penetration into sole
§ Raised digital pulse (single foot)
§ Discharge and pain with hoof testers at the site of penetration
§ Initial radiographs may be normal
– Ideally radiograph with nail still in place
– Then more once it has been removed
§ Managed with poultice, abx, NSAIDs, TAT (tetanus anti-toxin)
§ Lameness doesn’t resolve (consider more damage and septic pedal osteitis can occur)
§ Septic pedal osteitis diagnosed on repeat radiographs

Question 3

Tx

Answer 3

Surgical excision
- Under GA with additional perineural anaesthesia
- Enlarged the drainage tract, removing part of the sole overlying the sequestrum, remove the underlying soft tissues down to bone
- Infected bone removed and use a curette to scrape back the soft disease infected bone back to hard healthy bone
- Basically, anything that can be removed by gentle curettage is infected and should be taken away
- Lavage wound
- Pack and bandage it

Question 4

Hospital plate

Answer 4

• Normal shoe nailed to foot
• Attached to the normal shoe is a metal plate (hospital plate) which goes over the top and is bolted in place
• The hospital plate can be removed each day to allow the packing and bandaging under the plate to be removed and changed each day
• The hospital plate is usually in place for ~3 months
• Removed when the underlying hoof tissues becomes hard and dry

Question 5

Prognosis

Answer 5

• Excellent
  – as long as infection is removed
• Will go back to being sound and worked normally

Question 6

What is septic pedal osteitis?

Answer 6

• infection of the pedal bone