Pedal Osteitis & Periostitis
11 year old Throughbred mare
Previous palmar digital neurectomy was performed to alleviate pain associated with a non-healing, lateral, articular wing fracture of the distal phalanx. Prior to surgical intervention, low palmar digital perineural anesthesia had resolved her lameness.
The physical exam findings were unremarkable, and the horse was in excellent general condition.
DIAGNOSIS AND PROGNOSIS
Marked, active, proliferative changes along the dorsal aspect of the middle phalanx, and chronic degenerative disease of the distal phalanx conisisting primarily of osteolysis secondary to the lateral wing fracture were observed with the MR and radiographic imaging. The findings were suggestive of ongoing remodeling of the distal phalanx adjacent to the former fracture site (pedal osteitis), and inflammatory changes to the middle phalanx (periostitis).
Additional anesthetic was used around the dorsal aspect of the coronary band to desensitize the dorsal aspect of the pastern where the active osseous proliferative changes were observed on the middle phalanx. The lameness markedly improved.
Based on the case findings, doctors were cautiously optimistic that her lameness would improve with continued rest and resolution of the inflammation in the distal limb. The prognosis for returning to perform at her previous level of activity without ongoing lameness problems in the right forelimb remained fair to guarded.
Application of a wide webed aluminum or steel shoe to the right front hoof with the lateral hoof wall and lateral tow region "floated" (non-weight bearing). The left front hoof was to be shod routinely.
Administration of Phenylbutazone for 10 days to reduce inflammation
Topical application of Surpass(R) over the right front pastern region and coronary band to help decrease inflammation
Strict stall rest for 4 weeks. From 4 to 12 weeks she may have stall rest with a gradually increasing course of hand walking (starting at 5 minutes BID and increasing to 40 minutes by the end of the 12th week).
Lameness and radiographic reevaluation of her right front middle and distal phalanx in 12 weeks to assess response to treatment and determine whether continued stall rest is necessary.
Copyright © 2006 - University of Pennsylvania School of Veterinary Medicine, All rights reserved.
Faculty: Dr. Alexia McKnight
Student:Charles Bradley 2009