A study of naturally occurring cases of ovine foot abscess in New Zealand

A study was made of various aspects of 53 naturally occurring cases of foot abscess in sheep in New Zealand. Radiographic techniques were used to follow the progress of the lesion and from this it was concluded that foot abscess could be defined as an infection of the distal interphalangeal joint. The term “foot abscess” was considered preferable to the term “infective bulbar necrosis”.

The attack rate of foot abscess was reported to be higher for rams than for ewes and the condition was less prevalent during summer.

Once infection was established in the distal interphalangeal joint a relatively uniform and thus predictable series of events took place that inevitably resulted in some permanent damage and deformity to the digit. If rupture of the axial collateral ligaments occurred, the joint became unstable and the de- gree of permanent deformity was greater. Treatment with antibiotics did not appear to markedly affect the progress of the lesion or the outcome, once infection had become established in the joint.

Although the prognosis for complete recovery was poor, in most cases the foot healed sufficiently after a period of about two months to allow the animal to walk normally.     

Retrospective analysis of distal limb conformation and lameness in mature horses after desmotomy of the accessory ligament of the deep digital flexor tendon for management of a flexural deformity

Mature horses that present with flexural deformity of the distal interphalangeal joint and lameness isolated to the foot may obtain long‐term benefits from desmotomy of the accessory ligament of the deep digital flexor tendon (ALDDFT). This retrospective analysis of medical records and radiographs included 13 horses, aged ≥2 years, presented for lameness isolated to the hoof region and diagnosed with flexural deformity of the distal interphalangeal joint. Radiographic angles of the hoof and distal interphalangeal joint and lameness scores were compared before and after desmotomy of the ALDDFT. Follow‐up data including the ability to perform the intended use were obtained at least one year after surgery. There was improvement in the angle between the dorsal aspect of the third phalanx and the weightbearing surface of the hoof, improved alignment between the dorsal hoof wall and dorsal aspect of the third phalanx, and improved alignment of the distal interphalangeal joint. Lameness was decreased in 9/13 horses and 10/13 horses were performing at their level of intended use. Evidence of improved hoof conformation and lameness following desmotomy of the ALDDFT in lame horses with flexural deformity of the distal interphalangeal joint would indicate this procedure should be considered in mature horses.     

Ankylosis of the distal interphalangeal joint in a horse after septic arthritis and septic navicular bursitis.

A 6-month-old 300-kg Quarter Horse filly was treated for septic arthritis of the distal interphalangeal joint and septic navicular bursitis that developed as a result of a deep puncture to the foot. Initial treatment consisted of establishing ventral drainage for the navicular bursa, lavage of the distal interphalangeal joint, and administration of broad-spectrum antimicrobial drugs and non-steroidal anti-inflammatory drugs. Because of continuing sepsis in the distal interphalangeal joint, subsequent treatment included packing the defect in the bottom of the foot with cancellous bone in an attempt to prevent ascending contamination of the joint, placing the limb in a short limb cast, and inserting a Penrose drain into the joint for passive drainage of septic exudate. The goal of treatment was to encourage ankylosis of the distal interphalangeal joint. Because of the filly's persistent lameness and laxity of the lateral collateral ligament in the contralateral carpus, the palmar nerves of the affected foot were injected with a long-acting local anesthetic at the level of the proximal sesamoid bones to encourage weight-bearing. Ankylosis of the distal interphalangeal joint was complete 9 months after the puncture, but a grade-2 lameness remained and the horse had a varus deformity resulting from ligamentous laxity of the lateral collateral ligament in the contralateral carpus.     

