Case report

Abstract

A total of 17 dairy cows with sole ulcers were treated, and the healing process observed [USA; date not given]. Nine cows had mature, uncomplicated ulcers where the exposed corium appeared only slightly damaged in 6 cases, and more seriously damaged in 3 cases. The remaining 8 animals had complicated ulcers, all of which had a discharging tract at the ulcer site with swelling of the heel, coronary band, and flexor aspect of the digit extending to and above the metatarsus. Ulcers were regarded as typical lesions (Rusterholz ulcers) in 16 cows, and one cow had a heel ulcer. 16 of the 17 cows had ulcers that occurred on the lateral claw of the rear foot. Three cases had mature sole ulcers on one of the lateral hind claws, and early ulcers as evidenced by sole haemorrhage on the lateral claw of the opposite foot. Eight of nine uncomplicated ulcers showed progressive reduction in size following treatment. Using finger pressure, no pain response was present at the ulcer site after one week in 8 of 9 cases (89%). Ulcers with granulating corium healed more slowly (range 41-60 days; mean 48) compared with those where the corium appeared normal (range 12-28 days; mean 20). Sole ulcers recurred in 2 of the 9 cases (22%) within one month after the cow began bearing weight on the affected claw. In one of these cows, ulcers developed on 3 of the 4 hind claws. Histopathological examination of the left rear medial and lateral claws from this cow showed marked changes in the ventral surface of the third phalanx and the dermal papillae, as well as abnormal keratogenesis. Partial tenovaginotomy with resection of the deep flexor tendon was performed in 6 of the complicated sole ulcer cases. In the other 2 cases, tenovaginotomy was followed by claw amputation due to the intraoperative diagnosis of concurrent septic arthritis of the distal interphalangeal joint. In cases of partial tenovaginotomy, healing occurred over a period of 49-81 days (mean 68 days). Complications included excessive granulation tissue, abscess formation of the proximal outer compartment of the digital flexor tendon sheath, and overextension of the toe. For optimal healing to occur, weekly evaluation for the first 4 weeks following treatment may be beneficial with the following objectives: ascertain presence and position of the claw block; determine if progressive healing is occurring; determine if complications may be developing, such as a discharging tract at the ulcer site or swelling of the heel, coronary band or flexor surface of the digit; and finally, recheck for the presence of loose horn overgrowing the ulcer site which may result in further injury to the exposed corium and delay healing.