Radiographic imaging of the equine foot.

Radiographic examination of the equine foot can provide the veterinarian and farrier with a wealth of information. Positioning and selection of exposure factors are of central importance if one is to produce radiographs of maximum diagnostic value.     

Clinical examination of the equine foot

The foot is the most common source of limb pain. The problems vary from simple to quite complex. An accurate diagnosis is dependent upon a thorough and detailed knowledge of anatomy and of what is available in the way of ancillary examination techniques. The correction of most foot problems requires an appreciation of a multitude of factors and a thorough knowledge of farrier science.     

Radiographic measurement from the lateromedial projection of the equine foot with navicular disease

Radiographic measurements from the lateromedial projection of the equine foot were compared in three groups of horses. Group 1 consisted of 143 normal horses, group 2 were 60 horses with clinical navicular disease and group 3 were 161 horses with clinical and radiographic navicular disease. Several measurements tended to be larger in group 3 than group 1. An enlargement of the navicular bone was observed in proximodistal and dorsopalmar directions. Partial enlargement of the pedal bone was observed in groups 2 and 3. Few differences were observed between age classes. All horses aged four years and over had an increased length of the hoof in the dorosopalmar direction and a decrease of the cranial angle of the hoof. Enlargement of the navicular bone fits well into the concept of osteoarthrosis. The pedal bone was partly engaged. These findings may be an expression of a regional acceleratory phenomenon.     

Radiographic interpretation of normal skeletal variations and pseudolesions in the equine foot.

Effective radiographic interpretation requires a veterinarian who is knowledgeable of equine limb anatomy and the various principles that affect the resulting image. The normal and its variations must be recognized and understood before the abnormal can be confidently identified as pathologic. Proper patient positioning and sound radiographic technique are mandatory if reliable diagnostic radiographs are to be produced. This review emphasizes equine foot radiographic variations of normal and pseudolesions that occur with commonly used radiographic views performed in equine practice.     

Examination of the equine foot.

The examination of the foot must be based on observations of the hoof, followed by a careful determination of areas of pain. This must be followed by an assessment of the biomechanical forces on the hoof and limb. Finally, imaging gives insight into the nature of the injury and allows the examiner to prognosticate the outcome.     

Clinical anatomy of the equine foot

A review of investigations of the functional anatomy of the equine foot is presented. Emphasis is placed on the relationships of structures involved in the major diseases of the foot.     

Miscellaneous conditions of the equine foot

The etiology, clinical presentation, radiographic findings, diagnostic criteria, differential diagnoses, treatment, and prognosis are reviewed for several clinically important conditions of the equine foot. These include pedal osteitis, sheared heels, distal sesamoid bone (navicular) fractures, subchondral bone cyst of the distal phalanx, distal interphalangeal joint subluxation, congenital phalangeal hypoplasia, bipartite and tripartite distal sesamoid bones, keratoma, ossification of the cartilages of the distal phalanx (sidebones), necrosis of the cartilages of the distal phalanx (quittor), thrush, canker, vesicular stomatitis, and chronic selenium toxicosis.     

Radiographic identification of the equine ventral conchal bulla

Involvement of the ventral conchal sinus (VCS) is an important diagnostic and prognostic feature in cases of the equine sinus disease. The authors aimed to ascertain if the caudo-dorsal extension of the VCS, the ventral conchal bulla (VCB) is identifiable on plain radiographs of cadaver skulls without sinus disease. Bilateral frontonasal sinus flaps were made in 10 equine cadaver skulls. Plain lateral, lateral oblique and dorso-ventral radiographs were then obtained followed by the same views taken with stainless steel wire outlining the caudal border of the VCB. Plain radiographs were randomised and blindly evaluated by two observers who marked where they believed the VCB to be positioned. This was then correlated with the true position of the VCB using radiographs with wires in place. The ease of identification of the VCB was classified as 'easy' or 'difficult'. The VCB was correctly identified in 70 per cent of lateral radiographs, but only 45 per cent of lateral oblique radiographs and 17 per cent of dorso-ventral radiographs. If a clinician was confident that he or she could identify the VCB, they were usually correct. Conversely if the clinician judged VCB identification as 'difficult', they usually identified it incorrectly. In the authors' clinical experience, the VCB of horses with sinusitis involving this compartment is more radiologically evident than in clinically normal horses. Knowledge of the normal radiographic anatomy of this structure should aid clinicians in identifying horses with sinusitis affecting the VCS.     

