Foot issues Flashcards
(44 cards)
History of chronic heel pain can include…
- intermittent uni-bilat lameness
- worse after shoeing or walking on hard ground
- decr performance
Predisposing causes to foot pain
- poor shoeing
- hard ground
- abd stress forces (e.g turns, jumps, etc.)
- poor conformation
How does poor conformation cause navicular pain?
- incr stress center on navicular bone
- long toe = longer time to lift off ground = longer time stress on navicular bone
Dx options for foot lameness
- hoof tester
- wedge test
- flexion
- nerve/joint block
- Xray
What to block in foot lameness test
Joints more helpful than nerve as more specific: - DIP joint - navicular bursa Nerve blocks: - palmar digital (above P2) - Abaxial sesamoid n. block
What does palmar digital n. block block?
- DIP joint
- navicular apparatus
- all of sole
Procedure for navicular bursa block
- 3mL of block
- 5min wait (if longer diffuse to other structures)
Procedure for DIP joint block
- 5-6mL of block
- 10min wait
What views on Xray do you want? What are you looking for in those views?
- Lateral: enthesiophytes from collateral sesamoidean lig.
- Dorsoprox-palmarodistal: synovial formina on navicular bone
- palmaroprox-palmarodistal: flexor cortex erosions, corticomedullary definition (of nav bone)
What to do if:
- pain + xray abn
- pain + xray normal
- no pain + xray abn
- dx and tx
- need more info/dx
- depends if is significant
Advance dx for navicular structures?
- nav bursogram
- nuclear scintigraphy
- US
- MRI** (needed to ddx specific)
Tx for palmar heel pain
- rest: 3-4wk, 6-12m if ligament
- corrective shoeing
- systemic anti-inflammatories: phenylbutazone, hyaluronic acid, polysulf glycoaminoglycans
- local anti-inflammatories: hyaluonic acid, corticosteroids
- Bisphophonate
- extra-corp shockwave
- sx: neurectomy
Goal of corrective shoeing?
- front and back of hoof parallel to foot angle
- sole parallel to ground
- shorten toe to ease breakover
- trim so angle of front vs back edge of hoof <5d
Complications of neurectomy
- DDFT rupture, n. regrowth, neuroma/neuritis
Navicular bone fx tx and prognosis
- conservative: rest, bar shoe
- sx
- guarded
DIP osteoarthritis
- dx
- prognosis
- tx aim
- blocks
- irreversible
- palliative
Laminitis causes
- toxin (black walnut, red oak, avocado, white clover, selenium, rattle snake venom, Hg)
- iatrogenic
- infectious (endo/exotoxins)
- colic (endotoxins)
- carb overload
- metabolic/ hormone induced
- obesitiy
- MSK
- idiopathic
Laminitis pathophysiology (3 theories)
1) ischemia - reperfusion
2) enzymatic: metallomatrix proteins degrade lamella –> decr nutrience exchange
3) mechanical overload
Phases of laminits
1) dev: before clinical signs
- acute vasodilation, incr MMP
- ice and NSAID important here
2) acute (up to 72h): laminar degen, _3 not moved
3) chronic compensation: P3 moved but not anymore, no active laminar degen
4) chronic uncompensated P3 move, laminar degen
Exam steps for laminitis
- PE
- gait
- foot exam: digital pulses, sole, coronary band, hoof wall
characteristic gait for laminitis
put all 4 feet under, relunctant to move
What measurements to take on Xray
- coffin bone to dorsal wall width
- thickness of hoof wall
- hoof wall to top of P3 (coronary band to DDE distance?)
What is a venogram? use?
- xray with contrast in blood
- looking for avascular areas of foot in laminitis
- incl coronary plexus, circumflex vessels, terminal arch
Seqelae of laminitis
- rotation of P3 in hoof
- sinking of P3 in hoof
- loss of P3 bone
