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Joint & Physis Infections in Foals

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By Lauren Lamb, DVM

During foaling season, owners may notice that a foal is lame and suspect that the foal just got stepped on by the mare. While this could be the cause of the lameness, a more likely cause of this lameness is a septic physis or septic arthritis.

Septic arthritis means the foal has an infected joint. A septic physis means the foal has an infection in the growth plate. Both septic arthritis and a septic physis are life threatening conditions that need to have aggressive medical attention as soon as possible.

Foals have an increased risk of developing a septic joint or physis if they do not receive an adequate amount of colostrum from the mare. This colostrum needs to be in the foal’s gastrointestinal tract within 36 hours of being born. “Failure of passive transfer” is the phrase given to foals that do not receive enough colostrum.

Two common reasons a foal will not receive an adequate amount of colostrum — the foal not being able to stand and nurse the mare properly within the first 36 hours of being born is the most common cause of failure of passive transfer and due to a mare leaking a significant amount of colostrum prior to the foal being born. The colostrum contains anti-bodies that are vital for protecting the foal from infections caused by environmental bacteria.

Foals that are diagnosed with failure of passive transfer should receive one liter of plasma intra-venous. The plasma will have the anti-bodies that the foal will need to fight off any potential infections. Some veterinarians will also administer antibiotics to a foal with failure of passive transfer in additional to the liter of plasma. The antibiotics are used as another line of defense to prevent a foal from getting a septic joint or physis.

Foals have a unique blood flow at the physis and the joint, which is not seen in adult horses. The blood flow within the vessels in these locations will slow down. This slower moving blood will allow bacteria within the blood to attach to the vessel wall.

Once the bacteria attaches to the vessel wall, a bacterial infection can develop. The type of bacteria commonly isolated from septic joint and physis in foals are bacteria commonly seen in the foal’s environment. This is due the foal ingesting the bacteria as it explores the environment, or the bacteria can enter the body via the umbilicus.

Diagnosis of septic arthritis or physis is usually pretty straight forward. The foal will be lame (moderate to non-weight bearing) on the leg with the infection. Heat and swelling around the joint or physis that is infected frequently occurs. It will be very painful for the foal during palpation of the infected joint or physis. An infected joint will have an increased amount of fluid within it. The knee, fetlock, stifle and hock are the most commonly affected joints.

If a septic joint is suspected, a sample of fluid should be collected from the joint. This fluid should be cultured to identify the type of bacteria causing the infection. The fluid should also be analyzed to identify how many and what type of cells are present in the fluid.

Normal joint fluid will have less than 250 cells/mm3 and less than 10 percent of these cells should be neutrophils. A septic joint will have several 1000 cells/mm3 and 70 percent or more of these cells will be neutrophils. The neutrophils are the primary cells in the body that combat bacterial infections. If a bacterial infection is present, a larger number of these cells will be located in the joint fluid.

Radiographs of an infected joint should be taken to make sure that the infection in the joint has not spread to the bone. An ultrasound of the joint can be used to identify fibrin within the joint. The fibrin is produced secondary to the infection. The fibrin can act as a shelter for the bacteria to hide from the foal’s immune system and the antibiotics administered to fight the infection. If a large amount of fibrin is seen within the joint, the foal may need to have an arthroscopic surgery to remove the fibrin and improve the prognosis for a successful outcome.

Definitive diagnosis of a septic physis is confirmed with radiographs. Radiographs of a septic physis will have bone lysis (dark bone on radiographs) in the area where the infection is located. An ultrasound of the infected physis may show fluid in or around the physis.

Treatment of a septic joint involves a combination of local therapy and systemic therapy. Until the culture results are received, the foal will be started on broad spectrum systemic antibiotics.

Local therapy can be done either with injections of antibiotics into the joint or regional limb perfusions. Septic joints are usually flushed with several liters of sterile fluids to help remove bacteria and inflammatory mediators from the joint.

An arthroscopic surgery may need to be performed to flush the joint, remove any fibrin within the joint and debride any infected bone. Anti-inflammatory medication is used to help control the foal pain.

