Case Reports

Inferior Check Ligament Desmotomy to treat ‘club foot’

An extremely high hoof angle is often classified as a “club foot.” It is a result of contracture of the deep digital flexor (DDF) tendon in horses.  It often presents as a developmental orthopedic disease in growing foals.  There are many factors that contribute to this syndrome including genetics, nutrition, and hoof care.  It’s important to make the diagnosis early in order to take appropriate measures.  Club feet are categorized as types I through IV depending on severity.  Oftentimes grades I and II can be treated conservatively through nutrition, farriery, and toe extension devices.  However it is best to achieve correction before one year of age or permanent change to the hoof capsule and coffin bone may occur.  The inferior check ligament is a soft tissue structure connecting the proximal suspensory ligament to the deep flexor tendon.  Incising the structure can effectively decrease the tension of DDF contracture and allow the hoof angle to be returned to normal. 

Three non-responsive cases were presented to South Willamette Veterinary Clinic in 2007.  Conservative intervention had failed to produce acceptable results.  Ages of animals affected ranged from 6 to 11 months.  Digital radiographs were performed pre and post operatively.  An extended-toe shoeing device was applied before surgery and the hoof angle was drastically reduced.  The inferior check ligament was transected under general anesthesia and the leg was bandaged.   Postoperative care is critical for a successful and cosmetic outcome.  The foals were stall confined and hand walked for up to 8 weeks with special attention paid to continual bandaging and hoof care.  All animals’ surgeries resulted in a very cosmetic and functional foot and a good prognosis.  This technique helps maintain the horses’ future economic value and soundness.

Surgical Treatment for Severe Founder
Deep digital flexor (DDF) tenotomy (or transection) is indicated in some non-responsive laminitis cases. Laminitis is a complex disease that often results in coffin bone rotation within the hoof capsule. Correction of rotation cannot be always be achieved through corrective trimming or shoeing. Transection of the DDF tendon can be useful in salvaging a foundered horse that may be facing euthanasia. It is critical to address the cause of laminitis before considering surgery. These causes can include equine metabolic syndrome, Cushings disease, infection, and faulty hoof structure. Tenotomy should be considered especially for horses that could still be used for breeding, but sometimes they recover to permit light riding.

In August 2007, “Tanqueray” a 22-yr-old Arabian owned by Sherry Bernard of Oakridge was presented for chronic laminitis. Her hoof walls were long and radiographs revealed rotation and deterioration of each front coffin bone. The mare failed to respond adequately to phenylbutazone, corrective trimming, and support boot therapy. After careful discussion it was decided that DDF tenotomy was the best option available.

Under light sedation tourniquets were applied to each forelimb and regional nerve blocks were performed. While the mare was standing, incisions were made over the mid portion of each DDF. The tendons were carefully isolated and transected. Postoperative care included antibiotics, phenylbutazone, pressure bandaging and support boots. Corrective hoof trimming continued at weekly intervals and radiographs were repeated to monitor progress. Response to surgery was remarkable and the horse was much more comfortable within the first two weeks. Tanqueray no longer requires pain meds and light trail riding is anticipated for this summer.