Texas Equine Veterinary Association

www.texasequineva.com | 38 Penetrating wounds to the foot are always a concern. With multiple synovial structures and sensitive tissues, any wound has the potential to be catastrophic. Even if a synovial structure is not involved significant local infection and cellulitis can lead to stress overload on the healthy limb and the development of support limb laminitis. is article will discuss evaluation of penetrating injuries and lacerations of the foot and method of medical management. Detailed descriptions of surgical procedures is beyond the scope of this article. EVALUATION OF THE INJURY Seemingly superficial injuries to the digit can become serious infections. An understanding of the anatomy and underlying structures is important to triage the injury. A detailed visual examination of the digit is the base of the examination. Light debridement and cleaning of lacerations and cleaning and debriding possible puncture wounds to the foot help to determine what the next diagnostic steps should be. Sensitive areas to hoof tester pressure should be explored with a hoof knife to trim away exfoliating tissue of the frog/sulcus and may reveal a puncture wound. On the dorsal aspect of the foot, the coffin joint capsule extends above the coronary band and lacerations or punctures to the front of the foot frequently are synovial. Lacerations over the medial and lateral aspect of the foot can involve the joint, but if palmar/plantar can also involve the digital flexor tendon sheath or collateral cartilages. Trauma to the heel bulbs can involve the distal interphalangeal joint, the digital flexor tendon sheath and potentially the navicular bursa. Wounds to the bottom of the foot are equally serious. Punctures to the frog, sulcus, and bars may engage the navicular bursa, coffin joint or puncture the deep digital flexor tendon. Punctures in areas of the foot that do not involve synovial structures can traumatize the bone leading to fractures or bone sequesterum. If a foreign body is visible in the foot, it is advisable to perform diagnostic imaging prior to removal. Aer removal or if only a wound tract is visible, contrast material can be injected into the tract with a teat canula to identify the borders. If a synovial structure is suspected to be involved, sterile preparation and injection of sterile saline to distend the joint or bursa may identify open synovial structures. Including 2 to 3 ml of procaine penicillin in the injection can provide a color contrast to identify the leak. If the synovial structure is effusive or allows for aspiration of fluid, analysis of the synovial fluid should be performed, as well as culture with broth enhancement. Collection of fluid for culture is ideally done prior to antimicrobial therapy (local and systemic), but therapy should not be delayed if synovial fluid cannot be collected. If a synovial structure is involved or is suspected to be involved, referral to a hospital facility for debridement, surgical exploration, regional limb perfusion and IV antibiotics is indicated. Imaging of the foot is critical to identify the structures involved. Radiographs, with and without contrast, are the basic imaging. However, even quality radiographs will not identify so tissue lesions. Ultrasound of the palmar/plantar pastern can be used to investigate trauma to the tendon and evaluate for air within the bursa or tendon sheath. Ultrasound cannot be used to reliably image structures within the hoof capsule, therefore advanced imaging may be required. Computed tomography and MRI are quickly becoming available in many areas and can image limbs both standing and under anesthesia. Advanced imaging can identify so tissue lesion and tracts not visible radiographically. Medical or Non - Surgical Management of Hoof Wounds Ben Buchanan, DVM, DACVIM, DACVECC Practice Owner Brazos Valley Equine Hospital, Navasota "I like challenging cases that present a puzzle, whether that is a poor performance, illness, or critical case. I especially like cardiac cases and foals." – Dr. Ben Buchanan Dr. Ben Buchanan grew up in Navasota, Texas. He went to Texas A&M and graduated from there with his DVM in 2001. Aerwards, he completed two residencies; Large Animal Internal Medicine at University of Tennessee, Knoxville in 2004 and Emergency and Critical Care at University of Pennsylvania in 2005. Ben is also board certified in Internal Medicine and Emergency Critical Care. Ben joined BVEH Navasota in 2005, where he works alongside his father, T-Bone. He is also active in community outreach by speaking at meetings and events around the world regarding equine care. Ben is married to Shana, whom he met in veterinary school. Shana is a small animal veterinarian and owner of Lake Conroe Vet Group. ey have two children, Jane Marie and Terrell.

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