Topic:Deep Digital Flexor Tendon
The Deep Digital Flexor Tendon (DDFT) is a critical structure in the equine limb, extending from the muscles in the upper leg down to the coffin bone in the hoof. It is responsible for flexing the lower limb and plays a significant role in the horse's movement and weight-bearing capabilities. The DDFT runs behind the cannon bone and passes over the navicular bone before attaching to the pedal bone. Injuries to the DDFT can occur due to overuse, trauma, or degenerative changes, often leading to lameness and requiring careful management. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, function, injury mechanisms, and treatment options related to the Deep Digital Flexor Tendon in horses.
The effect of hoof angle variations on dorsal lamellar load in the equine hoof. In the treatment of laminitis it is believed that reducing tension in the deep digital flexor tendon by raising the palmar angle of the hoof can reduce the load on the dorsal lamellae, allowing them to heal or prevent further damage. Objective: To determine the effect of alterations in hoof angle on the load in the dorsal laminar junction. Methods: Biomechanical finite element models of equine hooves were created with palmar angles of the distal phalanx varying from 0-15°. Tissue material relations accounting for anisotropy and the effect of moisture were used. Loading conditions simulating t...
Desmotomy of the accessory ligament of the deep digital flexor tendon in the forelimb of 24 horses 2 years and older. To report outcome after desmotomy of the accessory ligament of the deep digital flexor tendon (ALDDFT) in adult horses (≥2 years) for treatment of desmitis of the ALDDFT or flexural deformity of the distal interphalangeal joint (FDDIJ). Methods: Case series. Methods: Horses with desmitis of the ALDDFT (n=9) and FDDIJ (n=15). Methods: Records (April 1996-July 2008) of 24 adult horses (mean age, 6.7 years) that had ALDDFT desmotomy were reviewed. Follow-up data was obtained 12-120 months after desmotomy. Results: Outcome was available for 22 horses; 18 (82%; 6 of 8 horses with desmitis of the ...
Evaluation of a tenoscopic approach for desmotomy of the accessory ligament of the deep digital flexor tendon in horses. To develop a tenoscopic approach for desmotomy of the accessory ligament of the deep digital flexor tendon (AL-DDFT) in horses. Methods: Experimental. Methods: Cadaveric forelimbs (n=10) and 4 forelimbs from 2 horses anesthetized for terminal teaching procedures, and 12 forelimbs of 6 experimental horses. Methods: Saline distention of the carpal flexor sheath facilitated insertion of an arthroscope into the distal medial aspect of the sheath between the AL-DDFT and deep digital flexor tendon (DDFT). Location of an instrument portal on the lateral aspect of the metacarpus was identified with a ...
Outcome after lacerations of the superficial and deep digital flexor tendons, suspensory ligament and/or distal sesamoidean ligaments in 106 horses. To report outcome after the surgical treatment of lacerations of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), suspensory ligament (SL), and/or distal sesamoidean ligaments (DSL) in horses. Methods: Case series. Methods: Horses (n=106) with lacerations of the SDFT, DDFT, SL, and/or DSL. Methods: Medical records (1988-2002) were reviewed for signalment, limb and tendon/ligament involvement (location and extent of injury, tendon sheath involvement), method of repair, and outcome. Results: The median age of horses was 7 years and the follow-up time ranged from 1...
Ultrasonographic findings in horses with foot pain but without radiographically detectable osseous abnormalities. Foot pain is an important cause of lameness in horses. When horses with foot pain have no detectable radiographic abnormalities, soft-tissue assessment remains a diagnostic challenge without magnetic resonance (MR) imaging. Ultrasonography can provide an alternative to MR imaging when that modality is not available but the extent of changes that might be seen has not been characterized. We reviewed the ultrasonographic findings in 39 horses with lameness responding positively to anesthesia of the palmar digital nerves and without radiographically detectable osseous abnormalities. Thirty of the...
Intrathecal deep digital flexor tenectomy for treatment of septic tendonitis/tenosynovitis in four horses. To describe partial removal of the intrathecal component of the deep digital flexor tendon (DDFT) in horses with chronic septic DDF tendonitis and tenosynovitis unresponsive to conventional therapy, and to report long-term outcome. Methods: Case series. Methods: Horses (n=4). Methods: Four horses with chronic septic DDF tendonitis and tenosynovitis were treated by surgical tenectomy of the intrathecal component of the DDFT, followed by stabilization in casts and subsequent corrective shoeing. All horses were previously managed unsuccessfully with combinations of conventional therapy consisting...
