Equine Athlete: Week 12

Hello again!  After a day of rest once returning from Youth Nationals we hit the ground running on Wednesday to get back to our home-base patients.  We spent the remainder of the week around Michigan and Indiana doing prep for the upcoming Canadian Nationals.  Although technically considered a 'normal' week, we did see some very interesting cases around the area.

Image I. Nail found in horses heel.

This week Dr. Hill, Dr. Smith, and I had full days every day.  Our week started off with a bang at a small private farm in Michigan.  We were called out to do a few lameness exams and treatments, which all went well.  Then, as we were cleaning up they asked if we could take a quick look at a 2 year old colt that had suddenly been found lame.  We  lunged the horse and pinpointed the area of concern.  As soon as we picked up the foot to do a flexion test we found the problem.  A nail was protruding from the horses heel (Image I).  The location of the nail was concerning as its angle of entry, from our external perspective, suggested possible involvement of the deep digital flexor tendon or navicular bursa. We took radiographs of the foot to make sure that no key structures were involved.  Luckily, the nail was 'U' shaped and only involved the edge of the heel bulb.  So, we simply removed the nail at the proper angle, soaked the foot, cleaned and dressed the area, and were off to our next stop after a very interesting morning.

Later in the week we were examining a Warmblood gelding that we have seen multiple times throughout the summer.  He was originally being rehabilitated from a suspensory injury and has been deemed sound in that leg.  Unfortunately, he has been having trouble moving forward and bending.  We watched him move and noticed that he wasn't tracking forward as well with his left front leg.  After an examination and blocking of the leg up to the level of the shoulder, we knew it had to be something higher up.  Dr. Hill went through a chiropractic exam and noticed that he was reluctant to bend his neck.  That tipped us off and so we radiographed the region of the that was most sore.  Immediately the problem was evident, arthritis of his 5th and 6th cervical vertebrae (Image II-IV).  Once the vertebrae become arthritic you can only manage the condition, but cannot cure it.  So we opted to take an aggressive approach and attempt to slow down the bone growth using OsPhos (bisphosphnate), and alleviate the pain by injecting the cervical facets.  The horses case will be followed over time to assess the level of arthritis in that region.

        

Image II. Normal vertebrae

Image III. Arthritic vertebrae

Image IV. Oblique view of the arthritic vertebrae

Image V. Clubbed foot on a 4 month old filly

Continuing on our adventurous week we were called to examine a four month old filly with a clubbed foot.  I have seen quite a few clubbed feet but have yet to see one this sever, and in this young of a horse.  The client wanted to radiograph the foot in order to determine whether or not she would be a candidate for corrective surgery (Image V).  Clubbed feet can have a variety of causes including genetic predisposition, improper farrier care, or an injury causing excessive flexion (to name a few).  In foals of this age the major problem is often excessive flexion of the deep digital flexor tendon (DDFT).  Tightening of the DDFT causes the toe to rotate downwards and, without correction, clubbing of the foot.  The heel will grow too long and the front of the foot will become steep and dished.  If caught early there are many options for correction.  Corrective bandaging, farrier work to lower the heal and lengthen the toe, and surgery are the most common.  In this severe of a case surgery was deemed the best option. Surgery for a clubbed foot involves severing the inferior check ligament in order to release tension along the back of the leg.  The procedure is officially termed an inferior check ligament (ICL) desmotomy.  By ligating the ICL you essentially 'release' the DDFT and allow it to relax.  This should lower the heel and improve the clubbed foot.  The client elected to send the filly to surgery.  I am awaiting news on whether or not it was a success.

This week was filled with a lot of interesting cases. Too many to share in this "quick" blog post.  I am grateful for all that I have learned this summer thus far.  By this point I am well able to follow the cases and understand what is happening.  I am excited to head up to Canada next week and see what is in store!