Equine Acute and Chronic Foot Problems

Question 1

List 6 visible lesions you may see on a horses foot

Answer 1

Bruising
Cracks
Swelling
Discharge
Widening of white line
Divergence

Question 2

List two reasons for palpation of the coronary band

Answer 2

Sinking of the extensor process of P3 in laminitic cases
Identifying effusion of the DIP joint

Question 3

Why may you palpate the coronary band circumfrentially?

Answer 3

To identify if a foot abscess has track up under the doral hoof wall and is about to burst at the coronary band

Question 4

How can you support a hoof with cracks going up from the floor?

Answer 4

Avoid a toe clip and use quarter clips instead to use the hoof as a single structure.

Question 5

What are the three synovial structures in the equine hoof?

Answer 5

Distal interphalangeal joint
Navicular bursa
Digital tendon sheath

Question 6

Which joint block may also affect the navicular bursa?

Answer 6

DIP joint blocks

Question 7

Which type of wound commonly causes infection of the navicular bursa?

Answer 7

Solar puncture wounds

Question 8

Which markers could you use when radiographing a horses foot?

Answer 8

Dorsal hoof wall
Coronary band
Point of frog

Question 9

Describe how you would perfom a P3 lateromedial radiograph, including the position of the foot, position of the casette and where the beam should be centered.

Answer 9

Position of foot: weight bearing on blocks
Casette: Against medial aspect of the limb on the ground, perpendicular to limb
Beam: Centered at mid coronary band with heel bulbs visually superimposed, generator on the ground

Question 10

List 7 lateromedial features of a radiograph of an equine foot to assess

Answer 10

Centre of arc of DIP vertically over middle of hoof and point of frog
Dorsal hoof wall/dorsal P3/heel/pastern
Coronary band - extensor process of P3
Solar thickness
Solar surface of P3 at 5-10 degrees from hoof
Wall thickness
Tip of P3 is a point not a lip
Extensor process shape (variable)

Question 11

Describe how you would perfom a P3 dorsopalmar radiograph, including the position of the foot, position of the casette and where the beam should be centered.

Answer 11

Position: weight bearing on blocks
Casette: on ground palmar/plantar aspect of limb, perpendicular to limb
Beam: parallel to ground, centered at coronar band

Question 12

List three feature of a dorsopalmar radiograph of the foot that you should loook out for

Answer 12

Mediolateral imbalance - difference between P3 and sole
Hoof wall flare
Shows mineralisation of ungal cartilage

Question 13

Describe how you would perfom a P3 dorso-proximal palmaro-distal oblique view radiograph, including the position of the foot, position of the casette and where the beam should be centered.

Answer 13

Position of the foot: weight bearing on tunnel
Casette: inside the tunnel
Beam: centered 2cm above the doral coronary band 60-65 degrees angle

Question 14

Describe how you would take a DP-PaDO radiograph

Answer 14

Focus on P3 or navicular bone
P3 first then; increase exposure, reduce collimation, change positioning for navicular bone

Question 15

List 5 features you may see on a DP-PaDO radiograph

Answer 15

Margin of P3
Wings of P3 DIP joint congruity
Crena - valuable appearance
Vascular channels normal

Question 16

Describe how you would perfom a P3 dorsolateral-palmaromedial oblique (DLPMO) radiograph, including the position of the foot, position of the casette and where the beam should be centered.

Answer 16

Position: weight bearing on tunnel
Casette: in tunnel
Beam: 60PrDi, 45 off DP, just distal to coronary band

Question 17

List 3 features of a DLPMO radiograph

Answer 17

Symmetry between sides and feet
Useful for pedal wings
DIP joint

Question 18

Describe how you would perfom a P3 palmaroproximal-palmardistal oblique radiograph, including the position of the foot, position of the casette and where the beam should be centered.

Answer 18

Position of foot: weight bearing on tuneel with limb placed caudally
Casette: in tunnel
Beam: 50-55PaPr centered just above heel bulbs

Question 19

Which three features of a palmaroproximal-palmarodistal oblique radiograph change appearance with the angle take?

Answer 19

Corticomedullary definition
Flexor margin shape
Overlap with P2/P3

Question 20

Which three features may you see on a transcutaenous ultrasound of the foot?

Answer 20

Collateral ligamnt of DIP (proximal portion)
DIP joint effusion (dorsally)
DDFT between heel bulbs

Question 21

LIst five equine hoof structures that are clearly visible on MRI

Answer 21

Pedal bone
Navicular bone
DIP joint
P2
Tendon sheaths

Question 22

What are the three main aetiologies of common causes of acute foot lameness?

Answer 22

Infection
Trauma
Laminitis

Question 23

Describe the aetiology, presentation, diagnosis and treatment of nail bind/pricked hoof in horses.

Answer 23

Aetiology - nail place in or axial to white line during farriery
Presentation - Acute severe lameness shortly after farriery
Diagnosis - hoof testers and paring
Treatment - rest, unshod, poultice

Question 24

Describe the aetiology, presentation, diagnosis and treatment of corns in horses.

Answer 24

Aetiology - collapsed bars, too long shoeing interval
Presentation - Mild-moderate lameness
Diagnosis - hoof testers, visible
Treatment - rest, unshod, poultice, reshoe after paring

Question 25

Describe the aetiology, presentation, diagnosis and treatment of hoof (subsolar) abscess in horses.

Answer 25

Aetiology - penetrating injury to solar surface, bacteria tracking up white line Presentation - Acute NWB lameness, increased digital pulses Diagnosis - pain on hoof testers and paring (pus will be released Treatment - rest, tubbing, poultice

Question 26

Describe the aetiology, presentation and investigation of deep puncture wounds in horses.

