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Puncture Wounds of the Foot in Horses

(Subsolar abscess, Septic navicular bursitis)

By

James K. Belknap

, DVM, PhD, DACVS, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University

Last full review/revision Sep 2015 | Content last modified Oct 2015

Puncture wounds are common in horses and are the most common cause of subsolar sepsis. Most puncture wounds result only in sepsis of the subsolar soft tissue (ie, subsolar abscess) but can be catastrophic when the puncture is in the frog and travels deep enough to enter synovial structures such as the navicular bursa, the distal interphalangeal joint, or possibly the deep digital flexor tendon sheath.

Puncture of the sole by a foreign body is associated with introduction of pathogenic microorganisms that lead to subsolar abscess formation. Lameness is usually severe; the degree of lameness may be similar to that of a fracture. The horse may stand pointing the affected foot. There is commonly a prominent digital pulse in the affected limb. If allowed to progress, the abscess may travel proximally to rupture at the coronary band; there will usually be edematous swelling proximal to the coronary band before rupture. Diagnosis is made by confirming the site of pain by pulling the shoe, using hoof testers, and picking or paring the suspect area to locate the foreign body or its dark tract. If a foreign body is found in the frog, it may be best to obtain a lateral radiograph of the foot to assess the structures penetrated before removing the offending object. If a tract is found in the frog, it should be probed and a radiograph taken with the probe in place. Because puncture wounds in or near the frog commonly enter a synovial structure, they constitute a serious problem requiring rapid, aggressive diagnosis and therapy. If a synovial structure is entered, the horse should be placed on broad-spectrum antibiotics and transported to a facility capable of advanced surgical and medical techniques; the affected synovial structure should be lavaged with sterile polyionic solution as soon as possible (within hours).

If a puncture wound is noted in the solar area, ensuring adequate drainage from the site helps prevent abscess formation. If there is a suspected abscess but no tract is found, the foot can be poulticed in an attempt to promote organization of the abscess for localization. If a tract is found that leads to a subsolar abscess, adequate drainage should be established with a hoof knife; the drainage hole should be kept as small as possible (~0.5–1 cm diameter) to avoid a prolapse of sensitive corium. Some farriers and veterinarians prefer to drain the abscess through the hoof wall (instead of the sole) if possible. Once the abscess has been entered, it should be probed to determine its extent; a palmar digital nerve block will usually be necessary before probing and lavage of the area. If the abscess underruns a large area of the foot, another small ingress/egress hole can be made at the farthest extent of the abscess from the original entry point, and lavage can be performed by placing a 14-gauge catheter or teat cannula into the affected subsolar space and flushing with saturated Epsom salt solution (made by adding Epsom salts to boiling water or saline until some salt crystals sit on the bottom of the container and will not go into solution). If a chronic subsolar abscess has developed, this treatment may have to be repeated daily to every other day for several treatments. The foot should be protected until there is full healing/epithelialization of the solar region entered; healing appears to be much more rapid and is easier to treat if the abscess is entered through the wall instead of the sole. All horses with puncture wounds should be immunized against tetanus. Local and systemic antibiotic therapy are not necessary for a sole abscess but should be considered with swelling above the coronary band (indicating septic cellulitis) and must be used aggressively if sepsis of a synovial structure is present.

