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Flashcards in Equine Foot (Bolt) Deck (58):
1

How can examination of the hoof wall be caried out?

- hoof testers
- palpation
- percussion
- response to local analgesia

2

Which structures can be palpated around the hoof?

- DOrsal DIP joint capsule
- DIP joint collateral ligaments
- Collateral cartilages
- distal recess DFTS + DDFT

3

Can you relate specific structures to pain in the hoof?

- no, not by direct visualisation palpaton or manipulation
- intrasynovial and perpheral nerve blocks not very specific

4

What should you look for when exmining the foot?

- digital pulses
- local heat
- DIP joint effusion
- pastern oedema

5

How can integrity of synovial structure be assessed?

- contrast bursography/radiography
- MRI (soft tissue info too)

6

What is nail prick and nail bind?

> nail prick
- nail driven through sensitive laminae
> nail bind
- nail driven too close to sensitive laminae
-> abscess

7

Tx septic pedal osteitis

- curettage
- wound care

8

Aetiology of hoof cracks?

- poor hoof quality
- thin hoof full
- abnormal hoof angles

9

Which direction are hoof cracks most commonly seen in?

- parallel to horn tubules and lamellae
- can extend into sensitive laminae

10

Tx hoof cracks

- shoe with bar shoe
- sutures/clamps/plates over cracks
- debridement and stabilisiation
> as long as don't reach the coronary band will be ok

11

Which aspects are foot imlanace looked at?

- lat-med (pedal bones should be in line - eg. club foot)
- dorsopalmar (mroe difficult to correct)

12

How are hoof wall avulsions formed?

- damage to coronary band -> permenantly disturbed growth

13

What is a keratoma? Common?

== "malignant tumour" -> columnar thickening of hoof horn extending towards inside of hoof
> aetiology: mechanical irritation/chronic infection (hoof abscess)
- ^ local pressure -> typical lysis distal phalanx with clear margins (not fuzzy like pedal osteitis)
- not common

14

Radiographic findings of keratoma?

- local pressure -> lysis and resorption of pedal bone tip

15

Tx keratoma

- remove (cut window, or go to sole but this will -> splay)

16

What 2 infectious causes of hoof pathology are most common?

> thrush
- looks like pus in the foot
- necrosis of the frog
- smelly
- usually limited to lateral and medial sulci of frog
> Canker
- cream cheesey
- deep layers of frog
- mixed bacterial infectioin of the entire frog and heel -> disintegration of intertubular horn
- warm humid enviroent
-
oungent and tendency to bleed

17

Tx canker/thrush

resection and debridement
- not often painful, will heal

18

Pathogenesis of white lien dz?

- deterioration of white line of hoof capsule -> loss of bond between oof wall and sole
- poor quality horn colonised by bacteria and funghu
- warm humid environment

19

Tx white line dz

> management
- dialy hoof care
- stall hygeine
> debridement of necrotic and diseased horn
- disinfect are
- sensitive laminae (protective bandage)
- sulci hardening solutions (formalin or others)

20

What is a hoof abscess? Ddx?

> Ddx pedal bone fx
- shod and unshod horses afefcted
- infection of area of sensitive laminae after bacterial penetration (can be aftr shoeing)

21

What is "gravel"? Ddx?

> gravel
- chronic foot abscess
- bursts out at coronary band
> Ddx: "Quittor" infection of lateral cartilages
- above the coronary band
- palmar/plantar

22

Best rads for navicualr bone fx?

- Dorsopalmar
- Skyline navicular bursa
- Echo other views

23

Tx navicular fx?

- fix with single lag screw
> no rotational stability but can minimise DJD In coffin and damage to DDFT

24

Ddx navicular fx?

> Bipartite navicular bone
- separate ossification centres
- congenital
- will be less lame than Fx!!
- can result in chronic lameness and DIP joint OA
- Rad other foot to r/o
- rare condition

25

What is navicular syndrome?

> most common forelimb lameness
> palmar heel pain
> no one cause, distinct pathophysiology or cure

26

Which stuctures are involved in navicular syndorme?

- navicular bone
- navicular bursa
- DDFT
- DIP
- collateral ligaments DIP joint

27

How es a DDFT tear appear on MRI?

Intense signal cf. surrounding DDFT

28

How may a DDFT tear present clinically?

3/10 lame
- blocked coffin and navicular bursa partial improvement

29

Tx DDFT Tear?

- navicular bursoscopy

30

Clinical scenario for navicular syndrome?

- 6-12 yo horses
- taller, lighter breeds (some evidence hereditary trait)
- usually bilateral
- insidious onset
- occassionaly "toe first" gait

31

Hx and PE associated with navicular syndrome?