Pick up the May issue to learn more!

Equine

Cudd Quarter Horses Production & Consignment Sale Benefits Rein in Cancer

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The Cudd Quarter Horses 38th annual sale is set for June 8 at the ranch in Woodward, Okla., and a special horse sold will benefit the Sooner State-based 501(c)(3) Rein in Cancer. Once again, Alice Goldseeker, a sorrel yearling mare by Bay John Goldseeker (King W Goldseeker x Jazzabell Jazz) out of Alices Cat (Cat Ichi x Squirrel Tooth Alice), will sell as lot #24 and, thanks to the generosity of Renee Jane Cudd, the proceed of her sale will go to benefit Rein in Cancer.

Rein in Cancer co-founder Shorty Koger expressed gratitude, saying, “We deeply appreciate Renee Cudd’s support of Rein in Cancer. The funds we provide are crucial for those facing the many challenges of cancer treatment.”

Cheryl Cody, President of Rein in Cancer, emphasized the importance of community support: “Support for Rein in Cancer means so much. The funds are allocated in two key ways: first, to sustain the Shirley Bowman Nutrition Center, which offers care to cancer patients regardless of their financial situation; and second, to provide direct financial assistance to individuals in the horse industry undergoing cancer treatment. Cancer affects everyone, whether personally or through loved ones, making this cause incredibly important. We are extremely grateful to Renee for her support.”

Cudd Quarter Horses was begun in 1985 by Renee Jane Cudd and her late husband, Bobby Joe Cudd. The ranch has been a leading breeder of AQHA Ranch and Roping horses for over 30 years, and the annual Production Sale is always a popular event. Renee noted, “Bobby Joe passed away in 2005, and I feel so lucky that I have been able to continue with it.”

For information on the sale, visit the Cudd Quarter Horses Facebook page.

Rein in Cancer was founded in 2007 by three friends: Shorty Koger of Shorty’s Caboy Hattery, Cheryl Cody of Pro Management, Inc., and healthcare professional Tracie Clark. These founders continue to lead the 501(c)(3) organization, which has raised millions of dollars. Rein in Cancer funds and supports the nutrition clinic at the University of Oklahoma’s Charles and Peggy Stephenson Cancer Center, offering services to all patients regardless of their ability to pay. Additionally, the organization provides direct financial assistance to individuals in the Western performance industry undergoing cancer treatments.

For information on Rein in Cancer, visit ReinInCancer.com.

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Equine Flexural Limb Deformities

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By Dr. Garrett Metcalf

Flexural limb issues can occur in different age groups of horses, starting with newborns up to two- to three-year-olds. These issues occur somewhat predictably in age groups and can be addressed rather quickly when needed. There are various treatments and methods that can be used to address flexural issues. This article will discuss the most common flexural abnormalities and treatment methods.

Foal Flexural Issues

Foal flexural issues are often considered congenital flexural limb abnormalities because they are born with them. We don’t fully understand why this occurs but there is some evidence in the human literature that lack of fetal activity in the womb causes club feet in babies. In foals, it is thought that uterine positioning is to blame for part of the contracted tendons. Other causes can be exposure of the mare to toxic plants or substances that may be toxic to the fetus.

The most common area that a foal will have contracture of limb is at the carpus or knee. These foals will not be able to fully extend the knee and often will affect both at the same time. These foals can have difficulty standing to nurse or will get fatigued quickly and will not be able to stand for longer periods of time. There can also be damage to the extensor tendons or even rupture of extensor tendons caused by the high strain placed on them when the foal tries to stay standing. The rupturing of these tendons is not overly concerning but the lack of extensor function can make the flexural limb deformity worsen.

Other common locations of flexural limb deformities can be at the fetlock or coffin joint level. These deformities are not usually as detrimental to allowing the foal to stand and nurse properly compared to carpal flexural deformities. These deformities can be addressed similar to carpal deformities with some exceptions.

