Summary Reasons for performing study: The diagnosis of foot‐related lameness often remains elusive and it can be difficult to offer rational treatment, or to predict outcome. Objectives: To describe the spectrum of injuries of the foot identified using magnetic resonance imaging (MRI), to determine their relative prevalence among MRI diagnoses and to establish the long‐term results of treatment. Methods: The MR images of horses examined from January 2001‐December 2003 were reviewed. Horses were selected for MRI if the pain causing lameness was localised to the foot using perineural analgesia but any clinical, radiological or ultrasonographic abnormalities were insufficient to explain the degree of lameness. The clinical significance of lesions identified using MRI was determined with reference to the results of local analgesia, radiography, ultrasonography and nuclear scintigraphy. Follow‐up information was obtained in January 2004 for horses which had been examined 6‐36 months previously and the outcome classified as excellent (horse returned to full athletic function without recurrent lameness), moderate (sound, but only in light work), or poor (persistent or recurrent lameness). Results: One hundred and ninety‐nine horses underwent MRI examinations. Deep digital flexor (DDF) tendonitis was the most common injury (59%) with primary injury in 65 horses (33%) and a further 27 horses (14%) having lesions of the DDF tendon and navicular bone. Seventeen percent of horses had injuries to multiple structures, including 24 with DDF tendonitis. Desmitis of a collateral ligament (CL) of the distal interphalangeal (DIP) joint was the second most common injury (62 horses, 31%), with primary injuries in 30 horses (15%) and a further 32 horses (16%) that had CL desmitis in conjunction with other injuries. Prognosis was best for horses with traumatic injuries of the middle or distal phalanges, with 5 of 7 horses (71%) having an excellent outcome. Horses with primary lesions of the DDF tendon or CL of the DIP joint had excellent results in only 13 of 47 (28%) and 5 of 17 horses (29%), respectively. Horses with combined injuries of the DDF tendon and navicular bone, or primary navicular bone abnormalities, had a poor outcome, with the majority of horses suffering persistent lameness. Conclusions: A wide variety of lesions associated with foot pain were identified using MRI, a high proportion of which were primary soft tissue injuries with a guarded prognosis for return to full athletic function. Potential relevance: It is now possible to propose more rational treatment strategies for the variety of foot injuries identified using MRI than had previously been possible; however, further information concerning aetiopathogenesis of these injuries is needed to improve their management.
Summary Reasons for performing study: There is a lack of long‐term follow‐up data for outcome of medical treatment of superficial digital flexor (SDF) tendonitis. Objectives: To determine whether intralesional injection of hyaluronan, beta aminoproprionitrile fumarate (BAPN) or polysulphated glycosaminoglycans (PSGAG) or systemic administration of PSGAG yielded better results than a controlled exercise programme alone in the management of SDF tendonitis, with a minimum follow‐up period of 2 years after resumption of full work; and to determine whether reinjury rate was related to sports discipline and whether fibre alignment score (FAS) at 4 months could predict outcome. Methods: In Study 1, 50 horses were managed by controlled exercise alone (Group A), 50 were treated with intralesional injection of hyaluronan (Group B), 20 received intralesional and systemic treatment with PSGAG (Group Ci) and 30 received systemic treatment with PSGAG (Group Cii). Horses in Groups B, Ci and Cii followed the same controlled exercise programme as Group A. In Study 2, 69 horses (Group D) were treated by intralesional injection of BAPN and followed a modified controlled exercise programme. Horses were re‐examined clinically and ultrasonographically at intervals. Follow‐up data were obtained for horses 2 years after resuming full work and for up to 6 years. Results: There was no significant difference in reinjury rate of the treated limb(s) between Groups A, B, Ci and Cii (42.5‐44.4%) (P>0.9). The reinjury rate (16%) in the treated limb(s) in Group D was significantly lower than in the other groups (P<0.001). However, when injury rate of the uninjured limb was considered, the results were similar to Study 1. In Study 2, the FAS at 4 months after treatment was a good predictor of outcome (P<0.001). Reinjury rates for different disciplines were similar in the 2 studies, with the risk of reinjury ascending from showjumpers to event horses to National Hunt and flat racehorses. Conclusions: Treatment with BAPN reduced the risk of reinjury in the treated limb, although the overall rate of subsequent injury was not affected. FAS at 4 months after treatment is a good predictor of outcome in the treated limb(s). Potential relevance: This study provides long‐term follow‐up data in horses from a variety of sports disciplines that can be used to provide prognostic information.
