Laurie's Blogs.

Hey Laurie, I've got a case I can't figure out. This dog came to me with the diagnosis of a SDF strain of digit 4 on the left front foot, 3 months duration. I didn't diagnose it and I don't think I actually could. All i found was some tenderness in the toe. Rads are supposedly clean. Pet was seen by another rehab vet. They tried laser therapy, but only 3 x and owner didn't think it helped any. The dog is only 1 year old and nutty without a physical release in the form of exercise. Very smart dog too. 

Dog was splinted initially but only for 4 days (pet didn't tolerate it). Then it was wrapped and covered in a boot for a week. Since then, it has turned into a chronic problem where the pet limps whenever it runs, jumps or plays ball. But the owner says it gets really cranky and bites if she doesn't get to exercise. So, I suggested swimming (they have to go a friends or to the lake though) for energy release and on off days, try uphill walking to offload the front end. As for exercises, I was going to do balance work and "gripping" type exercises but the owner tells me now that the dog is lame today. The only thing the dog did is walk 10 min uphill yesterday at a brisk pace and then 5 min of light play today. Limping pretty badly today per owner. I told owner today to go back to activity restriction except swimming for now. Any thoughts?

S

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So my first thought is... do you agree with the diagnosis and can you confirm it? If you think SDFT then you stretch the tendon to stress test (one toe at a time): flexed elbow, extended carpus, extend the MCP and then PIP joint. I'd want to check palmar sesamoids (via direct palpation). I'd want to stress test the MCL & LCL of each PIP & DIP. 

Now if you think that the Dx is correct, then you go with how would this be treated? Laser would be good, & some manual stretching would be good. Then... I'm not sure... maybe you think about taping... (I visualize circumferential taping around the distal phalanx - stick a cotton ball or wad of kleenex into the flexor space of the PIP... and then connect the circumferential tape of the distal phalanx to a circumferential tape at the MCP region (around the whole paw)…likely just above the MCP joints.... Connect the two by another strip or two of tape (skinny) on the undersurface of the paw. My idea is that you maintain a degree of flexion at the PIP joint.)

Or... you recommend a boot to cushion the joint and/or reduce use of the limb... from that perspective, you could also bandage or splint.

I hope this helps... but it really does boil down to your more certain diagnosis.

Laurie

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I knew you were going to say that! I couldn't confirm that diagnosis (of course, I didn't know how until you told me) This dog didn't tolerate either a splint or a bootie originally though so I'm not sure how that would go over again. Thanks for all your help, Laurie!

S