Variation in foot conformation in lame horses with different foot lesions

Foot conformation in the horse is commonly thought to be associated with lameness but scientific evidence is scarce although it has been shown in biomechanical studies that foot conformation does influence the forces acting on the deep digital flexor tendon (DDFT) and the navicular bone (NB). The aim of this study was to determine the relationships between foot conformation and different types of lesion within the foot in lame horses. It was hypothesised that certain conformation parameters differ significantly between different types of foot lesions. Conformation parameters were measured on magnetic resonance images in the mid-sagittal plane of 179 lame horses with lesions of their deep digital flexor tendon (DDFT), navicular bone (NB), collateral ligaments of the distal interphalangeal joints and other structures.Conformation parameters differed significantly between lesion groups. A larger sole angle was associated with combined DDFT and NB lesions, but not with NB lesions alone. A more acute angle of the DDFT round the NB was associated with DDFT and NB lesions, and a lower heel height index with DDFT injury. The larger the sole angle the smaller the likelihood of a DDFT or NB lesion with odds ratios of 0.86 and 0.90, respectively. This study shows an association between foot conformation and lesions but it does not allow the identification of conformation as causative factor since foot conformation may change as a consequence of lameness. Future studies will investigate foot-surface interaction in lame vs. sound horses, which may open a preventative and/or therapeutic window in foot lame horses.     

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 Assessment of the Equine Distal Phalanx Facies Flexoria

Abnormalities of the facies flexoria of the distal phalanx (FF) of the horse associated with podotrochlear syndrome have been scarcely described in the literature. The objective of this retrospective study was to determine correlation between modification of the FF and lesions of the podotrochlear apparatus. This study includes 100 horses referred for forelimb lameness that underwent a standardized magnetic resonance (MR) imaging protocol of the affected foot. Of the 100 MR studies, 74 had podotrochlear lesions and 26 free of podotrochlear lesions served as controls. A comparison of the FF compact bone thickness between affected and control feet was performed. Presence and location of a deep digital flexor tendon (DDFT) lesion was noted. Grading systems were used to score: FF osseous resorption, FF bone marrow lesion, FF sclerosis and abnormalities of the navicular bursa and the distal interphalangeal joint. Compact bone thickness of the FF was not increased in case of tendinopathy of the DDFT or other podotrochlear lesions (P = .86). Significant correlation was observed between osseous resorption of the FF at the level of the distal recess of the navicular bursa and synovial proliferation of the navicular bursa (P = .05). Compact bone thickening at the DDFT enthesis is not predictive of podotrochlear syndrome and should rather be considered as an interindividual anatomical variation. Navicular bursitis may play a role in osseous resorption of the FF.     

Histopathology in horses with chronic palmar foot pain and age-matched controls. Part 2: The deep digital flexor tendon

REASONS FOR PERFORMING STUDY: Causes of palmar foot pain and the aetiopathogenesis of navicular disease remain poorly understood, despite the high incidence of foot-related lameness. HYPOTHESES: Abnormalities of the deep digital flexor tendon (DDFT) may contribute to palmar foot pain; ageing degenerative changes may be seen in horses free from lameness; and horses with lameness are likely to have a greater severity of abnormalities than age-matched horses with no history of foot pain. METHODS: Feet were selected from horses with a history of uni- or bilateral forelimb lameness of at least 2 months' duration. Histology of the DDFT from the level of the proximal interphalangeal joint to its insertion were examined and the severity of lesions for each site graded. Associations between lesions of the navicular bone, collateral sesamoidean ligaments (CSL), distal sesamoidean impar ligament, navicular bursa, distal interphalangeal (DIP) joint synovium and collateral ligaments of the DIP joint and DDFT were assessed. RESULTS: There was no relationship between age and grade of histological abnormality of the DDFT. There were significant histological differences between groups for lesions of the dorsal layers of the DDFT, but not for lesions of the palmar aspect. There were significant associations between histological grades for the superficial dorsal layer of the DDFT and flexor aspect of the navicular bone; and between the deep dorsal layer of the DDFT and the proximal border and medulla of the navicular bone. The navicular bursa grade was correlated with grades for the superficial dorsal, deep dorsal and deep palmar layers of the DDFT. The histological grades for the CSL and the superficial dorsal layer of the DDFT were also associated. CONCLUSIONS: Pathological abnormalities in lame horses often involved the DDFT in addition to the navicular bone. Vascular and matrix changes may precede changes in the fibrocartilage of the navicular bone. POTENTIAL RELEVANCE: Identification of factors leading to vascular changes within the interstitium of the DDFT and changes in matrix composition, may help in future management of palmar foot pain.     

