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Topic:Distal Phalanx

The distal phalanx, also known as the coffin bone, is the innermost bone located within the hoof of a horse. It is a critical component of the equine skeletal system, providing structural support and playing a significant role in weight-bearing and locomotion. The distal phalanx is encased within the hoof capsule and interacts with various soft tissue structures, including the laminae, which connect the hoof wall to the bone. Conditions affecting the distal phalanx, such as fractures, infections, or laminitis, can have significant implications for a horse's mobility and overall health. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, biomechanics, pathology, and treatment options related to the distal phalanx in horses.
The microvasculature in the equine distal phalanx: implications for fracture healing.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    February 4, 2014   Volume 27, Issue 2 102-106 doi: 10.3415/VCOT-13-08-0105
Schade SM, Arnoczky SP, Bowker RM.To describe the intra-osseous microvasculature of the distal phalanx of the equine forelimb with regard to its potential clinical relevance. Methods: Eleven clinically normal equine forelimbs were used from six adult horses (range: 4 to 18 years old) euthanatized for reasons unrelated to lameness. In each limb the median artery was catheterized at the level of the carpus and India ink was injected under constant manual pressure. The limbs were frozen and 5 mm thick sections of the foot were cut in the sagittal, coronal, or transverse planes on a band saw. The sections were fixed in 10% formali...
Changes in navicular bone (os sesamoideum distale) shape in horses as a result of pathological alterations.
Folia biologica    June 19, 2013   Volume 61, Issue 1-2 1-10 doi: 10.3409/fb61_1-2.01
Komosa M, Purzyc H, Fraackowiak H.The main aim of the study was to compare the shape of navicular bones classified as normal and pathologically changed. A comparison of metric features of the navicular bone between different types of horses and associating the examined parameters to the size of the middle and distal phalanges was an additional aspect of the study. The material comprised 53 horses of various breeds which were divided into three types. Through anatomical examinations it was concluded that as many as 30 navicular bones were normal, while 23 were found to present pathological changes. The following methods of stat...
Magnetic resonance and radiographic diagnosis of osseous resorption of the flexor surface of the distal phalanx in the horse.
Equine veterinary journal. Supplement    March 2, 2013   Issue 43 3-7 doi: 10.1111/j.2042-3306.2012.00675.x
Young AC, Dimock AN, Puchalski SM, Murphy B, Spriet M.Osseous resorption of the flexor surface of the distal phalanx of the horse has been identified previously using magnetic resonance (MR) imaging; however, little is known about the prevalence and characteristics of this lesion. Objective: To establish the MR prevalence of resorptive lesions in the flexor surface of the distal phalanx and identify concurrent lesions associated with this finding and associations between the MR and radiographic findings. Methods: Horses with distal extremity MR and radiographs performed within 2 weeks of each other were included in the study. The flexor surface o...
Septic diseases associated with the hoof complex: abscesses, punctures wounds, and infection of the lateral cartilage.
The Veterinary clinics of North America. Equine practice    September 18, 2012   Volume 28, Issue 2 423-440 doi: 10.1016/j.cveq.2012.06.004
Redding WR, O'Grady SE.Hoof abscesses are probably the most common cause of acute severe lameness in horses encountered by veterinarians and farriers. Most affected horses show sudden, severe (acute) lameness; the degree of lameness varies from being subtle in the early stages to non-weight bearing. There is still debate between the veterinary and farrier professions as to who should treat a hoof abscess and the best method to resolve the abscess. Puncture wounds to the sole of the foot can introduce bacteria and debris to the solar surface of the distal phalanx and produce a fracture or a septic pedal osteitis.
Conservative management of a transverse fracture of the distal phalanx in a Quarter Horse.
Journal of the American Veterinary Medical Association    December 17, 2011   Volume 240, Issue 1 82-86 doi: 10.2460/javma.240.1.82
Sherlock CE, Eggleston RB, Howerth EW.A 7-year-old Quarter Horse gelding was evaluated because of sudden onset of severe left forelimb lameness of 4 days' duration. Results: Clinical evaluation and diagnostic perineural analgesia localized the lameness to the distal portion of the left forelimb. Radiography revealed a transverse fracture of the distal phalanx of the left forelimb. Results: The horse was treated conservatively with stall rest and stabilization of the hoof with fiberglass cast material and an elevated heel support. These treatments improved the lameness considerably. Over the following 4 months, the horse was exerci...
Persistent digital hyperthermia over a 48 h period does not induce laminitis in horses.
