Management of Knuckling in an Ostrich (Struthio camelus) Using a Custom-Made Orthotic Shoe.

A 4-year-old female ostrich (Struthio camelus) developed knuckling on its left foot after a traumatic event. Conservative treatment, rest, and traditional splinting methods failed to resolve the gait abnormality or improve mobility. A dynamic multicomponent orthotic shoe was then custom designed and fabricated with an ultra-high-molecular weight, low-pressure polyethylene polymer (St 1000 DIN16972 TG2) to correct the foot malposition. The affected foot and leg were wrapped with soft padding and the orthosis was attached and secured by nylon belts (Nylon PA [polyamide] 6, a semicrystalline polyamide polymer) with self-locking modified wrench straps. The orthosis immediately prevented knuckling and improved ambulation. After 2 weeks, this shoe was replaced with a modified orthotic shoe of lighter weight to improve kinetics and ease of use by the bird. The modified orthosis dramatically improved ambulation and was left attached to the affected leg for 7 more weeks. Thereafter, the bird was able to ambulate comfortably without the aid of the shoe, even though permanent anatomical changes to the affected leg seemed to restrict its speed of locomotion. The ostrich had another unfortunate traumatic event 10 weeks later, the result of which was knuckling on the contralateral (right) foot. After routine medical and supportive care, the orthosis was then applied to the right foot for a period of 9 weeks. During this period the bird was able to ambulate well, despite having to support the bulk of its weight on the previously affected left limb. At the end of 9 weeks, the orthosis was removed, and the bird was able to ambulate without aid, although the bird's speed of locomotion was considerably reduced. After recovery of its leg problems, the ostrich was confined to a relatively small paddock for the rest of its life.

MANAGEMENT OF PODODERMATITIS WITH AN ORTHOTIC BOOT IN A SOUTHERN ISABELA GIANT TORTOISE (CHELONOIDIS VICINA).

A 62-yr-old male Southern Isabela giant tortoise (Chelonoidis vicina) had a 1-yr history of chronic, reoccurring pododermatitis on the palmar surface of the left forelimb. Aggressive wound management was instituted and included surgical debridement, vacuum-assisted closure, and orthotic boot support during healing. A custom fabricated, carbon fiber clamshell Charcot Restraint Orthotic Walker walking boot was utilized to reduce focal pressure over the wound during weight bearing and promote a more normal gait. Distal padding was used to distribute pressure on the palmar surface of the left forelimb, with a focal depression in the padding preventing pressure directly over the wound. The design and trim lines were adjusted to allow shoulder and elbow motion without impingement. The clamshell design allowed relatively easy removal for wound inspection and dressing changes. The wound ultimately resolved after 9 wk of management with the orthotic boot, with no reoccurrence over the next 3 yr.

Use of physical therapy in a dog with bilateral severe plantigrade stance.

A 3.5 yr old spayed female Staffordshire terrier weighing 25.5 kg was presented with a 7 wk history of bilateral plantigrade stance in the pelvic limbs directly following an ovariohysterectomy procedure. Upon presentation, the dog had bilateral atrophy of the distal pelvic limb muscles, enlarged popliteal lymph nodes, and ulcerative wounds on the dorsa of her rear paws. Orthopedic examination revealed intact calcaneal tendons bilaterally and neurologic examination localized the lesion to the distal sciatic nerve. A diagnosis of compressive and stretch neuropathy was made affecting the distal sciatic nerve branches. Physical therapy modalities included neuromuscular electrical stimulation, ultrasound, and low-level laser therapy. Other therapeutic modalities included the use of orthotics and progressive wound care. The dog had increased muscle mass, return of segmental reflexes, return of nociception, and the ability to walk on pelvic limbs with higher carriage of the hock 15 mo following presentation. The use of custom orthotics greatly increased the quality of life and other physical therapy modalities may have improved the prognosis in this dog with severe bilateral plantigrade stance due to neuropathy.