- bilateral lamess
- toe elevation ^ lameness
- hoof testers usually negatvie
- + response to PDNB
- navicular and DIP

32

Further diagnostics for navicular syndrome?

- Radiography
- MRI [gold standard]
- CT
- Not really scintigraphy
- Ultrasoound (very user dependent)

33

Structures taken ou by palmar digital?

- DFTS
- Coffin joint
- Navicular bursa and bone
- Collateral ligaments
- hoof wall
- pedal bone
- T ligament
- Impar ligament

34

DIP joint blocking process

- go dorsal midline (through extensor tendon)
- can go palmar/plantar but risk of navicular bursa

35

Outline navicular bursa block

- midline - navicular position horizontal approach
- midline- navicualr position 30* oblique approach
- lateral palmar/plantar approach

36

Function and physiology of the hoof capsule?

> elastic and flexible under load
- "hoof mechanism"
> protective function
- stones and blunt trauma
> no possibility for swelling/draining
*weak point = WHITE LINE*

37

If navicular region is implicated in foot pain with diagnostic analgesia what further Dxx can be used?

Navicular bursoscopy

38

Current approach to tx of navicular syndrome?

Corrective farriery (roll toel use bar eg. Egg/heart bar) controlled exercise and pain relief

39

Where are osseus cyst like lesions commonly found?

Distal phalanx
- P3 near collateral ligament
Also in navicular bone and middle phalanx

40

Are osseus cyst like lesions always significant if found on imaging?

No! Verify with diagnostic analgesia

41

Tx available for distal phalanx DJP

- arthroscopy
- drilling (forage)
- medicating DIP

42

Why does the entire cyst need to be removed ?

Cyst lining secretes inflam mediators (PG2, IL1) disrupts inter stridulate cartilage

43

Typical presentation of distal phalanx (peda bone) fractures

- acute onset severe lamenss
- associated with excercise or kicking out

44

How can pedal bone fx be classified?

- numericl or descriptive
1: wing, non-articular
2: wing, articular
3: saggital
4: extensor process
5: comminuted
6: solar margin
7: foal

45

Are type 1 and 2 pedal bone fx seen easily on rads?

No not routine rads
- take appropriate obliques
- CT/MRI if necessary

46

How can fx be sen on mRI?

surrounded by decreased signal

47

WHen can type 3 fx be most eaily seen on imaging?

> 7d (bone resorption seen)
- before this hoof capsule will keep most fx. held together and not visable

48

What other structure is involved in a IV extenory process fx? Cause? Other things to r/o?

DIP joint
- displacement by common digital extensory tendon (Long in HL)
- matched fx bed and fragment can be seen
- NB: exensor yprcoess can be variable in shape, 2* ossification centres may appear similar to chip fx (dependant on clinical signs- verify need for sx)

49

Tx of wing fx? Poss complications?

- bar shoe
- foot cast/hoof cast
- lag screw?
> 6 months box rest
Complications
- OA DIP (type 2)
- fibrous union

50

Tx midsagittal fx? Poss complications?

- Lag screw + 3-6mo box rest
- Bar shoe + 6-12mo box rest
> complications
- OA DIP

51

Tx small extensor process fx? Large? Poss complications?

Small
- removal via arthroscopy or arthrotomy
+ 3-4mo box rest
> no complicatinos
Large
- removal arthrotomy
-lag screw
+ 4-6mo box rest
> OA DIP joint

52

Tx cominuted fx? Poss complications?

- transfixation cast
- euthanasia
+ 4-6mo box rest
> OA DIP or laminitis

53

Tx solar margin fx? Poss complications?

- bar shoe?
> 6 months box rest
- no complications

54

How do bar shoes work?

Eliminate "hoof mechanism" doesnt let capsule flex

55

Are foo cast advocated?

Not really necessary

56

Where are osteophytes commonly seen in DIP joint OA?

- @ po int of reflexion of joint capsule

57

Tx DIP joint OA?

> intra-articular medication
- sodium hyaluronate
- corticosteroids
- polysulphated GAGs (PSGAG)
- Il-1 R antagonist protein (irap)
> prolonged NSAIDs
> corrective farriery (=navicular syndrome, ^ heel to facilitate breakover)

58

What is pedal osteitis? What is its aetiology similar to?

= keratoma aetiology
- repetitive concussion -> chronic inflammation of the laminae -> bone resorption
- on rads lysis/resorption of bone not associated with hoof wall deformity and with FUZZY edges = pedal osteitis
- cf. keratoma with well defined clear margins