Influence of the position of the foot on MRI signal in the deep digital flexor tendon and collateral ligaments of the distal interphalangeal joint in the standing horse

Reasons for performing study: Hyperintense signal is sometimes observed in ligaments and tendons of the equine foot on standing magnetic resonance examination without associated changes in size and shape. In such cases, the presence of a true lesion or an artifact should be considered. A change in position of a ligament or tendon relative to the magnetic field can induce increased signal intensity due to the magic angle effect. Objectives: To assess if positional rotation of the foot in the solar plane could be responsible for artifactual changes in signal intensity in the collateral ligaments of the distal interphalangeal joint and in the deep digital flexor tendon. Methods: Six isolated equine feet were imaged with a standing equine magnetic resonance system in 9 different positions with different degrees of rotation in the solar plane. Results: Rotation of the limb induced a linear hyperintense signal on all feet at the palmar aspect of one of the lobes of the deep digital flexor tendon and at the dorsal aspect of the other lobe. Changes in signal intensity in the collateral ligaments of the distal interphalangeal joint occurred with rotation of the limb only in those feet where mediolateral hoof imbalance was present. Conclusions: The position and conformation of the foot influence the signal intensity in the deep digital flexor tendon and in the collateral ligaments of the distal interphalangeal joint. Potential relevance: The significance of increased signal intensity in the deep digital flexor tendon and in the collateral ligaments of the distal interphalangeal joint should be interpreted with regard to the position and the conformation of the foot.     

Communication between the distal interphalangeal joint and the navicular bursa in the horse at Computed Tomography Arthrography

Diffusion of drugs injected into the distal interphalangeal joint or the navicular (podotrochlear) bursa can influence diagnosis and treatment of foot pain. Previous anatomical and radiographic studies of the communication between these synovial structures have produced conflicting results and did not identify the location of any communication if present. This anatomic study aimed to assess the presence and site of communication between the distal interphalangeal joint and the navicular bursa in the horse by computed tomography arthrography. Sixty‐six pairs of cadaver forelimbs were injected with contrast medium into the distal interphalangeal joint and imaged by computed tomography arthrography. The presence of a communication, location of the communication and additional structural changes were assessed. Navicular bursa opacification occurred in 7 distal limbs (5.3%) following distal interphalangeal joint injection. One limb showed a communication through the T‐ligament and 6 limbs showed a communication through the distal sesamoidean impar ligament. In 3 cases, the communication through the distal sesamoidean impar ligament was associated with a distal border fragment. Our study showed that communication between the distal interphalangeal joint and navicular bursa is uncommon and inconsistent. Clinically, the presence of a communication could (1) influence the interpretation of diagnostic analgesia of the distal interphalangeal joint or the navicular bursa by facilitating the diffusion of local anaesthetic between these structures; (2) allow the drug and its potential adverse effects to spread from the treated synovial cavity to the non‐targeted synovial cavity; (3) be responsible for the failure of joint drainage in the case of sepsis.     

Arthrodesis of the Distal Interphalangeal Joint in Two Horses Using Three Parallel 5.5-mm Cortical Screws

The distal interphalangeal joint was successfully arthrodesed in two horses using three parallel 5.5-mm cortical screws and an autogenous cancellous bone graft. The screws were directed from the palmar proximal border of the second phalanx dorso-distally across the joint space and into the third phalanx. The technique was first developed on a normal horse. The second horse, a clinical case, ruptured its deep digital flexor tendon with complete luxation of the distal interphalangeal joint. Bony fusion of the distal interphalangeal joint occurred in both horses, but both also had residual lameness at a walk. Twenty-one months after the arthrodesis procedure, the clinical patient died from complications related to a subsolar abscess in the operated limb.     

