David Turley

Penetrating Wounds of the Foot

Penetrating wounds of the horse’s hoof are quite common with farrier nails and joinery screws being the most frequent cause. When a sharp object has penetrated the horse’s foot, it can potentially cause damage to the sensitive tissues and structures inside. Depending on the depth and location of entry, the penetration can result in very serious damage, and so a penetrating foot injury should always be carefully assessed by a vet.

The equine foot is comprised of hoof wall, sole and frog. Once the hoof wall or sole has been penetrated, the consequences will depend on what structures are damaged. The frog is the softest part of the foot and is prone to penetrating injuries. As the frog has deep grooves (or sulci) on either side, sharp objects can become wedged, before potentially being driven further into the foot.

The horse’s foot contains two very important synovial structures, the coffin joint and the navicular bursa. If either of these structures are penetrated, potentially life-threatening synovial bacterial infection almost always occurs. Prompt assessment of penetrating foot wounds should therefore be performed to assess the site, depth and angle of penetration.

The navicular bursa, is only about 3 cm from the sole; in a pony it is even less. Therefore, a short nail does not have to penetrate very far to reach the bursa. If bacterial infection develops in the navicular bursa or the coffin joint (or both) then there can be disastrous consequences. The body’s immune system, in its attempt to eradicate the infection, also damages the synovial structures themselves, for example destroying the smooth surface of cartilage. In a matter of just a few days, the combination of bacterial infection and inflammatory response can cause such extensive damage to a synovial structure that a horse will be lame for the rest of its life, even with treatment, and in such situations the horse often needs to be put to sleep.

If a nail extends deeper into the foot, it can come into contact with the pedal bone. If there is sufficient force of penetration, the pedal bone is damaged and becomes infected (septic pedal osteitis). Bacterial infection can “eat away” at the bone causing serious problems and treatment is not straightforward, as antibiotics find it very difficult to penetrate infected bone. Usually the entire puncture wound tract must be pared away and the pedal bone scraped away back to healthy bone. Obviously, this procedure has a long recovery time as healthy tissue must repair the hole made in the foot.

Tetanus from any penetrating foot injury is a potentially fatal disease that is extremely difficult to treat, however it is preventable by vaccination (see Vaccination page)

In most situations it is better to leave the nail in place, as long as the horse is not standing on it, driving it deeper into the foot. Try to keep the horse calm, hold the foot up if necessary, and call out one of our vets with an xray machine, as an emergency.

If the nail has only penetrated a short distance into the soft tissues of the sole, the nail is removed, and the entry tract is pared out and enlarged to ensure any pus can drain from the infected site. The tract is drained with iodine, and possibly antibiotic saline and a poultice is placed, to keep the wound clean and draining. Tetanus cover might be given if needed, and possibly antibiotics.

If deeper structures are suspected to be involved, our vet may decide to take radiographs before they remove the nail. This will tell them exactly where the nail has gone and which structures have been damaged by the nail. Bony damage may need surgical treatment and prolonged antibiotics. If the navicular bursa or coffin joint are shown to have been penetrated, the horse will need to be referred as soon as possible to an Equine Hospital for possible further MRI of the foot, and to surgically flush out the synovial structure.

Extracorporeal Shock Wave Therapy (ESWT)

Extracorporeal Shock Wave Therapy (ESWT)

ESWT has been used for many years in human medicine to treat many orthopaedic conditions such as tennis elbow, shoulder and heel injuries etc and is now a commonly used and effective treatment in equine medicine.

Some of the conditions commonly treated using ESWT include:

  • Osteoarthritis
  • Wounds and Chronic Wound Care
  • Acupressure Points
  • Non-union or delayed-healing of Fractured Bones
  • Joints
  • Bone
  • Large Muscles
  • Tendon Injuries
  • Chronic Back Pain
  • Ligament Injuries
  • Painful Scar Tissue
  • Trigger Points
  • Connective Tissue
  • Cosmetic Applications

Specific equine pathologies that have successfully been treated with Shock Wave Therapy include:

  • Insertional desmopathies such as proximal suspensory ligament desmitis, suspensory branch desmitis, suspensory avulsion fractures, inferior check ligament desmitis, distal sesamoidean ligament desmitis, nuchal ligament, and other ligament injuries
  • Tendinopathies with & without calcification such as superficial & deep digital flexor tendon injuries, e.g. bowed tendons.
  • Metacarpal Stress Fractures & dorsal metacarpal disease such as bucked shins
  • Fractures & stress fractures of splints, coffin bone fractures
  • Tibial & humeral stress fractures, and Bone Exostosis
  • Angular Limb Deformities (ALD) in Foals
  • Sesamoiditis & Sesamoid fractures
  • Navicular Syndrome (Caudal heel pain)
  • Osteoarthritis such as pastern degenerative joint disease (DJD), Ringbone, and hock degenerative joint disease, Bone Spavin
  • Osteochondrosis lesions (OCD)
  • Soreness/Stiffness in muscles and gluts
  • Sore back problems such as dorsal spinal process, sacroiliac problems, and Kissing Spines

The shock waves are created, emitted and directed onto the injured area. When the shock waves meet different types of tissues with differing make ups (i.e. bone/soft tissue interface) changes within the tissue are created.

