10e Congrès de médecine et chirurgie équine 10. Kongress für Pferdemedizin und chirurgie 10th Congress on Equine Medicine and Surgery

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Close this window to return to IVIS 10e Congrès de médecine et chirurgie équine 10. Kongress für Pferdemedizin und chirurgie 10th Congress on Equine Medicine and Surgery Dec.

1 Close this window to return to IVIS 10e Congrès de médecine et chirurgie équine 10. Kongress für Pferdemedizin und chirurgie 10th Congress on Equine Medicine and Surgery Dec , Geneva, Switzerland La pathologie du pied et son imagerie médicale Hufpathologie und Deren Bildgebende Verfahren Hoof Pathology and Medical Imaging Reprinted in the IVIS website with the permission of the organizers

2 10 th Geneva Congress of Equine Medicine and Surgery (Organization : Pierre A. Chuit, Founex; Dr Stephane Montavon, Avenches), Geneva (CH), December 2007 SHOEING FOR PALMAR HOOF PAIN Hans Castelijns, DVM CF, Cortona, Italy INTRODUCTION Palmar hoof pain (PHP) is usually defined as a positive reaction (absence or decrease of lameness) after a distal palmar digital nerve block (DPDN block near the margin of the ungular cartilages). Although sometimes defined as a heel block, it anesthetizes the DIP joint, the entire sole, the distal phalanx (PIII) and the navicular apparatus ( 1 / Schumacher 2006). Besides podotrocleosis, which in itself is a condition which encompasses more than just naviculitis or navicular syndrome, PHP may therefore be due to : Heel or solar bruises and / or abscesses. Severe thrush or canker. Trauma to the bulbs (over reaching injuries). Osteitis of P III. (wing) fractures of P III. Quarter cracks. Quittor. Artrosis-arthritis of the DIP joint. The last is not always easy to differentiate from podotrocleosis as DIP joint anesthesia (especially when more than 6 ml of local anesthetic is used), might, by distending the palmar pouches, anesthetizes the DPD nerves.( 1 / Schumacher 2006). CLINICAL EXAMINATION Careful clinical examination, including inspection, palpation, pulse taking and judicious use of hoof testers (before anesthesia of course), remains the most valuable tool in differentiating among the different conditions mentioned above. This examination requires patience and more clinical skills than is often assumed, but can, together with a good history work up, often save a lot of frustration. An especially valuable clinical test is the digital extension / elevation test. Traditionally done with a board, this test evaluates the horse s tolerance to dorsal extension, ( 2 /Desbrosse, 2002) fig.1 a,b,c,]. A graduated Digital Extension Device (DED) has been developed by the author which, besides measuring the exact degrees of tolerance to the dorsal extension of each forelimb, also permits evaluation and measurement of the tolerance to lateral and medial elevation of the foot, which causes collateromotion of the DIP joint (3/ Chateau et al, 2002). Tolerance to dorsal extension is variable for each limb, depending on conformation, and can vary in sound horses from around 30 (some quarter horses with straight short pasterns and tighter deep digital flexor tendons (DDFTs), to over 45 (e.g. some thorough bred horses with long oblique pasterns, and lax DDFTs). Sound horses tolerate lateral and medial elevations of the foot till the opposite side of the foot lifts off the surface of the DED. The degree of elevation at which this occurs, is much more standardized across breedand conformation types, than dorsal elevation; typically being 19 of lateral elevation and of medial elevation. Differences between lateral and medial degrees, are probably due to the fact that the test is performed with the opposite limb held off the ground, whereby the horse places the weight bearing, and tested, limb,closer to the midline of its body. Intolerance to dorsal extension may indicate : Podotrocleosis, including bursitis, impar ligament desmitis, distal DDF tendonitis and desmitis of the collateral ligaments of the distal sesamoid. Proximal DDF tendonitis. Inferior check ligament desmitis. Dorsal laminar inflammation. Intolerance to lateral or medial elevation may indicate : DIP, PIP or MC Phalangeal collateral ligament desmitis (on the opposite side of the elevation), Laterally or medially located subcondral bone lesions of the digital joints (on the ipsilateral side of elevation), Lateral or medial suspensory ligament branch desmitis (opposite side), Arthrosis of digital joints with lateral or medial bone spur formation (ipsilateral side, generally). 126 Congrès de médecine et de chirurgie équine, Genève 2007

