John Victor Lacroix

“ Injuries are the most constant cause of foot lameness, yet one must admit that there results complications because of infection in most instances; and that in some cases the injury is slight—just enough to permit the introduction of vulnerant organisms into the tissues. Therefore, one might well classify affections of the feet as infectious and non-infectious. There can be grouped in the class of infectious affections such conditions as nail pricks, calk wounds and canker. In the class of non-infectious affections one may consider conditions such as laminitis, strain and fractures. ”

“ The shape and size of a bone when injured, determines in a measure, the course and probable outcome in most cases, but of first and greater importance is the function of the bone. A fracture of the fibula in the horse need not incapacitate the subject, but a tibial fracture is serious and generally proves cause for fatal termination. The body of the scapula may be completely fractured and recovery will probably result in most cases without much attention being given to the subject, yet a fracture of the neck of this same bone constitutes an injury of serious consequence. ”

“ Where such inhumane and cruel treatment is given animals those responsible ought to be impressed with the unfairness to the animal as well as the economic loss occasioned by inflicting such unnecessary and merciless treatment upon their helpless and uncomplaining subjects. The very nature of the veterinarian's work affords him constant and frequent opportunity to convince those who are responsible for keeping animals in this manner, that it is inhumane and unprofitable. ”

“ Where less than six weeks of rest can be allowed the animal, one affected with bone spavin would therefore not be treated with the expectation of obtaining good results, as six weeks' time, at least, is necessary for a successful outcome. If the cost attending the enforced idleness of an animal of this kind is considered prohibitive for the employment of proper measures to affect a cure, and if lameness is slight, the animal should be given suitable work, but in cases of articular spavin in aged subjects, they should be humanely destroyed and not subjected to prolonged misery. ”

“ It is desirable, in some cases, to cause an animal to move from side to side; in other instances the subject is best made to walk or trot in a circle, and if the circle be very small the animal then particularly employs the inner fore leg as a pivotal supporting member. To augment the manifestation of certain affections, it is necessary to cause the patient to walk backward, and each one of these tests of locomotion serves to point out in a more or less characteristic manner, the site of the affection which is causing lameness in different cases. ”

“ In cases where extensive injury has been inflicted, and great pain exists, the foot is kept off the ground much of the time and it may be swung back and forth as in all painful affections of the extremity.
Nail punctures cause typical supporting-leg-lameness and in some cases certain peculiarities of locomotory impediment are worthy of notice. Punctures of the region of the heel, which directly affect or involve the deep tendon sheath, cause a type of lameness wherein pain is augmented, when dorsal flexion of the extremity occurs as well as when weight is borne. ”

“ A horse suffering from an otherwise remediable pelvic fracture may be so worried and tortured by being confined in a sling that the case calls for special attention and care because of the animal's temperament. Sometimes, the constant presence of a kind attendant will so reassure the subject that it will become resigned to unnatural confinement, in a day or two. This precaution may, in itself, determine the outcome, and the wise veterinarian will not overlook this feature or fail to deviate from the usual rote in the handling of average cases. ”

“ True lameness is such as is occasioned by structural or functional defects of some part of the apparatus of locomotion, such as would be caused by spavin, ring-bone, or tendinitis. False lameness is an impediment in the gait not caused by structural or functional disturbances, but is brought on by conditions such as may result from the too rapid driving of an unbridle-wise colt over an irregular road surface, or by urging a horse to trot at a pace exceeding the normal gait of the animal's capacity, causing it to "crow-hop" or to lose balance in the stride. ”

“ Wounds invading the tissues adjacent to joints, when these wounds are of considerable extent, cause inflammation of such articulations by contiguous extension of inflammation. As long as an injury remains practically aseptic, or if infected and the septic process does not involve the joint proper by direct extension, no more serious disturbance than a simple synovitis will result. If, instead, a periarthritic inflammation is serious or destructive in character, the type of arthritis will be grave—even though due to an indirect cause. ”

“ Sprains or injuries of lateral ligaments of the extremities, ringbone and certain foot affections, are made manifest by a side to side movement or a pivotal movement. In fact, wherever it is possible to cause undue or unusual tension to be exerted upon an inflamed structure, manifestation of pain is the response. In an inflamed condition of the lateral side of the phalanges, unequal weight-bearing such as a rough road surface will, by virtue of the leverage which the solar surface of the foot affords, cause undue strain upon such inflamed parts, and increased lameness is evident. ”

“ In all obscure cases of lameness a methodical and thoroughly practical examination of the animal according to an established procedure is necessary to determine the nature and source of the affliction. ”

