Hello and thank you in advance for any advice you can give.
Samantha is an 8 yr old FS Border Collie Mix that weighs approximately 50 lbs. She has radiographic evidence of severe OA on both hips and both stifles. She is weight shifting forward and has significant muscle atrophy of both hindlimbs. The left hind is much more severely affected than the right.
Owner has been managing her for some time on Previcox, Gabapentin and weekly laser therapy by the rDVM.
I saw her last week on Tuesday because she suddenly after lying down on Monday had no use of her left hindlimb. By the time I saw her she was grade 2/5 lame on the left hind.
Decreased extension at both hips. Normal ROM at both stifles but significant crepitus. No drawer or thrust present. Increased extension both hocks.
Tightness / trigger points iliopsoas and sartorius bilaterally, adductors bilaterally, triceps and lats bilaterally.
What confused me a bit is her gait in her left hindlimb. P3 and P4 have dorsal deviation (Almost like a digital flexor dislocation or rupture) but could not palpate a slip or find any swelling and it is only affecting the 2 middle toes. As she brings her left hind back to the ground it slaps the ground. Not sure if this is weakness or if I am missing something.
I treated her neck, back, hips, stifles and trigger points. Did joint compressions and grade 1 joint mobilizations. Owner called several hours later and said she was so please with how easy Samantha was moving but the foot was still slapping the ground. Her home exercises at this point are just weight shifting and stretching to begin improving weight bearing on her hindlimbs. Still bothered by the slapping gait though.
Anyone seen this or have an idea of what it could be? I will be seeing her later in the week - hopefully I can get video (owner is elderly and not tech saavy) of her gait.
Thanks again
Foot slapping gait in a hindlimb
Re: Foot slapping gait in a hindlimb
Hi Lori,
Just getting to this now. Great question... lots of juicy things to think about!
So - trigger points in the front end (she's pulling herself to get up and move forwards. Trigger points in the quads/sartorius, she's offloading, holding the legs in a bit of flexion. Trigger points in adductors - hip pain. These are secondary issues. You can treat the at some point, but they're not your focus.
Next - hock hyperextension correlates (as a compensation) with decreased hip extension.
Okay, then onto the meat of it... the exciting brain puzzle part of it!!! Sudden onset disuse of LH and a new slapping gait = Neurologic of lower motor neuron origin. Leaving differentials as being LS Disc Disease (and nerve root impingement), or an FCE in the caudal lumbar spine / cauda equina, or an ANNEPE (acute non compressive nucleus pulposus extrusion) which is more common in border collies with a mean age of seven (hmmm)... but it's more often T3-L3.
So it sounds like you've done a wonderful job so far... you likely just want to add some targeted therapies to the spine to help with healing of a potential L7 NR compression, impingement. I'd throw Tail Pull Traction into the home exercise program, and some mobilizations (flexion mobs) to L5, 6, & 7 & check the SIJ for a dysfunction as well, which can sometimes compromise how L7 sits and therefore if it pinches on a nerve. And laser L5-S1 region too.
In people we see this as a neurologic compromise. We might also see it in stroke patients, again with poor control of the Cranial Tibial (Tibialis Anterior) muscle. In order to not trip themselves up as they bring their leg forwards, they bend a little more at the knee and/or hip, and slap their foot down to ensure that it hits the ground flat versus with a droopy ankle / pointed foot. (I've also seen this in dogs with nerve palsy following an extracapsular repair (same vet - 3 dogs... coincidence? I think not!)
Now onto the toes. Ooo. This one is a stumper!!! I'm going to put as my best GUESS, that if there is neurologic compromise of the L7 region... then it's affecting not only Cranial Tibial, but also the Gastrocs and SDF / DDF (okay everything below the stifle... along with hamstrings). Side bar... indeed with weaker hamstrings and everything below the stifle, a slapping gait adds up: Lift from the hip to move the limb forwards and clear the floor, and placement is simply a release of the hip flexor, limited coordination from hamstrings, or lower leg muscles = slap.
Back on Topic. If everything is weak in the lower limb, then the dorsal ligament at the DIP joints is unopposed, thus making an appearance of a dorsal deviation / DDFT rupture. Middle 2 toes only... maybe just because they are most involved in weight bearing and most noticeable.
Okay back to you!!! Best of luck with this fascinating case!
Cheers,
Laurie
Just getting to this now. Great question... lots of juicy things to think about!
So - trigger points in the front end (she's pulling herself to get up and move forwards. Trigger points in the quads/sartorius, she's offloading, holding the legs in a bit of flexion. Trigger points in adductors - hip pain. These are secondary issues. You can treat the at some point, but they're not your focus.
Next - hock hyperextension correlates (as a compensation) with decreased hip extension.
Okay, then onto the meat of it... the exciting brain puzzle part of it!!! Sudden onset disuse of LH and a new slapping gait = Neurologic of lower motor neuron origin. Leaving differentials as being LS Disc Disease (and nerve root impingement), or an FCE in the caudal lumbar spine / cauda equina, or an ANNEPE (acute non compressive nucleus pulposus extrusion) which is more common in border collies with a mean age of seven (hmmm)... but it's more often T3-L3.
So it sounds like you've done a wonderful job so far... you likely just want to add some targeted therapies to the spine to help with healing of a potential L7 NR compression, impingement. I'd throw Tail Pull Traction into the home exercise program, and some mobilizations (flexion mobs) to L5, 6, & 7 & check the SIJ for a dysfunction as well, which can sometimes compromise how L7 sits and therefore if it pinches on a nerve. And laser L5-S1 region too.
In people we see this as a neurologic compromise. We might also see it in stroke patients, again with poor control of the Cranial Tibial (Tibialis Anterior) muscle. In order to not trip themselves up as they bring their leg forwards, they bend a little more at the knee and/or hip, and slap their foot down to ensure that it hits the ground flat versus with a droopy ankle / pointed foot. (I've also seen this in dogs with nerve palsy following an extracapsular repair (same vet - 3 dogs... coincidence? I think not!)
Now onto the toes. Ooo. This one is a stumper!!! I'm going to put as my best GUESS, that if there is neurologic compromise of the L7 region... then it's affecting not only Cranial Tibial, but also the Gastrocs and SDF / DDF (okay everything below the stifle... along with hamstrings). Side bar... indeed with weaker hamstrings and everything below the stifle, a slapping gait adds up: Lift from the hip to move the limb forwards and clear the floor, and placement is simply a release of the hip flexor, limited coordination from hamstrings, or lower leg muscles = slap.
Back on Topic. If everything is weak in the lower limb, then the dorsal ligament at the DIP joints is unopposed, thus making an appearance of a dorsal deviation / DDFT rupture. Middle 2 toes only... maybe just because they are most involved in weight bearing and most noticeable.
Okay back to you!!! Best of luck with this fascinating case!
Cheers,
Laurie
LAURIE EDGE-HUGHES