OTHER TOPICS IN THIS CHAPTER

Lameness in Horses
Overview of Lameness in Horses
The Lameness Examination in Horses
Imaging Techniques in Equine Lameness
Arthroscopy in Equine Lameness
Regional Anesthesia in Equine Lameness
Disorders of the Foot in Horses
Osseous Cyst-like Lesions in the Distal Phalanx in Horses
Bruised Sole and Corns in Horses
Canker in Horses
Fracture of Navicular Bone in Horses
Fracture of Distal Phalanx in Horses
Keratoma in Horses
Laminitis in Horses
Navicular Disease in Horses
Pedal Osteitis in Horses
Puncture Wounds of the Foot in Horses
Pyramidal Disease in Horses
Quittor in Horses
Quarter Crack in Horses
Scratches in Horses
White Line Disease in Horses
Sheared Heels in Horses
Sidebone in Horses
Thrush in Horses
Disorders of the Pastern and Fetlock
Fractures of the First and Second Phalanx in Horses
Fractures of the Proximal Sesamoid Bones in Horses
Osteoarthritis of the Proximal Interphalangeal Joint in Horses
Palmar/Plantar Metacarpal/Metatarsal Nonadaptive Bone Remodeling in Horses
Sesamoiditis in Horses
Chronic Proliferative Synovitis in Horses
Digital Sheath Tenosynovitis in Horses
Disorders of the Metacarpus in Horses
Tendinitis in Horses
Suspensory Desmitis in Horses
Inferior Check Desmitis in Horses
Bucked Shins in Horses
Exostoses of the Second and Fourth Metacarpal Bones in Horses
Fractures of the Small Metacarpal (Splint) Bones in Horses
Fracture of the Third Metacarpal (Cannon) Bone in Horses
Disorders of the Carpus in Horses
Fracture of the Carpal Bones in Horses
Subchondral Bone Disease of the Third Carpal Bone in Horses
Tearing of the Medial Palmar Intercarpal Ligament in Horses
Osteoarthritis of the Carpus in Horses
Distal Radial Exostosis and Osteochondroma of the Distal Radius in Horses
Carpal Hygroma in Horses
Rupture of the Common Digital Extensor Tendon in Horses
Disorders of the Shoulder in Horses
Developmental Diseases of the Shoulder in Horses
Fractures of the Shoulder in Horses
Bicipital Bursitis in Horses
Infection of the Shoulder in Horses
Suprascapular Neuropathy in Horses
Osteoarthritis of the Shoulder in Horses
Disorders of the Elbow in Horses
Developmental Orthopedic Disease in the Elbow of Horses
Fractures of the Elbow in Horses
Osteoarthritis of the Elbow in Horses
Collateral Ligament Injury in the Elbow of Horses
Disorders of the Metatarsus in Horses
Bucked Shins/Dorsal Cortical Fractures of the Third Metatarsal Bone in Horses
Exostoses of the Metatarsal Bones in Horses
Diaphyseal Fracture of the Third Metatarsal Bone in Horses
Incomplete Longitudinal Fractures of the Plantar Aspect of the Third Metatarsal Bone in Horses
Focal Bone Reaction and Avulsion Fractures of the Third Metatarsal Bone in Horses
Fractures of the Second and Fourth Metatarsal Bones in Horses
Enostosis-like Lesions of the Third Metatarsal Bone in Horses
Disorders of the Tarsus in Horses
Failure of Ossification of the Distal Tarsal Bones in Horses
Osteoarthritis of the Distal Tarsal Joints in Horses
Osteoarthritis of the Talocalcaneal Joint in Horses
Osteoarthritis of the Tarsocrural Joint in Horses
Synovitis/Capsulitis of the Tarsocrural Joint in Horses
Osteochondrosis of the Tarsocrural Joint in Horses
Osteitis of the Calcaneus in Horses
Fractures of the Distal Tarsal Bones in Horses
Fracture of the Talus in Horses
Fracture of the Fibular Tarsal Bone (Calcaneus) in Horses
Fracture of the Lateral Malleolus of the Tibia in Horses
Tarsal Joint Luxation in Horses
Desmitis of the Collateral Ligaments of the Tarsus in Horses
Rupture of the Fibularis (Peroneus) Tertius in Horses
Stringhalt
Curb in Horses
Disorders of the Tarsal Sheath in Horses
False Thoroughpin in Horses
Luxation of the Superficial Digital Flexor Tendon from the Tuber Calcanei in Horses
Gastrocnemius Tendinitis in Horses
Calcaneal Bursitis in Horses
Capped Hock
Disorders of the Stifle in Horses
Osteochondrosis of the Stifle in Horses
Subchondral Cystic Lesions in Horses
Meniscus and Meniscal Ligament Injuries in Horses
Cranial and Caudal Cruciate Ligament Injuries in Horses
Collateral Ligament Injuries in Horses
Intermittent Upward Fixation of the Patella and Delayed Patella Release in Horses
Fragmentation of the Patella in Horses
Patellar Luxation in Horses
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