Page 1096 - Adams and Stashak's Lameness in Horses, 7th Edition

1062 Chapter 10

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A B
Figure 10.33. Images of a newborn foal with a carpal flexural straighten the left forelimb more when standing than with manual
deformity. (A) The clinician is attempting to straighten the left force being applied while recumbent.
forelimb while the foal is recumbent. (B) Notice that the foal can

reflex (stretching the musculotendinous unit leads to
relaxation). All splinting devices require strategic
23
placement of padding, constant evaluation, and chang­
ing of the splints to prevent complications, as the skin
can be easily irritated in foals (Figure 10.34). To help
prevent decubital ulceration of the skin, many clini­
cians will keep the splints on for 6, 12, or 24 hours,
followed by an equal amount of time out of the splint
12
(bandage only). In more severe cases where the splint
needs to remain on, the angle of the splint will often
need to be changed every 1–2 days as the foal starts to
improve to prevent rotation and unequal pressure sores
and to continue to provide constant tension to the
limb.
Concurrent rupture of the extensor tendon usually
responds spontaneously with stall rest, but bandaging
and splinting may be needed to prevent knuckling over
at the fetlock. 23,38 There is no need for surgical interven­
tion in these foals as the ends will reappose naturally Figure 10.34. Image of a distal limb of a foal that had multiple
over about 6 months, with minimal swelling. 11,26 Exercise palmar splints applied to help straighten a fetlock flexural deformity.
is usually restricted initially because the foals often have Notice the decubital ulceration of the skin due to pressure from the
difficulty walking, but exercise may actually increase splinting.
strength and tone in the flexor muscles. 10
Surgical treatment of congenital tendon contractures is
usually the last resort and often unnecessary. Flexor tendon to correct severe flexural deformities of the fetlock in a
donkey and miniature horse and may be used as a salvage
tenotomies and carpal (inferior) or radial (superior) check procedure in some cases. 2,36 For most flexural deformities
ligament desmotomies have been used successfully but are of the pastern, surgical realignment and arthrodesis of the
not commonly indicated. 10,23 Transection of the superior pastern joint are usually performed with a fair prognosis
check ligament may benefit some foals that are chronically for soundness. Desmotomy of the peroneus tertius has
22
over at the knees because the carpus becomes more hyper­ been reported to improve a foal with a tarsal flexural
3
extended following transection. Transection of the palmar deformity. 30
carpal ligament in the palmar carpal joint capsule has been
35
used to treat foals with severe carpal flexural deformities.
Tenotomy of the ulnaris lateralis and flexor carpi ulnaris ACQUIRED FLEXURAL DEFORMITIES
2 cm proximal to the accessory carpal bone has been used
to treat less severe carpal flexural deformities with a very Acquired flexural deformities can be unilateral or
favorable outcome. It is important to know that if ten­ bilateral and usually affect the DIP joint (club foot) or
2,9
otomies of the superficial or deep digital flexor tendons are MCP joint (dorsal knuckling of the fetlock). Flexural
performed in severe cases, then the surgeon usually cannot deformities tend to occur in fast‐growing horses or in those
manually straighten the limb at surgery. This should not following a growth spurt. Flexural deformities of the DIP
dictate cutting more tendons or ligaments as many will joint typically occur in foals and weanlings, and flexural
straighten within a week after surgery. Over correction is deformities at the MCP joint are more typical of 1‐ to 2‐
possible. Arthrodesis of the fetlock joint has also been used year‐old animals (Figures 10.35 and 10.36). 24,32,33,35