Three-dimensional kinematics of the distal forelimb in horses trotting on a treadmill and effects of elevation of heel and toe

REASONS FOR PERFORMING STUDY: Comprehensive understanding of the 3-dimensional (3D) kinematics of the distal forelimb and precise knowledge of alterations induced by dorsopalmar foot imbalance remains incomplete because in vivo studies performed with skin markers do not measure the actual movements of the 3 digital joints. OBJECTIVE: To quantify the effects of 6 degree heel or toe wedges on the 3D movements of the 4 distal segments of the forelimb in horses trotting on a treadmill. METHODS: Three healthy horses were equipped with ultrasonic markers fixed surgically to the 4 distal segments of the left forelimb. The 3D movements of these segments were recorded while horses were trotting on a treadmill. Rotations of the digital joints were calculated by use of a joint coordinate system. Data obtained with 6 degree heel or toe wedges were compared to those obtained with flat standard shoes. RESULTS: Use of heel wedges significantly increased maximal flexion and decreased maximal extension of the proximal (PIPJ) and distal (DIPJ) interphalangeal joints. Inverse effects (except for PIPJ maximal extension) were observed with the toe wedges. In both cases, neither flexion-extension of the metacarpophalangeal joint nor extrasagittal motions of the digital joints were statistically different between conditions. CONCLUSIONS: At a slow trot on a treadmill, heel and toe wedges affect the sagittal plane kinematics of the interphalangeal joints. POTENTIAL RELEVANCE: Better understanding of the actual effects of toe and heel wedges on the 3D kinematics of the 3 digital joints may help to improve clinical use of sagittal alteration of hoof balance in the treatment of distal forelimb injuries.     

Hoof growth between two shoeing sessions leads to a substantial increase of the moment about the distal, but not the proximal, interphalangeal joint

REASONS FOR PERFORMING STUDY: There is little insight into the effects of routine farriery on the internal structures of the distal limb in sound horses. OBJECTIVES: To measure the effect of change in hoof conformation during a shoeing interval on the moments about the proximal and distal interphalangeal joints (PIPJ, DIPJ) and to determine whether and how the horse compensates for this change in hoof conformation. METHODS: Both front feet of 9 sound Warmblood horses were measured while standing on a pressure-force measuring system and radiographed in a lateromedial direction shortly after shoeing and 8 weeks later. From these data, ground reaction forces (GRF) and lever arms were measured in order to calculate joint moments. RESULTS: After 8 weeks, the moment about the PIPJ did not increase significantly, but the moment about the DIPJ did so, indicating a compensatory mechanism for a change in hoof conformation in the DIPJ. CONCLUSIONS: Standing horses compensate for hoof conformation change during an 8-week shoeing interval, which leads to increased DIPJ extension and consequently an increased loading of the deep digital flexor tendon. POTENTIAL RELEVANCE: This study quantifies the effect of a shoeing interval on the internal structures of the foot and helps to determine an appropriate shoeing interval for individual horses in which the hoof with the lowest hoof angle is the best indicator. The exact determination of an optimal individual shoeing interval requires further study.     

Three-dimensional kinematics of the equine distal forelimb: effects of a sharp turn at the walk

REASONS FOR PERFORMING STUDY: Sharp turns are suspected to increase expression of several distal forelimb lamenesses even at the walk but the biomechanical consequences of such a movement remain unknown. OBJECTIVE: To quantify the effects of a sharp turn at the walk on the 3-dimensional movements of the distal segments of the forelimb. METHODS: Kinematics of the distal segments were measured in 4 healthy horses invasively with an ultrasonic system. Three-dimensional rotations of the digital joints were calculated by use of a joint coordinate system. Data obtained for a turn at the walk were compared to those obtained in a straight line. RESULTS: During the stance phase in a turn, the inside forelimb underwent an adduction that induced lateromotion and medial rotation in the distal interphalangeal joint and medial rotation in the proximal interphalangeal joint. These movements were maximal at heel-off and decreased during breakover as the hoof underwent a sudden lateral rotation. CONCLUSIONS: Walking in a sharp turn affects the kinematics of the digital joints outside the sagittal plane. POTENTIAL RELEVANCE: This knowledge offers the opportunity to derive hypotheses on biomechanical factors that could contribute to the pathogenesis of digital injuries and on consequences for rational shoeing.     

