Farriery for the foal: A review part 2: Therapeutic farriery

The extensive nature of this topic warrants this review paper to be divided into two parts: ‘Basic trimming in foals’ and ‘Therapeutic farriery in foals’. Management of the feet and limbs during this juvenile period will often dictate the success of the foal as a sales yearling or mature sound athlete. Overall hoof care in the foal is often a joint venture between the veterinarian and the farrier. The orthopaedic disorders discussed in this paper that require input from the two professions are flexural limb deformities (FLD) and angular limb deformities (ALD). The concept of protecting the foot from the deleterious effects of mal-loading created by many FLDs and ALDs is just as important as using the symptomatology as an instrument to correct the deformity. This paper presents a review of the current information regarding the farriery for these two limb deformities while dispelling some of the anecdotal methodology, such as the use of toe extensions to treat flexural deformities, that presently exists. Considering the deficiency of information in the literature, segments of this text will be based on the author's extensive clinical practice, comprehensive clinical records and comparisons of case outcomes.     

Bilateral distal radial epiphysectomy and pancarpal arthrodesis for correction of complex carpal deformities in an American Miniature horse

A 9‐day‐old American Miniature horse was referred for evaluation and treatment of congenital bilateral carpal deformities. Clinical examination revealed a combination of flexural, angular and rotational deformities affecting both carpi. Radiographic evaluation of both forelimbs revealed malformation of the distal radial epiphysis accompanied by flexural contracture and external rotation of the limb distal to the antebrachial carpal joint. Conservative therapy was attempted with splints and bandages and failed to result in improvement. Surgical intervention was elected and a bilateral distal radial epiphysectomy and pancarpal arthrodesis performed. Fourteen months later the mare was turned out to pasture and ambulating well.     

A review of angular limb deformities

This article provides some guidelines for the evaluation and management of angular limb deformities in young horses. It begins by looking at factors that influence conformation and that should be taken into consideration when making a decision as to the significance of a particular conformational trait. Perinatal and acquired deformities are then discussed separately with an emphasis on the latter. Options for their correction are described as well as the results of recent publications using these techniques. Finally the approach to management of deformities at each of the most commonly encountered locations is described.     

Use of an external ring fixator for correction of an acquired angular limb deformity in a donkey

Numerous techniques for surgical correction of angular limb deformities in horses involving an osteotomy of the affected bone and stabilization with an internal fixation device have been described. However, because the osteotomy typically has to be performed at the level of the physis, leaving little bone between the physis and the nearest joint, stabilizing the osteotomy by use of internal fixation devices may be difficult. In horses with severe chronic angular limb deformities, the amount of soft-tissue contracture may make it impossible to correct the deformity during a single procedure without causing stretch injuries to the adjacent tendons and neurovascular structures. Adjustable external ring fixators incorporating hinged rods on 1 side of the limb and an angular motor assembly on the other may be useful for treatment of severe chronic angular limb deformities in younger equids, because they allow for gradual correction of the deformity.     

Principles of uniapical and biapical radial deformity correction using dome osteotomies and the center of rotation of angulation methodology in dogs

OBJECTIVE: To describe the normal anatomic axis of the canine radius in 2 planes (frontal, sagittal), and report the use and efficacy of dome osteotomies for acute correction of canine antebrachial deformities. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Normal antebrachii (n = 20) radiographs were used as a reference, and 7 dogs with 9 radial angular limb deformities that were corrected by use of dome osteotomies. METHODS: Orthogonal radiographs of 20 normal antebrachii were used to determine normal ranges of frontal (FPA) and sagittal plane anatomic axes (SPA). Pre and postoperative radiographs of 7 dogs (9 radii) that had surgical correction of radial angular limb deformities by dome osteotomies were reviewed. Success at deformity correction into established normal ranges and to the normal contralateral side, if present, was determined. RESULTS: Normal ranges were FPA, 0-8 degrees and SPA, 8-35 degrees . There were 4 biapical and 5 uniapical deformities. FPA and SPA were corrected into normal range in 66% and 78% of affected limbs, respectively; however, only 44% of radii were corrected into normal ranges in both planes. CONCLUSIONS: Ranges for normal canine radial axes can be used as goals for angular limb correction when there is bilateral angular deformity. The dome osteotomy technique is advantageous in certain conditions for biplanar deformity correction. CLINICAL RELEVANCE: Dome osteotomies can be used to correct radial deformities in the frontal and sagittal planes, with certain advantages, but are heavily reliant on appropriate preoperative planning.     