A Cross-Sectional Survey of Forelimb Hoof Conformation and the Prevalence of Flat Feet in a Cohort of Thoroughbred Racehorses in New Zealand

Racehorses in New Zealand predominantly train counter clockwise. This training pattern has been associated with between forelimb differences in bone mineral density profile and asymmetrical limb loading after training. At present, there is limited data on the hoof conformation of these racehorses. Distal forelimb and digital hoof conformation data were collected from 75 Thoroughbred racehorses (2–5 years old) from two training yards. Digital conformation was subjectively graded, and multiple hoof measurements were made with a modified tire gauge (sole and sulci depth) and from digital photographs. All the horses were shod by two registered master farriers within a median of 15 (interquartile range [IQR], 1–25) days before measurement. There were few distal limb conformation abnormalities scored. Most (62/75) horses presented with some deviation from normal hoof parameters, with 2 (IQR, 1–3) abnormalities reported per horse. The most common hoof abnormality was uneven sulci, which was identified in 43 horses and 59 affected hooves, followed by higher medial hoof wall height in 38 horses and 53 affected hooves. Many of the linear and hoof angle measurements and their ratios were within the bounds reported within the literature and indicative of a balanced foot. The length and width measurements increased with horse age. The dorsal hoof wall (DHW) length:heel length ratios were consistently less than 3:1, and the absolute difference between toe and heel angle was generally greater than 5°. Between limb hoof variation was identified for a number of the morphologic measurements including frog length and sole length and the ratio of sole width:sole length. Flat feet (lack of concave solar surface) were identified in 21/75 (28%) horses and in 28/150 (19%) forelimb hoofs. More horses had a flat left foot (10/75) than right foot (4/75), but seven horses had both feet classified as being flat. Flat feet had 2.4 (1.1–5.6, P = .036) greater odds of presenting with uneven sulci. These data indicate that uneven sulci depth and flatter hooves with may be a typical presentation of Thoroughbred feet. Asymmetry in measurements between limb may reflect the greater loading of the left forelimb when race training counter clockwise.     

Comparisons of computed tomography, contrast enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 1: anatomic visualisation scores

Reasons for performing study: To date, few reports exist comparing magnetic resonance imaging (MRI) and computed tomography (CT) for imaging of the equine distal limb, yet clinicians are required to decide which modality to use regularly. Objectives: To report and compare anatomic visualisation scores obtained for CT, contrast enhanced CT (CECT) and standing low‐field MRI (LFMRI) in the equine foot. Hypothesis: Anatomic visualisation score discrepancies would exist between CT, CECT and LFMRI. Methods: Images of 22 lame horses (31 limbs) undergoing both CT and LFMRI of the foot were reviewed. When available, CECT images were reviewed. The deep digital flexor tendon (DDFT) was categorised into proximal to distal levels (A–D), structures were assigned visualisation scores (Grades 0–3) and technique comparisons were made using the paired marginal homogeneity test. Results: Computed tomography and LFMRI had similar visibility scores for the navicular bone, middle phalanx, DDFT‐B, collateral ligaments of the distal interphalangeal joint and collateral sesamoidean ligament of the navicular bone. The proximal and distal phalanx had lower visibility scores with LFMRI. The distal DDFT (C–D), distal sesamoidean impar ligament and synovial structures had higher scores with LFMRI. Contrast enhanced CT lowered DDFT and collateral sesamoidean ligament scores and raised distal interphalangeal synovium CT visualisation scores. Conclusions and potential relevance: Visualisation scores differ depending on imaging technique and anatomic structure of interest. This information increases our understanding of the limitations of CT, CECT and LFMRI to visualise anatomy in clinical cases.     