3 Distal DDF tendonitis located in the lateral or medial lobes of the tendon, (opposite side). P III fractures (wing, ipsilateral side). Trimming mistakes are characterized by reduced elevation values on one side, accompanied by increased elevation values on the opposite side of the foot (trim more on the side of reduced elevation values). Finally, there are conditions which might reduce tolerance to extension in a combination of directions: dorsal and lateral, dorsal and medial, lateral and medial, all three. General objectives of therapeutic shoeing is to spare painful structures, but this can only be done by loading other structures more: e.g.: a reverse shoe on soft ground relieves the DDFT, but loads the superficial DFT and the suspensory ligament ( S:L.) more. Table 1 Illustrates therapeutic shoeing techniques for Palmar Hoof Pain conditions excluding DIP-PIP artrosis and podotrocleosis Table 2 Illustrates therapeutic shoeing techniques for DIP-PIP artrosis and for podotrocleosis DIAGNOSTIC IMAGING In recent years diagnostic imaging has made great strides, as first ultrasound and then MRI and CAT have allowed for much more detail when looking into the foot. High quality, (digital) X rays, including the use of contrast material, have also progressed, but the great difference is certainly the ability to better detect soft tissue injuries, which generally precede bony lesions [fig. 2]. Better diagnostics though, also means finding more lesions, often in different, even adjacent structures, each of which theoretically requires different biomechanical solutions (read shoeing strategies). This is another point which indicates the importance of a good, clinical work up; e.g. if a lesion in the distal DDFT, adjacent to a lesion in the straight distal sesamoidean ligament is detected, it is necessary to find out if the horse resents dorsal digital extension more than fetlock extension, before prescribing therapeutic shoeing [ fig. 3.a,b.]. THERAPEUTIC SHOEING TECHNIQUES The following elements should be taken into account when considering shoeing prescriptions : Type of lesion, clinical signs. Type of work-performance expected from the horse. Surface the horse works on. The last element is of paramount importance, because a lot of shoeing techniques which are based on changing around the ground wearing surface of the shoe, only work on penetrable ground. As far as the type of work goes, some disciplines require an enormous amount of work on (tight) circles others do not (e.g. standard bred racing). Some lesions hold out hope for eventual healing ( e.g. some soft tissue injuries ), and the therapeutic shoeing will only be temporary; other lesions are permanent (e.g. ring bone), and therapeutic shoeing techniques will be necessary for the rest of the horse s (working) life. Congrès de médecine et de chirurgie équine, Genève

4 Table 1 THERAPEUTIC SHOEING TECHNIQUES FOR PALMAR HOOF PAIN CONDITIONS EXCLUDING DIP-PIP ARTROSIS AND PODOTROCLEOSIS Condition Ground surface (Treatment) trimming, shoeing techniques - Other comments a) heel or solar bruises /abscesses Compact/deep 1)drainage, preferably through the hoof wall (not through the sole). Local disinfection animal lintex 2) Shoes which offer protection to the seat of corn, to the sole [fig. 4]; hospital plates, open up pad, which can keep bandaging or packing in. b) thrush or canker Compact/deep 1) surgical debridement 2) hospital plate 3) topical application of 50 /50 picryc acid and salicylic acid in c/ traumas to the bulb Compact/deep (often on deep ground) d) osteitis of P III Compact/deep (More problems on hard ground ) e) (wing) fractures of P III Stall rest recommended Rehab. on soft ground f) quarter cracks (q.c.) Compact/deep (worse on compact surface) powder postop. form every 2/3 days Topical treatment Over read books after healing, setting back the hind shoes, facilitating quicker dorsal break over on the front shoes (rolled, set back front shoes) slightly lowering, feathering the heels on the front hooves, shoes. 1.dorsal edge of P III ( responds to DPDN block) increase sole depth under the tip of P III, ( Rim) pads, glue on shoes, medium hard sole support packing under the palmar part of the hoof. 2. Palmar processes (negative palmar angle of P III), increase palmar sole depth, frog support pads (e.g. P.M: pads ) soft silicone or polyurethane packing. Onion shoes with high quality leather pads or Luwex Senior pads. Do not raise heels. Note : In case of (post neuroctomy) DDFT laceration : desmotomy of the extensor branches of the fetlock suspensory apparatus. (5 Leveillard) [fig. 5]. Sagittal fractures : four clipped shoe (two clips ahead of the widest part of the hoof, two clips just behind the widest part ) beveled ground surface of the shoe, negative pressure heart bar, that is with space between frog plate and frog [fig. 6 a,b.]. Wing fractures : idem with three clips (quarter clips plus one clip at the heel of the fractured palmar process). 1. Spontaneous, descending, painful q.c. s are caused by ipsilateral ungular, Cartilage entrapment by a shunted up heel wall. Heel wall should be lowered, to obtain at least 15 mm of free ungular cartilage margin above the hoof wall [ fig. 7 a,b ]. This is best done with a double trim method whereby after the initial trim of the hoof, a second trim on the side of the q.c. is performed, which goes from 0 at the ipsilateral toe to 6-8- mm at the ipsilateral heel in a straight line. 2. Debridement, medication, drainage and fixation of the crack. 3. Frog-support. COPPSC («Mercedes shoes ) [ fig.8 a, b]. Do not raise heels! ( 6 /Castelijns) g) Quittor Compact/deep Surgical debridement, regional A.B. perfusion, bar shoes, bandaging. 128 Congrès de médecine et de chirurgie équine, Genève 2007

