Food animal musculoskeletal foot Hermida Hawkins Baird 2-22-22 (1).pdf

Food Animal MS: Foot VCS 80920 Nickie Baird, DVM, MS, DACVS Jan F. Hawkins, DVM, DACVS Jesus Hermida, DVM, MS, DACVS Examination ► Musculoskeletal Examination ► Subjective evaluation § Physical examination ► Temperament: § Lack of halter training § Most commonly affected sites Examination ► Musculos...

Food Animal MS: Foot VCS 80920 Nickie Baird, DVM, MS, DACVS Jan F. Hawkins, DVM, DACVS Jesus Hermida, DVM, MS, DACVS Examination ► Musculoskeletal Examination ► Subjective evaluation § Physical examination ► Temperament: § Lack of halter training § Most commonly affected sites Examination ► Musculoskeletal Examination ► Subjective evaluation § Physical examination ► Temperament: § Lack of halter training § Most commonly affected sites Examination ► History ► Observation of stance and stride ► Physical examination: § Remember 80 to 90% of lameness originates distal to the fetlock and more specific the hind end (always examination of the claw) Examination ► History ► Observation of stance and stride ► Physical examination: § Remember 80 to 90% of lameness originates distal to the fetlock and more specific the hind end (always examination of the claw) History ► Detail § § § § § § § information of: Production levels Nutrition programs Vaccination Origin of the animal Changes in management Duration of the lameness Medication: dose, how long, and response Practitioner Challenge ► Farm Facilities ► Environment Farm Examination ► OBSERVE STANDING § Camp forward – toe pain § Camp back – heel pain, stifle pain (hind) ► Fetlock flexed – heel pain ► Lateral/medial preferential weight bearing Camp Forward Camp Back Fetlock Flexed Lateral-Medial Distribution Bilateral Distribution Farm Examination ► OBSERVE MOVING ► Preferential weight bearing ► Limb placement ► Stride length Limb Placement Limb Placement Limb Placement Limb Placement Differential diagnoses ► Sole abscess, ► Fracture, ► Joint luxation, ► Weight-bearing ligament or tendon injury, nerve injury ► Septic arthritis, and ► Septic tenosynovitis Farm Examination ► Stanchion ► Chute ► Rope and beam Farm Exam Foot Trim and Examination ► Observe walking to table ► Establish site and severity of lameness ► Clean and closely examine feet for swelling, signs of inflammation, traumatic lesions ► Trim foot if needed before further examination Table Table Tools for trimming ► Hoof nippers ► Electric grinders ► Hoof knives ► Safety glasses ► Hoof testers Foot trimming ► Nippers on extremely long toes Wall Cut Foot evaluation Foot evaluation Foot trimming ► Grinder predominantly ► Level heel to toe (careful not to dish wall) Check sole Foot Trimming/Examination ► Dub long toes if needed ► Pare soles with knives ► Follow any discolored tracts ► Hoof testers ► Palpation and manipulation Foot Trimming/Examination ► Follow any discolored tracts General Trimming ► Consider environment ► Beef vs dairy ► Shorten affected toe ► (decrease weight bearing) Dub Toe Conformation vs Posture Screw Claw ► Heavily muscled hind quarters ► Hind limbs - base narrow stance ► Lateral claw Screw Claw ► Heavily muscled hind quarters ► Hind limbs - base narrow stance ► Lateral claw Screw Claw ► Heavily muscled hind quarters ► Hind limbs - base narrow stance ► Predisposes to ulcerative lesion ► (Rusterholtz ulcer, Pododermatitis circumscripta, sole ulcer) Anatomy review Screw Claw ► Ulcer may invade coffin joint, navicular bursa and/or tendon sheath ► One of the most serious foot lesions ► Incidence from 3% to 18% ► There is a heritable component Screw Claw ► Predisposing Factors: § Third phalanx may have abnormal structure § Inappropriate weight bearing Rusterholtz ulcer ► Located in the region of the sole-bulb junction of the lateral claw on hind leg ► Usually near the axial region instead of the abaxial margin Deep Sepsis Screw Claw: Treatment ► Trim lateral toe to level ► Trim roll out of lateral wall (seldom possible) Screw Claw: Treatment ► Trim lateral toe to level ► Trim roll out of lateral wall (seldom possible) ► Shorten medial claw to widen base narrow stance ► Periodic trimming (1-2 X/yr) Sole ulcer ► Minimal dissection ► Treatment depends on sequela ► Regional antibiotics ► +/- block ► +/- bandage ► Anklyosis, amputation ► Tendon sheath drainage Sole ulcer ► Minimal dissection ► Treatment depends on sequela ► Regional antibiotics ► +/- block ► +/- bandage ► Anklyosis, amputation ► Tendon sheath drainage Sole ulcer ► Minimal dissection ► Treatment depends on sequela ► Regional antibiotics ► +/- block ► +/- bandage ► Anklyosis, amputation ► Tendon sheath drainage Block Sole ulcer ► Minimal dissection ► Treatment depends on sequela ► Regional antibiotics ► +/- block ► +/- bandage ► Anklyosis, amputation ► Tendon sheath drainage Block Sole ulcer ► Minimal dissection ► Treatment depends on sequela ► Regional antibiotics ► +/- block ► +/- bandage ► Ankylosis, amputation ► Tendon sheath drainage Block Interdigital Fibroma ► Proliferative reaction of the interdigital skin ► Incidence 1% to 4.8% ► Heritable component Interdigital Fibroma (corns) ► Field Dx easier than Trt ► Size does not correlate to lameness ► Lameness may be due to other reasons Fibroma (Fat Pad) Interdigital Fibroma (corns) ► Painful to palpation ► Proximal dorsal interdigital swelling ► Septic fat pad Septic Fat Pad Interdigital Fibromas (Treatment) ► Clean and bandage ► Surgical excision ► Regional IV anesthesia ► +/- fat pad Regional Anesthesia Septic Coffin Joint ► Chronic lameness ► Extension of sole disease ► Penetrating foreign body Septic Coffin Joint ► +/- osteomyelitis of the digit ► Severe lameness Septic Coffin Joint ► Swelling above coronary band ► Radiographs show widened joint space dt effusion or lysis ► Proliferative new bone Treatment ► Local antibiotics ► Regional antibiotics ► Systemic antibiotics ► Amputation ► Facilitated ankylosis Amputation ► Regional anesthesia ► Table restraint vs standing ► Gigli wire through skin and bone ► Flap or inverted “T” skin incision ► Angle amputation through distal P1 ► Open vs partial closure Inverted “T” Facilitated Ankylosis ► Regional anesthesia ► Table restraint ► Drill through coffin joint ► Copious lavage ► Wooden block ► Expensive and time consuming ► Better end result ► Periodic foot trimming Osteomyelitis of the Digit ► Delay in treatment reason for most failures ► Wooden block ► Prognostic ► Not therapeutic Wooden Blocks ► 2X4 grooved blocks ► 1 inch wood an option ► Commercially available products ► Trim claw and roughen wall ► Acrylic ► Reduce weight bearing Commercial Block Laminitis ► Subclinical ► Acute/Subacute ► Chronic Subclinical Laminitis ► High prevalence ► Associated abnormal hoof growth ► Generalized hoof weakness ► Bruises, white line disease, false sole Acute Laminitis ► Not common ► Grain engorgement ► Medial hind claws ► Prominent subcutaneous veins Chronic Laminitis ► Older dairy cows ► Rings on wall ► Flat toes ► High correlation with culling Puncture Wounds ► Often present as abscess after puncture has sealed ► Foreign body seldom in place ► Radiograph before removal if present to determine structures involved ► Repeat radiographs if recurrent abscesses occur Puncture Puncture wound Radiograph Subsolar Abscess ► Severe lameness ► Posture shifts weight from affected claw ► + to hoof testers ► Pare abscess to create drainage ► Trim affected claw shorter to reduce weight bearing ► +/- block ► +/- bandage Subsolar Abscess ► Radiograph if recurrent or not responsive to treatment ► Recurrent abscess may be related to P3 sequestrum ► Many abscesses secondary to puncture wound Recurrent abscess radiograph P3 Sequestrum Post op Vertical Fissures (Sand Cracks) ► Developmental ► Etiology???? § Secondary to poor hoof health? § Nutrition?? ► Lameness due to crack instability ► + to hoof testers Crack Vertical Fissures (treatment) ► Dremel and stabilize ► Wire and/or acrylic ► Groove proximal aspect ► Trim claw shorter or dub toe to reduce weight bearing ► Wooden block if needed ► Recheck periodically Dremel Wire Acrylic Horizontal Cracks ► Hardship grooves ► Stress such as feed changes, parturition ► Thimble toe ► Avulsion ► Treatment – dub toe ► Smooth wall with grinders Horizontal crack Thimble Toe Dub Toe P3 Fracture ► Lameness posture shifts weight bearing from affected claw ► Lameness intermittent severity ► No regional signs of inflammation ► Positive to hoof testers ► Concrete gutter injury ► Radiographic diagnosis Vertical P3 Fracture ► Most common form § Articular ► Treatment § Wooden block § Confinement P3 Fracture Horizontal P3 Fracture ► Less common ► Foot caught under gate or fence ► Hoof wall damage ► Very lame ► Respond initially to wooden block ► Poor prognosis dt sequestrum, septic joint ► Consider amputation P2 Fracture ► Uncommon ► Similar presentation ► Not sensitive to hoof testers ► Treat with wooden block P2 Fracture Digital Fibropapilloma ► Looks like a wart ► It is a wart Digital Fibropapilloma Hairy Heel Wart ► Dairy now beef as well ► Treponema ► Mild lameness ► Usually self limiting ► Spreads through herd ► Clean ► Topical tetracycline Hairy Heel Wart