Treatment of Flexural Deformities

Splints or casts can be used to stretch and support the effected limbs of foals. Splints are often preferred by most veterinarians because they can be repositioned or reset as needed. Splints are easier to place on the limbs of foals but they do need resetting every 24 to 48 hours. Casting of the limbs is more rigid but is not adjustable once placed. Casting is often needed in more severe cases and requires changing frequently. Whenever placing these devices, care must be taken to prevent splint or cast sores because foal skin is rather delicate.

Surgical intervention is needed in some cases of carpal flexural deformities. A study out of Australia found that cutting of two muscle/tendon groups on the back of the carpus greatly improved the ability to extend the carpus with splinting methods. Cutting of these tendons do not have consequence to future athletic function. The two muscles are called flexor carpi ulnaris and ulnaris lateralis.

An antibiotic called Oxytetracycline is helpful to treat flexural limb deformities because of its side effect of causing tendon laxity. The laxity is created by chelating calcium within the tendons and allows the relaxation of tendons. This method does have some risk because of the high dose required and renal injury that it can cause when not administered with IV fluids.

Toe extension shoes are used when it comes to dealing with lower limb flexural limb deformities. These shoes are often applied with adhesives and after the splinting or casting is no longer needed. The toe extension shoe allow foal to continue to stretch those tendons every time they take a step and prevent from becoming contracted again.

Older horses (six months or older) with contracted tendons often get acquired limb deformities and the horses need surgical intervention to correct these deformities. These surgeries cut or release check ligaments that allows the musculotendinous unit of the deep digital or superficial digital flexor tendon to elongate. The deep digital flexor tendon is responsible for causing club feet or a flexural limb deformity at the coffin joint. The superficial digital flexor tendon is responsible flexor tendon that causes a flexural limb deformity at the fetlock joint. The check ligaments attach the tendon to bone and do not allow the tendon to elongate past a certain point. By eliminating these ligaments the flexural limb deformity can be corrected by allowing the muscle to stretch since the tendon is much more rigid.

Flexural limb deformities can be caused by excessive laxity or weakness of the tendons. These deformities are often seen in premature foals or foals that are born at a much smaller birth weight. The excessive laxity will cause the toes of there feet to flip up in the air and the fetlocks to be touching the ground. The areas where the skin is contacting the ground will cause sores and abrasions. If these areas are note protected the wounds can get into deep structures causing serious infection and injury the flexor tendons.

Treatment for tendon laxity is to add heel extension shoes to keep the toes flat to the ground. The extension behind the foot forces the toe down under the foals own weight. As the foal becomes stronger from normal activity the muscle attached to the tendons can support the foal and the limb laxity will correct itself. Abrasions still can occur even with heel extension shoes are in place so bandages need to be applied to protect these areas.

Flexural limb issues are a common issue that horses and owners will face. It is best to have your horse evaluated by a veterinarian whenever these problems are suspected. Foal flexural limb deformities can be life threatening because of the limitation of standing on time to nurse colostrum. Without colostrum within the first hours of life the foal is a much higher risk of sepsis and death.

Read more in the August 2023 issue of Oklahoma Farm & Ranch.

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Equine Foot Abcesses

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What a pain!

By Dr. Garrett Metcalf, DVM

A foot abscess is a common occurrence in horses throughout the year. Often wet weather can play a factor in the increase number of foot abscesses that horses will experience. A foot abscess can cause a great deal of pain, lameness, swelling and misery to the horse that often needs to be addressed quickly and provide pain management to keep them comfortable. There are many methods of addressing a foot abscess that people use. This article will discuss techniques to evaluate and treat the abscess as quickly as possible.

Foot abscess is a focal or sometimes diffuse infection that is trapped between the sensitive and non-sensitive lamina of the foot capsule. A foot abscess can form randomly from the normal stresses and environmental changes that cause the foot to allow bacteria to enter down to the sensitive tissues. Other causes are penetrating injuries to the bottom of the foot that allows bacteria to enter the through the outer lamina, such as nails, sharp rocks or even thorns. Poor foot care and misplaced shoeing nails can also lead to foot abscesses. A common area for abscesses to form is at the white line (area where the sole and hoof wall meet) and at the bars of the heels.