Cutaneous adverse food reactions in dogs: Something new to chew on

It was hypothesised that there is increased blood vessel frequency and proteoglycan staining intensity within the distal aspect of the deep digital flexor tendon (DDFT) in horses with chronic foot pain. Samples of the DDFT from three standardised sites from 10 age-matched mature horses, with chronic foot pain (Group L) or with no history of forelimb lameness (Group N), were collected for this study. A histological analysis of haematoxylin and eosin-stained sections focussed on the frequency and location of blood vessels, while safranin 0 fast green staining was used for semi-quantitative assessment of matrix proteoglycan. The frequency and immunoreactivity of endothelial cell-labelled blood vessels were determined using factor VIII immunolocalisation.There was increased frequency of blood vessels (P = 0.048) and increased proteoglycan staining intensity (P = 0.028) in Group L, compared with Group N. Qualitative micro-anatomical differences in the matrix and tenocytes were noted between Groups N and L. There was reduced factor VIII staining within the vasculature of horses from Group L, compared with Group N. The results suggested that chronic foot pain may be associated with altered DDFT matrix composition, which could be a potential indicator of degenerative change. The increased vascularity may represent a reparative response to a degenerative tendonopathy.     

Histopathology in horses with chronic palmar foot pain and age-matched controls. Part 1: Navicular bone and related structures

REASONS FOR PERFORMING STUDY: Causes of palmar foot pain and the aetiopathogenesis of navicular disease remain poorly understood, despite the high incidence of foot-related lameness. HYPOTHESES: Abnormalities of the collateral sesamoidean ligaments (CSLs), distal sesamoidean impar ligament (DSIL), deep digital flexor tendon (DDFT), navicular bone, navicular bursa, distal interphalangeal (DIP) joint or collateral ligaments (CLs) of the DIP joint may contribute to palmar foot pain. METHODS: Feet were selected from horses with a history of unilateral or bilateral forelimb lameness of at least 2 months' duration that was improved by perineural analgesia of the palmar digital nerves, immediately proximal to the cartilages of the foot (Group 1, n = 32); or from age-matched control horses (Group 2, n = 19) that were humanely destroyed for other reasons and had no history of forelimb foot pain. Eight units of tissue were collected for histology: the palmar half of the articular surface of the distal phalanx, including the insertions of the DDFT and DSIL; navicular bone and insertion of the CSLs; DDFT from the level of the proximal interphalangeal (PIP) joint to 5 mm proximal to its insertion; synovial membrane from the palmar pouch of the DIP joint and the navicular bursa; CLs of the DIP joint and DSIL. The severity of histological lesions for each site were graded. Results were compared between Groups 1 and 2. RESULTS: There was no relationship between age and grade of histological abnormality. There were significant histological differences between groups for lesions of the flexor aspect, proximal and distal borders, and medulla of the navicular bone; the DSIL and its insertion and the navicular bursa; but not for lesions of the CSLs, the dorsal aspect of the navicular bone, distal phalanx and articular cartilage, synovium or CLs of the DIP joint. CONCLUSIONS: Pathological abnormalities in lame horses often involved not only the navicular bone, but also the DSIL and navicular bursa. Abnormalities of the navicular bone medulla were generally only seen dorsal to lesions of the FFC. POTENTIAL RELEVANCE: Adaptive and reactive change may be occurring in the navicular apparatus in all horses to variable degrees and determination of the pathogenesis of lesions that lead to pain and biomechanical dysfunction should assist specific preventative or treatment protocols.     

