Soft tissue injuries within the hoof Flashcards
What are the structures highlighted by the numbers 1, 9, 10, 13, 14, 15 and 16?
1.Third metacarpal/metatarsal
9.distal inter phalangeal joint
10.navicular bursa
13.DDFT
14.digital tendon sheath
15.T ligament
16.distal sesamoidan impar ligament
What are the stuctures in blue and red?
Navicular suspensory ligament (red) and distal sesamoidean impar ligament (blue)
What are the structures drawn onto the image here?
Collateral ligaments of the proximal and distal interphalangeal joints
What structures are drawn in red and yellow?
Oblique (red) and straight (yellow) sesamoidean ligaments
What is the typical clinical history from cases of soft tissue injuries within the foot?
Some horses have acute injuries with matching clinical histories
* Acute, unilateral, severe lameness
* Associated with athletic activity
Some horses have degenerative pathologies and histories to match
* Insidious/gradual onset/progressive/intermittent lameness
* Can be unilateral or bilateral
What would you find in your clinical exam investigating soft tissue injuries within the foot?
Palpation unremarkable in many cases
* Some acute pathologies may have transient increased digital pulses
* Exception to this are severe collateral ligament injuries
Sometimes sensitivity to hoof testers in heel region – unreliable!
What would you expect to find during your dynamic evaluation of a soft tissue injury in the foot?
Usually worse on hard surface
- Sometimes worst on soft surface!
Usually worse on the inside of a circle
- Sometimes not!
Not usually positive to distal limb flexion
- Collateral ligaments are exceptions
What radiographic and ultrasound imaging findings would we expect with soft tissue injuries in the foot?
Radiography
* Navicular bone changes seen with DDFT disease
* Ossified collateral cartilages are associated with collateral ligament disease
* Enthesious (bone surface where soft tissue attaches) changes seen with impar ligament disease and collateral ligament disease
Transcuneal ultrasound
* Small window through the frog to visualise a section of the DDFT and DSIL
* Requires careful foot preparation and overnight soaking
* Proximal navicular bursa visible between heel bulbs
What is the gold standard mode of imaging when ivestigating soft tissue injury in the foot? What are the advantages?
Standing low-field MRI is an investment >£1000 for a single foot
Benefits of MRI:
* Likely definitive diagnosis/diagnoses
* More accurate prognostication
* Guided specific medical treatments
* Specific indications for farriery
What is the most common soft tissue injury in the foot?
DDFT pathology
Focal core lesions
- Seen with various severities
* Found at different locations along the length of the tendon
* Can propagate proximally/distally with time
Sagittal splits
* Often seen at the level of the navicular bone
* Often propagate proximally/distally with time
* Especially after neurectomy
* Involve tendon surface so can lead to adhesion formation and bursitis
* Lameness often severe but very variable
Dorsal border lesions
- Dorsal border fibrillation
- Often causes bursitis and adhesion formation
- More of a degenerative pathology rather than acute injury
What types of lesions are shown in the 3 pictures?
A - core lesion
B - sagittal split
C - dorsal border lesion
What specific treatments are available for soft tissue injuries within the foot?
Focus on the navicular bursa
Intrabursal medications:
* Biologics in the acute phases of injury
* Corticosteroids to manage long-term signs
Navicular bursoscopy:
* Indicated for all lesions seen to communicate with the bursa
* Sagittal splits and dorsal fibrillation particularly
* Can break down adhesions surgically
* Debride fibrillated tissues which are drivers for synovitis
How can you prevent soft tissue injuries within the foot?
A foot with dorsopalmar/dorsoplantar foor imbalance will cause increased loading of palmar/plantar soft tissues:
- SDFT, DDFT, SL, DSIL….
A foot with poor lateromedial imbalance will cause increased loading of lateral and medial soft tissue structures:
- Collateral ligaments, navicular suspensory ligament
