Suspensory Body Break Down Following Deep Plantar Neurectomy and Fasciotomy

Case 1:
A 6yo WB mare used for high level dressage was examined with a history of poor performance and 1-2/5 RH lameness. A pain response could be elicited by applying digital pressure at the origin of the RH suspensory ligament. RH distal limb flexion worsened the lameness. There was no change in RH lameness following a low 6 point nerve block, but lameness was abolished following anaesthesia of deep branch of lateral plantar nerve. Nuclear scintigraphy and radiography stifles and hocks showed no abnormalities. Ultrasonography showed enlarged CSA of the proximal suspensory ligament with poor fibre pattern but no lesions within the ligament body. MRI showed moderate enlargement of PSL in both hind legs with adhesion to ALDDFT in the LH and irregularity of axial cortex of MT4 in the RH. (I need to check with radiologist if any lesions extended into ligament body). All images can be included.

Bilateral hind limb proximal suspensory ligament desmitis was diagnosed. The mare was treated with rest and controlled exercise, ESWT to the origin both hind suspensory ligaments and pentosan polysulphate on 4 occasions at weekly intervals. An initial improvement was noted at 3 months, but there was a subsequent return of lameness when the mare returned to full exercise. Bilateral deep planter neurectomy and fasciotomy performed under general anaesthesia in dorsal recumbency. The mare returned to full soundness and sucessful competition.

11 months after surgery the mare developed acuted 3/5 right hind lameness which worsened to limb flexion. There was swelling at the bifurcation of the suspensory ligament and the area was painful to palpation. Ultrasonography of the right hind suspensory ligament showed chronic damage at the origin, a very large hypoechoic area in the suspensory body just proximal to the bifurcation and damage to the lateral branch just below the bifurcation. The suspensory body was injected with platelet rich plasma and the mare was retired for breeding. [...]