Assessment of mild hindlimb lameness during over ground locomotion using linear discriminant analysis of inertial sensor data.

REASONS FOR PERFORMING STUDY: Hindlimb lameness is common and can be difficult to diagnose or quantify in evaluating response to nerve blocks. An objective measure of lameness can also be used to evaluate the effectiveness of the treatment's contribution to evidence-based medicine. The inertial sensor system can be used to capture 6 degree of freedom movement during over ground locomotion and here was used to quantify tuber coxae movement in nonlame and lame horses. HYPOTHESIS: Tuber coxae movement is useful for discriminating between nonlame and lame horses. OBJECTIVES: To measure left and right tuber coxae movement in lame and nonlame horses during over ground locomotion and to implement a linear discriminant analysis to discriminate between lame and nonlame horses. METHODS: Two inertial sensors were attached to the skin over left and right tuber coxae of 21 horses (9 mildly and 12 not lame). Horses were trotted on a hard surface. A total of 1021 strides were collected. For each stride 34 features were extracted from the dorsoventral and craniocaudal movement and used in 2 different classification scenarios (lame vs. nonlame or left lame, right lame and nonlame) using linear discriminant analysis. RESULTS: Six degree of freedom inertial sensors were successfully used to collect kinematic data continuously from left and right tuber coxae in horses during over ground locomotion. These data were used for an automated classification of lameness. In the first scenario, a sensitivity of 89% was achieved with a specificity of 75%. In the second scenario, all horses could be correctly assigned to the correct class in a simple 3 class reclassification test. POTENTIAL RELEVANCE: A mobile system that reliably detects and quantifies hindlimb lameness in horses during unconstrained locomotion could be a valuable tool to perform an evidence-based assessment of lameness in horses in a clinical setting, e.g. before and after nerve blocks or before and after surgery.

Two clinical manifestations of desmopathy of the accessory ligament of the deep digital flexor tendon in the hindlimb of 23 horses.

REASONS FOR PERFORMING STUDY: Desmopathy of the accessory ligament of the deep digital flexor tendon (ALDDFT) in the hindlimb is an unusual cause of lameness in horses, and reports of the condition are sparse. OBJECTIVES: To describe the clinical and ultrasonographic findings, therapy and outcome of 23 horses treated for desmopathy of the ALDDFT in the hindlimb. METHODS: Records of 23 horses with ultrasonographic evidence of desmopathy of the ALDDFT in one or both hindlimbs from 3 referral centres were reviewed retrospectively. Age, breed, sex, duration and nature of clinical signs, results of clinical and lameness examinations, treatment and outcome were recorded. RESULTS: In 13 horses (Group A), there was an acute onset of unilateral lameness. Ten horses (Group B) had an insidious or sudden onset of postural abnormality. There were 10 cobs, 5 British native-breed ponies and 8 horses of various larger breeds. Twenty horses were used for general purposes, and mean age was 12 years. Enlargement of the ALDDFT in the affected hindlimb(s) was identified in all horses. In 44% of horses, ultrasonographic abnormalities were localised to part of the ALDDFT. Treatment included box-rest and controlled exercise, and 10 horses were subjected to desmotomy or desmectomy of the ALDDFT. Seventy-three percent of horses in Group A returned to full function, while 90% of those in Group B remained lame. CONCLUSIONS: Two distinct clinical conditions are associated with the ALDDFT of the hindlimb. Traumatically induced injury resulting in acute onset lameness appears to have a favourable prognosis, with most horses returning to previous work. However, postural changes, once present, are irreversible and indicate a poor prognosis. POTENTIAL RELEVANCE: Desmopathy of the ALDDFT should be recognised as a potential cause of hindlimb lameness and this study provides clinical and prognostic information. Knuckling and/or semiflexion of the metatarsophalangeal joint may accompany the condition; therefore, if a horse is presented with a flexural deformity of this joint, desmopathy of the ALDDFT should be considered as a primary differential diagnosis.

Relationship of foot conformation and force applied to the navicular bone of sound horses at the trot.

REASONS FOR PERFORMING STUDY: Collapsed heels conformation has been implicated as causing radical biomechanical alterations, predisposing horses to navicular disease. However, the correlation between hoof conformation and the forces exerted on the navicular bone has not been documented. HYPOTHESIS: The angle of the distal phalanx in relation to the ground is correlated to the degree of heel collapse and foot conformation is correlated to the compressive force exerted by the deep digital flexor tendon on the navicular bone. METHODS: Thirty-one shod Irish Draught-cross type horses in routine work and farriery care were trotted over a forceplate, with 3-dimensional (3D) motion analysis system. A lateromedial radiograph of the right fore foot was obtained for each horse, and various measurements taken. Correlation coefficients were determined between hoof conformation measurements and between each of these and the force parameters at the beginning (15%) of stance phase, the middle of stance (50%) and at the beginning of breakover (86% of stance phase). Significance was defined as P<0.05. RESULTS: The force exerted on the navicular bone was negatively correlated (P<0.05) to the angle of the distal phalanx to the ground and to the ratio between heel and toe height. This was attributed to a smaller extending moment at the distal interphalangeal joint. There was not a significant correlation between the angle of the distal phalanx and the degree of heel collapse, and heel collapse was not significantly correlated to any of the force parameters. CONCLUSIONS: Hoof conformation has a marked correlation to the forces applied to the equine foot. Heel collapse, as defined by the change in heel angle in relation to toe angle, appears to be an inaccurate parameter. The forces applied on the foot are well correlated to the changes in the ratio of heel to toe heights and the angles of the distal phalanx. POTENTIAL RELEVANCE: Assessment of hoof conformation should be judged based on these parameters, as they may have clinical significance, whereas parallelism of the heel and toe is of less importance.

