What is Your Diagnosis?
In this section of the New Jersey Equine Clinic website you will find a new clinical case report every month. For each case we will provide background information and examination findings pertinent to the diagnosis along with a question or two for you to answer. You can access the case through our NJEC Facebook discussion tab and post your opinion as a comment on that page. After 24 hours we will provide the diagnosis and a brief discussion of the condition illustratrated by the case. Join us each month to learn about equine lameness or disease conditions and how they are diagnosed and treated. We hope that you enjoy this fun and unique format for client education...practical information from a reliable source!
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What is Your Diagnosis? - March 2011
History and Presenting Clinical Findings:
A yearling Thoroughbred colt was presented to the New Jersey Equine Clinic for evaluation and treatment of a lameness of the left front leg. He had been treated on the farm for a resistant thrush condition of the left front foot with copper sulfate, betadine solution and bleach. The foot was stabilized with an egg bar shoe.
Physical examination revealed a malodorous, proliferative, necrotic growth involving the heel area and the frog of the left front foot. The two images on the left below are lateral and solar views of the left front foot. The image on the right below was obtained after removal of the egg bar shoe and cleaning and drying the surface of the proliferative lesion.
What is your diagnosis?
What treatment options are available?
Diagnosis: Proliferative pododermatitis (canker).
Treatments described in the literature include surgical debridement and the application of topical medications including antibiotics, astringents, antiseptics, and caustic powders.
In this case, the proliferative lesions were removed with a combination of scalpel and laser dissection, followed by application of a hospital plate and packing of the surgical site with Metronidazole powder covered with dry gauze. A series of surgical procedures were performed with local anesthesia and standing surgical technique to completely eliminate the disease due to extensive involvement of the deep tissue layers of the hoof. Using this approach, the canker was eliminated and the hoof healed uneventfully.
Equine canker is a chronic, proliferative, suppurative, pododermatitis of the frog, bars, and sole and, in severe cases, the adjacent hoof wall. Canker appears as a soft, whitish, cauliflower-like proliferative growth and is often associated with a foul-smelling exudate. Although canker is often associated with wet or unhygienic (or both) stall conditions, it also may be seen in horses living in an ideal husbandry environment. The degree of lameness depends upon the extent and depth of the infection.
Although the prognosis for treatment of canker is guarded, a composite treatment plan that includes both aggressive surgical debridement and topical antimicrobial therapy offers the best chance for successful treatment. Metronidazole is a good choice for topical treatment due to the common involvement of anaerobic bacteria in these lesions. The treatment site must be kept clean and dry until healing is complete. This may take weeks to months to accomplish.