Veterinary journal (London, England : 1997)    October 22, 2011   Volume 192, Issue 3 435-440 doi: 10.1016/j.tvjl.2011.09.016
de Laat MA, Pollitt CC, Walsh DM, McGowan CM, Sillence MN.Persistent digital hyperthermia, presumably due to vasodilation, occurs during the developmental and acute stages of insulin-induced laminitis. The objectives of this study were to determine if persistent digital hyperthermia is the principal pathogenic mechanism responsible for the development of laminitis. The potent vasodilator, ATP-MgCl(2) was infused continuously into the distal phalanx of the left forefoot of six Standardbred racehorses for 48 h via intra-osseous infusion to promote persistent digital hyperthermia. The right forefoot was infused with saline solution and acted as an inter...
Management and outcome of fractures of the distal phalanx: a retrospective study of 285 horses with a long term outcome in 223 cases.
Veterinary journal (London, England : 1997)    June 16, 2011   Volume 192, Issue 2 176-182 doi: 10.1016/j.tvjl.2011.05.017
Rijkenhuizen AB, de Graaf K, Hak A, Fürst A, ter Braake F, Stanek C, Greet TR.A multicentre study of 285 cases was performed to enhance the management of distal phalangeal fractures on the basis of clinical evidence. The outcome after treatment was available for 223 of the cases. Horses with a non-articular type I fracture had a better prognosis (91.7%) for return to original or expected level of use than horses with an articular type II or III fracture (69.6% and 74.1%, respectively). The prognosis for types IV and V fractures was fair (57.7% and 57.1%, respectively) and for type VI good (80%). Horses with a hindlimb fracture had a significantly greater chance of a suc...
Comparisons of computed tomography, contrast enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 1: anatomic visualisation scores.
Equine veterinary journal    May 30, 2011   Volume 44, Issue 1 51-56 doi: 10.1111/j.2042-3306.2011.00372.x
Vallance SA, Bell RJ, Spriet M, Kass PH, Puchalski SM.To date, few reports exist comparing magnetic resonance imaging (MRI) and computed tomography (CT) for imaging of the equine distal limb, yet clinicians are required to decide which modality to use regularly. Objective: To report and compare anatomic visualisation scores obtained for CT, contrast enhanced CT (CECT) and standing low-field MRI (LFMRI) in the equine foot. Objective: Anatomic visualisation score discrepancies would exist between CT, CECT and LFMRI. Methods: Images of 22 lame horses (31 limbs) undergoing both CT and LFMRI of the foot were reviewed. When available, CECT images were ...
Fractures of the distal phalanx and associated soft tissue and osseous abnormalities in 22 horses with ossified sclerotic ungual cartilages diagnosed with magnetic resonance imaging. Selberg K, Werpy N.Ungual cartilage ossification in the forelimb is a common finding in horses. Subtle abnormalities associated with the ungual cartilages can be difficult to identify on radiographs. Magnetic resonance (MR) imaging findings of 22 horses (23 forelimbs) with a fracture of the distal phalanx and ossified ungual cartilage were characterized and graded. All horses had a forelimb fracture. Eleven involved a left forelimb (seven medial; four lateral), and 12 involved a right forelimb (five medial; seven lateral). All fractures were nonarticular, simple in configuration, and nondisplaced. The fractures ...
An investigation of the relationships between angles and shapes of the hoof capsule and the distal phalanx.
Equine veterinary journal    April 16, 2011   Volume 43, Issue 3 295-301 doi: 10.1111/j.2042-3306.2010.00162.x
Dyson SJ, Tranquille CA, Collins SN, Parkin TD, Murray RC.There is little scientific evidence to support the premise that poor foot conformation predisposes to foot pain and lameness. Objective: To determine relationships between external characteristics of the hoof capsule and angles of the distal phalanx; to determine variability in shape of the distal phalanx; and to investigate association between distal phalanx angles and the injury causing lameness. Methods: Feet were documented photographically and radiographically. Linear and angle measurements were obtained for the hoof capsule and distal phalanx and compared statistically. Horses were categ...
The effect of hoof angle variations on dorsal lamellar load in the equine hoof.
Equine veterinary journal    March 11, 2011   Volume 43, Issue 5 536-542 doi: 10.1111/j.2042-3306.2010.00319.x
Ramsey GD, Hunter PJ, Nash MP.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...
Is there an association between ossification of the cartilages of the foot and collateral desmopathy of the distal interphalangeal joint or distal phalanx injury?