POSITIVE CONTRAST MAGNETIC RESONANCE BURSOGRAPHY FOR ASSESSMENT OF THE NAVICULAR BURSA AND SURROUNDING SOFT TISSUES

Magnetic resonance (MR) imaging is often performed to determine the cause of palmar heel pain. We evaluated how distension of the navicular bursa affected the MR appearance of the navicular bursa and associated structures. An MR evaluation was performed on normal cadaver limbs and cadaver limbs from horses with lameness localized to the foot. The normal navicular bursae were injected with 2, 4, or 6 ml of solution. The bursae of the feet from lame horses were injected with 4 or 6 ml, and the MR study was repeated. All bursae were examined grossly to verify the presence or absence of adhesions. Clinical patients that had initial MRI abnormalities suggesting adhesions were also evaluated. Distension of the proximal recess of the normal navicular bursa, proximal to the collateral sesamoidean ligament was achieved with 2 ml. Separation of the collateral sesamoidian ligament from the deep digital flexor tendon (DDFT) was achieved with 4 ml. The separation of the navicular bone from the DDFT and distal sesamoidian impar ligament required 6 ml. Adhesions were more clearly defined in the bursa of the two pathologic cadaver limbs following distension. MR bursography used on clinical patients allowed the determination of the presence or absence of adhesions. In these horses, this determination could not have been definitively made without this technique. MR bursography is useful in horses where the presence of adhesions cannot be clearly defined by MRI.     

DEEP DIGITAL FLEXOR TENDONITIS IN THE EQUINE FOOT DIAGNOSED BY LOW-FIELD MAGNETIC RESONANCE IMAGING IN THE STANDING PATIENT: 18 CASES

Injury to the distal aspects of the deep digital flexor tendon (DDFT) is an important cause of lameness in horses. The purpose of this study was to review the magnetic resonance imaging (MRI) findings of 18 horses affected by DDFT injuries in the foot. The MRI was performed with the horses standing using an open low-field (0.21 T) MRI scanner. The results were compared with those previously reported for horses using high-field MRI. Eighteen of 84 horses (21%) with undiagnosed forefoot pain were found to have lesions affecting the DDFT. The history, clinical findings and results of radiography, diagnostic ultrasonography and nuclear scintigraphy of these horses were reviewed. The duration of lameness ranged from 1 to 12 months, and the severity varied from 1/10 to 6/10. Fifteen horses had unilateral lameness (right fore in nine, left fore in six), whereas three horses were bilaterally foreleg lame. Radiological changes, considered of equivocal significance, were found in six of 18 horses. Ultrasonographic changes involving the DDFT were identified in only one of nine horses. DDFT lesions were detected in both T1- and T2-weighted MRI sequences. Four different types of lesions were identified: core lesions, sagittal splits, dorsal border lesions, and insertional lesions. Combinations of different lesion types within the same horse were common. The types and locations of the DDFT lesions were similar to those previously reported using high-field MRI. The use of low-field standing MRI avoids the necessity for general anesthesia and access to conventional high-field MRI scanners. However, studies comparing the results of standing low-field MRI with high-field MRI (and other imaging procedures) are required before the sensitivity and specificity of the technique can be assessed.     

Collateral desmitis of the distal interphalangeal joint in conjunction with concurrent ossification of the cartilages of the foot in nine horses

The purpose of this study was to describe the frequency of occurrence of severe ossification of the collateral cartilages (sidebone) coexistent with collateral desmitis of the distal interphalangeal joint (DIPJ) in lame horses. Sidebone was diagnosed and graded on standard radiographs and soft tissue injuries of the foot were diagnosed using standing low‐field magnetic resonance imaging (MRI). Of 15 horses with forelimb lameness and severe sidebone, 9 had evidence of concurrent collateral desmitis of the DIPJ. All 15 horses had damage to other structures (including the deep digital flexor tendon, distal sesamoidean impar ligament, collateral sesamoidean ligament, navicular bone and distal phalanx) within the affected feet as identified on MRI. The clinical and pathophysiological significance of concurrent collateral desmitis of the DIPJ and sidebone is currently uncertain. However, this study shows that injuries to multiple structures within the foot are common and that collateral desmitis of the distal interphalangeal joint is frequently seen in lame horses in conjunction with severe ossification of the collateral cartilages.     