Effects of analgesia of the digital flexor tendon sheath on pain originating in the sole, distal interphalangeal joint or navicular bursa of horses

REASON FOR PERFORMING STUDY: Specific analgesic techniques are required in diagnosis of lameness to isolate the exact origin of pain to the many structures of the foot that may be involved. OBJECTIVE: To determine if analgesia of the digital flexor tendon sheath (DFTS) results in anaesthesia of other portions of the foot, such as the sole, distal interphalangeal joint (DIPJ), or navicular bursa (NB). METHODS: Lameness caused by pain in the dorsal margin or heel region of the sole of the foot was induced in 18 horses by: using set-screws to create solar pressure (Trial 1: n = 5); or administering endotoxin intrasynovially into the DIPJ (Trial 2: n = 6) and NB (Trial 3: n = 7). The gait of each horse was evaluated by examining videotape recorded before and after creation of lameness and after administration of mepivacaine hydrochloride into the DFTS. RESULTS: Median lameness scores in Trial 1 at 10 min post injection of the DFTS were not significantly different from those before administration of local anaesthetic solution into the DFTS (P> or =0.05), but median lameness scores were reduced significantly at 20 min (P< or =0.05). In Trials 2 and 3, median lameness scores were not significantly different at observations made at 10 and 20 min post injection of the DFTS. CONCLUSIONS: Analgesia of the DFTS has little effect on lameness caused by pain originating in the sole, DIPJ or NB. POTENTIAL RELEVANCE: Improvement of lameness in horses after intrasynovial analgesia of the DFTS is probably caused by attenuation of pain within the structures contained in the DFTS.     

Relationship of foot conformation and force applied to the navicular bone of sound horses at the trot

REASONS FOR PERFORMING STUDY: Collapsed heels conformation has been implicated as causing radical biomechanical alterations, predisposing horses to navicular disease. However, the correlation between hoof conformation and the forces exerted on the navicular bone has not been documented. HYPOTHESIS: The angle of the distal phalanx in relation to the ground is correlated to the degree of heel collapse and foot conformation is correlated to the compressive force exerted by the deep digital flexor tendon on the navicular bone. METHODS: Thirty-one shod Irish Draught-cross type horses in routine work and farriery care were trotted over a forceplate, with 3-dimensional (3D) motion analysis system. A lateromedial radiograph of the right fore foot was obtained for each horse, and various measurements taken. Correlation coefficients were determined between hoof conformation measurements and between each of these and the force parameters at the beginning (15%) of stance phase, the middle of stance (50%) and at the beginning of breakover (86% of stance phase). Significance was defined as P<0.05. RESULTS: The force exerted on the navicular bone was negatively correlated (P<0.05) to the angle of the distal phalanx to the ground and to the ratio between heel and toe height. This was attributed to a smaller extending moment at the distal interphalangeal joint. There was not a significant correlation between the angle of the distal phalanx and the degree of heel collapse, and heel collapse was not significantly correlated to any of the force parameters. CONCLUSIONS: Hoof conformation has a marked correlation to the forces applied to the equine foot. Heel collapse, as defined by the change in heel angle in relation to toe angle, appears to be an inaccurate parameter. The forces applied on the foot are well correlated to the changes in the ratio of heel to toe heights and the angles of the distal phalanx. POTENTIAL RELEVANCE: Assessment of hoof conformation should be judged based on these parameters, as they may have clinical significance, whereas parallelism of the heel and toe is of less importance.     

