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Experiences with foot punctures
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[ Experiences with foot punctures Recently on one of the veterinary e-mail lists there was a conversation about treatment of a chronic street nail puncture. A practitioner "inherited" the case after another veterinarian had performed several debridement surgeries on the foot, and six weeks later the horse was still experiencing a lot of pain. Phenylbutazone did not reduce the pain. Contrast radiography indicated involvement of the navicular bursa and the deep digital flexor tendon. Several foot experts responded with some very helpful suggestions, including the advice that raising the heel with a wedge pad might increase the comfort level of the horse by taking the tension off of the DDF tendon. A 2-inch high wedge was suggested for starters. Other veterinarians expressed concern that maybe the coffin joint was affected, and should be checked. One well-known surgeon said, "I have dissected the foot on some of the chronic cases that were euthanized for various reasons and have found that there is usually some degree of adhesions of the DDF tendon to the navicular bone. I think that even in the healthy/healed cases that have adhesions they are still not as likely to be sound." Another foot puncture case was discussed where a horse had kicked at a deer and the tip of an antler was embedded in the white line, up between the wall and the pedal bone in a hind limb just lateral to the toe. The antler piece was removed and the puncture was debrided to bone, irrigated, and treated topically. After two weeks the wound was still discharging, although the horse was much less lame. The veterinarian wanted to do a hoof wall resection to completely expose the wound. Several practitioners advised that a better approach would be through the sole. "All that is needed is a sharp hoof knife and a bone curette," was one comment. "The wound granulates in quickly, a shoe with hospital plate is used and you don't have the problems encountered with a resection." What happened? Radiography revealed a solar margin fracture with a 1 cm by lcm free fragment. The veterinarian on the case elected to do a partial hoof wall resection even though the wall was quite thick. "Although it is possible that this might have been removed adequately via the sole only, I elected to resect a short 'V' of wall also to allow better exposure," she said. "Initially I used a Dremel with an emery cutting disc but after the third one had shattered (these discs are too brittle), I simply cut full thickness grooves with the smallest Dremel burr and twisted off the piece with a pair of pliers. The burr worked extremely well for this purpose." After fragment removal, vigorous curettage and copious lavage, the hope is that no further complications will occur.
826
JOURNAL OF EQUINE VETERINARY SCIENCE
[ Experiences with foot punctures Recently on one of the veterinary e-mail lists there was a conversation about treatment of a chronic street nail puncture. A practitioner "inherited" the case after another veterinarian had performed several debridement surgeries on the foot, and six weeks later the horse was still experiencing a lot of pain. Phenylbutazone did not reduce the pain. Contrast radiography indicated involvement of the navicular bursa and the deep digital flexor tendon. Several foot experts responded with some very helpful suggestions, including the advice that raising the heel with a wedge pad might increase the comfort level of the horse by taking the tension off of the DDF tendon. A 2-inch high wedge was suggested for starters. Other veterinarians expressed concern that maybe the coffin joint was affected, and should be checked. One well-known surgeon said, "I have dissected the foot on some of the chronic cases that were euthanized for various reasons and have found that there is usually some degree of adhesions of the DDF tendon to the navicular bone. I think that even in the healthy/healed cases that have adhesions they are still not as likely to be sound." Another foot puncture case was discussed where a horse had kicked at a deer and the tip of an antler was embedded in the white line, up between the wall and the pedal bone in a hind limb just lateral to the toe. The antler piece was removed and the puncture was debrided to bone, irrigated, and treated topically. After two weeks the wound was still discharging, although the horse was much less lame. The veterinarian wanted to do a hoof wall resection to completely expose the wound. Several practitioners advised that a better approach would be through the sole. "All that is needed is a sharp hoof knife and a bone curette," was one comment. "The wound granulates in quickly, a shoe with hospital plate is used and you don't have the problems encountered with a resection." What happened? Radiography revealed a solar margin fracture with a 1 cm by lcm free fragment. The veterinarian on the case elected to do a partial hoof wall resection even though the wall was quite thick. "Although it is possible that this might have been removed adequately via the sole only, I elected to resect a short 'V' of wall also to allow better exposure," she said. "Initially I used a Dremel with an emery cutting disc but after the third one had shattered (these discs are too brittle), I simply cut full thickness grooves with the smallest Dremel burr and twisted off the piece with a pair of pliers. The burr worked extremely well for this purpose." After fragment removal, vigorous curettage and copious lavage, the hope is that no further complications will occur.
826
JOURNAL OF EQUINE VETERINARY SCIENCE