digital flexor avulsion

[AgileBeagle]

Patient is an 8 year old working/agility German Shepherd. High drive, doesn't do anything slowly. Acute onset of grade 2/5 lameness. 4th digit of R rear is hyperextended, which is particularly evident when sitting, not as noticeable when standing. See attached pics. (I apologize for them all being rotated!) Incidently the dog also has a R psoas strain, presumably from the same incident that injured the toe.
Question is, what is recommended for digital flexor avulsions? Surgery? Would any sort of external support be beneficial? Or just tincture of time? Owner is upper level trainer and would like to be able to compete again.
Thanks in advance for any thoughts!

[David Lane]

An upturned P3 indicates a deep digitital flexor avulsion, vs a superficial DF avulsion which results in flattening of the proximal interphalangeal joint.

There is no treatment that I am aware of. Surgery doesn't work because the tissue is too friable. On the plus side, there is little morbidity associated with this condition, even in working or competing dogs. Unless there is an additional problem with that toe, then this is unlikely to be the cause of the lameness.

[AgileBeagle]

Thank you David! I agree, I don't think the toe is causing the lameness. But the owner has concerns that there is an increased chance of it getting hung up on the weaves in particular.
I saw the dog again a couple of days ago,and was trying to get creative on some sort of wrap to keep the toe in a more natural position. What worked best was just taping the nails together of digits 3 and 4. The dog didn't seem to mind at all, and using black physiotape, it was barely noticeable. Maybe she could even get away with using that in competition.

Thanks again-

[David Lane]

In theory, I agree with the owner that the possibility exists, but the reality is that it doesn't happen very often. Attached are some images of a colleague's taping method.

[lehughes]

Interesting discussion. I would agree with both of you, that an avulsed DDFT doesn't cause lameness, nor do I think it impacts function to a high degree (i.e. getting caught up in weave poles).
What I have seen in the hundreds of sporting dogs I've gotten my hands on, is that toe injuries, toe arthritis, toe anything, is very common in sporting dogs. Nature of the games I guess.

In regards to taping, that might make sense if a dog can be non-weight bearing (like a human hand), in which case, there can be a reattachment of the tendon. (A friend of my kid had this happen after playing football - his was an extensor tendon on his middle finger. A finger brace sorted him out in a couple of weeks. Unfortunately with a dog, simple weight bearing will continue to pull up the tendon. So unless there is some way to offload the limb for a prolongued period of time... it's unlikely to heal. And for the same reasons that surgery doesn't work... this sort of immobilization is not likely to hold when taken out of immobilization either!

I would have concerns with 'buddy taping' that it could impact the forces of how the foot lands, and where the forces transmit through. Is it possible that a second injury could ensue? Possibly. In fact the chance is just as likely of that happening with tape as without.

Honestly, it is what it is.

Laurie