Medial collateral ligament desmitis of the distal interphalangeal joint in the hindlimb of a horse: treatment with cast immobilisation

A 12‐year‐old show‐jumping mare was presented for investigation of a chronic hindlimb lameness of 16 weeks duration. Perineural anaesthesia and ultrasonography localised the lesion to the medial collateral ligament of the distal interphalangeal joint of the left hindlimb. Treatment consisted of a heavily padded distal limb cast for 6 weeks, strict box rest and a strictly regulated hand walking program. Serial ultrasonographic examinations were performed throughout the rehabilitation period. Collateral ligament desmitis of the distal interphalangeal joint is a commonly diagnosed condition of the forelimb; however, hindlimb collateral ligament desmitis has been rarely reported. Ultrasonographic examination in this case was an invaluable diagnostic and follow‐up tool. Immobilisation of the foot by means of a heavily padded distal limb cast allowed excellent healing of the ligament and is presented as a novel treatment for collateral ligament desmitis. At the time of writing the mare had returned to her previous level of exercise and was showing no signs of lameness.     

Standing low-field magnetic resonance imaging in horses with chronic foot pain

Objective Conventional imaging modalities can diagnose the source of foot pain in most cases, but have limitations in some horses, which can be overcome by using magnetic resonance imaging (MRI). However, there are no reports of the MRI appearance and prevalence of foot lesions of a large series of horses with chronic foot lameness. Methods In the present study, 79 horses with unilateral or bilateral forelimb lameness because of chronic foot pain underwent standing low‐field MRI to make a definitive diagnosis. Results Of the 79 horses, 74 (94%) had alterations in >1 structure in the lame or lamest foot. Navicular bone lesions occurred most frequently (78%) followed by navicular bursitis (57%), deep digital flexor tendonopathies (54%) and collateral desmopathy of the distal interphalangeal joint (39%). Effusion of the distal interphalangeal joint was also a frequent finding (53%). Conclusion Low‐field MRI in a standing patient can detect many lesions of the equine foot associated with chronic lameness without the need for general anaesthesia.     

Osseous cyst‐like lesions in the feet of lame horses: Diagnosis by standing low‐field magnetic resonance imaging

Osseous cyst‐like lesions (OCLLs) were diagnosed by standing low‐field magnetic resonance (MR) imaging in 9 mature horses (age range 6–17 years). All horses had been subjected to a routine lameness evaluation (including standard foot radiographs) with no diagnosis being reached prior to MR imaging. The duration of lameness ranged from one month to one year. OCLLs were diagnosed in 12 feet. The site of the lesions included the distal phalanx in 11 feet (subchondral bone in 4, insertion of collateral ligaments of the distal interphalangeal joint in 4, insertion of the distal sesamoidean impar ligament in 3) and the subchondral bone of the distal aspect of the middle phalanx in one foot. OCLLs were characterised by discrete spherical or elliptical areas of high or intermediate signal in all MR sequences. In most cases the lesion was surrounded by a rim of bone with abnormally low signal.     

Flexural deformities of the distal interphalangeal joint (clubfeet)

A true clubfoot results from a flexural deformity of the distal interphalangeal joint that is characterised by a shortening of the deep digital flexor tendon musculotendinous unit. Flexural deformities are a problem not only in foals but are also responsible for the clubfoot conformation seen in mature horses. Treatment is most successful when the cause is investigated and therapy initiated as early as possible, and when the biomechanical properties of the foot are thoroughly understood. Flexural deformities in foals and mature horses are addressed through appropriate farriery, often combined with surgery.     

Anatomic variations and degenerative changes in the collateral cartilages and middle and distal phalanges of the forelimb in Ardenner colts

The anatomic variations and the degenerative changes in the collateral cartilages and middle and distal phalanges in 6 Ardenner colts were characterized by radiography, scintigraphy, and magnetic resonance imaging (MRI). The radiographic changes were assessed between the ages of 16.5 and 25 months. An anatomic variation of the middle and distal phalanges was demonstrated in some of the colts. MRI examination of the 6 colts revealed an association between the deep digital flexor tendon cross-sectional area and body weight as well as foot circumference. Also, a thin collateral sesamoidean (suspensory navicular) ligament was observed subjectively. The presence of an extensive ossification of the collateral cartilages of the foot was found in these young horses. The ossification was characterized by the existence of 2 separate ossification centers, which had a tendency to unite. The radiographic interphalangeal degenerative lesions seen appear as bone remodeling of the dorsal edges of the middle and distal phalanx, on the insertion sites of collateral ligaments of the distal interphalangeal joint, the digital extensor tendon, and the distal interphalangeal joint capsule.     