Foot lameness in dairy goats

An outbreak of foot lameness in a dairy herd of 170 goats is described. The herd, that was kept mostly indoors, was attended between December 2006 and November 2007. During this period, 15% of the goats showed lameness with foot lesions and 24% of the goats showed lameness without foot lesions. The foot lesions consisted of cracks and erosions on the horn of the bulbs of the heel that in most cases extended along the internal side of the axial hoof wall. The clinical diagnosis was interdigital dermatitis. Annual milk production was lower in lame goats compared to those that were not lame (P < 0.05). Furthermore, annual milk yield was significantly affected by the type of foot disease present and was significantly lower in cases with foot lesions than in the animals that were not lame (P < 0.05) and also in the lame goats without foot lesions (P < 0.05).     

Ultrasonographic diagnosis of injuries to the deep digital flexor tendon and associated structures in the equine foot (suprasesamoidean area)

Foot pain is the most common cause of lameness in horses. In sport horses, podotrochlear syndrome (‘navicular syndrome’) is reported to be the most frequent condition affecting the front foot. Ultrasonography has the potential to detect damage to the soft tissues as well as the bone surfaces; in some clinics it has become the technique of choice for the identification and documentation of many podotrochlear injuries. The purpose of this paper is to review the main pathological conditions of the proximal part of the podotrochlear apparatus (PTA) that can be diagnosed ultrasonographically, focusing on the deep digital flexor tendon (DDFT), podotrochlear bursa (PTB) and distal digital annular ligament (DDAL). Potentially significant ultrasonographic findings of the DDFT include thickening of one or both lobes, longitudinal tears, focal or diffuse changes in echogenicity, irregularities of the dorsal border and adhesions between the DDFT and the proximal sesamoidean ligament and/or distal sesamoid bone. Deep digital flexor tendon injuries are often associated with concurrent lesions of the PTB (acute to chronic bursitis) and of the DDAL (desmopathy). Both feet should be routinely examined as lesions of the PTA are often bilateral. We currently consider that ultrasonography should be routinely employed as the primary diagnostic procedure to complement radiography of the equine foot.     

Microanatomic characteristics of the insertion of the distal sesamoidean impar ligament and deep digital flexor tendon on the distal phalanx in healthy feet obtained from horses

OBJECTIVE: To describe microanatomic characteristics of the insertion of the aistal sesamoidean impar ligament (DSIL) and deep digital flexor tendon (DDFT) on the distal phalanx in horses. SAMPLE POPULATION: Healthy feet obtained from 62 horses of various breeds. PROCEDURE: Feet from 23 horses were used to histologically examine the insertion of the DSIL and DDFT (n = 7), its vasculature (10), and neural elements (6). In 39 other horses, the insertion zone was examined for proteoglycan. RESULTS: The insertion of the DSIL and dorsal half of the DDFT contained bundles of collagen fibers with intervening loose connective tissue septa with arteriovenous complexes (AVC) and nerve fibers. Microscopic examination revealed adaptive changes in the insertion with regard to proteoglycan content. In young adult horses, little or no staining for proteoglycans was evident, whereas in middle-aged horses, moderate proteoglycan staining was seen. Six older horses had slight proteoglycan staining at the insertion. CONCLUSIONS AND CLINICAL RELEVANCE: The study revealed that this region contained a rich neurovascular complex between the collagen bundles. A gradual increase in production of proteoglycan, evident at the insertion of the DSIL and DDFT on the distal phalanx, indicates that adaptive responses to stress rather than age alone may be the primary determining factor. These observations indicate that this insertion site may be susceptible to stress during stance and impact loading, because this region appears to be strategically situated to regulate important neurovascular functions of the foot.     

