Discussion related to the musculoskeletal system - injuries, post-op, lameness, extremity issues (joint, muscle, tenon, fascia...), axial skeleton issues, etc., as it relates to canine rehabilitation.
Hope you are well. My physio and I are struggling with a case and hope you may be able to help. The dog is a 1y 8m mn border collie. He has had bilateral FHO for Hip Dysplasia 6 months ago. He is unwilling to extend the upper part of the limb and has developed a intertarsal subluxation. Neoprene supports have been unsuccessful. We have been considering Articulating braces but these would be a custom fit. The owner is not keen on further surgery
Any suggestion gratefully received
So, you’ll need something that blocks the hyperextension (i.e. neoprene plus thermoplastic supports). It’s your 'next up’ custom, but not an orthosis-type custom splint/brace yet.
Does he have full hip extension? Is he also very straight in the stifles?
My thinking is either one of two things (as he reminds me of two different cases I’ve seen in the past):
1. CHD caused hip pain. He learned to avoid hip extension and never learned to walk right. Were the FHO’s successful? No pain now?? If yes, then you brace those tarsal joints and force the poor pup into walking and gaining hip extension. Cavaletti’s, hills, stairs, stretching out between two blocks or balls… all with the braces on. Get him to buy into hip extension as you protect the tarsal joints. Then, you need to strengthen gastrocs as a way to protect the tarsal joints. So exercises with the splints off: Sit to stands facing up hill or with front feet elevated on a step / stool, and destination jumping (onto a platform / surface, etc). As he buys into hip extension, then you remove the thermoplastic piece, replace with nylon/velcro rigid strip. Gradually remove that as well so you’re just left with the braces. He may or may not always need them, depending on how successful you are with getting him to change how he uses his body or if there is a conformational component.
2. The is a Conformational Component. There is one dog I see every year (for the last 4 years) at the STAAR Conference. His very dedicated vet brings him, and he is an interesting case. His legs look like the legs in this picture, but he didn’t have any hip issues or L-S issues (at the time he 1st presented) so his tarsi have been a mystery. The best I could say for why he looked / stood the way he did was leg length issues. If the rear legs are shorter than the forelimbs, a dog might hyperextend in order to keep his back level / balanced and for the normal weight bearing (i.e. 60/40 in favour of the front legs). I this scenario, the vet in charge of his rehab has braced the rear tarsal joints (just neoprene braces… which may help with proprioception only) and strengthening, and management of secondary issues. While he looks MARKEDLY better than he did 4 years ago, those who meet him for the first time go “OMG! This dog must be in so much pain! He looks terrible!” But he functions really very well!
3. Just thought of this. It’s the obvious. Pain at the hip. Bone spur needing 2nd surgery. Or shortening of the iliopsoas b/c of past issues / non-use - requiring stretching and myofascial work.
I saw a young Collie several years ago between 10-12 months of age that had bilateral tarsal hyperextension. I consulted you on it Laurie! We used neoprene braces from Therapaw, did mostly land based therapeutic exercises, especially gastroc stengthening and he eventually recovered and got out of the braces. I think avoiding rigid support is best to work on strengthening the muscles to support the ankle properly but if they keep breaking over cranially that is tough to look at!
I think these cases can do well and benefit from rehab NOT surgery.
This particular Collie did NOT have any hip or knee problems.
As a surgeon, I see lots of ankle problems in the Collie breeds, including fractures, luxations and just weak ankles in general like these hyperextension cases. The fractures and luxations are of course potentially surgical.
Caroline