Effect of heel elevation on forelimb conformation in horses

OBJECTIVE: To determine the conformational changes in the distal forelimb of horses following heel elevation of 15 degrees and greater. An experimental study with repeated, within-horse measurements. PROCEDURE: Five clinically normal, mixed-breed horses were used to determine distal forelimb conformation following heel elevation from 0 to 45 degrees in 15 degree increments. Data were also compared to conformation of the limb in a Kimzey splint. Conformation was determined using lateral to medial radiographic projections. Conformation parameters assessed included measurement of apparent lengths of digital flexor tendons from the origin of their accessory ligaments to the points of insertion, and the joint angles of the distal limb. RESULTS: For angles of heel elevation from 15 to 45 degrees, the degree of joint angulation increased (increasing flexion) with heel elevation for the metacarpophalangeal, and proximal and distal interphalangeal joints. Conversely, the measured apparent lengths of the digital flexor tendons in the distal limb, decreased. CONCLUSION: The data supports the practice of elevating the heel (greater than 15 degrees) for conditions in which decreased fetlock extension may be desired such as with laceration or injury to the digital flexor tendons. Further study is required to determine whether heel elevation greater than 15 degrees reduces in vivo digital flexor tendon tension and also to ensure that the marked flexion of the distal interphalangeal joint with greater heel elevation is not detrimental over a prolonged period that may be required for the rehabilitation of flexor tendon injuries in the horse.     

Calculated forelimb flexor tendon forces in horses with experimentally induced superficial digital flexor tendinitis and the effects of application of heel wedges

OBJECTIVE: To calculate forces in the flexor tendons and the influence of heel wedges in affected and contralateral (compensating) forelimbs of horses with experimentally induced unilateral tendinitis of the superficial digital flexor (SDF) tendon. ANIMALS: 5 Warmblood horses. Procedure-Ground reaction force and kinematic data were obtained during a previous study while horses were trotting before and after induction of tendinitis in 1 forelimb SDF and after application of 6 degrees heel wedges to both forehooves. Forces in the SDF, deep digital flexor (DDF), and the suspensory ligament (SL) and strain in the accessory ligament (AL) of the DDF were calculated, using an in vitro model of the distal region of the forelimb. RESULTS: After induction of tendinitis, trotting speed slowed, and forces decreased in most tendons. In the affected limb, SL force decreased more than SDF and DDF forces. In the compensating limb, SDF force increased, and the other forces decreased. After application of heel wedges, SDF force in both limbs increased but not significantly. Furthermore, there was a decrease in DDF force and AL strain. CONCLUSIONS AND CLINICAL RELEVANCE: The increase in SDF force in the compensating forelimb of horses with unilateral SDF tendinitis may explain the high secondary injury rate in this tendon. The lack of decrease of SDF force in either limb after application of heel wedges suggests that heel wedges are not beneficial in horses with SDF tendinitis. Instead, heel wedges may exacerbate the existing lesion.     

Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 1: forelimb foot and carpus

This paper tests the hypothesis that the local analgesic agent mepivacaine diffuses between adjacent equine synovial structures in the forelimb and with greater frequency than latex, gelatine dye or contrast media. We report the incidence of diffusion of mepivacaine between the distal interphalangeal joint (DIPJ) and navicular bursa (NB) of the forelimbs and between the intercarpal (IC) and radiocarpal (RC) joints of 31 fresh equine cadavers. The DIPJ of one forelimb and the NB of the contra lateral forelimb and the RC joint of one forelimb and the IC joint of the contra lateral forelimb were injected with mepivacaine. After flexion and extension of the joints, synovial fluid was obtained from the synovial structures adjacent to the injected synovial structures. The concentration of mepivacaine in these samples was determined using an enzyme linked immunosorbent assay. For samples obtained by dilution of synovial fluid, the concentration of mepivacaine was determined by comparing the concentrations of urea in the diluted synovial fluid and the concentration of serum urea. Mepivacaine diffused from the DIPJ to the NB or from the NB to the DIPJ in 25/25 (100%) limbs. Mepivacaine diffused from the IC to RC joints in 24/25 (96%) limbs and from the RC to IC joints in 21/25 (84%) limbs. It was detected at concentrations >0.3 mg/l in 9/25 (36%) of IC joints after RC joint injection and in 25/25 (100%) of the NB after DIPJ injection; at concentrations >100 mg/l in 2/25 (8%) of IC and RC joints and 12/25 (48%) of NB following DIPJ injection; and at concentrations >300 mg/l in 1/25 (4%) in the IC joints following RC joint injection and in 11/25 (44%) of DIPJ following NB injection. The results show greater diffusion of mepivacaine between adjacent synovial structures than assumed from previous anatomical, latex injection and contrast arthrographic studies. This study showed that commonly performed intrasynovial analgesic techniques in the forelimb of the horse are not as specific as previously reported.     