An investigation of the shape of the hoof capsule in hindlimbs,its relationship with the orientation of the distal phalanx and comparison with forelimb hoof capsule conformation

There is limited information documenting hind foot conformation. The objectives of the study were to describe the shape of the hoof capsule of hindlimbs from the lateral aspect in horses of variable breeds, and, within horses, to compare the conformation of the hoof capsule of forelimbs and hindlimbs and determine the orientation of the distal phalanx within the hoof capsule in hindlimbs. Lateral photographs of the fore and hind feet (n = 225) and lateromedial radiographs of the hind feet (n = 29) were obtained. Differences among breed and shoeing status groups were assessed using multivariable mixed-effects linear regression models. Angular parameters and ratios of linear measurements were compared between fore and hind feet; angular radiological variables and photographic parameters of the hind feet were compared. The mean dorsal hoof wall angle for hind feet (50.9°±3.7°) was smaller than forefeet (51.8°±3.9°) (P = 0.04). The mean heel angles for hind feet (36.4°±9.6°) were smaller than forefeet (40.1°±9.3°; P < 0.001). Dorsal hoof wall (P < 0.001) and heel (P = 0.002) angles were larger in unshod than shod feet. In the hind feet, the dorsal hoof wall was parallel to the dorsal aspect of the distal phalanx. The median angle of the distal phalanx to the horizontal (angle S) was 0.6° (interquartile range: −1.4, 2.3°). There was a positive relationship between angle S and the hoof wall angle (W); each 1° increase in angle S was associated with 0.6° increase in angle W (P < 0.001). Angle S was also positively associated with photographic heel angle; each degree increase in the angle S was associated with 1.8° increase in the heel angle (P < 0.001). It was concluded that the angle of the distal phalanx to the horizontal in hindlimbs is smaller than published values for forelimbs. The orientation of the distal phalanx in hindlimbs is correlated with external characteristics of the hoof capsule.     

Biochemical characterisation of navicular hyaline cartilage,navicular fibrocartilage and the deep digital flexor tendon in horses with navicular disease

The study hypothesis was that navicular disease is a process analogous to degenerative joint disease, which leads to changes in navicular fibrocartilage and in deep digital flexor tendon (DDFT) matrix composition and that the process extends to the adjacent distal interphalangeal joint. The objectives were to compare the biochemical composition of the navicular articular and palmar cartilages from 18 horses with navicular disease with 49 horses with no history of front limb lameness, and to compare navicular fibrocartilage with medial meniscus of the stifle and collateral cartilage of the hoof. Cartilage oligomeric matrix protein (COMP), deoxyribonucleic acid (DNA), total glycosaminoglycan (GAG), metalloproteinases MMP-2 and MMP-9 and water content in tissues were measured. Hyaline cartilage had the highest content of COMP and COMP content in hyaline cartilage and tendon was higher in lame horses than in sound horses (p<0.05). The concentration of MMP-2 amount in hyaline cartilage was higher in lame horses than in sound horses. The MMP-2 amounts were significantly higher in tendons compared to other tissue types. Overall, 79% of the lame horses with lesions had MMP-9 in their tendons and the amount was higher than in sound horses (p<0.05). In horses with navicular disease there were matrix changes in navicular hyaline and fibrocartilage as well as the DDFT with potential implications for the pathogenesis and management of the condition.     

Distal border fragments and shape of the navicular bone: radiological evaluation in lame horses and horses free from lameness