Equine veterinary journal    August 19, 2010   Volume 42, Issue 6 504-511 doi: 10.1111/j.2042-3306.2010.00100.x
Dyson S, Brown V, Collins S, Murray R.Associations between degree of ossification of the cartilages of the foot and injuries to other structures of the foot have been suggested, but have not been investigated by large scale studies. Objective: To describe the frequency of grade >3 ossification of the cartilages of the foot (possibly significant ossification, PSO), mediolateral symmetry of ossification and left-right symmetry between feet; and to investigate associations between PSO and injury of either the collateral ligaments (CLs) of the distal interphalangeal (DIP) joint or the distal phalanx. Objective: Possibly significant os...
Maggot debridement therapy for laminitis.
The Veterinary clinics of North America. Equine practice    August 12, 2010   Volume 26, Issue 2 447-450 doi: 10.1016/j.cveq.2010.06.002
Morrison S.Maggot debridement therapy is a nontraumatic, minimally invasive method to treat infections in a foot compromised by chronic laminitis. A mechanical strategy must first be in place to address the instability of the distal phalanx and hoof capsule. Adverse reactions to maggot debridement therapy are uncommon and the only side effect observed has been irritation or hypersensitivity at the site. Chronic laminitic cases of sepsis/necrosis within the hoof benefit from this procedure due to the noninvasive, continuous debridement and healing properties provided by the larvae.
Farriery for chronic laminitis.
The Veterinary clinics of North America. Equine practice    August 12, 2010   Volume 26, Issue 2 407-423 doi: 10.1016/j.cveq.2010.04.008
O'Grady SE.Laminitis is considered chronic once the distal phalanx has displaced within the hoof capsule. Chronic laminitis generally occurs as a direct sequel to acute laminitis. Clinical evaluation of chronic laminitis is best performed with a thorough clinical examination and radiography. The mainstay of hoof care is therapeutic farriery. In this article, the goals and principles of hoof care, the appropriate trim and various shoes that form the bulk of farriery for chronic laminitis, and surgical treatments are discussed.
Chronic laminitis: foot management.
The Veterinary clinics of North America. Equine practice    August 12, 2010   Volume 26, Issue 2 425-446 doi: 10.1016/j.cveq.2010.06.003
Morrison S.Laminitis is a disease of the suspensory apparatus of the distal phalanx, which can advance to the chronic stage with varying degrees of structural failure. Because the disease may ultimately lead to mechanical failure of the digit, a foot management plan is required to effectively and mechanically treat these cases. Many laminitis cases can be successfully rehabilitated back to athletic soundness, light use, breeding, or pasture soundness, whereas others suffer from permanent instability and never enjoy an acceptable level of comfort. To understand how to minimize damage in the acute laminiti...
The distal sesamoidean impar ligament: comparison between its appearance on magnetic resonance imaging and histology of the axial third of the ligament.
Equine veterinary journal    June 9, 2010   Volume 42, Issue 4 332-339 doi: 10.1111/j.2042-3306.2010.00068.x
Dyson S, Pool R, Blunden T, Murray R.There is limited knowledge about the interpretation of alterations in the distal sesamoidean impar ligament (DSIL) detected using magnetic resonance imaging (MRI) and their correlation with histopathology. Objective: There would be: 1) a correlation between histopathology and MRI findings; and 2) a relationship between MR abnormalities at the origin and the insertion of the DSIL, between insertion and body; and origin and body. Methods: Fifty limbs from 28 horses were examined using high-field MRI and histopathology. MR abnormalities of the DSIL, its origin on the navicular bone and its insert...
Osteomyelitis and osteonecrosis after intraosseous perfusion with gentamicin.
Veterinary surgery : VS    April 29, 2010   Volume 39, Issue 5 644-648 doi: 10.1111/j.1532-950X.2010.00685.x
Parker RA, Bladon BM, McGovern K, Smith KC.To describe and discuss previously unreported complications associated with intraosseous perfusion with gentamicin in horses. Methods: Case report. Methods: Ten-year-old Warmblood gelding. Methods: Intraosseous perfusion with gentamicin into the proximal phalanx (P1) was used as part of the treatment regimen for distal interphalangeal joint and navicular bursa synovial sepsis. Although the sepsis responded favorably complications developed at the perfusion site, including persistent osteomyelitis, progressive osteonecrosis, and ultimately pathologic fracture of P1. Results: The progression of ...
Chronic laminitis: strategic hoof wall resection.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 197-205 doi: 10.1016/j.cveq.2009.12.009
Rucker A.In the chronic-laminitic foot, severe soft-tissue compression and compromised circulation can result in osteitis and sepsis at the margin of the distal phalanx. Resultant inflammation and sepsis may cause the coronary corium to swell, drain, or separate from the hoof capsule, usually within 8 weeks of laminitis onset. Slow-onset cases of soft-tissue impingement can develop secondary to distal phalanx displacement due to lack of wall attachment. With either presentation, partial upper wall resection is required to reverse compression and vascular impingement by the hoof capsule. If the patholog...