Effects of 'navicular' shoeing on equine distal forelimb kinematics on different track surface.

Orthopaedic shoeing applied for disorders such as navicular disease is mostly evaluated on hard track surfaces, but very often horses are ridden only on soft tracks. To compare the effects of normal shoes, eggbar shoes, and shoes with heel wedges (5 degrees) on the kinematics of the distal forelimb on hard and soft track surfaces, eleven sound Dutch Warmblood horses were led across three different tracks (an asphalt, a fibre/sand mix (= Agterberg), and a pure sand track) with three different shoe types (a normal shoe, an eggbar shoe, and a shoe with heel wedges). The hoof rotation and the maximal extension of the fetlock joint at midstance period were recorded by an infrared-light based gait analysis system (ProReflex) at walk and at trot. Statistical analysis revealed significant effects of track and shoe type, and a shoe-track interaction (p<0.05). On soft track surfaces, the equilibrium of the distal forelimb dictated a 1.5-4 degrees forward rotation of the normal or eggbar shod foot, the most on a sand track. The wedge effect on hoof rotation, however, was always significantly greater, but similar to that on the hard track surface (5 degrees forward rotation). The maximal fetlock extension was less on a soft surface, in particular on the sand track (p<0.05). This decrease was most pronounced when the horses were shod with heel wedges and was least pronounced with normal shoes. In conclusion, in particular the sand track allows a forward rotation of the hoof and thus relief of pressure in the navicular area, and a decrease in maximal fetlock extension and thus unloading of the fetlock joint. The extra forward rotation of the hoof induced by heel wedges on hard tracks was almost the same on soft track surfaces. Eggbars and fibre/sand mix tracks have intermediate effects on unloading of the distal forelimb.     

Evaluation of the diffusion of corticosteroids between the distal interphalangeal joint and navicular bursa in horses

OBJECTIVE: To determine whether clinically effective concentrations of methylprednisolone or triamcinolone can be achieved in the navicular bursa after injection of methylprednisolone acetate (MPA) or triamcinolone acetonide (TA) into the distal interphalangeal joint (DIPJ) and whether clinically effective concentrations of these drugs can be achieved in the DIPJ after injecting the navicular bursa with the same doses of MPA or TA. ANIMALS: 32 healthy horses. PROCEDURES: Horses in groups 1 through 4 received 40 mg of MPA in the DIPJ, 10 mg of TA in the DIPJ, 40 mg of MPA in the navicular bursa, and 10 mg of TA in the navicular bursa, respectively. Concentrations of corticosteroids that diffused into the adjacent synovial structure were determined. RESULTS: For group 1, injection of MPA into the DIPJ yielded a mean +/- SD concentration of 0.24 +/- 0.072 microg of methylprednisolone/mL in the navicular bursa. For group 2, injection of TA into the DIPJ yielded 0.124 +/- 0.075 microg of triamcinolone/mL in the navicular bursa. For group 3, injection of MPA into the navicular bursa yielded 0.05 +/- 0.012 microg of methylprednisolone/mL in the DIPJ. For group 4, injection of TA into the navicular bursa yielded 0.091 +/- 0.026 microg of triamcinolone/mL in the DIPJ. CONCLUSIONS AND CLINICAL RELEVANCE: A clinically effective concentration of methylprednisolone or triamcinolone diffused between the DIPJ and navicular bursa after intra-articular or intrabursal injection, which would justify injection of the DIPJ with MPA or TA to ameliorate inflammation of the navicular bursa.     

