TREATMENT OF DISTAL TARSAL AND
PROXIMAL METATARSAL LAMENESS
Michael Schramme
VetAgro Sup, Campus Veterinaire de Lyon, Marcy L’Etoile, Rhones-Alpes, France
PROXIMAL SUSPENSORY DESMITIS
Medical management
Conservative treatment of PSD has traditionally relied on prolonged stall rest
(3 months) with limited in-hand walking. In a series of cases of chronic
hindlimb PSD with long-term follow-up, less than 20% of horses returned to
full work following this treatment regimen. Experience with different treatment
modalities has led to the recommendation that acute PSD (4-6 weeks) should
be treated with a local (periligamentous) infiltration of an anti-inflammatory
and rest. Reduction of inflammation may reduce the risk of a resulting
compartment syndrome/neuropathy and persistent chronic lameness.
Therapeutic shoes with a broad web in the toe and narrow branches at the
heels should always be used in horses with PSD to reduce extension of the
fetlock on soft ground. Some authors recommend egg bar shoes to support
the fetlock joint, which seems somewhat contradictionary. Some horses can
work satisfactorily with phenylbutazone without apparent deterioration of
clinical signs.
Refractory cases can be managed with extracorporeal shock wave therapy
(ECSWT) or radial pressure wave therapy which appears to be helpful in
some cases. Forty one percent of 43 horses with chronic PSD were sound
and in work 6 months after treatment. The outcome was inversely related to
the severity of the lesion.
Intra-lesional injections of mesenchymal stem cells, platelet-rich plasma or
ACell have more recently been recommended although there is concern that
these injections in the absence of a fasciotomy can increase the risk of a
compressive neuropathy which is thought to be involved in the
aetiopathogenesis. No significant comparative case studies have been
published to determine which of these intralesional treatments, if any, is the
most effective.
It has been suggested that dressage horses tolerate hindlimb PSD less well
than show jumpers or event horses, probably because the temperament of the
horses is different and the enjoyment of jumping can override low-grade pain.
For dressage horses, modification of the training program is often required,
particularly in terms of avoiding a fatiguing training session in deep or loose
surfaces. Medium and extended paces should be avoided as far as possible
during training. Young dressage prospects may need a 3-month period of rest
after purchase and then a very gradual introduction into their work program to
try to prevent PSD from becoming clinically apparent.
15-‐18
February
2016
East
London
Convention
Centre,
East
London,
South
Africa
171