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Correctly Healing The Dreaded Heel Bulb Laceration
You know what they say - if they can find something to hurt themselves on, they will!!
Heel bulb lacerations are a common problem with horses, and can be tough to heal completely without taking the right steps. Read on for a full understanding of how to properly and successfully treat this injury.
A Ten year old gelding was seen by the Western Veterinary Hospital (WVH) ambulatory service for a laceration to his right lateral heel bulb. No lameness was evident on physical exam. The wound was thoroughly cleaned and debrided of non-healthy tissue. Radiographs were taken to assess if any bone structures, coffin joint, or pastern joint were affected. The wound was then packed with antibiotic ointment and a simple bandage was placed. The next day the horse was brought to the WVH for placement of a distal limb cast (foot cast). Ranger was sedated and then blocked using local anesthetic to facilitate further cleaning and debriding of the wound to a healthy granulation tissue. Next, the wound was sutured and a light bandage was applied. Following, a fiberglass cast was placed over the hoof and to just below the fetlock. Ranger was placed on antibiotics for few days to prevent infection and given a tetanus prophylaxis. Bute was prescribed for 3-5 days as needed for pain. We highly recommended a small stall and twice daily observation for lameness and heat at the cast. To level out the walking surface an equine SoftRide® was placed on the opposite foot.
Fig. 1 below depicting the chronic laceration that failed to heal without immobilization (cast).
How these lacerations usually happens: The laceration is usually made by scrap metal, over extension with a shoe on the hind limb, or with wire from a fence.
Why it usually fails to heal: The location of this wound creates a very long healing process due to the motion in this area. Simply suturing and bandaging does not restrict motion in this area long enough for the healing process to complete. This can lead to upset owners and increased veterinary bills.
The solution to the problem: By cleaning, debriding, and suturing the wound. And immediately following with a cast placed on the distal limb just distal to the fetlock joint. By casting this distal limb, motion is restricted over the heel bulbs allowing it to healing. Antibiotics and Non-steroidal anti-inflammatories (Bute) are given on a case by case basis. Two to three weeks later the cast is removed and the wound is reassessed. Usually due to being in a cast for this length of time there is some local skin inflammation (redness) which can be treated with a light bandage for a couple of days after cast removal.
Fig.2 depicting a foot cast below the fetlock.
At home care: depending on the case the horse is usually sent home and allowed to be monitored by the owner. The most important signs to watch for is a lameness or heat in the cast. These can indicate either a cast sore or a worsening infection under the cast. The horse should be confined in a small dry stall until the cast is removed. Other side effects such as diarrhea or colic should be monitored if the horse is prescribed NSAID’s and Antibiotics.
Fig. 3 depicting the wound on Fig. 1 immediately after foot cast and skin sutures removal.
Conclusion: Distal limb foot cast is a safe and effective way to treat heel bulb lacerations in the horse.
Please call the WVH if you have any questions or concerns regarding a wound that does not heal in a timely manner.