Recent advances in conservative and surgical treatment options of common equine foot problems.

Foot problems are very common causes of lameness in horses. With the recent diagnostic advances to evaluate and treat foot pathology as well as to monitor response to therapy, it is now possible to more accurately evaluate the effectiveness of many of these treatments. This review details some of the recent advances of the most common conservative and surgical treatment options for foot problems in horses, including an overview of evidence on the efficacy to support the use of these treatment options and on factors that may affect prognosis.

Outcome of palmar/plantar digital neurectomy in horses with foot pain evaluated with magnetic resonance imaging: 50 cases (2005-2011).

REASONS FOR PERFORMING STUDY: There is limited knowledge of the foot lesions that influence the outcome of palmar/plantar digital neurectomy (PDN). OBJECTIVES: 1) To report the short- and long-term outcomes of horses that underwent PDN to alleviate chronic foot pain due to lesions diagnosed by magnetic resonance imaging (MRI) and 2) factors that may influence the outcome of PDN. STUDY DESIGN: Multicentre retrospective study. METHODS: Medical records of 50 horses subjected to PDN due to chronic foot pain were reviewed. Age, breed, sex, athletic activity, duration of lameness, affected limb(s), response to anaesthesia of the palmar/plantar digital nerves, MRI findings and surgical technique were analysed together with follow-up data to identify factors that influenced the long-term outcomes. RESULTS: Forty-six of 50 horses (92%) responded positively to surgery; 40 (80%) were able to return to their previous athletic use for a median time of 20 months (range: 12-72 months). Eighteen (36%) horses developed post operative complications including residual lameness, painful neuromas, or early recurrence of lameness. Horses with pre-existing core or linear lesions of the deep digital flexor tendon (DDFT) had significantly shorter periods of lameness resolution after surgery than horses with dorsal border lesions of the DDFT or other foot lesions. CONCLUSIONS: Palmar/plantar digital neurectomy can improve or resolve lameness in horses with foot pain unresponsive to medical therapy without serious post operative complications. However, horses with core or linear lesions of the DDFT should not be subjected to PDN as these horses experience residual lameness or early recurrent lameness after surgery. Magnetic resonance imaging can be used to identify these horses.

Outcome of medical treatment for horses with foot pain: 56 cases.

REASONS FOR PERFORMING STUDY: Currently, there are limited data regarding the long-term outcome of horses with foot pain treated with corrective shoeing, rest and rehabilitation, and intrasynovial anti-inflammatory medication to target lesions detected with MRI. OBJECTIVE: To report the long-term (≥12 months) outcome of horses with foot lesions following medical therapy. HYPOTHESES: 1) There is no association between clinical parameters considered and a poor response to therapy. 2) Horses with a deep digital flexor tendinopathy are less likely to respond to medical therapy than horses without a deep digital flexor tendinopathy. METHODS: The medical records of horses with foot pain subjected to MRI examination and medical therapy (2005-2007) were evaluated retrospectively. Data collected included history, signalment, occupation, duration and severity of lameness at the time of MRI, radiological and MRI abnormalities. Number of treatments, complications and long-term response to treatment were obtained by detailed telephone questionnaires. Association between clinical and MRI findings and long-term lameness were investigated. RESULTS: Frequent abnormal structures included the navicular bone, the deep digital flexor tendon, the navicular bursa and the distal interphalangeal joint. Thirty-four of 56 horses (60.7%) failed to return to previous level of exercise due to persistent or recurrent lameness or owners' decision to decrease the horse's athletic level; however, 11 horses (32.3%) were being used for light riding. Prognosis for horses with concurrent deep digital flexor tendon, navicular bone and navicular bursa lesions was worse than horses with individual lesions. Deep digital flexor tendinopathy was strongly associated with persistent or recurrent lameness. CONCLUSIONS: Horses with multiple foot lesions managed with conservative therapy have a guarded prognosis for long-term soundness. Deep digital flexor tendinopathies negatively influence prognosis.

Mastocytoma in the common carpal sheath of the digital flexor tendons of a horse.

A 13-year-old Morgan gelding was examined for right forelimb lameness and tenosynovitis of the right common carpal sheath of the digital flexor tendons. The horse had moderate right forelimb lameness at the trot and marked effusion of the right common carpal sheath of the digital flexor tendons. Ultrasonographic examination revealed a soft tissue mass within the proximal pouch of the affected tendon sheath, located adjacent to the distal physis of the radius. Cytology and culture of the fluid revealed a sterile, eosinophilic tenosynovitis. Tenoscopic exploration confirmed the presence of a capsulated soft tissue mass. Thecotomy was required to fully debride the mass, which histology revealed to be a mast cell tumour. At 22 months postoperatively, the horse developed mild right forelimb lameness and eosinophilic tenosynovitis because of recurrence of the mastocytoma. Mastocytosis is a possible differential diagnosis in any horse exhibiting lameness associated with tenosynovitis. Surgical excision combined with rest and postoperative intrasynovial and systemic corticosteroids may be palliative.