Radiographic imaging of the equine foot

Imaging the Equine Foot

Over the past 5 years, advancements in diagnostic imaging technology have led to improvement of radiographic technique and development of standing computed tomography (CT) and PET-CT scanners. Although these modalities are in their initial stages of development and clinical applications, they are meant to revolutionize the diagnosis and management of diseases of the foot in the standing patient, in particular detecting subclinical lesions, and the establishment of computer-assisted surgical suits. This article also reviews the improved radiographic projections of the equine foot and benefits of high-field and contrast magnetic resonance imaging (MRI) in diagnosis of cartilage and ligamentous pathologies.

Comparative evaluation of tomosynthesis, computed tomography, and magnetic resonance imaging findings for metacarpophalangeal joints from equine cadavers

OBJECTIVE

To describe the technique and assess the diagnostic potential and limitations of tomosynthesis for imaging of the metacarpophalangeal joint (MCPJ) of equine cadavers; compare the tomosynthesis appearance of pathological lesions with their conventional radiographic, CT, and MRI appearances; and evaluate all imaging findings with gross lesions of a given MCPJ.

SAMPLE

Distal portions of 4 forelimbs from 4 equine cadavers.

PROCEDURES

The MCPJs underwent radiography, tomosynthesis (with a purpose-built benchtop unit), CT, and MRI; thereafter, MCPJs were disarticulated and evaluated for the presence of gross lesions. The ability to identify pathological lesions on all images was assessed, followed by semiobjective scoring for quality of the overall image and appearance of the subchondral bone, articular cartilage, periarticular margins, and adjacent trabecular bone of the third metacarpal bone, proximal phalanx, and proximal sesamoid bones of each MCPJ.

RESULTS

Some pathological lesions in the subchondral bone of the third metacarpal bone were detectable with tomosynthesis but not with radiography. Overall, tomosynthesis was comparable to radiography, but volumetric imaging modalities were superior to tomosynthesis and radiography for imaging of subchondral bone, articular cartilage, periarticular margins, and adjacent bone.

CONCLUSIONS AND CLINICAL RELEVANCE

With regard to the diagnostic characterization of equine MCPJs, tomosynthesis may be more accurate than radiography for identification of lesions within subchondral bone because, in part, of its ability to reduce superimposition of regional anatomic features. Tomosynthesis may be useful as an adjunctive imaging technique, highlighting subtle lesions within bone, compared with standard radiographic findings.

Determination of Positional Parameters of the Distal Phalanx Within the Hoof Capsule in Sound Colombian Paso Horses

The economic relevance, populational importance and expansion of the Colombian Paso Horse to other latitudes calls for a growth in studies based on this type of horse. Lack of written reports about the relationship of the distal phalanx (DP) within the hoof in this gaited horse makes it important to establish a baseline to determine hoof health and possible alterations. The purpose of this study was to report, for the first time, the positional parameters of the distal phalanx, and its relationship within the hoof in sound Colombian Paso Horses. A latero-medial radiographic image of each digit was taken in 45 horses between 3 and 5 years old, distributed into groups according to the gaits determined by FEDEQUINAS. Three angles and three distances were measured. The dorsal wall thickness (W-T) was measured proximally and distally, and the sole depth (P-S) was measured dorsally and palmarly/plantarly. As expected, these distances showed moderate to strong positive correlations in front (W-Tp/W-Td r = 0.53; P-Sd/P-Sp r = 0.72) and hind feet (W-Tp/W-Td r = 0.61; P-Sd/P-Sp r = 0.71). The palmar/plantar angle of the distal phalanx (PA) and sole depth (P-S) showed that the distal phalanx of the hind feet is flatter compared to the front. The results of this study show differences in the positional parameters of distal phalanx compared to other breeds of horses and provides information for veterinarians and farriers working with Colombian Paso Horses.

Unipodal stance influences radiographic evaluation of foot balance in horses

Lifting the contralateral forelimb (unipodal stance) is often used as a method of restraint in horses. This experimental one group pretest, posttest study was conducted to evaluate the effects of unipodal stance on quantitative radiographic parameters in equine forefeet. Seven nonlame horses were randomly selected. Lateromedial (LM) and dorsopalmar (DP) projections were acquired for both forefeet, squarely placed on blocks, using two X-ray generators. Radiographs of each foot were acquired first in a bipodal stance, immediately followed by the same radiographic projections obtained in a unipodal stance. The following measurements were recorded for each stance: distal interphalangeal joint (DIPJ) space width on both projections; mediolateral joint balance as the difference between lateral and medial DIPJ space widths on DP projections; extensor process-to-middle phalangeal condyle distance; and deep digital flexor tendon angle on LM projections. A matched pairs design and Student's t-test with a 95% confidence level were used to test for statistical significance. Compared to a bipodal stance, lateral DIPJ space width was significantly reduced on unipodal DP views, whereas mediolateral joint imbalance and to a lesser extent medial DIPJ space width were significantly increased. On unipodal LM views, there was a significant higher degree of DIPJ flexion. These findings suggest that stance should be carefully taken into consideration when measuring radiographic parameters in equine forefeet, especially if assessing foot balance and conformation, as unipodal stance significantly affects the mediolateral balance of the DIPJ on DP radiographs and significantly alters the phalangeal axis on LM radiographs.