Magnetic resonance (MR) imaging is increasingly used in the diagnosis of equine foot pain, but improved understanding of how MR images represent tissue-level changes in the equine foot is required. We hypothesized that alterations in signal intensity and tissue contour would represent changes in tissue structure detected using histologic evaluation. The study objectives were to determine the significance of MR signal alterations in feet from horses with and without lameness, by comparison with histopathologic changes. Fifty-one cadaver feet from horses with a history of lameness improved by palmar digital analgesia (n = 32) or age-matched control horses with no history of lameness (n = 19) were stored frozen before undergoing MR imaging and subsequent histopathological examination at standard sites (deep digital flexor tendon, navicular bone, distal sesamoidean impar ligament, collateral sesamoidean ligament, and navicular bursa). Using MR images, signal intensity and homogeneity, size, definition of anatomic margins, and relationships with other structures were described. Alterations were graded as mild, moderate, or severe for each structure. For each anatomic site examined histologically the structures were described and scored as no changes, mild, moderate, or severe abnormalities, also taking into account adhesion formation within the navicular bursa detected on macroscopic examination. Alterations in MR signal intensity were related to changes at the tissue level detected by histologic examination. A sensitivity and specificity comparison of MR imaging with histologic examination was used to evaluate the significance of MR signal alterations for detection of moderate-to-severe lesions of the deep digital flexor tendon (DDFT), navicular bone, distal sesamoidean impar ligament (DSIL), collateral sesamoidean ligament (CSL) and navicular bursa. Agreement between the MR and histologic grading was assessed for each structure using a weighted kappa agreement. Direct comparison between histology and MR imaging for individual limbs revealed that signal alterations on MR imaging did represent tissue-level changes. These included structural damage, fibroplasia, fibrocartilaginous metaplasia, and hemosiderosis in ligaments and tendons; trabecular damage, osteonecrosis, fibroplasia, cortical defects, and increased vascularity in bone; and fibrocartilage defects. MR imaging had a high sensitivity and specificity for most structures. MR imaging had high specificity for lesions of the DDFT, CSL and navicular bursa, quite high specificity for lesions of the medulla of the navicular bone and its proximal aspect, with moderate specificity for the DSIL, and distal, dorsal and palmar aspects of the navicular bone, and was sensitive for detection of abnormalities in all structures except the dorsal aspect of the navicular bone. When MR and histologic grades alone were compared, there was good agreement between MR and histologic grades for the navicular bursa, DDFT, navicular bone medulla and CSL; moderate-to-good agreement in gr...
There are close interactions between injuries of the components of the podotrochlear apparatus, the DDFT, the navicular bursa and the DIP joint. Further knowledge about the biomechanical risk factors for injury may have importance for both disease prevention and management.
Palmar foot pain is a common cause of lameness. Magnetic resonance imaging (MRI) has the potential to detect damage in all tissues of the equine foot, but an understanding of the differences in magnetic resonance (MR) images between feet from horses with and without palmar foot pain is required. This study aimed to describe MR findings in feet from horses with no history of foot-related lameness, and to compare these with MR findings in horses with lameness improved by palmar digital local analgesia. Thirty-four limbs from horses euthanized with a clinical diagnosis of navicular syndrome (ameness >2 months duration, positive response to palmar digital nerve blocks and absence of other forelimb problems) (Group L), and 25 feet from age-matched horses with no history of foot pain (Group N) were examined. For each anatomic structure, MR signal intensity and homogeneity, size, definition of margins, and relationships with other structures were described. Alterations in MR signal intensity and homogeneity were graded as mild, moderate, or severe and compared between Groups L and N. Results revealed that there were significant differences in MR images between Groups N and L. Multiple moderate-severe MR signal changes were present in 91% of limbs from Group L and moderate (none were graded severe) in 27% of limbs from Group N. In most Group L limbs, more than three structures and frequently six to eight structures were abnormal. Concomitant abnormalities involved most frequently the deep digital flexor tendon, distal sesamoidean impar ligament, navicular bone, collateral sesamoidean ligament, and navicular bursa (with significant associations in severity grade between these structures), sometimes with involvement of the distal interphalangeal joint and/or its collateral ligaments. It was concluded that findings on MR images were different between horses with and without foot pain, and that pain localized to the foot was associated with MR changes in a variety of structures, indicating that damage to several structures may occur concurrently and that MR imaging was useful for evaluation of foot pain.
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