Electrosurgical tenoscopic desmotomy of the accessory ligament of the superficial digital flexor muscle (proximal check ligament) in horses. To report a tenoscopic technique using monopolar electrosurgery to transect the accessory ligament of superficial digital flexor muscle (AL-SDFM) and outcome in 33 horses. Methods: Case series. Methods: Horses (n=33). Methods: Medical files and surgery video recordings of horses that had AL-SDFM desmotomy performed by tenoscopy with monopolar electrosurgical electrodes were reviewed. Results: Of 33 horses, 24 were Standardbred racehorses with surgery performed bilaterally for superficial digital flexor tendonitis and 9 horses had flexural deformity. Severe (n=6) and mild (6) intrathecal hemorr...
Assessment of ultrasonographic morphometric measurements of digital flexor tendons and ligaments of the palmar metacarpal region in Icelandic Horses. To obtain morphometric values for the superficial digital flexor tendon, deep digital flexor tendon, accessory ligament of the deep digital flexor muscle, and suspensory ligament in the palmar metacarpal region of Icelandic Horses. Methods: 50 nonlame Icelandic Horses in training. Methods: Horses included 2 stallions, 30 geldings, and 18 mares from 4 to 20 years of age with a body mass index from 149.1 to 250.11 kg/m2. Transverse ultrasonographic images were obtained with an 8- to 10-MHz linear transducer and a standoff pad. In both forelimbs, the cross-sectional area, circumference, dorsopalm...
Relationship between muscle forces, joint loading and utilization of elastic strain energy in equine locomotion. Storage and utilization of strain energy in the elastic tissues of the distal forelimb of the horse is thought to contribute to the excellent locomotory efficiency of the animal. However, the structures that facilitate elastic energy storage may also be exposed to dangerously high forces, especially at the fastest galloping speeds. In the present study, experimental gait data were combined with a musculoskeletal model of the distal forelimb of the horse to determine muscle and joint contact loading and muscle-tendon work during the stance phase of walking, trotting and galloping. The flexor te...
Determination of T1 relaxation time of normal equine tendons using magic angle magnetic resonance imaging. Seven isolated equine front limbs were used to establish the normal T1 relaxation time of equine superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), and suspensory ligament (SL) using magic angle magnetic resonance (MR) imaging. MR imaging of the metacarpi was performed with the limbs positioned at 55° (the magic angle) relative to the main magnetic field. Transverse spin-echo proton density and inversion recovery images were acquired. T1 relaxation time was calculated based on ratios of signal intensity determined from the different pulse sequences. T1 relaxation tim...
Anatomical, magnetic resonance imaging and histological findings in the accessory ligament of the deep digital flexor tendon of forelimbs in nonlame horses. Detailed magnetic resonance imaging (MRI) and histological appearances of the accessory ligament of the deep digital flexor tendon (AL-DDFT) have not been documented previously in detail. Objective: To: 1) describe anatomical connections between the AL-DDFT and adjacent structures; 2) describe high-field and low-field MRI and histological appearances of the AL-DDFT in the forelimb of horses with no carpal or proximal metacarpal pain; and 3) assess the relationship between age, breed, gender, height, weight and MRI findings. Methods: Ten forelimbs were dissected to determine anatomical relation...
Outcome of medical treatment for horses with foot pain: 56 cases. Currently, there are limited data regarding the long-term outcome of horses with foot pain treated with corrective shoeing, rest and rehabilitation, and intrasynovial anti-inflammatory medication to target lesions detected with MRI. Objective: To report the long-term (≥12 months) outcome of horses with foot lesions following medical therapy. Objective: 1) There is no association between clinical parameters considered and a poor response to therapy. 2) Horses with a deep digital flexor tendinopathy are less likely to respond to medical therapy than horses without a deep digital flexor tendino...
Ultrasonographic morphometric measurements of digital flexor tendons and ligaments of the palmar metacarpal region in Haflinger horses. The aim of the study was to determine morphometric values of the superficial and deep digital flexor tendon, the inferior check ligament and the suspensory ligament in the palmar metacarpal region of sound Haflinger horses using ultrasonography and to assess the influence of different factors on them. The findings were compared with the literature. A total of 30 sound Haflinger mares aged 4-20 years were used. Transverse ultrasound images were obtained with an 8-10 linear MHz transducer and the cross-sectional area, the circumference and the dorsopalmar and lateromedial width were determined f...