FEASIBILITY FOR ULTRASOUND‐GUIDED INJECTION OF THE COLLATERAL LIGAMENTS OF THE DISTAL INTERPHALANGEAL JOINT IN HORSES

Desmitis of the collateral ligament of the distal interphalangeal joint is a cause of lameness in performance horses. The objective of this prospective, experimental, ex vivo feasibility study was to evaluate the success of ultrasound‐guided injection of the collateral ligaments of the distal interphalangeal joint in the equine forelimb. Seventy‐six ultrasound‐guided dye injections of the collateral ligament of the distal interphalangeal joint were performed on horses’ cadaver limbs. The hooves were sectioned transversely to verify the location of the dye relative to the collateral ligaments and surrounding structures. Evaluations of transverse sections were performed independently by two experienced observers. A scoring system was used to assess injection of the collateral ligament of the distal interphalangeal joint at the proximal, middle, and distal aspect over the length of the ligament. The collateral ligament was injected at any point in 97.4% of cases. The ligament was injected over the entire scored length in 43.2% of cases (32/74), over two scored length areas in 45.9% of cases (34/74), and in one area in 10.8% of cases (8/74). The distal interphalangeal joint and the common digital extensor tendon were also injected in 81.6% (62/76) and 43.4% (33/76) of the cases, respectively. Use of the ultrasound had a positive and negative predictive value of 98% and 9%, respectively. In this study, ultrasound guidance was useful for confirming injection of the collateral ligament of the distal interphalangeal joint but did not prevent injecting the distal interphalangeal joint and the common digital extensor tendon.     

A review of how magnetic resonance imaging can aid in case management of common pathological conditions of the equine foot

Magnetic resonance imaging (MRI) has become a valuable tool for the diagnosis of a multitude of conditions previously grouped into the vague diagnosis of palmar heel pain based on the response to palmar digital nerve diagnostic analgesia. The use of MRI not only determines a specific pathological diagnosis of the numerous structures within the foot but also the findings of the MRI help direct treatment and rehabilitation protocols, as well as providing prognostic information. Common injuries include damage to the navicular apparatus, deep digital flexor tendon, arthropathy of the distal interphalangeal joint and desmopathy of the collateral ligaments of the distal interphalangeal joint. This article reviews common MRI abnormalities in the equine foot and how treatment can be directed by the findings. Medical and surgical treatment options, as well as shoeing and rehabilitation protocols, are also discussed in relation to MRI findings. Using MRI can help create a more individually tailored and case‐specific treatment regimen, which can, in turn, promote a more positive outcome in equine cases.     

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.     

Anatomical considerations of the distal interphalangeal joint of sheep

The ligamentous attachments and the extent of the capsule of the distal interphalangeal joint of sheep was studied using both dissection and radiographic techniques. The distal interphalangeal joint was considered to be most vulnerable to infection and trauma on the axial, or interdigital, aspect where the joint capsule protrudes above the coronary border. In sheep the interdigital ligament and each proximal collateral sesamoidean ligament help to unite the two digits: a role performed in cattle by the cruciate ligament.     

