The Equine Foot

Question 1

What is the normal function of the hoof and capsule?

Answer 1

Elastic and flexible under load
Protective
No possibility for internal swelling or drainage

Question 2

What is the weak point of the hoof capsule?

Answer 2

The white line

Question 3

What techniques can be used for diagnosis of disease in the hoof capsule?

Answer 3

Hoof testers, palpation, percussion, response to local analgesia, radiography, MRI

Question 4

What structures can be palpated inside the hoof capsule?

Answer 4

Dorsal DIP joint capsule, DIP joint collateral ligaments, collateral cartilages and distal recess to DFTS and DDFT

Question 5

Why is it difficult to relate pain to specific structures?

Answer 5

Can’t really use direct visualisation, palpation or manipulation
Intra-synovial and peripheral nerve blocks aren’t very specific

Question 6

What farriery related disease can damage the laminae

Answer 6

Nail prick or nail blind

Question 7

What are hoof cracks?

Answer 7

Disruption to the hoof wall parallel to horn tubules and laminae
Can extend into the sensitive laminae causing pain and lameness

Question 8

What is the aetiology of hoof cracks?

Answer 8

Poor horn quality
Thin hoof wall
Abnormal hoof angles

Question 9

How do you treat hoof cracks?

Answer 9

Plating or gluing to support hoof and prevent widening and extension to coronary band

Question 10

What can hoof capsule punctures lead to?

Answer 10

Septic pedal osteitis

Question 11

What foot imbalances can cause disease to the hoof capsule and laminae?

Answer 11

Broken back axis, broken forward foot, club foot

Question 12

What causes hoof wall avulsions?

Answer 12

Damage to the coronary band results in permanently disturbed growth

Question 13

What is a keratoma?

Answer 13

Columnar thickening of hoof horn extending towards inside of the hoof mostly in the dorsal wall

Question 14

What is the aetiology of a keratoma?

Answer 14

Mechanical irritation or hoof abscess

Question 15

What internal trauma can a keratoma cause?

Answer 15

Increased local pressure so typically lysis of distal phalanx

Question 16

What is the treatment for a keratoma?

Answer 16

Local resection trying not to extend to solar margin

Question 17

What is thrush?

Answer 17

Infection leading to necrotic processes in frog area usually limited to lateral medial sulci

Question 18

What is canker?

Answer 18

Mixed bacterial infection in deeper tissue layers of entire frog and heel

Question 19

What does canker lead to?

Answer 19

Disintegration of intertubular horn

Question 20

When does canker occur?

Answer 20

Warm humid environment

Question 21

What does canker look like?

Answer 21

Cheesy white pus with a pungent odour with a tendency to bleed

Question 22

How do you treat canker?

Answer 22

Resecting affected area

Question 23

What does white line disease lead to?

Answer 23

Loss of band between hoof wall and sole

Question 24

What happens in white line disease?

Answer 24

Poor quality horn gets colonised by different bacteria and fungi

Question 25

What is the treatment for white line disease?

Answer 25

Meticulous daily hoof care, stall hygiene, debridement of necrotic and disease horn, disinfect area, protect laminae with bandage, use hardening solutions on sulci

Question 26

What do hoof abscesses result from?

Answer 26

Infection of sensitive laminae after bacterial penetration

Question 27

Where do chronic abscesses burst out and what treatment is required?

Answer 27

Coronary band | Lavage

Question 28

What is quitter? What treatment is often needed?

Answer 28

Infection of collateral cartilage and often requires removal of part of cartilage

Question 29

What are bipartite navicular bones? What are their clinical significance?

Answer 29

Congenital anomally | Important DDx to fractures and can result in chronic lameness and DIP joint osteoarthritis

Question 30

What is navicular syndrome?

Answer 30

Palmar heel pain with no one cause, distant pathophysiology or cure

Question 31

What are advanced imaging methods used to visualise for navicular syndrome?

Answer 31

Navicular bone, navicular bursa, DDFT, DIP joint, collateral ligaments of DIP joint

Question 32

What is the classic history behind navicular syndrome?

Answer 32

6-12 year old, taller lighter breeds, usually bilateral, insidious onset, occasionally toe first gait

Question 33

What is the diagnostic approach to navicular syndrome?

Answer 33

History, toe elevation may increase lameness, hoof testers usually negative, positive response to palmar distal nerve block, radiography, MRI, CT, nuclear scintigraphy, ultrasonography

Question 34

What is the current approach to treatment of navicular syndrome?

Answer 34

Identification of affected structures, navicular bursoscopy, corrective farriery, controlled exercise, pain relief

Question 35

Where are osseous cyst like lesions seen?

Answer 35

Distal phalanx in midline near collateral ligament Navicular bone Middle phalanx

Question 36

What are the significance of osseous cyst like lesions?

Answer 36

Vary | Diagnose with diagnostic analgesia

Question 37

What is the treatment for osseous cyst like lesions?

Answer 37

Arthroscopy, drilling and medicating DIP joint

Question 38

How do distal phalanx fractures present?

Answer 38

Acute onset severe lameness due to exercise or kicking

Question 39

What are the different classifications of distal phalanx fractures?

Answer 39

``` Type 1 = wing, non-articular Type 2 = wing articular Type 3 = sagittal Type 4 = extensor process Type 5 = comminuted Type 6 = solar margin ```

Question 40

What radiographs need to be taken to see wing fractures?

Answer 40

Oblique projections

Question 41

What treatments are appropriate for wing fractures? What are possible complications?

Answer 41

Bar shoe, foot cast, hoof cast, lag screw and box rest for 6 months OA of DIP joint and fibrous union possible

Question 42

What treatments can be used for midsagittal fractures? What are possible complications?

Answer 42

``` Lag screw (3-6 months) or bar shoes (6-12 months) OA of DIP joint with bar shoe ```

Question 43

What treatment is used for small extensor process fractures?

Answer 43

Removal by arthroscopy or arthotomy with 3-4 month box rest

Question 44

What treatment is used for large extensor process fractures? Complications?

Answer 44

Removal by arthrotomy or lag screws with 4-6 months box rest | OA of DIP joint

Question 45

What is the treatment for comminuted fractures? Complications?

Answer 45

Transfixtion cast with 4-6 months box rest | Possible OA of DIP joint or laminitis

Question 46

What is the treatment for solar margin fractures?

Answer 46

Bar shoe with up to 6 months box rest

Question 47

What is the treatment for DIP joint osteoarthritis?

Answer 47

``` Intra-articular medication/prolonged use of NSAIDs/corrective farriery +/- sodium hyaluronate Corticosteroids Polysulphated glycosaminoglycans IL-1 receptor antagonist protein ```