Meg had a phenomenal interview with Jennifer Brown about digit injuries in this week’s Podcast. Did you catch it?
Here are the highlights:
What are the common ways in which digits are injured?
There is a difference between sporting dogs and pet dogs. Pet dogs most commonly suffer unobserved trauma in the yard leading to fractures of the digits.
In sporting dogs, there is most likely a link to the terrain the dogs are on. We don’t have enough information at this point to know which surfaces are more closely linked to digit injuries than others.
Dogs in competition can catch a toe on an obstacle during agility training; however these injuries also occur in other sporting dogs where the obstacles are completely different, and so we can’t really link the injury to a specific obstacle.
And at this stage we don’t have enough information on how to prevent these injuries!
What degree of lameness can we expect in these cases?
The majority of cases have a dramatic lameness, especially for fractures, but also for strain and sprain injuries. We might see a non-weight bearing lameness, or they might have a weight bearing lameness for a few steps and then suddenly lift the leg dramatically for a few further strides. Often the leg is snapped up and held high.
Dogs with arthritic digits show more chronic low-grade lameness.
I noticed in your webinar that you use flexion tests during the evaluation?
In equine practice, flexion tests are a large part of lameness examinations. These can be a really valuable tool in canine lameness assessments, too. With regard to digit injuries, the digits can be flexed as a unit, as well as individually, to isolate the digits that are primarily causing the pain response, narrowing down the problem, especially when X-rays are not revealing.
Another tool used in equine practice that can be helpful in canine practice is diagnostic joint blocks. Some interesting work is being done in this area that might be helpful in small animal practice going forward.
For the sports dog with a sprain or strain, what is the prognosis for them to compete again?
All of them go back to competition and generally do very well. Occasionally the dog will develop OA in that joint, which can be intermittently painful and might need long-term management. The hyperextension injuries tend to be fairly resilient and will go back to competition successfully, as long as they are non-painful and sound.
Is there not a worry that if the toes are hyperextended they can sustain another injury?
I haven’t had any cases that have re-injured. When both the 2nd and 3rd digits are hyperextended, then the 1st and 4th are taking more strain, and I have had dogs that get painful at the metacarpal and metaphalangeal joints, but no … it is not really a problem.
Do many of the dogs have surgery?
All my cases have been on conservative management. The only cases I have referred for surgery have been amputations, when we have started getting other compensatory problems or have not been able to manage an arthritic digit conservatively. Not many cases have needed this – most respond well to conservative management.
The same applies to fractures. Most surgeons say that as long as the bones in the fracture are in the same zip code, they will heal!
What are the strategies you use to treat these digital injuries?
It depends on the injury, but I will do anything from taping with an extension block to buddy taping, to splinting. For arthritic joints or bad strains or sprains with swelling, I will inject the joints with PRP or similar. And then, of course, the standard modalities for active inflammation and pain management. I will also often use topical DMSO a fair bit on swollen digits.
With buddy taping, how long are you generally keeping the dogs taped?
Generally, four to six weeks of full-time taping, depending on the injury. Buddy taping involves taping the affected digit to another digit to support it. A modified extension block taping for hyperextension injuries helps pull the toe into flexion and maintains it there.
Both of these methods are subject to co-morbidities – there are consequences or potential problems as a result of the taping. If there are comorbidities in a specific case, we may have to modify how long the patient is taped for. Tendon injuries take months to heal, and so require support for much longer periods of time.
You can use Elastoplast or K-tape to tape the toes … however you can get the job done! You are only limited by your imagination.
Owners are very good at learning how to apply tape to their own dogs, allowing them to change the tape as needed.
What therapeutic exercises do you use?
In people, a big part of rehab for digits involves gripping-type exercises, active range of motion exercises, and graduated splinting.
In dogs, we can’t use all of these tools, but we can look at movements that target the flexors and extensors of the limbs and the toes. Exercises where they grip and hold with their toes are really good. Unstable surfaces, digging, air mattress exercises. We want to see the dog moving the digits during the exercise. Every dog will be a bit different, and you need to test what works for the individual dog to achieve that range of motion in the digits.
Crawling is a really valuable exercise as well; they will reach and grip with their toes as they move forward.
Many dogs don’t like to have their feet touched, and if they are painful, this is even more likely. So this is commonly a challenge we are faced with. Use good pain management, use distractions as needed, and use good handling and positive reinforcement skills.
Terrain changes make another valuable exercise. We have a lot of soft sand here in Florida, so in the beginning of the injury, walk on the hard sand; later in rehab, walk on the soft sand. Some dogs will grip more over grass.
The owner needs to be observant of the response of the patient to the changes in terrain.
Do you use booties for these patients?
I don’t often use them. They primarily provide foot protection, so I’m not sure how much digit stabilisation they would provide. I have used some of the custom booties for old dogs that have chronic hyperextension of all digits to help them cope with their co-morbidities. I’ve had varied success with their use. There are also unintended consequences and changes to their movement and their function which can be undesirable.
If you would like more detailed information on how to treat and work with digit injuries, please watch the full webinar by Jennifer Brown in the Small Animal Members portal.
You can expect to learn more about:
- Anatomy of the digits
- The prevalence of digital injuries and the available research
- Diagnostic modalities and processes, including using flexion tests
- How to use and perform the different taping techniques
- Consequences of immobilisation – intentional and unwanted.
- Dealing with co-morbidities
- Rehabilitation for a return to sport
- And much more.
Please watch or listen to the full podcast if you want to learn all the details about:
- Jennifer’s journey into rehabilitation from equine veterinary practice to disaster relief, and much more;
- the effect of booties on the biomechanics and ability of search and rescue dogs to function optimally;
- some interesting details on digit rehabilitation; and
- a discussion of a particular case mentioned by a Vetrehabber.