Tenoscopy of the navicular bursa: a new therapeutic approach for horses affected by “palmar pain syndrome.” Endoscopic technique review and personal experiences. Tenoscopy of the navicular bursa has been recently introduced as a diagnostic and therapeutic treatment in cases of palmar foot pain syndrome. A deep digital flexor tendon transthecal approach was suggested in 1999, and the endoscopic technique has been reviewed. Smith and coworkers have recently reported good and promising results. An anatomic cadaver limb study was performed, and the endoscopic technique was evaluated. Subsequently, a 14-year-old Argentine mare, affected by palmar foot pain syndrome, was treated. Clinical data, MRI and endoscopic findings, and a 6-month follow-up evaluation ...
Autologous conditioned plasma as therapy of tendon and ligament lesions in seven horses. This case report describes the intralesional application of autologous conditioned plasma (ACP) in seven horses as treatment of severe tendinitis of the superficial digital flexor tendon, deep digital flexor tendon, or desmitis of the inferior check ligament. Follow-up data of the horses revealed a positive outcome in 10 to 13 months post injury. All horses treated with ACP were either performing in their previous work-load or were back in full training. Further studies with long-term follow-up will have to be performed to support these clinical intermediate-term observations.
Navicular bursoscopy in the horse: a comparative study. To compare the proportion of the proximal recess of the navicular bursa that could be examined through a single endoscopic portal and the severity of iatrogenic lesions between conventional and modified approaches. Methods: Descriptive study. Methods: Equine cadaver forelimbs (n=16). Methods: Arthroscopic access to the navicular bursa in 1 limb of each pair was by a conventional approach and in the other limb, by a modified approach using sharp dissection through the distal digital flexor sheath, immediately palmar to the T ligament. The time required to access the bursa and the estimated prop...
Aspartic acid racemization and collagen degradation markers reveal an accumulation of damage in tendon collagen that is enhanced with aging. Little is known about the rate at which protein turnover occurs in living tendon and whether the rate differs between tendons with different physiological roles. In this study, we have quantified the racemization of aspartic acid to calculate the age of the collagenous and non-collagenous components of the high strain injury-prone superficial digital flexor tendon (SDFT) and low strain rarely injured common digital extensor tendon (CDET) in a group of horses with a wide age range. In addition, the turnover of collagen was assessed indirectly by measuring the levels of collagen degradation mark...
Magnetic resonance signal changes during time in equine limbs refrigerated at 4 degrees C. When ex vivo magnetic resonance (MR) imaging studies are undertaken, specimen conservation should be taken into account when interpreting MR imaging results. The purpose of this study was to assess MR changes during time in the anatomic structures of the equine digit on eight cadaver limbs stored at 4 degrees C. The digits were imaged within 12 h after death and then after 1, 2, 7, and 14 days of refrigeration. After the last examination, four feet were warmed at room temperature for 24 h and reimaged. Sequences used were turbo spin echo (TSE) T1, TSE T2, short tau inversion recovery (STIR), a...
A review of tendon injury: why is the equine superficial digital flexor tendon most at risk? Tendon injury is one of the most common causes of wastage in the performance horse; the majority of tendon injuries occur to the superficial digital flexor tendon (SDFT) whereas few occur to the common digital extensor tendon. This review outlines the epidemiology and aetiology of equine tendon injury, reviews the different functions of the tendons in the equine forelimb and suggests possible reasons for the high rate of failure of the SDFT. An understanding of the mechanisms leading to matrix degeneration and subsequent tendon gross failure is the key to developing appropriate treatment and p...
Magnetic resonance imaging findings in horses with recent onset navicular syndrome but without radiographic abnormalities. Seventy-two horses with recent onset of navicular syndrome and normal radiographs were assessed. Horses underwent magnetic resonance (MR) imaging of both front feet. All abnormalities were characterized and the most severe abnormality identified, if possible. Abnormal signal intensity in the navicular bone was the most severe abnormality in 24 (33%) horses. Pathologic change in the deep digital flexor tendon was the most severe abnormality in 13 (18%) horses. Pathologic change in the collateral sesamoidean ligament was the most severe abnormality in 11 (15%) horses. Pathologic change in the di...
Influence of the position of the foot on MRI signal in the deep digital flexor tendon and collateral ligaments of the distal interphalangeal joint in the standing horse. Hyperintense signal is sometimes observed in ligaments and tendons of the equine foot on standing magnetic resonance examination without associated changes in size and shape. In such cases, the presence of a true lesion or an artifact should be considered. A change in position of a ligament or tendon relative to the magnetic field can induce increased signal intensity due to the magic angle effect. Objective: To assess if positional rotation of the foot in the solar plane could be responsible for artifactual changes in signal intensity in the collateral ligaments of the distal interphalangeal ...