“ Prognosis.—In adult animals, radial fracture constitutes a grave condition; generally speaking, prognosis, in such cases, is unfavorable. Because of the leverage afforded by the extremity, immobilization of the radius is difficult. Any sort of mechanical appliance, which will immobilize these parts, is likely to produce pressure-necrosis of the soft structures so contacted. There is occasioned thereby much pain and the subject becomes restive, unmanageable and sometimes the splints are completely deranged because of the animal's struggles, and much additional injury to the leg is done. ”

“ The affection is not benefited by treatment, and while a horse's leg may become so heavy and cumbersome as to mechanically impede its gait, as well as to fatigue the subject when made to do service even at a slow pace, elephantiasis causes no constitutional derangement. The hind legs, in elephantiasis, are affected and a unilateral involvement is more often seen than a bilateral one. The legs may be enlarged from the extremity to the body, but ordinarily the affection does not extend higher than the hock or the mid-tibial region. ”

“ When only an abrasion is caused, little if any lameness occurs, but where interfering is continued and nerves are involved or subfascial infection and extensive inflammation succeed such abrasions, marked lameness and evidence of great pain are manifested. Frequently, in chronic cases affecting the hind leg, the fetlock assumes large proportions, and at times during the course of every drive the subject strikes the inflamed part, immediately flexing and abducting the injured member, and the victim hops on the other leg until pain has somewhat subsided. ”

“ The noble tendency of the horse to serve its master under the stress of pain, even to the point of complete exhaustion and sudden death, should win for these willing servants a deeper consideration of their welfare. ”

“ Another fault in conformation is the existence of a weak hock that is set low down on a crooked leg, especially when such a member is heavily muscled at the hip. Given such conformation in an excitable horse, and curb is usually produced before the subject is old enough for service. It is certain that in cases where conformation is bad, greater strain is put upon the plantar ligament. This structure serves to bind the tibial tarsal (calcis) bone to the metatarsus; traction exerted upon its summit by the tendo Achillis is great when animals run, jump or rear and also at heavy pulling. ”

“ If the disease is confined to the hind feet, they are placed well forward to relieve the strain on the toe caused by the downward pull of the perforans (deep flexor) tendon, but in place of the front feet being kept in front of a perpendicular line, as they are when the disease is confined to the front ones, they are placed far back under the body, so they will carry the maximum share of the body weight of which they are capable. The position of the feet is of great importance and offers symptoms that should not be overlooked. ”

“ The so-called dislocation of the stifle in the horse is a misnomer. That the patella is capable of being dislocated is beyond doubt, but the ordinary condition described under that term, when the stifle and hock are rigid while the foot is turned back with its wall on the ground, is nothing more than spasm of the muscles which keeps the patella drawn up. ”

“ Because of the fact that the average layman believes that practically every case of fore-leg lameness wherein it is not obvious that the cause is elsewhere, is due to a shoulder affection of some kind, we may be too hasty in giving the client assurance that no "sweeny" exists. In some of these cases where a diagnosis of "shoulder lameness" has been made and the client has been assured that no sweeny exists, the patient is returned in about a week and there is then marked atrophy of one or both of the spinatus muscles. ”

“ If all four feet are involved, the animal stands in the usual position assumed in health, but if urged to move, the least effort to do so usually brings on chronic spasms of the entire body. In very severe cases, a slight touch of the hand will develop the spasms. At times they are so severe, and have such short intermissions, that the disease has been mistaken for tetanus. However, the clonic nature of the spasm should prevent such an error. If they are lying down, it is difficult to get them to arise, and if they do so, they show marked symptoms of pain for some time after rising. ”

“ Where a vulnerant body penetrates all structures and invades the interior of the joint capsule the result is that a more or less active disturbance is incited. The introduction of a sterile instrument into a joint cavity, under strict asepsis, where a perfect technic is executed, does not cause perceptible manifestation of the injury, if the opening so made is small—such as a suitable exploratory trocar makes. But a puncture made in a similar manner and with the same instrument without due regard to asepsis is likely to cause an infectious synovitis and arthritis usually follows. ”

“ When an animal is made to travel in a circle, when a member affected with supporting-leg-lameness is on the inner side of the circle, lameness is accentuated because weight is borne by the lame leg for a greater length of time, the result of such circuitous manner of locomotion. In swinging-leg-lameness, on the other hand, because pain is increased at the time an affected member is being advanced, lameness is increased when the subject is made to travel in a circle, with the lame leg on the outside of a circle thus described. ”

“ Often, before being able to distinguish the presence of a hyperthermic condition, one is impressed with the fact that an animal manifests evidence of being supersensitive. In fact, some animals in the anticipation of pain at the touch of an injured part, will instinctively withdraw—in self-protection—such an ailing member or resist the approach of the practitioner. This sensitiveness is more apparent in animals that have been subjected to previous manipulation or treatment which has occasioned pain, and consequently, allowance must be made for this exhibition of fear. ”

