Page 1101 - Adams and Stashak's Lameness in Horses, 7th Edition

Lameness in the Young Horse 1067

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A B
Figure 10.41. (A) Lateral radiograph of a foal with a club foot. Lateral radiograph of the distal phalanges on a yearling with a
Remodeling and lysis of the distal aspect of the distal phalanx was chronic MCP flexural deformity. Note that even though the fetlock
present, and the foal had a concurrent abscess in the toe. (B) joint has no changes, the DIP joint is chronically subluxated.

strain on the SDFT and suspensory ligament is debata­
ble, but most clinical cases respond best to heel eleva­
tion in contrast to lowering the heels. 2,23 Heel elevation
(2–3 cm) combined with a 1‐ to 2‐cm toe extension also
has been advocated. Corrective shoeing is often com­
2
bined with splinting of the MCP joint to prevent dorsal
knuckling of the fetlock. The PVC splint is applied to
the palmar aspect of the distal limb to pull the fetlock
in a palmar direction. Conforming the PVC splint (using
heat) to the palmar aspect of the limb or use of fiber­
glass cast material may improve the effectiveness of the
splinting. 2
Corrective trimming and shoeing, and splinting if
used, may contribute to lameness in some horses by
increasing tension on the palmar soft tissues. In addi­
Figure 10.42. Rocker shoe placed on a 2‐year‐old horse after tion, horses must bear full weight on the limb(s) to
trimming its heel so that it could rest it forward if painful but would achieve the maximum benefit of nonsurgical treatment.
transfer weight to the palmar structures when walking. Walking on Therefore, low doses of oral NSAIDs are recommended
flat surfaces is crucial for this type of shoe to be effective. for 1 to 2 weeks to help stretch the musculotendinous
unit. Oxytetracycline IV can be used as an adjunct
the force palmarly. As the heel is trimmed, the horse treatment similar to that in foals with congenital flex­
27
may experience pain related to stretching the DDFT and ural deformities, but appears to be less effective in older
may require NSAID administration. In older individuals, animals.
another way to help counteract this pain is to use a
rocker shoe that can serves to slowly stretch the DDFT Surgical Treatment
(Figure 10.42) after the trim, but the horse must be
walked on a firm surface to ensure that downward force The decision for surgical treatment of DIP and MCP
goes through the heel. joint flexural deformities depends on the severity of the
It is generally recommended to raise the heels with deformity, age of the horse, and response to conservative
corrective shoeing to treat horses with MCP joint treatment. Surgical intervention is the only alternative in
deformities. This is thought to relax the DDFT and cases that do not respond to conservative methods.
cause the fetlock to drop. 23,32 However, each case should Surgical options for foals with deformities of the DIP
be evaluated individually by placing wedges under the joint include an inferior check ligament desmotomy or
foot to either elevate the heel or elevate the toe to DDFT tenotomy at the level of the pastern or mid‐meta­
observe which scenario improves the angle of the fet­ carpus. 1,2,15,29,33 Foals treated at a younger age (younger
lock (Figure 10.43). Whether heel elevation reduces than 6–8 months) with an inferior check ligament