Comparative study of the characteristics and properties of tendinocytes derived from three tendons in the equine forelimb. The aim of this study was to determine the characteristic differences in tendinocytes derived from tendons in the equine forelimb, superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT) and common digital extensor tendon (CDET), in morphology, proliferation, collagen production ability and ability for synthesis of matrix metalloproteinases (MMPs). Significant differences were observed in cell number in vivo. The cellular number was largest in the SDFT and smallest in the CDET. The values of in vitro proliferation ratios and ability for synthesis of collagen and MMPs were l...
Morphometric data on the accessory ligament of the deep digital flexor tendon in the equine hindlimb. Desmopathy of the accessory ligament of the deep digital flexor tendon (ALDDFT) in the hindlimb has recently been described as a cause of lameness in horses. However, there is limited morphometric data on this ligament. In the present study, the ALDDFT was carefully dissected in 165 hindlimbs that were collected from an abattoir. Length, width (lateral-to-medial) and thickness (plantar-to-dorsal) of the ligament were measured. It was found that the ALDDFT may be absent in a minority of horses, but when it was present the general morphology was variable. The ALDDFT can be a single rectilinear s...
Pressure distribution between the deep digital flexor tendon and the navicular bone, and the effect of raising the heels in vitro. The objectives of this study were to topographically map pressure distribution across the palmar surface of the navicular bone in response to forces applied by the deep digital flexor tendon (DDFT), and evaluate the effect of raising the heels in vitro . A rig was constructed to hold an equine cadaver limb and apply controlled pressure to the navicular bone from the DDFT. Pressure-sensitive paper was used to quantify and map the resultant pressure. Changes in response to heel wedges (5 degrees and 10 degrees ) were recorded. The areas subject to maximum pressure from the DDFT were: the central...
Use of contrast-enhanced computed tomography to assess angiogenesis in deep digital flexor tendonopathy in a horse. We compared contrast-enhanced computed tomography (CT) and high field magnetic resonance (MR) imaging in a horse with deep digital flexor tendonopathy. Lesions in the distal extremity were documented grossly and histopathologically. In contrast-enhanced CT, the deep digital flexor tendon lesions were markedly contrast enhancing with evidence of angiogenesis in the core and dorsal border lesions. The lesion morphology was clearly delineated on MR imaging, but without contrast media angiogenesis cannot be identified. Gross examination, histopathologic examination, and CD31 immunohistochemistry c...
The effects of limb posture on relationships between in vitro radial hoof strain, load and joint angles. Radial strain in normal hooves has been found to vary with strain gauge location, limb posture and sample limb but reported magnitudes were considered to be low. More accurate measurement of radial strain may enhance the understanding of hoof function. Objective: To explore in vitro radial hoof strain in relation other kinetic and kinematic variables that may be related. Methods: Five normal forelimbs were removed at the proximal articular surface of the third metacarpal bone (McIII). The limbs were loaded using a modified Instron test machine. Six calibrated infrared cameras captured movement...
Outcomes of podotrochlear (navicular) bursa injections for signs of foot pain in horses evaluated via magnetic resonance imaging: 23 cases (2005-2007). To determine clinical outcome following intrathecal injection of the podotrochlear (navicular) bursa for signs of foot pain in horses evaluated via magnetic resonance imaging (MRI) and evaluate efficacy of corticosteroids administered with or without hyaluronate. Methods: Retrospective case series. Methods: 23 horses. Methods: Data collected included signalment, history, intended use, duration and severity of lameness, results of diagnostic anesthesia, radiographic abnormalities, MRI abnormalities, and outcomes for return to use. Results: MRI was conducted on 23 horses with lameness localized ...
Lesions of the deep digital flexor tendon in the digit: a correlative MRI and post mortem study in control and lame horses. Lameness associated with lesions of the deep digital flexor tendon (DDFT) in the digit is now recognised as an important cause of lameness, but there is currently limited information about the pathological nature of the lesions. Objective: To compare: signal intensity changes on magnetic resonance images with histopathology; and histopathological changes in the DDFT from horses with no history of foot-related lameness (Group C) and horses with lesions of the DDFT confirmed using magnetic resonance imaging (MRI) (Group D). Methods: Transverse sections of the DDFT were harvested from 3 sites in ...