“ Subjects that are very lame—so lame that little weight is borne by the affected member—are, of course, unfit for service and as a rule are not difficult of diagnosis. For instance, a fracture of the second phalanx would cause much more lameness than an injury to the lateral ligament of the coronary joint wherein there had occurred only a slight sprain, and though crepitation is not recognized, the diagnostician is not justified in excluding the possibility of fracture, if the lameness seems disproportionate to the apparent first cause. ”

“ Next in importance is the age of the animal suffering fracture of the bone. Capacity for regeneration is naturally greater in a vigorous, young animal than in aged or even middle-aged subjects. A healthy condition of the bone and the body favor the process of repair in case of fracture, and prognosis may be favorable or unfavorable, depending upon these factors mentioned for consideration. Individuals of the same species, differing in temperament, may comport themselves in a manner that is conductive to prompt recovery, or to early destruction. ”

“ Where pain is not so great that relaxation of parts does not occur, one can, by gently moving an extremity in various directions—as in flexion, extension and lateral motion as well as by rotation—cause to be manifested this peculiar grating,—the friction of newly broken bone. This is known as true crepitation. Where the subject, suffering phalangeal fracture, manifests evidence of pain due to tensing the structures about a fractured part, one may anesthetize the parts by using about two cubic centimeters of a two per cent. solution of cocain upon the plantar nerves, proximal to the fracture. ”

“ When the foot that inflicts the injury happens to be unshod, a contusion of the injured member is occasioned, but in the majority of instances, wounds that demand attention are the result of shoe calks which have penetrated the tissues in the region of the coronary band. Often calk wounds are self-inflicted. When animals are excited and in turning crowd one another, they often perform dancing movements which frequently result in deep calk wounds of the coronet. Some horses have a habit of resting the heel of one hind foot upon the anterior coronary region of the other. ”

“ In valuable breeding animals, owners may prefer that treatment be attempted when a lateral luxation and detachment of but one common ligament have permitted luxation without complete disarticulation and rupture of the joint capsule. In such cases, by immobilizing the affected parts as in fracture, and confining the subject in a sling for about sixty days, partial recovery may occur in some instances.
Experience has shown that where luxation with detachment of a collateral ligament occurs, recovery is slow and incomplete—there always results considerable exostosis at the site of injury. ”

“ If the tissues are not divided and the wound is chiefly of the subsurface structures, there will not immediately occur pronounced local evidence of the existence of injury; but as soon as the lame animal is made to move, the peculiar character of the impediment (supporting-leg lameness with the affected foot kept well in advance of its normal position) directs attention to the extremity and all of the symptoms of acute inflammation are discovered. ”

“ Theories that heredity is responsible have their supporters and advocates of hypotheses attributing it to disease of the sciatic nerve, patellar subluxation, fascial contraction of various muscles, "dry spavin" (tarsal arthritis) , iliac exostoses, disease of the foot and contraction of the hoof, are on record in veterinary literature. This ailment affects old horses more frequently than it does young and is seen in all breeds of animals including mules. ”

“ Injuries of all kinds are the more frequent causes of hip lameness. In such cases, lameness may result directly and resolution be prompt, or the claudication become aggravated in time, due to muscular atrophy or degenerative changes affecting the hip joint or nerves. Rheumatism or metastatic infection may be the cause of hip lameness as well as affections of the pelvic bones, lumbar and sacral vertebrae. Hip lameness may also be provoked by melanotic or other tumors.
In the diagnosis of hip lameness, one is guided in a general way by the character of the impediment manifested. ”

“ Septic synovitis and infectious arthritis are always serious affections even in young animals and much depends upon individual resistance and early rational treatment in such cases, if recovery is to follow.
The same general plan of treatment is indicated in this kind of septic synovitis as is employed in all cases of infective synovitis and septic infection in open joints. There is to be considered, however, the fact that the young animal is more agile, a better self-nurse, and in a general way more apt to recover than is the adult, under similar conditions. ”

“ Symptomatology.—No trouble is experienced in diagnosing distension of tendon sheaths, for the affection is very palpable. During acute inflammatory stages of this affection, some lameness is present—in infectious inflammation lameness is intense. Local heat and pain upon manipulation are readily discernible in all acute cases. And finally, where there is reason for doubt, an aseptic exploratory puncture of the wall of the fluctuating enlargement may be made with a suitable trocar, and the discharging synovia will be proof of the existence of synovial distension. ”

“ If the subject does not soon succumb, it is compelled to undergo days or even weeks of unnecessary suffering, and too often in such cases, it is later deemed advisable to destroy the animal because of the cost of continuing treatment until the horse is serviceable. Therefore, it is evident that when such joints as the carpus or tarsus are open and infection exists, if they are not promptly treated and the infectious process checked, it is neither humane nor practical to prolong treatment. ”