A comparison of three horseshoeing styles on the kinetics of breakover in sound horses.

A variety of horseshoe designs are believed to 'ease' breakover, or the unloading of the foot once the heels leave the ground. In this study, conventional toe-clip shoes, quarter-clip shoes, fitted to the white line at the toe, and Natural Balance horseshoes were fitted to the front feet of 9 sound Irish Draught-cross type horses. Forceplate and video motion analyses were undertaken during trot locomotion to determine the moment arm of the ground reaction force on the distal interphalangeal (DIP) joint, the peak DIP joint moment and the peak compressive force on the navicular bone. DIP joint moment arm during breakover was reduced with both Natural Balance (mean +/- s.d. 77 +/- 7 mm) and quarter-clip shoes (78 +/- 9 mm) compared to the toe-clip shoes (86 +/- 6 mm) (P<0.01). Peak DIP joint moment was not significantly different (175 +/- 37,171 +/- 38 and 175 +/- 31 Nmm/kg, in Natural Balance, quarter-clip and toe-clip shoes, respectively) and neither was peak force on the navicular bone (5.52 +/- 1.52, 5.79 +/- 1.53 and 6.14 +/- 1.47 N/kg, respectively). Breakover duration (heel off to toe off) was not significantly reduced by the Natural Balance shoes (39 +/- 6 ms) or the quarter-clip shoes (40 +/- 6 ms) compared to toe-clip shoes (42 +/- 9 ms). This study has demonstrated that the use of Natural Balance shoes reduces the moment arm of the ground reaction force (GRF) during breakover but does not reduce the peak DIP joint moment or the force on the navicular bone.

Use of a bioabsorbable implant for the repair of severed digital flexor tendons in four horses.

A new bioabsorbable implant composed of poly-L-lactic acid was used to repair the severed digital flexor tendons of four horses. The limbs were immobilised with distal casts which were changed after six to eight weeks and removed after 12 to 16 weeks. The horses were followed clinically and ultrasonographically for from seven to 19 months after the surgery. The ultrasonographic examination after the cast had been removed showed that the implants had been well incorporated into scar tissue. Two of the horses were mildly lame at the trot seven months after the surgery, but had returned to work after 12 months. The other two horses are still lame. No complications were observed with the implant.

The use of intrathecal analgesia and contrast radiography as preoperative diagnostic methods for digital flexor tendon sheath pathology.

REASONS FOR PERFORMING STUDY: The sensitivity of ultrasonography for the diagnosis of manica flexoria (MF) tears within the digital flexor tendon sheath (DFTS) is lower than for diagnosis of marginal tears of the deep digital flexor tendon (DDFT). Additional diagnostic tools would assist in appropriate decision making for either conservative or surgical management. OBJECTIVES: To evaluate the improvement in lameness of horses with MF or DDFT tears following intrathecal analgesia and to assess the sensitivity and specificity of contrast radiography for the diagnosis of these tears. METHODS: The case records of horses presented to a referral clinic over a 7-year period that underwent intrathecal diagnostic analgesia, or intrathecal analgesia and contrast radiography, of the DFTS with subsequent tenoscopy were examined. RESULTS: Fifty-three limbs had intrathecal diagnostic analgesia performed and 23 contrast tenograms were assessed in horses undergoing DFTS tenoscopy. Horses with DDFT tears were significantly more likely to respond positively to intrathecal diagnostic analgesia than those with MF tears (P = 0.02). Using contrast radiography, tears of the MF were predicted with an overall sensitivity of 96% and specificity of 80%; marginal tears of the DDFT were predicted with an overall sensitivity of 57% and specificity of 84%. CONCLUSIONS: The results of intrathecal analgesia of the DFTS in combination with contrast radiography have a high sensitivity for predicting MF tears. The sensitivity of contrast radiography for predicting tears of the DDFT is lower but the specificity remains high. POTENTIAL RELEVANCE: Contrast radiography performed at the same time as intrathecal analgesia provides useful information regarding the presence of MF tears and DDFT tears, which can assist in the decision of whether to manage the lameness conservatively or with tenoscopic evaluation.