Surgical management
Should conservative therapy be unsuccessful, a surgical option of neurectomy
of the deep branch of the lateral plantar nerve and a plantar fasciotomy has
been proposed. This technique was first introduced by Bathe in 2003 and has
now become the treatment of choice for all cases of chronic cases of PSD
without osseous pathology. However, care should be taken in selecting the
appropriate cases. There are indications that horses with ultrasonographically
apparent, marked disruption to the proximal part of the suspensory ligament
are at increased risk of subsequent exacerbation or rupture. Horses with poor
conformation (straight hocks and hyperextended fetlocks) are also poor
candidates. Finally it must be remembered that a neurectomised horse is not
officially allowed to compete under FEI rules. Eight weeks following surgery,
horses are generally permitted to resume a normal, ascending work
programme. Long-term follow-up reveals a success rate of 78% defined as a
horse remaining free of lameness for at least one year after surgery. However,
if other concurrent abnormalities are present contributing to the horse’s poor
performance, success rate drops to 44%. Horses with a straight hock and
fetlock hyperextension remain lame.
Osteostixis of the proximal plantar aspect of the MtIII may also help with some
horses with chronic injuries with radiological abnormalities, marked
scintigraphic IRU or MRI evidence of refractory osseous pathology. However,
the technique is invasive and has yet to be shown effective in a large number
of horses.
DISTAL TARSAL OSTEOARTHRITIS
Spontaneous progression of joint destruction from early degeneration, through
active osteoarthritis, to bony ankylosis has not been documented. It is clear
however, that the state of ankylosis is generally associated with a pain-free
limb. Treatment of osteoarthritis is always palliative and is aimed at
eliminating pain and rendering the horse useful, rather than restoring to joint
function to normal. Both non invasive and invasive techniques have been
used to achieve this objective. Conservative (non-invasive) treatments consist
of systemic or intra-articular medication, corrective shoeing and/or adaptation
of the horse’s exercise regimen. Invasive treatments for bone spavin have
been designed to remove direct pressure over the affected area, to promote
fusion of the affected joints, to remove sensory perception from painful joints
or to reduce the subchondral bone pressure adjacent to affected joints. The
plethora of treatment options available appears to indicate that none of them
is totally effective.
Shoeing
Hoof care preference is to balance the foot and achieve a dorsal hoof angle 1°
to 2° steeper than the pastern and square or roll the toe. As much foot as
possible should be removed in the process to improve stability. The most
commonly used shoeing adaptations consist of lateral extensions or trailers,
heel elevations and rolled toes. Lateral extension shoes aim to minimize the
axial swing of the foot. Wide-webbed wedged (flat) aluminum shoes, help
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February
2016
East
London
Convention
Centre,
East
London,
South
Africa
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