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Lameness, wing: bar shoe, foot/hoof cast or lag screw, box rest for 6m.…

- - - - internal swelling
      - drainage
  - - - local heat, digital pulses, DIP joint effusion, pastern oedema
  - - - limited use for feet, user dependent
    - - high sensitivity, low specificity
    - - correct identification of affected structures with advanced imaging modalities (combine with findings for diagnostic analgesia)
        
        navicular bursoscopy (indications from diagnostic analgesia and advanced imaging)
        
        corrective farriery
        
        controlled exercise
        
        pain relief
  - - - chronic foot abscess
    - - quittor (infection collateral cartilage)
        
        pain, fistulous tract, requires resection
  - - - mechanical irritation
      - hoof abscess
    - - typical lysis of distal phalanx
  - - - infection leading to necrotic processes in frog area
      - usually limited to lateral and medial sulk of frog
    - - mixed bacterial infection in deeper tissue layers of entire frog and heel leads to disintegration interlobular horn
      - warm, humid environment
      - cheesy white pus, pungent odour, tendency to bleed
  - - - protective bandage
    - - formalin, iodine, alternatives
  - - - advanced blocking required of distal interphalangeal joint and navicular bursa
  - - - lag screw, box rest 3-6m
      - bar shoe, box rest 6-12m
      - OA DIP joint
    - - if small - removal arthroscopy, arthrotomy and box rest 3-4m
      - if large - removal (arthrotomy/lag screw) and box rest for 4-6m. Complication = OA DIP joint
    - - transfixation cast and box rest 4-6 m
      - euthanasia
      - complications = OA DIP joint and laminitis
    - - bar shoe and box rest up to 6m
- - - - systemic inflammation, endothelial activation, leucocyte adhesion and emigration, cytokine expression, oxidative injury
      - hypoxic cellular injury
  - - - insulin dysfunction
        
        hyperinsulinaemia
        
        excess insulin response to oral carbohydrate
        
        tissue insulin resistance
      - increased fasting, altered adipokines and obesity
      - dx
        
        history
        
        clinical signs
        
        demonstration of ID
        
        fasting insulin and glucose
        
        dynamic test
      - tx
        
        wt loss, exercise +/- pharmacological agents
    - - loss of dopaminergic inhibition
      - excessive production of PI hormones
      - cortisol, CLIP + others affect insulin
      - hyperinsulinaemia --> laminitis
      - dx
        
        clinical signs
        
        basal ACTH
        
        seasonally adjusted reference range
        
        TRH stim test
      - tx
        
        pergolide
    - - dexamethasone reduces insulin sensitivity, causes exaggerated increase in insulin in PL
      - only animals with pre-existing laminitis risk factors
      - prednisolone only increased risk of recurrent not initial episodes
    - - overconsumption NSC (fructan + starch + sugar)
        
        NSC = energy for growth of plants
        
        NSC content of pasture fluctuates widely
        
        decreases when plant growing
        
        greater in late spring
        
        low in haulage (more palatable), NSC of hay depends on content of grass
        
        increases when plant photosynthesising
        
        high light intensity, low temp, lack of water
      - Diet
        
        base diet on forage/fibre, not sugar/starch
        
        if need extra energy use oil or unmollassed beet pulp
        
        Beet pulp 0.2-0.7kg/day
        • Vegetable oil; max 1ml/kg/day
        
        If feed cereals ensure cooked
        • Makes starch easier to digest in SI
        
        Small cereal meals • <0.5kg/100kgbwt
        
        add vit and mineral supplement
      - grazing
        
        consider zero grazing
        
        turn out late night to early am (low NSC)
        
        restrict in spring and autumn (growing)
        
        avoid if frost with bright sunshine or drought
        
        rotate paddocks to keep grass at appropriate height
        
        restrict intake (muzzle, strip grazing)
        
        regular exercise
        
        prevent obesity
      - cinnamon, magnesium, chromium? no equine studies
  - - - high mortality
      - inadequate perfusion
      - not direct mechanical overload
  - - - loss of strength of lamellar attachment
      - distal phalanx no longer suspended in the hoof capsule
  - - - contact with trigger, lasts up to 72h
  - - - lameness affecting 2 or more limbs
      - characteristic stance
      - bounding digital pulses
      - increased hoof walls temperature
      - pain on hoof tester pressure at region of point of frog
      - palpable depression at coronary band
    - - may take at first presentation if concerned P3 moved
        
        depression at coronary band
        
        softening of sole at point of frog
      - may take later if not improving
      - can be difficult if very painful
        
        may have to nerve block
        
        take machine to horse
      - lateromedial radiographs of feet
      - good foot preparation
      - markers
        
        dorsal hoof wall, starting at coronary band
        
        +/- point of frog
      - pedal bone rotation
      - founder distance
  - - - NSAIDs (PBZ, flunixin - IV/ORAL)
      - opiates (morphine, pethidine, fentanyl) controlled drugs, short acting and side effects
    - - essential
      - increase bedding
        
        depth, bring to door
      - frog support
        
        bandages, lilypads, NFS
      - frog and sole support
        
        styrofoam, dental impression material
    - - ACP
    - - sepsis associated laminitis
      - ice
      - chill distal to carpus/tarsus
      - 10C
      - no complications
    - - no grass
      - 1.5-2% body weight, poor quality hay
      - no or minimal concentrates
      - HiFi
      - unmollassed sugar beet
  - - - depression extends all way round coronary band suggests sinker = 20% survival
    - - rotation
    - - 8 weeks: 95% alive
        
        lower body wt, optimal body condition and mild laminitis were significantly associated w survival
        
        ACP may be associated w survival
      - 72% sound at trot (more likely in small horses)
      - 59% ridden again
        
        more likely if no previous laminitis
- - - - palpation of joints: distension, temperature, pain, range of motion
  - - - diagnostic imaging
  - - - soft v hard
    - - severe lameness/suspected fracture (walk)
    - - owner and separate rider
    - - STB pacers and trotters
- - - - changes in shoeing or related changes
      - changes in training or performance intensity
      - changes in health and diet
      - current medication and response, response to rest
- - - - difficult to identify subtle lameness
      - useful for back/rider/saddle associated problems
    - - steadiest and most rhythmic gait in most horses
      - preferred for lameness examination
  - - - sound (lameness not perceptible under any circumstances)
    - - lameness difficult to observe and not consistently apparent, regardless of circumstances e.g. weight carrying, surface, circling, inclines, hard surface
    - - lameness difficult to observe at walk or when trotting in a straight line, but consistently apparent under certain circumstances (e.g. weight carrying, surface, circling, inclines, hard surface)
    - - lameness consistently observable at a trot under all circumstances
    - - lameness is obvious at a walk
    - - lameness produces minimal wt bearing in motion and/or at rest or a complete inability to move
  - - - usually more pronounced on opposite (sound) fore or hind limb, except tendon or suspensory ligament damage
    - - cranial and caudal phase of stride
- - - - louder noise
- - - - louder noise