Concrete use of the joint coordinate system for the quantification of articular rotations in the digital joints of the horse

A method is detailed allowing the computation of three-dimensional (3D) joint angles. Each joint of the equine digit is modelled as a sequence of three single axis rotary joints. The Joint Coordinate System was used; it involves a specific sequence of cardanic angles. The decomposition of the angles was chosen so that the three elementary angles coincide with the flexion/extension, passive abduction/adduction and lateral/medial rotations. The algorithms and kinematic procedures were described for the equine front digital joints. This method was tested in vitro on four forelimbs. For each limb, angle values were measured while the member was loaded by a press (from 500 to 6000 N). These tests were repeated while a wedge raised one part of the hoof (toe, heel, lateral and medial sides) in order to induce modifications of the angular patterns of the joints. This method allowed a precise quantitative determination of 3D joint movements. The modifications occurring with the wedges are clearly identified and confirm some previously published semi-quantitative observations. Moreover, this method provides a way to collect objective data on the functional anatomy of joints and could be used to study connective shoeing thoroughly. It may be directly applied to other species and may be used by researchers interested in discreet articular movements, especially occurring in other planes than the sagittal one.     

Osteochondral fragmentation of the palmarolateral/plantarolateral aspect of the distal phalanx in four horses: A novel location

Four horses presenting for lameness were diagnosed with unilateral osteochondral fragmentation (OCF) of the palmarolateral/plantarolateral aspect of the distal phalanx within the distal interphalangeal joint (DIPJ). Histological evaluation of one case supported a diagnosis of osteochondritis dissecans (OCD), with patient age and history from two cases suggesting a traumatic origin. Lesion appearance on conventional radiography, computed tomography (CT), nuclear scintigraphy and magnetic resonance imaging (MRI) are described. Fragmentation was best identified on dorsal 65° proximal-palmaro/plantarodistal oblique (D65°PrPDiO/D65°PrPlDiO) and dorsal 65° proximal-palmaro/plantarodistal lateral oblique (D65°Pr45°L-PDiMO/D65°Pr45°L-PlDiMO) radiographic projections of the foot, but articular pathology appeared more severe on cross-sectional imaging modalities. In all cases, lameness was refractory to conservative management. Arthroscopic evaluation of the DIPJ was performed in three horses, although the lesion was inaccessible in two. In one horse, access to the lesion was possible due to increased joint laxity, presumably due to concurrent soft tissue injury. One horse was euthanased after failed conservative management, one was pasture sound following palmar digital neurectomy 12 months after initial presentation, one returned to racing and one was lost to follow-up. Osteochondral fragmentation at this location has not previously been described, treatment options are limited and the prognosis appears to be poor.     

Ultrasonographic examination of the collateral ligaments of the distal interphalangeal joint in horses. Part B: Abnormal findings and lesions

Ultrasonography is an easy and rewarding technique for the assessment of collateral ligaments of the distal interphalangeal joint (CL‐DIPJ) desmopathies and enthesopathies. Comparison between ligaments of both feet and oblique incidence improve sensitivity and specificity of the ultrasonographic diagnosis. The main limitation of the procedure is imaging the distal part of the CL‐DIPJ and corresponding fossa of the distal phalanx. Alone, or in combination with other imaging procedures, ultrasonography is valuable in the diagnosis of the injured structures, which may help to determine the corrective shoeing and the rehabilitation programme of the horse.     

Three-dimensional kinematics of the equine interphalangeal joints: articular impact of asymmetric bearing

The objective of this study was to assess the effects of asymmetric placement of the foot on the three-dimensional motions of the interphalangeal joints. Four isolated forelimbs were used. Trihedrons, made of three axes fitted with reflective markers, were screwed into each phalanx. They allowed to establish a local frame associated with each bone and thus to define the spatial orientation of the phalanges. The limbs were then placed under a power press, and subjected to compression with gradually increasing force (from 500 to 6 000 N). The procedure was performed in neutral position and with the lateral or medial part of the foot raised by a 12 degrees wedge. Flexion, collateromotion (passive abduction/adduction) and axial rotation of the interphalangeal joints were measured using a cardan angle decomposition according to the principle of the "Joint Coordinate System" described by Grood and Suntay. Raising the lateral or medial part of the hoof induced collateromotion (about 5.6 degrees +/- 0.8) and axial rotation (about 6.5 degrees +/- 0.5) of the distal interphalangeal joint. The proximal interphalangeal joint underwent axial rotation (about 4.7 degrees +/- 0.5 at 6 000 N) and slight collateromotion. Both interphalangeal joints underwent collateromotion in the direction of the raised part of the foot (i.e., narrowing of the articular space on the side of the wedge), whereas axial rotation occurred in the direction opposite to the raised part of the foot. These results confirm the functional importance of interphalangeal joint movements outside the sagittal plane. In particular they demonstrate the involvement of the proximal interphalangeal joint in the digital balance. These data are helpful for the identification of biomechanical factors that may predispose to interphalangeal joint injury. Also the data may be of use for the rational decision making with respect to exercise management and corrective shoeing of the lame horse.     

