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TOPIC: DFT lesion and neurectomy

DFT lesion and neurectomy 10 Mar 2011 02:22 #1

  • Rick Talbert
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I shoe a chronic foundered horse that is very lame due to a DFT lesion, nothing has seemed to help very much. It is stoic to hoof testers across the sole, but shows heel pain (not so much with the testers, but very evident at a walk). Nav bone appears ok, but without clogs and a #4 curtis hamilton wedge it doesn't want to take a step. The horse doesn't respond well to taking away the wedge, nor does it respond well to frog support. I inherited the case a year ago, and we have managed to rebuild a good bit of sole mass, but regardless of the shoeing strategy applied the lameness remains significant. Horse has been this way for more than 5 years and is has been a long term daily pain med addict. It was my thought that it is time to consider a neurectomy, but was told that this may cause vasculature problems since the horse has foundered and therefore could cause the hoof capsule to detach. I have never heard of this being a potential problem, and cannot find any info to cite secondary vasculature complications of nuerectomies in foundered hooves. Has anyone had any experience with this being an issue?
Rick Talbert
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RE:DFT lesion and neurectomy 10 Mar 2011 22:14 #2

  • Ray_Knightley
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Would be a very dangerous thing to do I would think ,and lasts sometimes less than two years ,those nerve ends dock on somewhere just introducing a new pain at the end of the day ,if the tip of p3 does not pop out first .

Does the horse not have a pedel ostitis maybe if nothing is working from outside ?
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RE:DFT lesion and neurectomy 11 Mar 2011 15:09 #3

  • mwmyersdvm
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Dr. Redden has had experiences with these. The horse moves too much on the damaged tissue and ecentually sloughs the hoof. A neurectomy will only work if a low palmar block is effective. I treated a long standing chronic case that had a neurectomy done at a referral center. It was not effective and I got him going again with a Redden Wedge aluminum shoe that was greatly rockered. If we could see some films and video of this horse, more assistance may be able to be rendered. There is also a neuritis condition that has been seen in these chronic cases, especially in the winter. Can you give a bit more detailed history of the case? Any possibility of this horse being insulin resistant?

M. W. Myers, D.V.M.
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RE:DFT lesion and neurectomy 11 Mar 2011 16:50 #4

  • brian robertson
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What exactly does it take, for some folks to say, "this horse needs to die"?
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RE:DFT lesion and neurectomy 12 Mar 2011 00:43 #5

  • mwmyersdvm
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I have had some horses that if everything is pulled into place can recover to a reasonable level of comfort. Diet, pasture control, checking for metabolic problems, etc. The horse I worked on earleir in this string was lame for four years and went back to giving lessons. Perhaps if I saw this horse I might concur on euthanasia, but I really don't have enough data to recommend this. If there are no funds to do this fully and all of the usual areas have been covered then I would readily agree.

M. W. Myers, D.V.M.
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RE:DFT lesion and neurectomy 12 Mar 2011 06:11 #6

  • Rick Talbert
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I dont have any videos, sorry. Horse has had a tenotomy. Horse has a good deal of capsular rotation, and has slightly subluxated PIJ in the front left, that seems to stay in that position regardless of the angle of P3. Horse grows a healthy hoof and has been this way for many years. But the strange thing really is that the horse, like I said is stoic across the toe and exhibits only heel pain. The horse blocked out to a PDN. I agree with the comment about what does it take for some owners to put a horse down, but this owner is one of those who is not going to do it. Dr Meyers, I had shod the horse in the roller motion morrison T-shoes with a #2 curtis hamilton wedge, increased the wedge to a #4. Took it out of the T-shoes and put it in clogs with a #4 wedge, as the thickness of the clog allowed me to grind in more mechanics. I have put them on with and without IM. I have tried some frog support but that had to immediately be taken off. I am curious about what you said about the sloughing off of the hoof capsule. The horses that did this, did they have a stabile hoof capsule to begin with? I guess I would have thought that the horse would still have sensation in the front portion of the hoof, and therefore would still be limited some from pain due to rotation which would prevent this from occuring especially if the hoof capsule had a healthy enough proximal connection to P3 and a decent blood supply. Would not a neurectomy only alleviate pain from the back half of the hoof? The only way I could get any more mechanics under the hoof would be to nail on a baseball. I just did the horse the other day, but I will try to get some photos next go round. I strongly suspect a DFT lesion, but the vet and I are basically exhausted with the shoeing and feel that what we have achieved is about as good as we can expect. Neurectomy was what we were thinking until a conversation with another vet in Texas I think advised against it saying the horse would slough off the hoof capsule. That threw a monkey wrench in those plans, but while I can see that being the case in some foundered hooves, I would roll the dice in this situation. I tend to think it would be fine. Horse is stalled all the time except for hand walking anyway. And if it has complications so be it, that may only expedite the inevitable.;)
Rick Talbert
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RE:DFT lesion and neurectomy 12 Mar 2011 13:35 #7

  • Mark_Gough
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Rick, when I see a horse go better in clogs it causes me to wonder how much better it might do in a Ron Aalders type of banana shoe. Perhaps a banana would give the horse a chance to demonstrate optimal mechanics. We can shape a clog for breakover and add a best-guess wedge but the mechanics are then predefined and the horse has to work with what we give him. The banana provides the horse with options to fine tune each foot. While there are premanufactured roller motion shoes available, I've not seen any that appear to provide as much versatility in radius as the ones that Ron forges. It's as close as anything to the "baseball" you mentioned. I also think that with some equine problems, even the best applied mechanics just aren't going to help. That's when it's time for the vet to have that unfortunate conversation with the owner.

Just a thought.

Cheers,
Mark
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RE:DFT lesion and neurectomy 12 Mar 2011 18:02 #8

  • dave murray
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Rick, another option you can talk over with the vet is to do cryosurgery on the nerves instead of actually going in and cutting them.
Cryo is the use of liquid nitrogen to deep freeze the nerves if you will.
i have seen it done on some racehorses i have shod with some success.
could be a less costly alternative that could give the horse some added comfort for a while.
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RE:DFT lesion and neurectomy 13 Mar 2011 03:26 #9

  • Rick Talbert
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2 good ideas. Thanks Mark and Dave.
Rick Talbert
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RE:DFT lesion and neurectomy 13 Mar 2011 16:20 #10

  • mwmyersdvm
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My question would be,did the tenotomy initially make the horse better? If so then doing it below the fetlock may yield some relief. However,you may have a great deal of scar tissue buildup in the P3 joint capsule preventing relief of the angle you are seeing. These are tough cases and long term pain killers may be in order for them. Fircoxib (Previcox) has shown a great deal of promise in some of these. As long as the heel block works, then a neurectomy may be an option. If the hoof capsule sloughs, at least you will have closure and the horse is out of pain, initially, from the neurectomy and finally from euthanasia that no one will question. It is an odd win-win, but it would be defined that way from the horse's viewpoint.

If you want to try the firocoxib/phenylbutazone protocol you use 57mg firocoxib twice daily for two weeks then 57 mg daily indefinitely. Add to this, one gram phenylbutazone twice daily one week, then one gram daily for two weeks and stop the phenylbutazone while the firocoxib is continued.

M. W. Myers, D.V.M.
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