Foot (Morton-from slides)

Question 1

Forelimb weight bearing

Answer 1

60% of weight

Question 2

95% of forelimb lameness originates

Answer 2

distal to the carpus

Question 3

Hindlimb weight bearing

Answer 3

35-40% of weight

Question 4

80% hindlimb lameness probably originates from

Answer 4

Hock or stifle

Question 5

Role of forelimbs versus role of hindlimbs

Answer 5

Fore: shock absorption
Hind: propulsion

Question 6

Most common causes of lameness are

Answer 6

OA and soft tissue injuries

Question 7

Structures of the foot

Answer 7

1. Proximal phalanx
2. Middle phalanx
3. Distal phalanx
4. DDFT
5. Navicular suspensory ligament
6. Navicular bone
7. Impar ligament
8. Digital cushion
9. Sensitive laminae

Question 8

Synovial spaces of the foot

Answer 8

1. Distal interphalangeal joint (DIPJ)
   - dorsal pouch
   - palmar recess
2. Digital Flexor Tendon Sheath (DFTS)
3. Navicular bursa

*T ligament-separates the 3 synovial structures

Question 9

Low ringbone

Answer 9

OA of coffin joint

-chronic, low-grade, progressive lameness

Question 10

High ringbone

Answer 10

OA of PIPJ

Question 11

Distal interphalangeal OA DX

Answer 11

PE
-Effusion of DIPJ
-Dorsal/palpable exostosis
LE
-Positive resp DIPJ IA anesth
-Partial response PD n. block, w/dorsal branch
-May require AS n. block to eliminate lameness

Question 12

DIPJ OA and rads

Answer 12

• May be unrewarding
• May not correlate to dz
• Osteophytes/enthesophytes

Question 13

Osteophyte

Answer 13

bony projection at joint space

Question 14

Enthesiophyte

Answer 14

Bone projection at attachment of tendon or ligament

Question 15

DIPJ OA TX (conservative)

Answer 15

1. Rest and controlled exercise
2. Chondroprotective therapies
   - PSGAG (Adequan)-IM
   - Hyaluronic acid (Legend)-IV
   - Oral glucosamine/chondroitin
3. NSAIDS PRN

Question 16

DIPJ OA IA TX

Answer 16

1. Hyaluronic acid
2. Corticosteroids
   - triamcinolone
   - betamethasone
3. Biologics/regenerative tx
   - stem cells
   - PRP
   - ACS

Question 17

DIPJ OA SX

Answer 17

1. Arthroscopy-limited success but diagnostic
2. Arthrodesis-end stage/salvage
   - rarely performed (orientation of joint access difficult)

Question 18

DIPJ OA arthrodesis techniques

Answer 18

1. cartilage debridement, screws and PMMA

2. cartilage debridement, bone graft

Question 19

DIPJ OA prognosis

Answer 19

1. Variable, related to degree of osteoarthrosis
2. Degree of IA analgesia response indicative of response to IA tx
3. Progressive
4. Arthrodesis is salvage, limited performance

Question 20

DIPJ Collateral ligament Desmitis

Answer 20

• Affects show jumpers, dressage horses, WBs

- Increased stress placed on CLs when horse moves in a circle (OUTSIDE LEG)

Question 21

DIPJ Collateral ligament Desmitis etiology

Answer 21

Asymmetric foot placement more stress

• foot imbalance, varus/valgus, uneven footing, sliding/rotation
• primary ligament degeneration
• acute trauma-not common, protected by hoof wall

Question 22

DIPJ Collateral ligament Desmitis DX

Answer 22

1. MRI gold standard
   - lesions often distal in hoof capsule
   - VERY position dependent (magic angle artifact)
2. Rads-solar margin view
   - remodeling of COLLATERAL FOSSA on proximal PIII

Question 23

DIPJ Collateral ligament Desmitis TX

Answer 23

1. Rest and controlled exercise
2. Corrective trimming/shoeing
3. NSAIDS
4. ESWT
5. Intralesional biologic/regenerative therapies
   - imaging guided

Question 24

DIPJ Collateral ligament Desmitis prognosis

Answer 24

28-79% return to previous level activity
Often concurrent DIPJ OA
Presence concurrent lesions decreases prognosis

Question 25

Type of phalanx fractures

Answer 25

1. wing fx 2. articular wing fx 3. midline from solar margin to joint fx 4. extensor process fx 5. comminuted fx 6. chip fx 7. foal and I dunno fx

Question 26

Etiology P3 fx

Answer 26

1. majority are at high speed - sometimes kicking wall or bad step 2. standardbreds over-represented

Question 27

CS P3 fx

Answer 27

1. Acute, relatively severe lameness 2. Fore/hind limb 3. Positive to hoof testers 4. Increased digital pulses 5. Heat in hoof wall 6. DIPJ effusion (if articular)

Question 28

DX P3 fx

Answer 28

1. Rads-may need to wait 7-10 days 2. Don't do blocks if you suspect fx 3. CT most useful advances imaging

Question 29

Type 1 P3 fx

Answer 29

Abaxial/wing fx, non-articular TX: food cast, rest Prog: Good, radiographic non-union common

Question 30

Type 2 P3 fx

Answer 30

Abaxial/wing fx, articular TX: Foot cast, rest or screw fixation Prog: fair/good, radiographic non-union common, OA likely

Question 31

Type 3 P3 fx

Answer 31

Axial/Sagittal fx TX: Screw fixation or conservative Prog: Guarded unless < 2 yrs old, OA develops

Question 32

Type 4 P3 fx

Answer 32

Extensor process fx, may also be a form of OC TX: fragment removal Prog: Good; depends on frag size and presence OA

Question 33

Type 5 P3 fx

Answer 33

Comminuted fx TX: Foot cast, rest Prog: Poor

Question 34

Type 6 P3 fx

Answer 34

Solar margin fracture TX: rest Prog: Good

Question 35

Type 7 P3 fx

Answer 35

Solar margin fracture in a foal TX: rest Prognosis: good

Question 36

Side bone

Answer 36

``` Ossification of collateral cartilages More common in -medial to lateral hoof imbalance -common interference -older age -drafts ```

Question 37

Side bone tx

Answer 37

1. Therapeutic shoeing (hoof balance, bar shoe +/- pads) 2. Local corticosteroid injection 3. NSAIDS 4. Evaluate CLs of DIPJ and treat if desmitis