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What Can Radiology Tell Us About Palmar Foot Pain?
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INTRODUCTION
Familiarity, convenience and cost mean that radiography has remained an important tool in the investigation of foot pain in horses despite the increased accessibility of advanced imaging modalities, such as nuclear scintigraphy and magnetic resonance imaging. Comparison with the other imaging modalities has increased recognition of the limitations of radiography in the diagnosis of foot pain (Dyson 2002; Dyson et al. 2006) but these may be minimised by evaluating radiological findings together with the results of physical examination, gait assessment and diagnostic local anaesthesia.
Radiology can play a role in the diagnosis of a number of conditions that are commonly associated with palmar foot pain, including dorsopalmar foot imbalance, navicular disease and fracture of the palmar portion of the distal phalanx. Given the lack specificity of local anaesthetic techniques used to localise pain to the foot, radiography may also contribute to diagnosis by helping to ruling out some of the causes of foot pain that are not restricted to palmar structures, for example, osteoarthritis of the distal interphalangeal joint.
RADIOGRAPHY
The foot should be carefully prepared to remove any dirt or loose horn that might result in radiographic artefacts. Packing of the frog sulci with Playdoh, or similar material, is recommended to avoid problems with interpretation caused by gas densities overlying the palmar foot in dorsoproximal-palmarodistal oblique projections. Leaving the shoe on for lateromedial projections can be helpful to the assessment of foot balance; if retained for the other projections, the shoe frequently obscures areas of interest. The projections required will vary according to the suspected diagnosis but include lateromedial, dorsoproximal-palmarodistal oblique centred and exposed for the distal phalanx, dorsoproximal-palmarodistal oblique centred and exposed for the navicular bone (and tightly collimated to reduce the scatter generated by the high exposures that are used), palmaroproximal-palmarodistal oblique, dorsopalmar, and oblique projections of the palmar processes of the distal phalanx. [...]
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