"A simple heel bulb laceration may look like a regular 'nothing' cut, but it could be life-threatening if it's in the coffin joint, so you need to get it evaluated right away," said Robin M. Dabareiner, DVM, PhD, Dipl. ACVS, while describing a study she completed recently with colleagues at Texas A&M University (TAMU) College of Veterinary Medicine. "Ninety-five percent of horses with this injury go back to being athletes with no hoof defect if they're caught early."

Heel bulb lacerations are a common equine injury in Texas because of the abundance of barbed wire and structures and barriers made out of tin and metal pipe. Dabareiner said horses often step on pieces of sharp-edged tin that have fallen from the barn, or they will kick through walls or barriers and slice their heel bulbs on the metal. (She recommends covering tin walls with plywood to reduce the likelihood of injury.)

The retrospective study involved 101 horses evaluated and treated for heel bulb lacerations between 1988 and 1994 (the data was compiled by a TAMU resident in the mid-1990s, but it hadn't been analyzed). The results appeared in a February edition of the Journal of the American Veterinary Medical Association. Most of the horses were not treated with antimicrobial drugs prior to TAMU referral. In 17 of the horses, synovial (joint) structures were involved, and the coffin joint was most commonly affected. The veterinarians euthanatized one of the horses after his initial examination because of severe joint infection. 

In examining the cases in the study, Dabareiner noted that little has changed in the way veterinarians evaluate and treat heel bulb lacerations since 1988. To assess a heel bulb laceration, TAMU veterinarians block the foot with local anesthesia. If the laceration is close to a synovial (joint) structure, which should be sterile inside, the vet injects sterile fluid through the injury into the coffin joint so it distends the area. If the fluid squirts out of the wound, the vet knows the joint is involved and the wound is cleaned and debrided before a hoof cast is applied. In cases that don't involve the joints, typically the wounds are sutured (if fresh enough) and a foot bandage is applied.

In recent years, more aggressive techniques have been added to inspect and treat these injuries. Dabareiner and her colleagues noticed that in cases treated since 1994 (these were not included in the current study), "If a synovial structure was involved, we were more aggressive in treating with arthroscopy surgery and, more often than not, regional limb perfusion. I really think the outcome would be better if the coffin joint were involved had that (the aggressive treatment) been done in the earlier cases."

Due to the frequency of injuries with synovial structure involvement in the study, Dabareiner and her colleagues recommend that horses referred to a secondary examiner (such as at the university) be treated by the attending veterinarian with a broad-spectrum antimicrobial and non-steroidal anti-inflammatory drugs prior to transport.

After the initial examination in the 1988 study, 56 of the 100 horses were treated with systemically administered antimicrobial drugs. Out of the 61 horses for which follow-up information was available, 51 returned to their intended use with no further problems. Ten had complications associated with their wound; five of those were euthanatized and one horse died from an unrelated cause. Horses that had lacerations with synovial structure involvement had worse outcomes than those with injuries that didn't involve the joint.

It used to be that a horse couldn't be sent home for recovery because of the chances of that horse getting a cast sore, which can cause secondary problems. "There's a trick to putting a foot cast on, and we can send the horse home to the owners and in two weeks, they can bring back the horse (for cast removal). It keeps the price down for the owners," she added. Once the horse has the cast removed, he should wear a bandage for about two weeks. Dabareiner says that if a horse is assessed and treated early enough, he might only need about four to six weeks before going back to work.

Still, the key is to act quickly if your horse has a heel bulb laceration. "If you have a puncture wound or anything into a synovial structure, it takes about three days for a horse to start limping on it," she explained. "That's how long it takes for the bacteria to build up and cause lameness. By that time it's too late to treat them--there's so much bacteria there we can't clear the infection and we end up putting the horse down. You need to evaluate them on day one."  

About the Author

Stephanie L. Church, Editor-in-Chief

Stephanie L. Church, Editor-in-Chief, received a B.A. in Journalism and Equestrian Studies from Averett College in Danville, Virginia. A Pony Club and 4-H graduate, her background is in eventing, and she is schooling her recently retired Thoroughbred racehorse, Happy, toward a career in that discipline. She also enjoys traveling, photography, cycling, and cooking in her free time.

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