Lameness

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.

PRP Therapy

PRP: Platelet Rich Plasma

Platelet-rich-plasma (PRP) can be used for the treatment of joints, bursae and soft tissue injuries.

Platelets are a component of blood that are capable of releasing many growth factors such as platelet-derived growth factor, transforming growth factor beta and vascular endothelial growth factor. These growth factors are important for regulating a huge number of cellular processes that encourage the formation of blood vessels and the proliferation of new tissue.

PRP is very quick to obtain from your horse and can be ready to inject in as little as 15-30 minutes, depending on the method used.  We take approximately 50mls of blood from your horse and centrifuge or filter it to concentrate the platelets to produce the PRP.

PRP is injected directly into the site of injury and works best where there discrete area of damage, such as a tendon core lesion. However, it has a wide array of uses including aiding the healing of joints, bursa and soft tissue injuries (such as suspensory ligament or flexor tendon strains).

PRP is able to act as a scaffold for proliferating cells which makes it a useful treatment prior to stem cell therapy.

Another great advantage to PRP is that it can be legally used in competition horses where drug testing would detect commonly used controlled substances.

For more information on PRP, please telephone your vet or call the office on 01306 627 706 to discuss.

Mud Fever

Mud Fever

It’s that time of year where mud fever is a problem many horse owners will be faced with.  Mud fever or pastern dermatitis is a common bacterial infection usually seen on the heel bulbs and back of the pastern.  There is usually a dominant bacteria such as Dermatophilus congolensis but the condition is frequently a complex mix of different bacterial and fungal species.

What does mud fever look like?

  • Matted hair with crusting and scabs
  • Small, ulcerated, moist lesions
  • Thick, creamy, yellow/white/green discharge
  • Deep cracks in the skin
  • Hair loss (alopecia)
  • Heat, pain, swelling with possible associated lameness

What can cause mud fever?

  • Soil type – some soils can predispose horses to mud fever so outbreaks on yards can be common
  • Prolonged damp – either in the field or from deep, dirty, wet bedding.
  • Feathering – heavy feathering can predispose horses to infestation with Chorioptes mites (feather mites) which can increase the risk of mud fever.
  • Trauma to the skin can provide an entry point for the bacteria
  • White limbs have been suggested to be more susceptible to mud fever

How do you treat mud fever?

  1. Clip the affected area – remove the hair so the skin can dry out. Removing feathers also allows you to better access the skin to treat and inspect it.
  2. Wash with an antimicrobial and antibacterial shampoo or scrub, such as Malaseb or dilute hibiscrub then rinse and dry thoroughly. Continue once daily for 1 week.
  3. Gentle removal of softened scabs can help to decontaminate the area. Do not remove dry or well adhered scabs as this can leave an open wound in the skin and predispose to further infection.
  4. Apply an antibacterial cream such as Flamazine to the affected area twice daily. Our own antibiotic Mud Fever solution is very effective at treating even the worst of mud fever.

When should I call my vet?

  • If your horse becomes lame
  • The condition continues to get worse or does not show any sign of improvement
  • There is swelling of the area or leg
  • You have any other worries

 Please don’t hesitate to call us today if you have any concerns or questions regarding the health of your horse

IRAP Treatment

IRAP Treatment

Degenerative joint disease or osteoarthritis is a very common disease in both young and old horses. It presents as lameness, joint swelling and inflammation caused by cartilage damage and inflammation of the joint synovium.  This damage results in the release of inflammatory mediators, notably Interlukin-1 (IL-1) which in turn leads to further cartilage damage.

IRAP or Interleukin-1 Receptor Antagonist Protein prevents  IL-1 from binding to its receptor, stopping it from causing further inflammation and joint damage.

IRAP is produced by your horse’s blood cells and this treatment allows us to harnesses its anti-inflammatory protein and directs it to where it is needed.  We take approximately 50mls of your horse’s blood and transfer it into a container designed to stimulate the production of IRAP. The container is incubated for 24 hours while this process takes place.  The blood is then centrifuged to remove the cells leaving behind the now IRAP rich plasma.

This plasma is injected into the diseased joint every 7-10days for 3-5 treatments.

IRAP treatment is ideal for horses with mild to moderate radiographic signs of joint disease. It is not recommended in those with joint fragments but can be a useful tool to speed up recovery following their surgical removal and is considered low risk with few complications have been noted.

IRAP can be a great maintenance therapy for competition horses. It can reduce the need for steroid joint medications and can be used in conjunction with routine joint injections throughout the competitive season.

Please get in touch to discuss this treatment with us.

 

Digital Radiography – X-RAYS

Digital Radiography

At Shotter & Byers we are proud to own five top of the line wireless Eklin digital x-ray machines.  These allow us to take exceptional quality images that can be viewed instantly beside your horse without the constraints of wires.

We also have a wired system that displays the images instantly and a number of x-ray generators to be used with more traditional digital x-ray plates that are developed at our office.

This array of x-ray equipment allows us to provide you and your horse with an exceptional and fast veterinary diagnostic service.

Diagnosing Lameness

Diagnosing Lameness

All cases of lames are different but this post gives a general breakdown of some of the steps that may go into a lameness workup.

  1. Review of Medical History

Your vet will ask you questions about your horse and gather any information they may feel is relevant to the current situation.

  1. Visual Examination at Rest

By visually examining your horse at rest your vet can note its conformation, balance, weight-bearing and look for any signs of injury.

  1. Examination in Motion

Your vet may wish to see your horse in motion.  It may be required to be seen moving in a straight line, in circles, in hand or on the lunge. Occasionally your vet may also request to see your horse under saddle to get a more compete view of the presenting lameness.

  1. Hands on Exam

Your vet will palpate your horse, checking joints, bones, muscles, tendons and ligaments for any signs of injury or abnormality.

  1. Application of Hoof Testers

This piece of equipment allows your vet to apply pressure to areas of the foot to look for abnormal sensitivity or pain.

  1. Flexion Tests

Your vet will hold a leg in a flexed position for a period of time before evaluating your horse in motion once more. Your horses’ response to flexion tests can help identify the cause of the lameness.

  1. Nerve and Joint Blocks

Local anaesthetic can be injected into joints or around nerves to numb certain areas.  Blocking is a very useful diagnostic technique for identifying the location of a lameness.

  1. Imaging

Imaging is a further step towards identifying the cause of lameness. There are two main imaging techniques that can be brought to your horse, x-ray for bony structures and ultrasound for soft tissues. Other methods such as MRI, CT and scintigraphy are available but often require sending your horse to a hospital facility.

We offer state of the art digital x-rays which can be viewed instantly on a computer beside your horse and diagnostic ultrasound.

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.

 

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