5 Table 2 THERAPEUTIC SHOEING TECHNIQUES FOR DIP-PIP ARTROSIS AND FOR PODOTROCLEOSIS Condition: DIP, PIP artrosis and / or podotrocleosis, e.g. single collateral ligament lesion, single lobe of distal DDFT, single collateral ligament of Nav. e.g. artritis DIP artrosis e.g. NAV. Bursitis Distal DDF tendonitis impar lig. Desmitis. e.g. DIP arthrosis and podotrocleosis Intolerance to : Works on surface Shoeing, trimming techniques Lateral elevation or median Lateral and medial Dorsal extension Dorsal extension and lateral and medial elevation. deep Narrow web shoe, beveled ground surface on the side of intolerance, wider ground surface on the opposite side, short hooves, short shoeing intervals [fig. 9]. compact 1. flexible shoes (e.g. Flaps, easy walker) [ fig. 10]. 2. strongly beveled ground surface (outside rim) on the side of intolerance. 3. Rockered ipsilateral toe shoe ( French rockered toe ). 4. Full rolling motion shoes, slightly displaced towards the opposite side of the intolerance. Note : Short intervals do not leave heels too long / high, specially in the case of dorsal entheseophytes. deep 1. short, barefoot trim, well rounded borders not too much heel. 2. Flexible shoes, short shoeing intervals 3. Half round section shoes, tightly fit (e.g. classic roller or eventer) [ fig. 11]. compact 1. French rockered toe (rocker goes from quarter over the toe to opposite quarter; heels stay flat. 2. Half round section shoes. 3. Full rolling motion shoes (e.g. rock n roll, PG shoes) [fig. 12 a,b.] Note : consider shock absorption ( aluminum, pads), keep shoeing intervals short, do not set the shoes too wide. deep 1. rolled-rockered - set back- toe shoes. 2. the same plus egg bar. 3. Reverse shoeing [fig. 13]. compact 1. rolled-rockered toe. 2. Blunt - set back toe, e.g. NBS or Sagittal [fig. 14,a,b]. 3. Aluminum square toed (wear is faster in the toe between shoeing intervals). 4. Shock absorbing pads, mild frog support pads (test for sensibility of the frog area). 5. Full rolling motion shoe s with the ground area at the toe strongly beveled; the higher total thickness of the shoe permits an extreme rolled toe. deep 1. Set back shoe (blunt toe) with beveled ground edges and egg bar. 2. Palmar frog and sole support. (less heel penetration). 3. Full rolling motion shoe with heel bar [fig. 15]. compact 1. Full rolling motion shoe, with small central base, well set back. 2. Shock absorbing pad if sensitive to hammer blows to the shoe, short shoeing intervals. Congrès de médecine et de chirurgie équine, Genève

Equine Lameness & Imaging Techniques

Equine Lameness & Imaging Techniques Peter Heidmann DVM MPH Specialist in Equine Internal Medicine Montana Equine Medical & Surgical Center www.montanaequine.com 406-285-0123 Types of lameness Skeletal