Reasons for performing study: The significance of distal border fragments of the navicular bone is not well understood. There are also no objective data about changes in thickness and proximal/distal extension of the palmar cortex of the navicular bone. Objectives: To describe the distribution of distal border fragments and their association with other radiological abnormalities of the navicular bone and describe the shape of the navicular bone in sound horses and horses with foot‐related lameness, including navicular pathology. Methods: Sound horses had radiographs acquired as part of a prepurchase examination. Lame horses had forelimb lameness abolished by palmar nerve blocks performed at the base of the proximal sesamoid bones. Diagnosis was assigned prospectively based on results of local analgesia and all imaging findings. The thickness of the palmar cortex of the navicular bone and size of proximal/distal extensions were measured objectively. Other radiological abnormalities were evaluated subjectively and each navicular bone graded. Results: Fifty‐five sound and 377 lame horses were included. All measurements were larger in lame compared with sound horses except the size of the distal extension of the palmar cortex. Fragments were observed in 3.6 and 8.7% of sound and lame horses respectively and in 24.1% of horses with a diagnosis of primary navicular pathology. There was an association between fragments and overall navicular bone grade, radiolucent areas at the angles of the distal border of the navicular bone and number and size of the synovial invaginations. Conclusions and potential relevance: The palmar cortex of the navicular bone was thicker in lame compared with sound horses. Distal border fragments were most frequent in horses with navicular pathology. Evaluation of changes in shape of the navicular bone may also be important for recognition of pathological abnormalities of the bone.     

Verification of scintigraphic imaging for injury diagnosis in 264 horses with foot pain

REASONS FOR PERFORMING STUDY: Nuclear scintigraphy is commonly used as a diagnostic aid for foot pain, but there is limited information about different patterns of radiopharmaceutical uptake (RU) and their correlation with the results of other imaging modalities. OBJECTIVES: To describe patterns of RU in horses with foot pain. MATERIALS AND METHODS: Scintigraphic images of the feet of 264 horses with front foot pain were analysed subjectively and using region of interest analysis. Magnetic resonance images of all feet were analysed prospectively; the navicular bones were reassessed retrospectively and assigned a grade. A Spearman rank correlation test was used to test for a relationship between the scintigraphic grade of the navicular bone and magnetic resonance imaging (MRI) grade. Sensitivity and specificity of scintigraphy for detection of lesions in the deep digital flexor tendon (DDFT), the collateral ligaments (CL) of the distal interphalangeal (DIP) joint and the navicular bone were determined. RESULTS: Increased radiopharmaceutical uptake (IRU) was detected in: a) the navicular bone (36.6%); b) pool phase images in the DDFT (13.0%); and c) at the insertion of the DDFT on the distal phalanx (14.3%). There was focal IRU at the insertion of the medial or lateral CL of the DIP joint in 9.4% and 1.5% of limbs, respectively. There was IRU in the medial and lateral palmar processes in 7.6% and 3.4% of limbs, respectively. There was a significant positive correlation between the scintigraphy grade and total MRI grade for the navicular bone and no difference between either focal or diffuse IRU and total MRI grade. There was high specificity, but low sensitivity of scintigraphy for detection of MR lesions of the navicular bone, the DDFT and the CLs of the DIP joint. CONCLUSIONS: Positive nuclear scintigraphic results are good predictors of injury or disease of the navicular bone, DDFT and CLs of the DIP joint. However, a negative scintigraphic result does not preclude significant injuries. CLINICAL RELEVANCE: Nuclear scintigraphy is a useful tool in the investigation of foot lameness and may help to determine the significance of MR lesions, especially if >1 lesion is identified that may be contributing to lameness.     

Evaluation of tachykinins and their receptors to determine sensory innervation in the dorsal hoof wall and insertion of the distal sesamoidean impar ligament and deep digital flexor tendon on the distal phalanx in healthy feet of horses

OBJECTIVE: To localize substance P (SP) and neurokinin A (NKA) and their receptors in the insertion of the distal sesamoidean impar ligament (DSIL), deep digital flexor tendon (DDFT), and dorsal hoof wall of healthy feet of horses. SAMPLE POPULATION: 18 healthy feet from horses. PROCEDURE: Samples from the dorsal hoof wall and insertion of the DSIL and DDFT of 10 feet were processed for immunocytochemical analysis, using rabbit polyclonal antisera raised against SP and NKA. Tissue sections from 8 feet were incubated with 125-labeled SP to localize tachykinin receptors and their specificity and with control solutions of radioactive SP and excess nonradioactive SP to identify areas of nonspecific binding. RESULTS: Many nerves immunoreactive for SP and NKA were localized to the region of the insertion of the DSIL and DDFT and the accompanying microvasculature and arteriovenous complexes (AVC) as well as to the microvasculature of the dorsal hoof wall. Specific neurokinin 1 receptors were localized over the microvessels and AVC of the insertion zone and small microvessels of the hoof wall. CONCLUSIONS AND CLINICAL RELEVANCE: These results document that the microvasculature of the equine foot is richly innervated and has specific receptors for tachykinins. Distributions of these tachykinin receptors on the microvasculature suggest that they form an important vasodilatory mechanism for controlling blood flow through the DSILDDFT insertion and dorsal hoof wall.     