Radiographic examination of the canine spine

Radiography plays an essential part in the diagnosis of spinal disease in the dog. Careful positioning of the patient and attention to technique are important in obtaining diagnostic films and sedation or general anaesthesia is usually required, especially if the animal is in pain or muscle spasm. Additional information may be obtained by myelography, a technique in which a water-soluble iodine-containing contrast medium is injected into the subarachnoid space via the cisterna magna, under general anaesthesia. The advent of two new contrast media, iopamidol and iohexol, has rendered this a relatively safe procedure which may be carried out in practice. The radiological features of a variety of canine spinal conditions are discussed, including congenital and developmental abnormalities, infective, nutritional and degenerative conditions and trauma and neoplasia.     

Eye examination as part of the equine prepurchase examination

Prepurchase examination (PPE) is the most common reason for eye examination in first opinion equine practice. This paper describes a standard protocol for competent eye examination in the PPE, and reviews the interpretation of the more common clinical findings, particularly in relation to their expected influence on functional vision and their progression. The content is based on the limited existing literature, the personal opinions and experience of the author, and from discussions held with colleagues over the past 30 years.     

Radiographic anatomy of the soft tissue attachments of the equine stifle

REASONS FOR PERFORMING STUDY: Radiography is a very important aspect of equine stifle imaging. The precise radiographic anatomy of the soft tissue structures of the equine stifle has not been described previously. OBJECTIVE: To describe the anatomical relationship between sites of attachment of soft tissue structures of the equine stifle and their locations on standard radiographic views. METHODS: The sites of bony attachments of the tendons, ligaments and fibrous portion of the joint capsules of equine stifles were determined by gross dissection. These sites of attachment were transposed onto one set of bones deprived of soft tissue and mapped using radiopaque markers. This specimen was then radiographed in the standard radiographic projections (lateromedial, caudocranial and caudal 60 degrees lateral-craniomedial oblique) to determine the position of the attachment sites on the radiographs. RESULTS: Two radiographic maps were drawn per radiographic projection, one for the attachment sites of the ligaments and tendons and one for the attachment sites of the joint capsules. CONCLUSIONS AND POTENTIAL RELEVANCE: The radiographic maps of the precise position of the soft tissue attachments of the tendons, ligaments and joint capsules of the equine stifle should assist interpretation of equine stifle radiographs.     

Multiple keratomas in an equine foot

A 19-year-old, Arabian gelding was presented for left hindlimb lameness and deviation of the hoof wall. Radiographs revealed a semicircular, radiolucent area in the lateral edge of the distal phalanx. Three distinct keratomas were successfully removed following hoof wall resection.     

Scintigraphic examination of the cartilages of the foot

REASONS FOR PERFORMING STUDY: Radiographic examination of the cartilages of the foot is well documented; however, there is limited information about their scintigraphic assessment. OBJECTIVES: To evaluate the scintigraphic appearance of the cartilages of the foot using subjective and quantitative image analysis and to correlate radiographic and scintigraphic findings. HYPOTHESES: An ossified cartilage would have similar radiopharmaceutical uptake (RU) to the ipsilateral aspect of the distal phalanx; RU would extend throughout the length of the ossified cartilage; a separate centre of ossification (SCO) would be identified on a scintigraphic image; and fracture or trauma to an ossified cartilage would manifest as increased RU (IRU). METHODS: Front feet (n = 223) of horses (n = 186) that had dorsopalmar radiographic views and dorsal scintigraphic images were included in the study. The cartilages of the foot were graded radiographically and scintigraphically. Quantitative evaluation of the scintigraphic images was carried out using region of interest (ROI) analysis. For statistical analysis RU ratios were used. Correlations between a radiographically detected SCO and focal RU and between IRU and radiographic abnormalities were assessed. RESULTS: There was a good correlation and an excellent agreement between radiographic and scintigraphic grades. ROI analysis showed a proximal to distal increase in RU ratios within each cartilage of the foot. A radiographically identified SCO could be detected scintigraphically in 12/17 feet (70.6%). Thirty-eight feet had IRU in the region of a cartilage, 25 of which (65.8%) had corresponding radiographic abnormalities. Fracture of an ossified cartilage was associated with IRU in all horses. CONCLUSIONS AND POTENTIAL RELEVANCE: Scintigraphy may give information about the potential clinical significance of ossification of the cartilages of the foot and associated lesions, therefore prompting further investigation by use of a uniaxial ipsilateral palmar nerve block and imaging, using either magnetic resonance imaging and/or computed tomography.     