Do Metal Shoes Contract Heels?—A Retrospective Study on 114 Horses

Heel contraction is an undesired but common condition in domestic horses. Some authors indicate shoeing as a risk factor. There is a correlation between shoeing and a restriction of heel expansion, but the clinical significance is unknown. This study aimed to evaluate the influence of shoeing and other risk factors, such as age, access to paddock, and breed, on heel contraction. This study included 114 horses, 55 of which were barefoot their whole life and 59 had been shod consistently for at least the previous year. The width and length of the frog were measured. Linear mixed-effects models were performed for the width:length ratio, where the fixed effects were age, sex, breed, pasture or paddock time, shoeing and its duration, and limb. The random effects included the horse and the yard. Although heel contraction occurs more often in shod horses compared with barefoot horses, the difference between the two conditions was not statistically significant, when other factors were considered. The most important factors that impacted contraction were individual horse features and breed (P < .001). The effect of age and a yard was noticed (P < 0,5). The sex, paddock time, and the shoeing and its duration were found not to have statistical significance. The study concluded that heel contraction is multifactorial problem, mainly caused by breed and unknown features correlated with individual. It was not confirmed that horseshoeing causes heel contraction. Because of significant difference in incidence of contraction between yards, there is a need to further investigation of environmental factors causing this hoof distortion.     

Unipodal stance influences radiographic evaluation of foot balance in horses

Lifting the contralateral forelimb (unipodal stance) is often used as a method of restraint in horses. This experimental one group pretest, posttest study was conducted to evaluate the effects of unipodal stance on quantitative radiographic parameters in equine forefeet. Seven nonlame horses were randomly selected. Lateromedial (LM) and dorsopalmar (DP) projections were acquired for both forefeet, squarely placed on blocks, using two X‐ray generators. Radiographs of each foot were acquired first in a bipodal stance, immediately followed by the same radiographic projections obtained in a unipodal stance. The following measurements were recorded for each stance: distal interphalangeal joint (DIPJ) space width on both projections; mediolateral joint balance as the difference between lateral and medial DIPJ space widths on DP projections; extensor process‐to‐middle phalangeal condyle distance; and deep digital flexor tendon angle on LM projections. A matched pairs design and Student's t‐test with a 95% confidence level were used to test for statistical significance. Compared to a bipodal stance, lateral DIPJ space width was significantly reduced on unipodal DP views, whereas mediolateral joint imbalance and to a lesser extent medial DIPJ space width were significantly increased. On unipodal LM views, there was a significant higher degree of DIPJ flexion. These findings suggest that stance should be carefully taken into consideration when measuring radiographic parameters in equine forefeet, especially if assessing foot balance and conformation, as unipodal stance significantly affects the mediolateral balance of the DIPJ on DP radiographs and significantly alters the phalangeal axis on LM radiographs.     

Comparison of conventional and alternative arthroscopic approaches to the palmar/plantar pouch of the equine distal interphalangeal joint

