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Monday, January 12, 2015
Tendon Surface Angle (TSA) is measured on this distal part of the navicular bone compared to a level ground marker. This is relative to the course of the deep digital flexor tendon takes at turns to attach to the coffin bone. Monitoring the change of TSA with your applied orthotic is of value especially cases that show navicular bone lesions in this region. Simply changing DB may be beneficial in many cases however raising PA and TSA is often required to be therapeutic.
Monday, December 22, 2014
3) The cassette/plate should be touching the hoof on the medial side in the lateral view to prevent as much magnification as possible.
|Good Bone Detail but not good for soft tissue|
Monday, October 27, 2014
Whats in a toe angle? Here are two foals that would be considered to have a club foot with a toe angle of close to 64 degrees. However what makes up the angle on the inside dictates what the foot will do and what it takes to manage it. The foot on the left has a lower bone angle and a higher Palmar angle. This is a system that is under higher deep flexor tension rasingbthe heel and palmar angle. Notice there is more dishing of the toe on the left radiograph as well. All indications that the deep flexor acting very heavy on the coffin bone.
The radiograph on the right has a very large bone angle and lower Palmar angle, and no dishing.
Palmar angle plus the bone angle will equal the toe angle.
The hoof on the left will require more attention directed at relieving deep flexor tension via shoeing mechanics (rocker shoe) or surgery (check ligament desmotomy). The hoof on the right will be easier to manage with trimming alone and or low scale rocker shoe to add some foot mass to further protect the fragile coffin bone during development.
This is why radiographs are so very helpful in managing foot problems. You will never go wrong gaining specific information about your problem.
Sunday, January 5, 2014
The images in the left are post shoeing radiograph from the 30 day post tenotomy visit and the images on the right are 30 days after that or 60 days post tenotomy. The inital shoes are glued on and are usually left on for the first 10-12 weeks and many cases are barefoot at that time. This case was growing so rapidly and to properly manage the palmar angle (prevent from getting into the negative zone) the shoe was removed, the foot trimmed and very lightly nailed back on parallel the the wings of the coffin bone. Again note the amount of sole depth recovery within this 30 day period.
The bottom two images are 90 days post tentomy. This horse is comfortable barefoot and can maintain a zero to slightly positive palmar angle.
Plan is for this horse to start hand walking daily for 5-10 minutes just to get him out of the stall. Recheck at 4-6 week intervals with radiographs to insure continued foot mass recovery and maintenance of the palmar angle. This horse may very well be able to do some light riding in another 6-8 months with some turnout. Because of the severe bone remodeling that had already occurred I am hesitant to say he will return to 100 percent of what he was prior lamintis but can have a good quality of life.
Below are images that are taken 30 days after placement in the nanric modified ultimates placing the palmar angle at approximately 20 degrees
On the left below is a venogram of the left hind on initial exam and a follow up venogram 10 days later while wearing the modified ultimates placing the palmar angle at 20 degrees. Note the significant improvement in vessel filling over the coronary band, the more normal appearance in the circumflex junction and return of solar and terminal papillae.
Below in the left column is 10 days post wedging and 30 days post in the right column.
These are just three cases from this summer and fall that demonstrated the quick response I am looking for. Understanding the mechanics relative to the deep flexor and its role in a failing lamellar bond has proven very beneficial in my practice. Monitoring the failing system with serial venograms will inform you quicker than plain radiographs. Instead of waiting around for 4-6 weeks to evaluate the response in sole depth and hoof wall growth the venogram will demonstrate the level of compromise days to weeks before any changes can be noted otherwise. This allows quicker changes in mechanical therapy and less irreversible damage. This prevents chronic pain and abscesses.
What do you consider a success? Patient comfort? What level of sole depth recovery in a period of time do you expect with your laminitis therapy?
Wishing you happy and prosperous new year.
All the best
Sammy L. Pittman, DVM