New Hoof Radiograph


Stephanie Stout
 

Hi Dr. Kellon and Everyone, 

Per your advice Dr. K, I got a radiograph of King's front right foot that has kept abscessing. It actually stopped draining a couple days ago, and is currently not draining, but I don't know how long that will last. Besides trimming/backing of the toe which I have an appointment with my farrier on Monday - what do you all see and what are your suggestions? 

https://ecir.groups.io/g/CaseHistory/photo/1402/3?p=Name,,,20,1,0,0

Thanks!! 

--
Stephanie & King
October 2014
Oregon
Case History 


Lavinia Fiscaletti
 

Hi Karen,

I've added a mark-up to King's album:

https://ecir.groups.io/g/CaseHistory/album?id=1402&p=pcreated,,,20,2,0,0

Was he standing squarely on the foot when that view was taken? It doesn't appear so.

Green are the trim lines - way too much toe and excess hoof capsule height. Whether or not the heels can be lowered further is going to depend in part on what the rest of the bony column alignment is when he is actually weighting the leg. Initially, I wouldn't lower them more than in the mark-up. Yellow lines are evidence of sinking - which is not new. It was present on the last xrays as well. Pink area shows fuzziness on the dorsal surface of P2, which is consistent with ringbone formation.

There is a considerable amount of erosion of the tip of the coffin bone (inside purple circle). There are also several dark shadows that could be gas pockets, abscess collections and/or infection so otseomyelitis is a concern. When the toe is taken back, it is likely there will be some kind of exudate inside, as well as possible open gaps. The overall texture may be punky.

I've asked Dr. Kellon to please comment as soon as she has a moment.
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team


Eleanor Kellon, VMD
 

Hi Stephanie,

There is a lot of excess foot here - both toe and hoof length in general. The vertical measurement line shows roughly where the hoof wall should be and everything to the left of that line is excess.  The long horizontal line is where the bottom of the foot should be, with everything below that excess length. As another example, the beginning of the toe bevel at ground level should be under the tip of the coffin bone and I think you can see how far forward of that point it is.

I'll bet you have noticed his feet grow really fast. They do this in an effort to put as much distance as possible between the internal structures and the ground. However, if not controlled this is counterproductive.

Otherwise, of concern is the multiple lucencies (black areas), possible calcifications (white areas) in the laminar space and closer to the bone as well as obvious bone loss at the tip of the coffin bone. This is a normal hoof for comparison:

http://www.equipodiatry.com/images/valueofradio/2.jpg

Some of what looks like calcification could actually be dirt on the surface. Can't tell with only one view. In any event the changes tell a story of infection which certainly fits with his history. The important question is whether that infection has penetrated the bone - osteomyelitis.  If the drainage holes are still open your vet could inject contrast material to see where it goes. Otherwise, it would be good to obtain all three standard views of the foot to get a better idea of how much bone has been destroyed.

I would be aggressive with the trim. There's a good chance that will lead to an impressive round of abscess drainage but that's a good thing.  If an avenue opens on the sole you can try treatment with medical maggots to destroy infected and damaged tissue.  Another option for osteomyelitis is regional limb perfusion with antibiotics.  Unfortunately, bone infections do not respond to oral or even intravenous antibiotics because the blood supply to bone tissue is too poor to deliver a high enough concentration of the drug.



--
Eleanor in PA

www.drkellon.com 

EC Owner 2001


Stephanie Stout
 

Hi Lavinia and Dr. K,

Lavinia - no, he was not standing completely horizontal/squarely to the ground. He does not want to put his foot completely horizontal on the ground, and I'm not sure if it is due to his foot/abscess problems or due to the tendon damage/injury in his leg(it's King so must be complicated). Thank you for the mark-ups. I'm going to print it off to show to my farrier on Monday. My farrier is wonderful, but I know trimming off this much hoof is out of his normal comfort zone. I don't blame him.....trimming blood/fluid/puss freaks me out as well!

I also got a DP radiograph view but the vet forgot to send it. I will ask them to send it to me on Monday. I will post a picture on Monday after the trim of his hoof as well. I don't know if King will allow the farrier to trim it all off on Monday so we might end up doing half on Monday and half later in the week. King is a super patient, but he is sore so it is hard on him. 

Do you think it's just a huge abscess? Do I need to try to find a vet that will do a regional limb perfusion? Can you please explain that to me as I've never heard of it? I just Google searched it, and got myself more confused I think. Can it be done in the barn, or does he have to go into a clinic? Should I wait to see if he stops draining after the toe is trimmed or what should I do?


Thank you again. King says thank you as well for helping as I would be lost without you ladies.

-- 

Stephanie & King
October 2014
Oregon
Case History 


Lavinia Fiscaletti
 

Hi Stephanie,

Here's some info on RLP in the files:

https://ecir.groups.io/g/main/files/Regional%20Limb%20Perfusion

It can be done in the barn.

All of that excess hoof needs to come off asap because it is sealing in a lot of unhealthy material and making the situation worse. If you need to do it in two sessions within this week, that would work. Another option would be to nerve block his front feet so that he can stand comfortably while the farrier works.

You/we need more information to be able to figure out exactly what is going on inside. The DP xray will help, as will opening up all that necrotic material. Then you take all the new information and formulate a plan moving forward.
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team


Stephanie Stout
 

Thank you, Lavinia. I will post updated pictures of his hoof on Monday as well as the DP xray. 

Thank you again!

P.S: Do you ever visit Central Oregon?? :) 
--
Stephanie & King
October 2014
Oregon
Case History