Lameness in 46 horses associated with deep digital flexor tendonitis in the digit: diagnosis confirmed with magnetic resonance imaging

REASONS FOR PERFORMING STUDY: The differential diagnosis of foot pain has long proved difficult and the use of magnetic resonance imaging (MRI) offers the opportunity to further the clinical understanding of the subject. OBJECTIVES: To determine the incidence of deep digital flexor tendon (DDFT) injuries in a series of 75 horses with lameness associated with pain localised to the digit, with no significant detectable radiographic or ultrasonographic abnormalities, using MRI; and to describe a variety of lesion types and relate DDF tendonitis with anamnesis, clinical features, response to local analgesic techniques and nuclear scintigraphic and ultrasonographic findings. METHODS: All horses undergoing MRI of the front feet between January 2001 and October 2002 were reviewed and those with DDFT injuries categorised according to lesion type; horses with primary tendonitis (Group I) and those with concurrent abnormalities of the navicular bone considered to be an important component of the lameness (Group II). The response to perineural analgesia of the palmar digital nerves and palmar (abaxial sesamoid) nerves, intra-articular analgesia of the distal interphalangeal (DIP) joint and analgesia of the navicular bursa were reviewed. The result of ultrasonography of the pastern and foot was recorded. Lateral, dorsal and solar pool and bone phase nuclear scintigraphic images were assessed subjectively and objectively using region of interest (ROI) analysis. RESULTS: Forty-six (61%) of 75 horses examined using MRI had lesions of the DDFT considered to be a major contributor to lameness. Thirty-two horses (43%) had primary DDFT injuries and 14 (19%) a combination of DDF tendonitis and navicular bone pathology. Lesions involved the insertional region of the tendon alone (n = 3), were proximal to the navicular bone (n = 23) or were at a combination of sites (n = 20). Lesion types included core lesions, focal and diffuse dorsal border lesions, sagittal plane splits, insertional injuries and lesions combined with other soft tissue injuries. Many horses had a combination of lesion types. Lameness was abolished by palmar digital analgesia in only 11 of 46 horses (24%). Twenty-one of 31 horses (68%) in Group I showed > 50% improvement in lameness after intra-articular analgesia of the DIP joint, whereas 11 of 12 horses (92%) in Group II had a positive response. Twelve of 18 horses (67%) in Group I had a positive response to analgesia of the navicular bursa. Nineteen horses had lesions of the DDFT extending proximal to the proximal interphalangeal joint seen using MRI, but these were identified ultrasonographically in only 2 horses. Scintigraphic abnormalities suggestive of DDFT injury were seen in 16 of 41 horses (41%), 8 in pool phase images and 8 in bone phase images. CONCLUSIONS AND POTENTIAL RELEVANCE: DDFT injuries are an important cause of lameness associated with pain arising from the digit in horses without detectable radiographic abnormalities. Lameness is not reliably improved by palmar digital analgesia, but may be improved by intra-articular analgesia of the DIP joint in at least 68% of horses. Ultrasonography is not sensitive in detecting lesions of the DDFT in the distal pastern region, but a combination of pool and bone phase scintigraphic images of the digit is helpful in some horses. Further follow-up information is required to determine the prognosis for horses with lesions of the DDFT in the digit and to establish whether this is related to lesion severity and/or location.