Odd foot

[lehughes]

Hello - I am writing from home about a case a colleague saw this weekend so I have only the information I was given. The good news is I have her notes, pictures of the patient, x-rays, and radiology report. I'd like to see what your thoughts are. I may get to see the patient in the future.
Thanks for your help.

The doctor's notes are in the beginning of the radiology report below:
Patient Name Sassy Patient ID 732
Species: Canine Breed: Fox Terrier
Age: 9 years 11 months Sex: Female(Spayed)
Modality/Images : DX/2 Date Of Study: Sun, 10 Jul 2016
Wt.: N/A Temp.: N/A Pulse: N/A Resp.: N/A
No call was requested
Case History:
Client Concern: Three weeks ago back left foot looked flat but it wasn't bothering her. 3 days ago owner thought the pads looked swollen. She is still taking metacam daily from knee surgery. She is not limping or acting like the foot bothers her ever. Activity is normal. 2 weeks ago she started sleeping behind the couch. Other than that her activity is normal. Stools normal. Eating and drinking normally. Heartworm preventative given the first of the month. Topical flea/tick medication given the 15th of the month.
Diet: IVet weight control 1/2 cup plus 1/2 package of Caesar 2x daily. Plus treats
Temperature:103.4
Body Condition Score:8/9
Pain Assessment:0
Mouth/Teeth/Gumsnot fully evaluated
Eyes:Normal
Ears:Normal
Nose:Normal
Throat:Normal
Coat:Normal
Skin:several skin masses
Abdomen:palpated wnl
Heart/Lungs:no murmur or arrhythmia, clear lung sounds
Lymph Nodes:Normal
Musculoskeletal System:See images. Nails were long (trimmed today). Left rear limb: all toes splayed laterally & phalanges are flattened. Most medial pad is enlarged in length and width (double the size of the same pad on the right rear limb), mild abrasion on medial aspect of that pad, likely from where it contacts the ground. Possible firm mass immediately dorsal to that pad at the tarsal-metatarsal area. Also possible soft tissue, mass inbetween 2 most lateral digits - skin is slightly red, scaled, and has some alopecia. No pain palpated, walks/trots normally. All other limbs/paws appear normal.
Tentative Diagnosis:neoplasia vs tendon/ligament rupture vs other
Overweight
Treatment Plan:Continue Metacam SID. Trimmed nails.
Recommendations:Additional recommendations pending radiology report - may consider scheduling rehab consult.
Technician: JPT -
Comments:Radiographs sent to antech
Staff:47
Description:
Findings:
Hind limbs: Two images are provided. Mild tarsometatarsal osteoarthrosis is present on the left. Enthesophtye formation is present at the distal aspect of the left second metatarsal bone. Moderate increase in soft-tissue opacity surrounds the left second digit. Mild osteoarthrosis is present at the left fourth and fifth metatarsal phalangeal joints. An opaque object is present between the middle phalanx of the right third and fourth digits on the craniocaudal image.
Assessment:
Mild to moderate, multifocal metatarsophalangeal joint osteoarthrosis of the left hind. This may be secondary to or associated with the reported abnormal carriage of the left hind limb. Ligamentous laxity is possible. Increased soft-tissue opacity surrounding the left second digit may also be secondary to the reported abnormal foot positioning. soft tissue swelling, inflammation or soft tissue mass cannot be ruled out. A systemic disorder causing ligamentous laxity cannot be ruled out.

Superficial debris is suspected for the opacity between the right third and fourth digits.

Mild left tarsometatarsal osteoarthrosis.

C.C., DVM, CCRT

[lehughes]

Hey C,

So I saw this on the VetRehab forum as well, and I'd tend to think along the lines of the other thinking of cancer.
However, the splayed foot also reminds me of a family of GSP's I treat. A brother and sister and both had huge spayed feet secondary to compensating for elbow arthritis or carpal arthritis.
The pics also remind me of a Sheltie I saw with total foot and then carpal / tarsal break down secondary to prolongued use of a Quinlone family of antibiotics (secondary to a stubborn UTI / Bladder infection). I did a Pubmed search and found a correlation in people with this kind of antibiotic and tendon weakening.
I am also reminded of a labrador retriever who just had overall laxity and toes were all oddly turned out as well - no pain, but the result of laxity and use.
Which then takes me down the path of wondering if he may have had a SDFT rupture in multiple toes that then led to this abnormal look just due to use of the limb and the already present laxity.

In any of these case... what to do? Just support for the OA.

And again, my apologies for the delayed response.

Cheers,
Laurie