Subjective and quantitative scintigraphic assessment of the equine foot and its relationship with foot pain

It was hypothesised that in solar bone images of the front feet of clinically normal horses, or horses with lameness unrelated to the front feet, there would be less than a 10% difference in the ratio of uptake of radiopharmaceutical in either the region of the navicular bone, or the region of insertion of the deep digital flexor tendon (DDFT), compared to the peripheral regions of the distal phalanx. Nuclear scintigraphic examination of the front feet of 15 Grand Prix show jumping horses, all of which were free from detectable lameness, was performed using dorsal, lateral and solar images. The results were compared with the examinations of 53 horses with primary foot pain, 21 with foot pain accompanying another more severe cause of lameness and 49 with lameness or poor performance unrelated to foot pain. None of the horses with foot pain had radiological changes compatible with navicular disease. All the images were evaluated subjectively. The solar views were assessed quantitatively using regions of interest around the navicular bone, the region of insertion of the deep digital flexor tendon and the toe, medial and lateral aspects of the distal phalanx. In 97% of the feet of normal showjumpers, there was <10% variance of uptake of the radiopharmaceutical in the navicular bone, the region of insertion of the DDFT and the peripheral regions of the distal phalanx. There was a significant difference in uptake of radiopharmaceutical in the region of the navicular bone in horses with foot pain compared to normal horses. There was a large incidence of false positive results related to the region of insertion of the DDFT. Lateral pool phase images appeared more sensitive in identifying potentially important DDFT lesions. There was a good correlation between a positive response to intra-articular analgesia of the distal interphalangeal joint and intrathecal analgesia of the navicular bursa and increased uptake of radiopharmaceutical in the region of the navicular bone in the horses with primary foot pain. It is concluded that quantitative scintigraphic assessment of bone phase images of the foot, in combination with local analgesic techniques, can be helpful in the identification of the potential source of pain causing lameness related to the foot, but false positive results can occur, especially in horses with low heel conformation.     

Magnetic resonance imaging of the equine foot: 15 horses

REASONS FOR PERFORMING STUDY: Foot pain is a common cause of equine lameness and there have been significant limitations of the methods available for the diagnosis of the causes of foot pain (radiography, nuclear scintigraphy and ultrasonography). Until recently, magnetic resonance imaging (MRI) in the horse has been limited to examination of cadaver limbs. OBJECTIVES: Our purpose was to 1) describe MRI of the foot in live horses, 2) describe MRI findings in horses with foot pain in which a definitive diagnosis could not be established by alternative means and 3) correlate MRI findings with other methods of clinical investigation. METHODS: The feet of 15 horses with unilateral (12) or bilateral (3), forelimb (14) or hindlimb (1) lameness associated with foot pain of previously ill-defined origin were examined using MRI. The horses were examined in right lateral recumbency under general anaesthesia, with the feet positioned in the isocentre of a flared end 1.5 Tesla GE Signa Echospeed magnet. Images were obtained in sagittal, transverse and dorsal planes using 3-dimensional (3D) T2* gradient echo (GRE), spoiled gradient echo, fat-saturated 3D T2* GRE and short inversion recovery sequences. Image acquisition took approximately 1 h. RESULTS: Abnormalities of the distal interphalangeal joint (DIP) cartilage and/or subchondral bone, periarticular osteophyte formation, distension of the DIP joint capsule with or without synovial proliferation, distension of the navicular bursa with or without evidence of chronic inflammation, surface and core lesions in the deep digital flexor tendon, abnormal signal within the navicular bone, evidence of mineralised fragments in the distal sesamoidean impar ligament, irregular outline of and signal in the medial cortex of the distal phalanx, and an abnormal signal on the dorsal aspect of the distal phalanx consistent with laminitis were identified. CONCLUSIONS: MRI permits the diagnosis of a variety of lesions involving different structures within the foot that cannot be diagnosed using other means, thus enhancing our knowledge of the causes of foot pain. Potential relevance: With further experience it is likely that lesions involving other structures will also be identified. Long-term follow-up data is required to determine the prognosis for the injuries described.