Foot abscess can cause a horse to have variable amounts of lameness, but generally they will be lame at a walk or even be non-weight bearing from the severity of the pain. Swelling starting at the foot and working its way up the limb can be noted when the abscess is trying to migrate out at the coronary band. These types of abscess are often referred to as “gravel” abscesses. “Gravel” is no more than just a regular foot abscess that has found the path of least resistance to the coronary band, where it ruptures out and causes a draining tract. An abscess in the hind foot can make the horse move rather abnormal to the point that it makes owners and veterinaries perceive the horse as acting neurologic.

Examination of the horse for lameness is the first step in diagnosing a foot abscess. The horse will often be lame at walk but some need to be watched at a trot to determine the lame limb. Lameness localization with regional nerve blocks can help make sure the pain is coming from the foot and not other parts of the limb. The foot will often have an increase digital pulse with occasional notable heat in the foot. The pulse is from inflammation causing a bounding of the digital arteries most notably behind the ankle region. The foot examination often needs to be performed with the shoe removed from the foot if the horse is shod. Hoof testers help pinpoint the area of most concern on the foot and often horses will be rather painful in response to the pressure created by the hoof testers. Knifing the foot out to clean up and remove any old sole or frog material is imperative to be able to locate the abscess with as much accuracy as possible. Often there will be a defect in the hoof or a dark focal tract that will lead to the abscess.

Treatment of the foot abscess can be done multiple ways and many people have lots of opinions on this topic. My treatment of choice is to open that abscess as soon as possible to give the horse nearly immediate relief and to quickly resolve the abscess infection. There are many methods to doing this but a good sharp hoof knife or loop knife one of the easiest ways to get the abscess drainage through the bottom of the foot. Whenever drainage of the abscess is achieved at the bottom this can eliminate the formation of a “gravel” and keep it from migrating out at the coronary band. Also drainage at the bottom allows a more effective treatment of the abscess with topically applied poultice agents. After the abscess has been opened to drain, bandaging the foot with a poultice agent is effective at eliminate the abscess and preventing foreign material from packing to the abscess area.

A great method of bandaging the foot is with the use of a large baby diaper. The diaper is very absorbent and foots the foot rather well. The diaper can be covered with layers of Vetrap, Duck Tape and Elaskiton to keep it protected or the foot can be placed in a medicine boot to keep the diaper protected.

Poultice choices are rather personal experience or availability, but also depend on the nature of the abscess. Epsom salt based foot poultice agent called Magna Paste or similar products are rather good at drawing out the remaining part of the abscess once it is opened. A homemade poultice of sugar combined with Betadine solution can make a really good poultice. There are various other topical agents that can be used effectively. The main thing when choosing a topical product is to make sure it is safe and that it has some antimicrobial properties.

Some foot abscess cases can be difficult to pinpoint and to drain. In these situations often time, pain management and soaking of the foot in Epsom salt water baths can help to allow the abscess rupture or make it easier to identify. In rather difficult abscess or when abscesses keep reoccurring in the same location, X-ray imaging of the foot is helpful to examine the structures of the foot. The abscess itself cannot be seen often with X-ray because the abscess fluid is the same density as the hoof wall. The only way to identify an abscess on X-ray is if there is gas present in the abscess making it visible on the film. Whenever there is a penetrating injury to the foot, X-ray is a must to make sure that the injury is not going into the deeper structures of the foot like the coffin joint or navicular bursa. These injuries are much more serious and need to be examined as quickly as possible. It is also recommended whenever possible to leave the penetrating object in the foot until the X-ray is taken. This will help the veterinarian understand what structures may have been injured.

Prevention of foot abscess is not always possible but a great start to this is really good hoof care. Routine trimming on a timely schedule is key part of good hoof care. The longer the feet go without a trim can affect the lamina and cause stretching of the white line, opening it up to allow bacteria to enter the foot. The use of special shoeing nails and other methods of good shoeing practices also limit the risk of abscessation.

Read more in the June issue of Oklahoma Farm & Ranch.

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