Assessing the Effect of Packing the Sulcus on Image Quality in Equine Digital Radiography

The requirement to pack the sulcus of the equine foot as an aid to diagnostic interpretation before acquisition of dorsoproximal-palmarodistal oblique projections is debatable. The purpose of this study was to investigate the benefit of packing the sulcus in the assessment of normal anatomy. 23 cadaver limbs were radiographed in a podoblock (https://www.podoblock.com/products-page/podoblock/podoblock/) A non-packed image (NP) and a packed image (P) of the same foot were acquired. The image quality of P was graded against the reference NP by five observers, where -1=P was superior, 0=no difference between P and NP, and +1=NP was superior. Four anatomical criteria were used: the distal solar margin of the distal phalanx (DP), the vascular channels of DP, the palmar aspect of the distal interphalangeal joint and the articulation of the navicular bone with DP. A total Visual Grading Analysis Score of 0.28 indicates a preference for NP images. Packing was of benefit in only 10.8 per cent of cases. While judicious high-quality packing may be of benefit in a minority of cases, the routine packing of the sulcus in equine radiography was not found to be of benefit in the assessment of anatomical features in this study.

Treating laminitis: beyond the mechanics of trimming and shoeing

Laminitis is typically classified into developmental or prodromal, acute, subacute, and chronic phases. Scientific evidence regarding the pathophysiology of laminitis does exist, but it is often conflicting and dependent on the clinician's interpretation/understanding of the study or the model used for inducing laminitis. The diagnosis of laminitis consists of obtaining an accurate history, performing a thorough physical examination, and taking good-quality radiographs. The use of radiographs for diagnosis and interpretation of laminitis is an absolute necessity for the clinician. Laminitis is one disease that requires the assembly of a team consisting of the veterinarian, the farrier, and the owner to be successfully treated.

The effect of hoof angle variations on dorsal lamellar load in the equine hoof

REASONS FOR PERFORMING STUDY

In the treatment of laminitis it is believed that reducing tension in the deep digital flexor tendon by raising the palmar angle of the hoof can reduce the load on the dorsal lamellae, allowing them to heal or prevent further damage.

OBJECTIVE

To determine the effect of alterations in hoof angle on the load in the dorsal laminar junction.

METHODS

Biomechanical finite element models of equine hooves were created with palmar angles of the distal phalanx varying from 0-15°. Tissue material relations accounting for anisotropy and the effect of moisture were used. Loading conditions simulating the stages in the stance where the vertical ground reaction force, midstance joint moment and breakover joint moment were maximal, were applied to the models. The loads were adjusted to account for the reduction in joint moment caused by increasing the palmar angle. Models were compared using the stored elastic energy, an indication of load, which was sampled in the dorsal laminar junction.

RESULTS

For all loading cases, increasing the palmar angle increased the stored elastic energy in the dorsal laminar junction. The stored elastic energy near the proximal laminar junction border for a palmar angle of 15° was between 1.3 and 3.8 times that for a palmar angle of 0°. Stored elastic energy at the distal laminar junction border was small in all cases. For the breakover case, stored elastic energy at the proximal border also increased with increasing palmar angle.

CONCLUSIONS AND POTENTIAL RELEVANCE

The models in this study predict that raising the palmar angle increases the load on the dorsal laminar junction. Therefore, hoof care interventions that raise the palmar angle in order to reduce the dorsal lamellae load may not achieve this outcome.

Digital venography in horses and its clinical application in Europe

Clinical diagnostic venography allows in vivo visualization of the digital venous system and the effects of venocompression related to foot load and laminitis pathology. Venography has predictive potential and helps the clinician anticipate and treat laminitis tissue damage before it is detectable by plain radiography. The authors describe the podiatry radiographic technique to correctly perform digital venography and the modifications they have developed. The authors provide guidelines for the interpretation of laminitis venograms in the context of laminitis chronology. Frequent venographic monitoring of laminitis helps clinicians understand the sometimes puzzling chronology of the disease process and improves therapeutic outcome.

The effect of hoof trimming on radiographic measurements of the front feet of normal Warmblood horses

The understanding of the normal position of the third phalanx (P3) and the distal sesamoid bone in relation to the size and shape of the hoof capsule in sound horses is helpful in the diagnosis of equine foot lameness. Some measurements on radiographs used to define the position of the pedal bone within the hoof capsule are significantly influenced by hoof trimming and the height of the withers. In this study, the front hooves of 40 Warmblood horses were radiographed twice, eight weeks apart, both before and after their hooves were trimmed by an experienced farrier. Using the software programme Metron PX, 22 parameters on the lateromedial view and 16 parameters on the dorsopalmar view were measured and the effect of hoof trimming and height of the withers were calculated, respectively. Some of the hoof parameters showed mild positive correlation with the height of the withers. In 70% of the horses the left hoof capsule and P3 were significantly larger than the right. Hoof trimming had a remarkable influence on hoof conformation, especially for parameters in the toe region. Of all the measurements that describe the position of the third phalanx (P3) in relation to the hoof capsule, the distances between the distal tip of P3 to the solar surface of the foot, P3 to the tip of the toe and P3 to the point of break-over showed the greatest differences before and after trimming. The database of the present study can be used by farriers and veterinarians as a guideline for routine and corrective shoeing of Warmblood horses.