Answer 26

Aetiology - usually foreign body, if in situ leave Presentation - acute NWB lameness Investigation - hoof testers, paring, radiographs, MRI

Question 27

Which structures must you assess when a deep puncture wound of a horses foot is present?

Answer 27

Distal interphalangeal joint Navicular bursa Digital flexor tendon sheath

Question 28

Describe the aetiology, presentation, diagnosis and treatment of pedal osteitis in horses.

Answer 28

Aetiology - septic focus in P3, often following PIF/puncture Presentation - Acute severe lameness, increased digital pulses Diagnosis - pain on hoof testers, imaging Treatment - cureete back to healthy bone, remove any sequestrate which has formed. Management of open wound.

Question 29

Describe the aetiology, presentation and diagnosis of P3 fractures in horses.

Answer 29

Aetiology - trauma, kick wall Presentation - acute onset severe lameness Diagnosis: radiography, MRI, CT

Question 30

List two treatment options for P3 fractures

Answer 30

Surgical lag screw Conservative bar shoe and rest

Question 31

Describe the aetiology, presentation, diagnosis, configuration and treatment of navicular bone fractures in horses.

Answer 31

Aetiology - trauma Presentation - Acute severe lameness, increased digital pulses Diagnosis - radiographs, MRI Configuration - usually parasaggital and slightly oblique Treatment - surgical lag screw Conservative; bar shoe with quarter clips, rest

Question 32

Describe the aetiology, presentation and treatment of a fracture of ossified ungual cartilages in horses

Answer 32

Aetiology - ossification of ungual cartilages is usually an asymptomatic condition but they are predisposed to trauma Presentation - Acute severe lameness, increased digital pulses, pain on palpation of heel bulbs Treatment - rbar shoes with quarter clips and rest

Question 33

What are the four main phases of laminitis in horses?

Answer 33

Developmental stage - causal event until clinical signs Acute - from onset of signs to 72 hours, may include structural failure Sub-acute - repair over 2-3 months Chronic - structural failure develops over indefinite period

Question 34

List four things that you may see on a radiograph of a horse with laminitis

Answer 34

Rotation, sinking, gas, remodelling/lysis

Question 35

List 5 aims of treatment for laminitis in the horse

Answer 35

Manage primary cause Alter laminar perfusion Reduce inflammation Mechanical support Pain relief

Question 36

How could you treat laminitis in the developmental phase?

Answer 36

Treat primary cause Alter laminar perfusion Prevent inflammation and analgesia Mechanical support

Question 37

How could you treat laminitis in the acute phase?

Answer 37

Alter laminar perfusion Prevent inflammation and analgesia Mechanical support

Question 38

What are the two most common categories of chronic lameness in the horse?

Answer 38

Soft tissue lesions within the foot Osteoarthritis

Question 39

List three structures that can be strained/sprained in the equine foot, causing chronic lameness

Answer 39

Collateral ligaments of the distal interphalangeal joint Distal deep digital flexor tendon Impar ligament of the navicular bone

Question 40

Describe the clinical signs and treatment of a subchondral bone cyst in P3

Answer 40

Clinical signs: lameness, effusion of DIP Treatment: translesional screw used from dorsal aspect

Question 41

Describe the aetiology and clinical signs of navicular disease

Answer 41

Aetiology: unclear, likely degenerative predisposed by poor foot conformation Clinical signs: chronic, often bilateral, low grade forelimb lameness, worse when lunged on a hard circle. Postive response to PBNB

Question 42

Describe four radiographic changes of navicular bone disease seen in horses

Answer 42

Circumscribed lucent lesions within the flexor cortex of medulla of the bone Disruption or alteration of the opacity, contour or thickness of the flexor cortex Medullary sclerosis with blurring of the trabecular pattern and loss of corticomedullary definition Increased number and/or size or change in shape of lucencies on the distal border of the bone

Question 43

Describe the treatment for navicular disease

Answer 43

Farriery - egg bar shoe with heel cushioning Analgesia - NSAIDs Bisphosphonates Surgery

Question 44

Describe the aetiology, clinical signs, diagnosis and treatment of a keratoma in horses

Answer 44

Aetiology - benign tumour with SOL effects Clinical signs - mild intermittent lamness, recurrent abscesses, defect in white line at sole, distortion of hoof wall Diagnosis - blocks to PDNB, radiography, MRI Treatment - surgical resection, minimally invasive resection

Question 45

Describe the aetiology, clinical signs and treatment of thrush in horses

Answer 45

Aetiology - infection and necrosis in the sulci, predisposed by poor environment, fusobacterium invades as an opportunist. Clinical signs - black malodourous discharge around the frog Treatment - pare, foot hygiene

Question 46

Describe the aetiology, clinical signs and treatment of seedy toe in horses

Answer 46

Aetiology - disruption of the white line, often subsequent to multiple abscesses Clinical signs - mild-moderate lamness, associated with severe lamness, when abcess forms Treatment - resect defect with paring

Question 47

Describe the aetiology, clinical signs and treatment of canker in horses

Answer 47

Aetiology: poorly understood (bovine papilloma virus) Clinical signs: predominantly draught horse hindlimbs, chronic, moist hypertrophic pododermatitis Treatment: debride, antiseptics and dressings

Question 48

Describe the aetiology, presentation, clinical signs and treatment of quittor in horses

Answer 48

Aetiology: wound to coronary band, deep puncture wound to sole Presentation: heavy driving horses Clinical signs: painful swelling, ruptures and drains Treatment: Surgical removal of necrotic cartilage and tissue