Pathology of the distal phalanx in equine laminitis: more than just skin deep.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 155-165 doi: 10.1016/j.cveq.2009.12.001
Engiles JB.The etiopathogenesis of laminitis is complex and involves multiple tissue types. It may be initiated by biomechanical, traumatic, inflammatory, vascular, toxic, and metabolic factors. Although histopathologic changes occurring within the lamellae of experimental models of laminitis are well described and reported, histopathologic changes occurring in the distal phalanx are not, even though gross and radiographic evidence of disease are often apparent and bony lesions could be considered a significant source of pain. Recent scientific evidence indicates that the microenvironment of bone is an i...
Carbohydrate alimentary overload laminitis.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 65-78 doi: 10.1016/j.cveq.2010.01.006
Pollitt CC, Visser MB.In acute laminitis, the suspensory apparatus of the distal phalanx fails at the lamellar dermal/epidermal interface. A grading system for the histopathology of laminitis is based on the consistent pattern of histologic changes to the secondary epidermal lamellae, basal cells, and basement membrane that occur as carbohydrate-induced laminitis develops. The actual trigger factors of carbohydrate-induced laminitis remain unidentified.
Clinical presentation, diagnosis, and prognosis of chronic laminitis in North America.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 141-153 doi: 10.1016/j.cveq.2009.12.006
Hunt RJ, Wharton RE.Chronic laminitis involves laminar morphologic changes resulting in digital collapse and can vary greatly in its clinical manifestation depending on duration, severity of lameness, and stability of the distal phalanx/hoof wall interface. Accurate assessment of the whole patient is mandatory and consideration must be given to signalment, occupation, and owner expectations, as well as history and etiology, which often predict the broad course of the disease. Diagnosis is made via physical examination with adjunctive serial radiographic evaluation and possibly venography. Eventual functionality o...
The anatomy and physiology of the suspensory apparatus of the distal phalanx.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 29-49 doi: 10.1016/j.cveq.2010.01.005
Pollitt CC.The equine hoof capsule protects the softer, more sensitive, structures within. Failure of the connection between hoof and bone (suspensory apparatus of the distal phalanx or SADP) results in the crippling lameness of laminitis. Active basal cell proliferation occurs principally in tubular hoof and proximal and distal lamellae. The remaining lamellae are virtually non-proliferative and the hoof wall moves past the stationary distal phalanx, by controlled activation and inhibition of constituent proteases. The lamellar corium derives most of its blood supply from the branches of the terminal ar...
Long-term outcome after arthroscopic debridement of distal phalanx extensor process fragmentation in 13 horses.
Veterinary surgery : VS    March 10, 2010   Volume 39, Issue 1 107-114 doi: 10.1111/j.1532-950X.2009.00608.x
Crowe OM, Hepburn RJ, Kold SE, Smith RK.To report long-term outcome after arthroscopic removal of fragmentation of the extensor process of the distal phalanx in horses. Methods: Case series. Methods: Adult horses (n=13). Methods: Medical records (2003-2004) of horses that had arthroscopic debridement of fragmentation of the extensor process of the distal phalanx were reviewed. Inclusion criteria included: lameness localized to the foot, fragmentation of the extensor process of the distal phalanx debrided arthroscopically, and a follow-up period of > or = 4 years. Results: Of the 13 horses, lameness was resolved in 11 (85%) initia...
Use of computed tomography in standing position to identify guidelines for screw insertion in the distal phalanx of horses: an ex vivo study.
Veterinary surgery : VS    July 4, 2009   Volume 38, Issue 3 373-379 doi: 10.1111/j.1532-950X.2009.00502.x
Vandeweerd JM, Perrin R, Launois T, Brogniez L, Clegg PD, Desbrosse FG.To compare the precision of radiography and computed tomography (CT) preoperatively in the standing position for identification of guidelines for screw insertion in the distal phalanx, and to identify whether standing CT might improve operative time compared with preoperative radiographic planning. Methods: Experimental ex vivo study. Methods: Cadaveric equine thoracic limb pairs (n=10). Methods: Insertion of a 4.5 mm cortex screw in lag fashion into an intact distal phalanx was evaluated in 2 groups (n=10) of cadaveric equine thoracic limbs. In 1 group, the site, direction, and length of the ...
The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments.