Active tension‐extension splints: A novel technique for management of congenital flexural deformities affecting the distal limb in the foal

A variety of methods are described for managing distal limb flexural deformities in the foal, including intravenous oxytetracycline and splint or cast use. This case series describes a novel technique that creates an ‘active tension‐extension splint’ by wiring the toe into a custom‐made fibreglass splint and therefore into active extension. A dorsal fibreglass splint is made by halving a cast that is set around the affected leg with padding underneath it, so that it is sculpted to a more appropriate anatomical shape. Cerclage wire is placed through the toe and the dorsal aspect of the splint, then tightened to pull the limb into active extension. Foals with distal limb flexural deformities that were treated in this way were followed up by examination of hospital records and telephone questionnaire. Records were examined for 13 foals treated between 2004 and 2010. One foal developed septic osteitis of the distal phalanx due to suspected laminar penetration; other post operative complications seen were bandage sores and minor cosmetic scarring. Out of 10 foals where follow‐up by questionnaire was available, 8 had complete resolution of their deformity following active tension‐extension splinting, one required inferior check ligament desmotomy for complete correction and one had carpal flexural deformities that did not resolve. All that survived to adulthood are sound and have achieved their intended purpose. This previously unpublished technique using a wire through the toe to create an active tension‐extension splint has a high success rate for correction of congenital flexural deformities affecting the distal interphalangeal and metacarpo‐/metatarsophalangeal joints in the foal. The majority of post operative complications are minor and easily managed. This is a simple technique that can improve the management of neonatal distal limb deformities both in a hospital situation and for equine practitioners in the field.     

Commercial diet recommendations and follow-up for a large breed puppy with an intrahepatic portosystemic shunt

A 6-month-old, intact male Great Dane dog fed a veterinary therapeutic liver diet was evaluated after diagnosis of an intrahepatic portosystemic shunt and hind limb angular limb deformity to determine appropriateness of diet. Evaluation of the current diet revealed it to be inadequate to meet the nutrient requirements of a large breed puppy. The dog clinically improved following a change in diet. There was no longer any angular limb deformity and no reported neurological signs. This report highlights the importance of appropriate feeding management during growth and demonstrates that although veterinary therapeutic diets may appear to be an appropriate choice initially, they may not be ideal for growing puppies as a long-term feeding option.Key clinical message:An individual approach is key for nutritional management of complicated canine veterinary medical cases and includes consideration of the patient’s life stage requirements when modifying nutrient intake to manage clinical disease.     

T-plate fixation of distal radial closing wedge osteotomies for treatment of angular limb deformities in 18 dogs

OBJECTIVE: To describe the surgical technique and clinical results of treatment for forelimb angular limb deformities, secondary to premature distal radial or ulnar physeal closure, by using T-plate fixation of a distal radial closing wedge osteotomy in 18 dogs. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: 18 client-owned dogs. METHODS: The medical records of 18 dogs that underwent a distal radial closing wedge osteotomy with T-plate fixation for correction of a forelimb angular limb deformity were reviewed. Small pins (Kirschner wires) were used to obtain the appropriate alignment of the antebrachiocarpal and elbow joints and proper limb orientation. In-hospital follow-up evaluation was obtained at the time fracture healing was observed radiographically. Further long-term follow-up was obtained by owner interview. RESULTS: Osteotomy sites were radiographically healed within 4 to 12 weeks (mean, 8 weeks) after surgery in the 14 dogs that returned for in-hospital follow-up. Limb function was graded as good or excellent in all dogs. Long-term follow-up by owner interview rated limb function and cosmetic appearance as good to excellent in all dogs. Plate removal was necessary in one dog 7 months after surgery because of osteopenia in the radius. CONCLUSION: This surgical technique was considered successful in the treatment of angular limb deformities in all dogs. A good to excellent prognosis is to be expected with this technique, with minimal complications. CLINICAL RELEVANCE: The use of a T-plate for the correction of angular limb deformities has not been previously described in the literature. This technique permits accurate correction of the angular limb deformity and minimizes postoperative complications.     