Retrospective study of outcome following desmotomy of the accessory ligament of the deep digital flexor tendon for type 1 flexural deformity in Thoroughbreds

Objective Determine the long‐term outcome for Thoroughbreds undergoing desmotomy of the accessory ligament of the deep digital flexor tendon (DAL‐DDFT) for type 1 flexural deformity of the distal interphalangeal joint (DIPJ). Design Retrospective matched cohort study Procedure Medical records were retrieved over a 17‐year period for Thoroughbreds that underwent DAL‐DDFT for type 1 flexural deformity. Long‐term outcome was determined by analysis of race records and comparison with maternal siblings. Comparisons between cases and controls included 2‐year‐old, 3‐year‐old and total career performance data. Results There were 46 cases of DAL‐DDFT. The mean age at surgery was 151 days (median 118, range 2–562); 48% of case horses and 77% of 90 controls started in a race. For case horses that did race, the time to first race, total number of starts and prize money per race were not significantly different to maternal siblings. Age at the time of surgery did not alter the likelihood of starting a race. Conclusion Thoroughbreds undergoing DAL‐DDFT for type 1 flexural deformity of the DIPJ are less likely to race when compared with their maternal siblings. For those that do race, the time to first race, total races and earnings per race are not different from controls. There is no evidence to suggest that age at the time of surgery influences the likelihood of racing.     

Diagnostic analgesia of the equine digit

Analgesia usually occurs within 5 min after administration of local anaesthetic solution into joints or around nerves in the distal portion of the limb. Gait should be assessed within 10 min after diagnostic regional analgesia of the distal portion of the limb because rapid diffusion of anaesthetic solution can result in anaesthesia of other nerve branches, thus confusing results of the examination. A palmar digital nerve block (PDNB) anaesthetises most of the foot, including the distal interphalangeal (DIP) joint (coffin joint), rather than just the palmar half of the foot, as was once commonly believed. To avoid partially anaesthetising the proximal interphalangeal joint (pastern joint), the palmar digital nerves should be anaesthetised near or distal to the proximal margin of the collateral cartilages. Clinicians should be aware that an abaxial sesamoid nerve block (ASNB) may ameliorate or abolish pain within the metacarpo/metatarso‐phalangeal joint (fetlock joint). Mepivacaine administered into the DIP joint desensitises the DIP joint and probably the palmar digital nerves to also cause anaesthesia of the navicular bursa, the navicular bone, the toe region of the sole, the digital portion of the deep digital flexor tendon (DDFT) and the distal portions of the collateral ligaments of the DIP joint. When a large volume of mepivacaine HCl (e.g. 10 ml) is administered, the heel region of the sole may also be desensitised. Only a small percentage of horses with disease of the collateral ligament(s) of the DIP joint show a significant improvement in lameness after intra‐articular analgesia of the DIP joint, and no horse is likely to improve after intrabursal analgesia of the navicular bursa. A PDNB, however, improves lameness substantially in most horses that are lame because of disease of the collateral ligament(s) of the DIP joint, and all affected horses are likely to become sound after an abaxial sesamoid nerve block. The degree of improvement in lameness associated with injury to one or both collateral ligaments of the DIP joint after PDNB is determined by the extent of the injury and the level at which the palmar digital nerves are anaesthetised. The further proximal the level of the injury within the collateral ligament, the less likely that lameness is ameliorated by analgesia of the DIP joint or a PDNB. Verschooten's technique appears to be the most accurate technique for centesis of the navicular bursa. Even though analgesia of the DIP joint results in analgesia of the navicular bursa, analgesia of the navicular bursa does not result in analgesia of the DIP joint. Pain arising from the DIP joint can probably be excluded as a cause of lameness when lameness is attenuated by analgesia of the navicular bursa. Analgesia of the digital flexor tendon sheath (DFTS) is likely to desensitise only structures that are contained within or border on the sheath itself (i.e. the superficial and deep digital flexor tendons, the straight and oblique distal sesamoidean ligaments, the annular ligaments of the fetlock and pastern, and the portion of the DDFT that lies within the foot). Because lameness caused by disease of the DDFT within the foot may fail to improve appreciably after analgesia of the palmar digital nerves, the DIP joint, or the navicular bursa, a portion of the DDFT within the foot and distal to the DFTS probably receives its sensory supply from more proximal deep branches of the medial and lateral palmar digital nerves that enter the DFTS. Performing intrathecal analgesia of the DFTS on horses with lameness that is unchanged after anaesthesia of the palmar digital nerves but resolves after an ASNB, may be useful in localising lameness to that portion of the DDFT that lies within the foot. Resolution of lameness after intrathecal analgesia of the DFTS justifies suspicion of a lesion within the digital portion of the DDFT or within structures contained within the DFTS. The belief that concurrent or sequential intra‐articular administration of medication substantially increases the risk of joint infection or that inflammation caused by the local anaesthetic solution may dampen the therapeutic response to intra‐articular medication appears to be unfounded.     