Equine veterinary journal    July 1, 2009   Volume 41, Issue 4 335-341 doi: 10.2746/042516409x370766
Bosch G, de Mos M, van Binsbergen R, van Schie HT, van de Lest CH, van Weeren PR.Extracorporeal shock wave therapy (ESWT) is frequently used in equine practice, but little is known about its biological action. Objective: To study the effects of ESWT on matrix structure and gene expression levels in normal, physiologically loaded tendinous structures in ponies. Methods: Six Shetland ponies, free of lameness and with ultrasonographically normal flexor and extensor tendons and suspensory ligaments (SL), were used. ESWT was applied at the origin of the suspensory ligament and the mid-metacarpal region of the superficial digital flexor tendon (SDFT) 6 weeks prior to sample taki...
Development of intraosseous infusion of the distal phalanx to access the foot lamellar circulation in the standing, conscious horse.
Veterinary journal (London, England : 1997)    June 21, 2009   Volume 183, Issue 3 273-277 doi: 10.1016/j.tvjl.2009.05.008
Nourian AR, Mills PC, Pollitt CC.Intraosseous (i.o.) infusion of the distal phalanx (IOIDP) as a delivery route targeting hoof lamellar tissue of standing, conscious horses was evaluated. Following sedation and regional nerve blockade in six Standardbred horses, a microdialysis (MD) probe was implanted into the hoof lamellar tissue of one forelimb. A purpose designed cannulated bone screw was introduced into the body of the distal phalanx, approximately 6 cm from the MD probe. Gentamicin solution (25 mg/mL) was infused at 20 microL/min through the bone screw for 2 h without the application of a tourniquet. MD and blood sample...
Multiple keratomas in an equine foot.
The Canadian veterinary journal = La revue veterinaire canadienne    December 2, 2008   Volume 49, Issue 9 904-906 
Christman C.A 19-year-old, Arabian gelding was presented for left hindlimb lameness and deviation of the hoof wall. Radiographs revealed a semicircular, radiolucent area in the lateral edge of the distal phalanx. Three distinct keratomas were successfully removed following hoof wall resection. Kératomes multiples sur le pied d’un cheval. Un cheval Arabe hongre âgé de 19 ans a été présenté pour une boiterie du membre postérieur gauche et une déviation de la paroi du sabot. La radiographie a révélé une région semi-circulaire radiotransparente au niveau du bord latéral de la phalange distale....
Radiographic, scintigraphic and magnetic resonance imaging findings in the palmar processes of the distal phalanx.
Equine veterinary journal    December 18, 2007   Volume 40, Issue 1 57-63 doi: 10.2746/042516407X223707
Nagy A, Dyson SJ, Murray RM.Increased radiopharmaceutical uptake (IRU) in the palmar processes of the distal phalanx is recognised but its clinical significance has not been established. Objective: To investigate the relationship between radiographic, scintigraphic and MRI findings in the palmar processes of the distal phalanx. Objective: Increased radiopharmaceutical uptake in the palmar processes of the distal phalanx is associated with MRI abnormalities; IRU and MRI abnormalities are over-represented in lame limbs. Methods: Clinical data, radiographic, scintigraphic and MRI findings of 258 horses with unilateral or bi...
Septic osteitis of the distal phalanx in foals: 22 cases (1995-2002).
Journal of the American Veterinary Medical Association    June 5, 2007   Volume 230, Issue 11 1683-1690 doi: 10.2460/javma.230.11.1683
Neil KM, Axon JE, Todhunter PG, Adams PL, Caron JP, Adkins AR.To determine the clinical characteristics and outcome of foals with septic osteitis of the distal phalanx. Methods: Retrospective case series. Methods: 22 foals. Methods: Information obtained from medical records included signalment; clinical, laboratory, and radiographic findings; treatment method; and outcome. Foals included in the study had lameness referable to the foot, radiographic evidence of localized lysis or focal loss of bone density of the distal phalanx, and suppurative discharge or necrosis of the affected bone evident at surgery. Foals with a history or evidence of penetrating w...
Sonographic anatomy of the palmarodistal aspect of the equine digit. Bolen G, Busoni V, Jacqmot O, Snaps F.Although ultrasonography is widely used in equine orthopedics, its use in the distal portion of the digit is still limited. The purpose of this descriptive study was to document the normal ultrasonographic appearance of the palmarodistal aspect of the digital area imaged between the bulbs of the heels. Ultrasonographic images were obtained with a 7.5 MHz microconvex transducer in 10 fresh equine cadaver forelimbs and five soundhorses. Sagittal, parasagittal, and transverse images were obtained from the proximal aspect of the middle phalanx to the distal sesamoid bone. Anatomic sections were ob...