Biologic Effects:

  • Vasodilation and new vessel growth
  • Stem cell activation
  • Anti-inflammatory effects
  • Release of growth factors
  • Release of neurotransmitters

Clinical Effects:

  • Increases blood supply
  • Regenerates soft tissue
  • Regenerates bone
  • Reduces pain
  • Promotes faster healing

Essentially, shockwaves work by marshaling the natural healing response and can be applied safely and easily without the risk of any side effects.

The treatment can be useful in cases of chronic pain that have been unresponsive to conventional treatment and typically involves three treatments at two week intervals.

 

Castration

WHY?

Colts are generally castrated for ease of management. The main concern in any scenario is the risk of unwanted coverings, resulting in the pregnancy of young mares, or competition horses not intend for breeding at that time. Most intact colts are difficult to keep in company with other mares, geldings or stallions, especially as they get older and the male hormones increase. They can become difficult to handle, and in some cases become dangerous to handlers and other horses around them. Occasionally some of these dangerous traits do not all disappear after castration, as they become learned, so we often encourage castration before these behaviours are learned, to reduce the risk of them remaining.

People often worry about the loss of breeding potential, should their horse turn out to be a high achiever. In most cases I believe the horse would have never achieved such high achievements if remaining intact, and being constantly distracted by the sights and smells of other horses around them.

HOW?

At Shotter and Byers we aim to perform as many castrations standing, under heavy sedation and local anaesthetic as possible. This method reduces the cost, the time taken and the risk of a general anaesthetic to the horse. The other method, under a general anaesthetic is useful in very small ponies where simply getting in under the abdomen while the pony is standing is impossible, or where a very fractious horse means standing sedation remains too dangerous for the surgeon. There are many factors to consider when making this choice, and they are best discussed with one of our vets when they arrive at the castration.

WHAT AGE?

A colt can be castrated at any age, as long as both testicles are descended sufficiently. There is a body of opinion that castration should be left as late as possible, in order to allow the horse to ‘mature’. However there is no evidence that foals left entire develop any differently from those castrated early. Indeed, on the continent it is common place for colt foals unsuitable to be kept for breeding purposes to be castrated when still suckling from the mare. There is evidence to suggest that those foals castrated at such a young age recover from the operation faster and with fewer complications than their older counterparts.

WHEN?

Colts can be castrated at any time of year; however they should ideally be castrated either in the spring or autumn, in order to avoid the flies and heat of the summer and the deep mud of winter, both of which can increase the risk of post-operative complications. We like to organise castrations for the morning time if possible, so the horse can wake up and be monitored through the afternoon, and any required checks or follow-ups can be done by the vet during normal hours.

PREPARATION

If possible, and if safe to do so, it is best to visualise, if not indeed feel two testicles in the scrotum, before booking castration, so as to confirm the surgery is possible. All our vets will do this before being the procedure anyway, but it is best to check in advance. On the day of the procedure we prefer a well-lit, dry and clean straw bedded quiet stable if possible. This is because shavings, sawdust or chopped straw all makes its way into a wound easier, and is best avoided if possible. Castration can be performed outside in a yard or a field if necessary. The only other things the vet will want are a bucket of warm clean water, and a competent handler for the horse.

AFTERCARE

Most horses will be turned out in a small paddock soon after surgery, depending on the size and age of the horse. The vet will confirm the plan at the time of castration. Complete box rest is not encouraged, as exercise will promote drainage and minimise swelling at the surgical site. The colt may be prescribed a short course of antibiotics and painkillers following surgery. It is best if your colt has received its primary course of tetanus vaccinations at least four weeks before the procedure, but if not, let the attending vet know, and tetanus anti-toxin will be given at the time of surgery. The surgical site will need to be inspected on a daily basis for rapid detection of any possible complications. If there are no post-operative complications the incisions should be completely healed within ten days.

A small amount of blood dripping from the wound in the first twenty-four hours after castration is normal, but if it ever exceeds a fast drip, please ring Shotter and Byer Practice, or the castrating vet immediately. A small amount of swelling after the procedure is also normal, the scrotum may return to the size it was pre-surgery for a few days, but this is normal, and will reduce over a few days if exercise levels are maintained. If swollen more than this, or anything is seen hanging from the incision site, please feel free to contact the vet direct, or please send a picture through to the vet for further advice.

Colt can remain fertile for up to two months after being gelded, so should not be turned out with mares for at least two months following castration.

If you are considering castrating a colt, please feel free to ring our practice, or one of our vets direct to discuss logistics, and costings in advance. We can get it organised and booked in to suit you.

 

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