Correction of angular limb deformities in foals: A review

Angular limb deformities may result in permanent impairment of the foal, if not corrected early. Due to the simplicity of the approach and the effectiveness of hemicircumferential transection and periosteal stripping, the general practitioner can benefit from this technique. In most cases where this procedure is applicable, correction of the angular limb deformity is achieved. Overcorrection does not appear to be a problem.     

Congenital bilateral aplasia of the metacarpophalangeal joints in a foal

A 2‐day‐old Warmblood filly was presented for examination of an angular limb deformity of the left front limb and an upright conformation of both metacarpophalangeal joints. Radiological examination revealed bilateral absence of the metacarpophalangeal joint space with fusion of the third metacarpal bone and first phalanx (synostosis). No treatment was undertaken. The filly was readmitted to the clinic 10 weeks later for bilateral front limb lameness. On radiological examination, the synostosis of the front metacarpophalangeal joints was still present. Physitis of the distal growth plate of the right third metacarpal bone and proximal growth plate of the right proximal phalanx, and an avulsion fracture of the palmaromedial and proximal aspect of the left middle phalanx, with a cystic like lesion on the medial aspect of distal first phalanx and proximal middle phalanx were diagnosed. Given the poor prognosis, the foal was subjected to euthanasia. Post mortem examination confirmed the absence of the metacarpophalangeal joint space with a trabecular bony union between the third metacarpal bone and the first phalanx. A rudimentary joint capsule was present at the level of the absent joints as well as a small zone of articular cartilage, which invaginated over a short distance into the dorsal trabecular bone on the right front limb. On the medial aspect of the left proximal interphalangeal joint, a focal defect of articular cartilage with exposure of subchondral bone was observed. This is the first case report of a foal born with congenital aplasia of both metacarpophalangeal joints. Congenital malformations should be considered as differential diagnosis in lame foals or foals born with angular or flexural limb deformities.     

Racing and sales performance after unilateral or bilateral single transphyseal screw insertion for varus angular limb deformities of the carpus in 53 thoroughbreds

Objective: To evaluate the racing and sales performance of Thoroughbred horses with varus angular limb deformities of the carpus treated by unilateral or bilateral single transphyseal screw (STS) placement. Study Design: Case series. Animals: Thoroughbred horses (n=53). Methods: Medical records (January 1, 2005–December 31, 2006) of yearling Thoroughbreds treated for carpal angular limb deformity by transphyseal screw insertion in the distal aspect of the radius were reviewed. Retrieved data were sex, surgery, and screw removal dates, surgical site, appearance, limb(s) affected, type of angular limb deformity, and degree of angular deviation measured by a goniometer. Racing and sales data were collected for analysis from an online racing site for all treated horses and their maternal siblings. Results: No significant differences were identified between treated horses and their maternal siblings in yearling sale price, 2‐year‐olds in training sale price, percent starters, percent winners, and starts, earnings, and earnings/start made during the 2‐ and 3‐year old years. Conclusions: No deleterious effects on sales or racing performance were identified after use of STS in the distal aspect of the radius of Thoroughbreds for the treatment of varus angular limb deformities of the carpus.     

