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Sensible Treatment of Claw Disorders including Pain Management
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Objectives
To review common approaches to treatment of claw disorders with emphasis on what therapies are useful and which are potentially counterproductive? To suggest a sensible treatment strategy that incorporates a comprehensive plan for pain management.
Materials and Methods
Information for this presentation has been derived from personal research and a review of pertinent literature on the subject of the treatment of claw disorders.
Results of a 2-Part ISU Study
A survey of veterinarians and hoof trimmers in North America on treatment practices indicated that topical treatments for claw horn lesions were used by 59% of veterinarians and 53% of hoof trimmers. The medication used most frequently was the soluble powder form of tetracycline or oxytetracycline (48% by veterinarians and 81% by hoof trimmers) followed by copper sulfate for veterinarians and ichthammol ointment (a sulphurous, tarry compound with mild antiseptic properties used primarily as a drawing agent) for trimmers (Kleinhenz, 2014).
Results of the survey prompted a follow-up study to determine the effect of topical treatment with oxytetracycline soluble powder or powdered copper sulfate on the rate of wound healing in 18 cows with claw lesions. Cows were randomly divided into a treatment group: treated topically with oxytetracycline soluble powder (7) or copper sulfate powder (3) and a bandage; and a control group (8): no topical treatment and a bandage. Photos of lesions were taken at 24 hours post treatment when the bandages were removed and again at day 21 following the day of treatment. Photos were evaluated by 2 independent observers who scored the lesions for the visual presence of granulation tissue and evidence of re-epithelization. Based upon observer scores at day 21, lesions topically treated with oxytetracycline or copper sulfate were more likely to have abnormal or exuberant granulation tissue (observer agreement on 15/18 observations, p > 0.0054) and less likely to have evidence of re-epithelization (observer agreement on 11/18 observations, p > 0.0553). Although the number of observations is admittedly small, these data suggest that topical treatment with oxytetracycline or copper sulfate may delay wound healing (Shearer et al., 2015).
Tetracyclines are known for their ability to cause tissue irritation when used intramuscularly and copper sulfate is corrosive to the skin and eyes. Information from the equine literature indicates that treatments with low pH and corrosive properties cause cellular toxicity, which is likely to interfere with cell migration and proliferation in the early stages of wound healing.
Use of a Bandage
Despite evidence of a therapeutic benefit, the use of a bandage for the treatment of claw lesions was cited as a routine procedure for 53% of both veterinarians and hoof trimmers alike. A well-bandaged foot simply looks better and leaves one with the sense of a more professional job. However, these esthetics are short-lived as the housing systems for most dairy cows requires them to parade through a footbath or enter a manure slurry covered floor. What started out as a clean medicated bandage soon becomes one soaked in footbath solutions and organic matter. Possibly, it is for these reasons in part that healing was delayed by the use of a bandage in three well-controlled studies (White et al., 1981; Pyman, 1997; Kluwitter et al, 2019).
Sensible Treatment of Claw Lesions
There is little dispute that corrective trimming and the use of a foot block to elevate an injured claw make good sense. However, based upon available literature and the studies cited above, there is little justification for the routine topical treatment in combination with the use of a bandage. More important than selecting a topical treatment or a what kind of bandage to use is having a plan that assures prompt examination and treatment of lame cows. Finally, claw lesions are painful; provisions for managing pain whether associated with therapeutic trimming or during the post treatment period are important considerations. A multimodal treatment regimen would include the following:
- use of intravenous regional or ring block anesthesia for corrective trimming
- sedative-analgesics to reduce the pain and anxiety
- careful corrective trimming avoiding injury to adjacent healthy corium tissues,
- use of an orthopedic foot block
- administration of analgesics in the post treatment period
- comfortable housing and attentive management of lame cows’ post-treatment.
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