SDFT injury / toe injury

[lehughes]

Hi Laurie,
I just got referred a 2 year old lab for a one year history of left forelimb lameness. The previous vet had done basic shoulder rads and basic elbow rads that were normal. On my orthopedic exam, the only place the pet was painful was digit 4 left front around the 1 phalanx. He was painful when I rotated it to the left or right and was painful when it was extended but not when it was flexed. This was repeatable pain and I could not elicit pain in any of the other toes. Assuming the rads I sent off were normal, would this be a SDFT injury? I saw that you had a 2014 article on your website about possibly taping the toe for a SDFT dog. This is clearly a chronic injury, how long do you think the toe would need to be taped? I also have laser and underwater treadmill at my disposal to use for rehab. I was planning laser and manual therapy but not sure if the UWTM would fit into the picture. Thanks for your help.
LS

[lehughes]

Hi L,

Sorry for my tardy reply…

So, my thoughts about the case as described would be that this is not a SDFT injury. I would actually think that it could be a sesamoid injury / fracture / sesamoiditis.
I’d try palpating the underside of the MCP joint.
A SDFT injury results in a ‘long toe’ (one that looks longer and flatter than the ones around it - or the other side).
Which… after trying some taping, I don’t think it helps if there has been a complete tear. Tried it on a few… but haven’t had success. So I now just suggest padding under the foot for walking / hiking on rocky / uneven surfaces.

Same goes for sesamoid fracture or sesamoiditis - padding. Plus laser & PEMF to help with healing. AND modified / restricted activity. I don’t think UWT is critical to recovery.

Given that it’s been a couple of week now, let me know how things have gone!

Cheers,

Laurie

[lehughes]

Hi Laurie,
Well, between now and when I wrote to you, I started taking the Canine Rehab Institute's first module, and I have now also realized that it can't be a SDFT issue. I'm guessing maybe an issue with collateral ligaments. Could be sesamoiditis, but would think that the radiologist would have noticed that. I am starting by doing a cast for three weeks to stop movement at the joint. We have been lasering weekly when we do bandage changes. He seemed a little improved at the last visit. What type of padding are you referring to? Like a boot? I know their goal is to have him be a hunting dog, and I'm a little worried that I won't get him to heal completely with a ligament injury because they can take so long to heal, if they heal at all.
L

[lehughes]

Ah, Okay…

Well, in regards to the radiologist seeing sesamoiditis, since that’s inflammatory and not a boney change, he/she might have missed - like a collateral ligament issue.
Hard to say on my end at this point. Still more questions: Is there pain if you stress test the MCL or LCL ligaments? With a collateral ligament injury, I usually find pain with full flexion and not just extension or rotations. As far as return to sport with an MCL or LCL issue - I’d say that most sporting dogs have a messed up toe or several toes, so it’s not so bleak. A sesamoid fracture on the other hand could be problematic. Did you try pushing your finger into the palmar surface of the MCP joint? The cast could help with reducing weight bearing to help it to heal (if that’s what it is).
As for padding, I did mean something like a boot… but with added padding in the bottom. Could put padding in a sock… just cushioning.

Anyways… best of luck on figuring out this dog!!

Cheers,

Laurie