Use of hinged circular fixator constructs for the correction of crural deformities in three dogs

Background Hinged circular external skeletal fixator constructs are used to perform sequential correction of angular limb deformities, often with resultant limb segment lengthening, via distraction osteogenesis. Although there are several reports describing the use of these constructs for correction of antebrachial deformities in dogs, there is little information regarding their use on other limb segments. This report describes the use of hinged circular fixator constructs for the correction of acquired crural deformities in three skeletally immature dogs. Case reports Two dogs had purely frontal plane deformities (one valgus, one varus) and the third dog had frontal (valgus) and sagittal (recurvatum) components to its deformity. At the time of long‐term evaluation, frontal plane angulation relative to the contralateral limb improved from 40° to 22° of valgus, 30° to 5° of valgus, and 20° to 1° of varus in the three individual dogs. Tibial length discrepancies of 12% and 22% that were initially present in two dogs were improved to 6% and 10%, respectively, of the contralateral tibial length at the time of final evaluation; both dogs had compensatory growth of the ipsilateral femur and all dogs had an excellent functional outcome. Conclusion These cases illustrate the value of using hinged circular fixator constructs for correction of crural angular deformities, particularly when length discrepancies of the tibia are present.     

Canine pedal injury resulting from metal landscape edging

Background – This study was performed to document the frequency and severity of limb injuries that occur when dogs come in contact with metal landscape edging. A retrospective study from 1997 to 2007 was performed at Colorado State University veterinary teaching hospital. Sixty dogs were admitted to hospital for traumatic limb injuries resulting from metal landscape edging identified by a computerized medical records search. Key Findings – Most dogs were young, large breed dogs. All 60 dogs suffered traumatic pedal lacerations when contacting metal landscape edging, the majority of which occurred on the forelimbs. Eighty‐five percent required surgical repair. All 60 dogs were discharged from the hospital and 30 were available for long‐term follow‐up. While most dogs healed with a perfect cosmetic outcome, 3 dogs with tendon involvement developed residual digital deformities. Significance – Dogs are at risk of injury when exposed to metal landscape edging. Severity of pedal injury determines treatment protocol and prognosis for recovery.     

Periosteal transection of the proximal phalanx in foals with angular limb deformities of the metacarpo/metatarsophalangeal area

Bilateral angular limb deformities of the metacarpo/metatarsophalangeal regions in 2 foals are discussed. Periosteal transection was used to correct the deformity in both foals. In one foal, only the right forelimb was treated because the deformity in the left forelimb did not appear to warrant surgery. Subsequently, an angular limb deformity, which could have been prevented, developed in the left forelimb. A third foal developed a deformity in the proximal phalanx after periosteal transection of the distal third metatarsal bone.     

Skeletal Atavism in a Miniature Horse

An 8-month-old miniature horse filly was presented for evaluation of severe rotational and angular limb deformities of the thoracic and pelvic limbs. On radiographic examination, complete ulnas and fibulas were identified. These findings are consistent with a condition previously described as a form of atavism. The term atavism is used to describe the reappearance of a trait or character that was seen in all earlier evolutionary specimens of a particular species, but has not been seen in recent ancestors. The atavistic traits of complete ulnas and fibulas have previously been described in Welsh and Shetland Ponies, all of which had severe rotational and angular limb deformities. In this horse, bilateral osteochondritis dissecans of the medial trochlear ridge of the talii were also identified. To the authors' knowledge, this is the first report of the atavistic traits of complete ulnas and fibulas seen in the miniature horse.     

Single transphyseal screws for the correction of moderate to severe angular limb deformities in 28 Thoroughbred foals

This study reports on the effective use of a single transphyseal screw for the treatment of moderate to severe angular limb deformities (ALDs) of the fetlocks and carpi of 28 young Thoroughbred foals. The objective was to evaluate the surgical management of foals with moderate to severe ALDs treated with single transphyseal screws. Evaluation of medical records of 28 Thoroughbred foals treated with single transphyseal screws placed across the distal radial, metacarpal and metatarsal physes was undertaken. The angle of joint deviation was measured prior to implantation and at removal of the implants, and the degree of improvement was calculated. A total of 39 screws were placed: 24 in the distal metacarpus or metatarsus and 15 in the distal radial physis. Varus or valgus deformities in the fetlock improved by 4–5° over a period of 15–30 days. Varus or valgus deformities in the carpi improved by 8–11° in 11–56 days. One case failed to improve adequately due to implant infection. Single transphyseal screws were effective in treating moderate to severe varus and valgus ALD of the fetlocks and carpi in young Thoroughbred foals. Further investigation into their use in the distal radius in young foals is needed. While single transphyseal screws are almost exclusively used by some clinics in the distal metatarsal and metacarpal physes, many clinicians do not use them in the distal radial physis of young foals due to fear of over‐correction, physitis and metaphyseal collapse. This was not observed in any of our cases.     