Reasons for performing the study: The conventional arthroscopic approach to the palmar/plantar aspect of the distal interphalangeal joint (DIPJ) may result in the inadvertent penetration of the digital flexor tendon sheath (DFTS) and the navicular bursa (NB). This iatrogenic communication would be undesirable subsequent to arthroscopic lavage of a septic DIPJ. Hypothesis: A lateral/medial approach to the palmar/plantar aspect of the DIPJ will result in a significantly lower rate of inadvertent penetration of the DFTS and NB, whilst still providing adequate intra‐articular evaluation. Methods: The conventional palmar/plantar approach or a novel lateral/medial approach to the DIPJ was performed on cadaver fore‐ and hindlimbs (30 limbs/approach). Subsequently, India ink was injected into the dorsal pouch of the DIPJ, and the DFTS (n = 60) and NB (n = 20) were examined for the presence/absence of ink. In addition, observations of the number of attempts made to access the joint, evidence of iatrogenic intra‐articular trauma and occurrence of incomplete visualisation of the palmar/plantar pouch were recorded. Results: With the conventional approach, DFTS penetration was noted in 18/30 (60%) of the limbs, compared to 1/30 (3.3%) with the lateral/medial approach (P≤0.001). NB penetration was seen in 5/10 limbs with the palmar/plantar approach compared to 0/10 with the lateral/medial approach (P = 0.01). No significant differences were found between the approaches in the number of attempts made to access the joint, the incidence of iatrogenic intra‐articular trauma, or the occurrence of incomplete visibility of the palmar/plantar pouch. Conclusions: The novel lateral/medial approach to the DIPJ significantly decreases the risk of inadvertent penetration of the DFTS and NB. Potential relevance: The novel lateral/medial approach to the DIPJ is an effective technique to gain access to the palmar/plantar pouches, and is particularly advantageous for arthroscopic lavage of a septic DIPJ.     

The effect of bilateral palmar digital nerve analgesia on the compressive force experienced by the navicular bone in horses with navicular disease

Horses with navicular disease have an increased load on the navicular bone in early stance. This has been suggested to be a response to pain in the heel region. Seven horses with clinical, radiographic and scintigraphic signs of navicular disease underwent forceplate and kinematic analysis before and after desensitisation of the heel region with a bilateral palmar digital nerve block. The compressive force exerted on the navicular bone during stance, and stride kinematics, were determined in each state. After regional analgesia of the palmar digital nerves (PDNB) the compressive force on the navicular bone was lower throughout stance. The mean +/- s.d. peak force at the beginning of stance was 7.05+/-1.10 N/kg before, and 6.46+/-1.15 N/kg after PDNB (P = 0.01) and at the end of stance the mean peak values were 5.00+/-2.05 N/kg before, and 4.39+/-1.65 N/kg after PDNB (P = 0.05). We explained this finding as indicating that the horse responds to heel pain (including pain in the navicular region) by contracting the deep digital flexor muscle to unload the heels. This increases the compressive load on the navicular bone, which may cause remodelling and, in some horses, damage to the overlying flexor cartilage, which is then painful and identified as navicular disease. This mechanism identifies navicular disease as a possible end point for a variety of heel related conditions.     

Lameness and poor performance in horses used for team roping: 118 cases (2000-2003)

OBJECTIVE: To determine the types of musculoskeletal problems that result in lameness or poor performance in horses used for team roping and determine whether these problems are different in horses used for heading versus heeling. DESIGN: Retrospective study. ANIMALS: 118 horses. PROCEDURE: Medical records of team roping horses that were evaluated because of lameness or poor performance were reviewed to obtain information regarding signalment, primary use (ie, head horse or heel horse), history, results of physical and lameness examinations, diagnostic tests performed, final diagnosis, and treatment. RESULTS: Among horses evaluated by lameness clinicians, the proportion with lameness or poor performance was significantly greater in horses used for heading (74/118) and lower in horses used for heeling (44/118) than would be expected under the null hypothesis. Most horses examined for poor performance were lame. A significantly greater proportion of horses used for heading had right forelimb lameness (26/74 [35%]), compared with horses used for heeling (7/44 [16%]). Horses used for heading had more bilateral forelimb lameness (18/74 [24%]), compared with horses used for heeling (4/44 [9%]). Horses used for heeling had more bilateral hind limb lameness (3/44 [7%]), compared with horses used for heading (0%). The most common musculoskeletal problems in horses used for heading were signs of pain limited to the distal sesamoid (navicular) area, signs of pain in the navicular area plus osteoarthritis of the distal tarsal joints, and soft tissue injury in the forelimb proximal phalangeal (pastern) region. Heeling horses most commonly had signs of pain in the navicular area, osteoarthritis of the metatarsophalangeal joints, and osteoarthritis of the distal tarsal joints. CONCLUSIONS AND CLINICAL RELEVANCE: Horses used for heading were most commonly affected by lameness in the right forelimb. Horses used for heeling had more bilateral hind limb lameness than horses used for heading.