Hi Laurie,
My name is K.C. and I am a small animal veterinarian in Pennsylvania. My personal dog has recently developed some interesting issues and I wanted to reach out and see if you had any input as your website has some great insight. Huckleberry is 5 yo MC coonhound mix who had a 2 month history of grade II/V right front lameness. He was diagnosed by MRI with a supraspinatus insertionopathy. During the diagnostic process he developed swelling of both of his calcaneon tendons (left greater than right) just proximal to the point of the calcaneus (pictures attached). He is nonpainful and sound on them and never has had a hindlimb lameness. I ultrasounded the tendons and found very small fluid pocketing but not enough to aspirate. He is in a rehab program right now for his shoulder and I am icing and cold lasering the tarsi as well. Do you have any exercises for this type of chronic calcanean tendonopathy that I could try?
Thanks for your time!
Regards,
K.C.
Calcaneal Swelling
Calcaneal Swelling
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Re: Calcaneal Swelling
Hi K,
Interesting case. And it leaves me with lots of questions… as well as things to try, which may help or be diagnostic if they don’t help!!
So my first though. Did the SS tendinopathy cause a weight shift to the rears which resulted in the Calcaneal pathology? Could be. Or b/c there was no lameness in the rears, are the findings there simply non-problematic and were just never identified before now? i.e. They are the norm for this dog.
Let’s start with the supraspinatus. Continue with laser. Scrap the ice (modern research shows it is nothing more than a pain killer. It has questionable use for tendinopathies. And if swelling was the reason you chose it, then don’t. Swelling is a natural, normal, necessary process in a joint that helps to stimulate healing. Icing is on the way out.) Add in eccentrics (push ups, down hill walking, play bow, then eventually trotting and landing a jump.)
Then to the rear legs. Interesting you can’t get any pain. Try squeezing the tendon from multiple aspects (squeeze side to side, cranial-caudal) and push the tendon into the back of the calcaneous. There is a bursa in the region - the retrocalcaneal bursa. And given that you found a small fluid pocket on U/S, this would be my best guess at what it is, as compared to a tendinopathy (where you would have a ‘hole’ and/or disorganized fibres, but not a pocket of fluid.
To treat a bursa from a rehab perspective: Laser, Ultrasound, and/or acupuncture, plus ‘relative rest' might do the trick. If you think it really is a tendinopathy, then eccentrics would help (sit to stand, sit to stand facing up hill, backwards walking, jumping UP onto something), OR these might irritate the region if it’s a bursa (which would be diagnostic).
Now, in physical therapy, we talk a lot about function. How is the problem impacting function? What can you do to improve function? What are your goals as they relate to function? By the sounds of it, these thickening are not impacting function. And unless you can find pain, they aren’t creating any issue for this dog. So the practical side of me say, don’t worry about them much. If you are lasering the shoulder, throw a couple of zaps at the the calcaneal tendon, but beyond that, don’t fuss too much unless they become a problem - causing pain or impacting function.
I hope this helps!
All the best,
Laurie
Interesting case. And it leaves me with lots of questions… as well as things to try, which may help or be diagnostic if they don’t help!!
So my first though. Did the SS tendinopathy cause a weight shift to the rears which resulted in the Calcaneal pathology? Could be. Or b/c there was no lameness in the rears, are the findings there simply non-problematic and were just never identified before now? i.e. They are the norm for this dog.
Let’s start with the supraspinatus. Continue with laser. Scrap the ice (modern research shows it is nothing more than a pain killer. It has questionable use for tendinopathies. And if swelling was the reason you chose it, then don’t. Swelling is a natural, normal, necessary process in a joint that helps to stimulate healing. Icing is on the way out.) Add in eccentrics (push ups, down hill walking, play bow, then eventually trotting and landing a jump.)
Then to the rear legs. Interesting you can’t get any pain. Try squeezing the tendon from multiple aspects (squeeze side to side, cranial-caudal) and push the tendon into the back of the calcaneous. There is a bursa in the region - the retrocalcaneal bursa. And given that you found a small fluid pocket on U/S, this would be my best guess at what it is, as compared to a tendinopathy (where you would have a ‘hole’ and/or disorganized fibres, but not a pocket of fluid.
To treat a bursa from a rehab perspective: Laser, Ultrasound, and/or acupuncture, plus ‘relative rest' might do the trick. If you think it really is a tendinopathy, then eccentrics would help (sit to stand, sit to stand facing up hill, backwards walking, jumping UP onto something), OR these might irritate the region if it’s a bursa (which would be diagnostic).
Now, in physical therapy, we talk a lot about function. How is the problem impacting function? What can you do to improve function? What are your goals as they relate to function? By the sounds of it, these thickening are not impacting function. And unless you can find pain, they aren’t creating any issue for this dog. So the practical side of me say, don’t worry about them much. If you are lasering the shoulder, throw a couple of zaps at the the calcaneal tendon, but beyond that, don’t fuss too much unless they become a problem - causing pain or impacting function.
I hope this helps!
All the best,
Laurie
LAURIE EDGE-HUGHES