Correction of angular limb deformity in two subspecies of flamingo (Phoenicopterus ruber) utilizing a transphyseal bridging technique.

Three hand-raised American flamingo (Phoenicopterus ruber ruber) chicks and one hand-raised Chilean flamingo (Phoenicopterus ruber chilensis) developed valgus angular limb deformities of the proximal tarsometatarsal bone. All flamingos underwent surgical correction to unequally retard the growth plate using transphyseal bridging. Positive profile pins were placed in the proximal epiphysis and distal to the growth plate in the metaphysis on the convex side of the affected tarsometatarsus. Various banding techniques were used in each flamingo to create tension. Three of the four flamingos responded in 7-14 days with correction or slight overcorrection of the valgus limb deformity. The fourth flamingo's leg deformity did not improve for reasons thought to be related to improper implant placement. Growth plate retardation by transphyseal bridging proved successful in correcting valgus limb deformity of the proximal tarsometatarsus. This technique may be considered as an option for correction of angular limb deformities of the proximal tarsometatarsus in flamingos less than 90-120 days of age.     

Femoral head excision after coxofemoral luxation in an Arab filly: Four years follow‐up

A foal with a cranio‐dorsal coxofemoral luxation was treated with a prosthetic capsulorraphy technique after open reduction. After reluxation a femoral head ostectomy was performed for salvage purposes. The filly was discharged with minimal lameness and was using the limb properly after 51 days of hospitalisation. Four years later the filly is still doing well as a breeding mare, with an acceptable quality of life despite angular deformities in the contralateral limb.     

Complications after two transphyseal bridging techniques for treatment of angular limb deformities of the distal radius in 568 Thoroughbred yearlings

Reasons for performing study: Surgical correction of carpal angular limb deformities by growth retardation is commonly undertaken with a screws and tension band wire loop technique (S&W) or a single transphyseal screw (STS). This study compares complications after S&W and STS bridging in the distal radius of Thoroughbred yearlings. Objective: To compare the prevalence of complications serious enough to require follow‐up radiographs following either S&W or STS surgery for growth manipulation in the distal radius of Thoroughbred yearlings. Methods: Medical records and radiographs from Thoroughbred yearlings (age range 261–457 days) treated for carpal angular limb deformities at a single hospital over 2 years were reviewed. Each of the techniques was used exclusively during a single year. The complication threshold criterion for inclusion was the need for nonroutine radiographs of the operated site anytime after implant insertion or removal. Results: Of 568 horses, 253 received S&W and 315 received STS. Horses were of similar age at the time of surgery for STS and S&W. Single transphyseal screws were left in place for a significantly shorter amount of time (16 days). Sex, the limb(s) treated and medial vs. lateral placement were not significantly different between techniques. Complications included physitis post implant removal, metaphyseal collapse post implant removal, infection, overcorrection and seroma formation severe enough to require radiography. Physitis and metaphyseal collapse occurred significantly more frequently with STS compared with S&W. Infection, overcorrection and seromas were not significantly different between techniques. Conclusion: The STS and S&W techniques are both viable treatment options for correction of carpal angular limb deformities. However, horses treated with the STS technique have a significantly increased risk of developing physitis or metaphyseal collapse. Potential relevance: Horses treated with STS bridging have a significantly increased risk of developing the post correction complications of moderate to severe physitis and metaphyseal collapse compared with horses treated with S&W bridging.