Can pedal osteitis be managed in the standing patient?

Introduction

Infection of the hoof is probably the most common cause of lameness in horses. The clinical signs of a hoof infection are variable and septic pedal osteitis can be a potential sequelae of penetrating wounds, subsolar abscesses and laminitis [1]. The cause of infection is normally one or more of the many ubiquitous bacteria living on the hoof or in the horse´s environment. Affected horses normally have a history of chronic lameness with drainage of purulent exudate from the foot that often resolves and recurs at a later time. Radiographic examination often will reveal decreased bone density, demineralisation and irregularity of the bone margins at the level of the infected bone [2]. Treatment requires a combination of surgical debridement of the infected bone and surrounding tissues in addition to systemic and local antimicrobial therapy. The surgical debridement of the infected bone is normally carried out in the standing sedated horse under regional anaesthesia with the application of a tourniquet to control haemorrhage. However, in horses with a difficult temperament, general anaesthesia is indicated. The sole or hoof wall can be approached initially with hook knifes and motorised instruments to gain access to and allow curettage of the lesion. After the infected tissues are removed the defect is lavaged, topical antibiotics and sterile bandages are applied. Systemic antibiotic administration is continued until a healthy bed of granulation tissue has covered the pedal bone. At this point, application of a hospital plate is indicated to reduce the amount of bandaging materials and reduce the pressure on the surgical site. […]