Ultrasonographic examination of the dorsal aspect of the distal interphalangeal joint of the horse

Ultrasonographic examination of the dorsal aspect of the distal interphalangeal joint is part of the routine examination of the foot structures. The purpose of this paper is to describe the ultrasonographic anatomy of the area, and normal transverse and longitudinal images. Clinical cases are presented to illustrate abnormal findings and lesions of the dorsal aspect of the joint. Ultrasonography can complement radiography for the diagnosis and documentation of many soft tissue and joint abnormalities such as synovitis, fluid distension, cartilaginous defects, periarticular osteophytes and bone fragments.     

RADIOGRAPHIC MEASUREMENTS OF HOOF BALANCE ARE SIGNIFICANTLY INFLUENCED BY A HORSE'S STANCE

Hoof balance radiographs are commonly used as the basis for corrective farriery decision‐making in horses, however there are limited published data quantifying effects of the stance of the horse or the horizontal radiographic beam angle. In this analytical study, the influence of variation of the horse's stance in the craniocaudal and lateromodial plane on hoof balance measurements as well as the influence of variation of the horizontal radiographic beam angle on dorsopalmar hoof balance measurements was examined. Distal left thoracic limb lateromedial radiographs were acquired using a standardized protocol while varying the craniocaudal stance of five horses, each selected to be sound and conformationally normal. Dorsopalmar foot radiographs were acquired while varying the lateromedial stance; and variable angle horizontal beam dorsopalmar foot radiographs were acquired while keeping the limb position constant. Analyses of measurements demonstrated that hoof pastern angle had a linear relationship (R² = 0.89, P < 0.001) with craniocaudal stance of the horse. The relationship of joint angle and stance was greater for the distal interphalangeal joint angle (R² = 0.89, P < 0.001) than the proximal interphalangeal joint angle (R² = 0.65, P = 0.001). The distal phalanx angle did not change with craniocaudal stance variation. The proximal interphalangeal joint width, distal interphalangeal joint width, or distal phalanx height did not change with lateromedial stance variation, nor within a 15 degree dorsolateral to caudomedial and dorsomedial to caudolateral variation from the dorsopalmar axis. Findings indicated that positioning of the thoracic limb needs to be considered during radiographic interpretation and decision‐making for corrective farriery.     

MAGNETIC RESONANCE IMAGING FINDINGS OF DESMOPATHY OF THE COLLATERAL LIGAMENTS OF THE EQUINE DISTAL INTERPHALANGEAL JOINT

We report the use of a low-field magnetic resonance (MR) imaging system for the detection of desmopathy of the collateral ligament of the distal interphalangeal joint and the long-term outcome. Twenty horses were studied and their medical records and MR images were reviewed retrospectively. Long-term follow-up information was obtained by telephonic questionnaires of owners, trainers, or referring veterinarians. Desmopathy of the medial collateral ligament (80%) and enthesopathy of the affected collateral ligament (80%) were common MR imaging features. Treatment consisted of stall rest followed by a rehabilitation period. Additional treatments included shoeing, extracorporeal shock wave therapy, application of a half limb or foot cast, and medication of the distal interphalangeal joint. Twelve (60%) horses returned to their previous level of exercise and maintained their previous level, whereas eight horses had a poor outcome. Low-field MR imaging in the standing patient can be used to detect collateral ligament desmopathy of the distal interphalangeal joint without a need for general anesthesia.