Health & Management / Ruminants Pain Management / Techniques and protocols OVERVIEW:
Pain Prevention for Foot Surgery in Ruminants:
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Introduction and General Information

Foot surgery in ruminants involves several procedures including amputation of a digit, placement of an indwelling catheter for joint lavage, and arthrodesis. Foot surgery is likely to cause pain. (J303.12.w1)
Published Guidelines linked in Wildpro
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Reasons for the procedure

Surgical treatment of foot lesions may be required:
  • Digit amputation: 
    • The aim of digit amputation is to relieve pain, return the animal to sound gait and normal production, and to prevent infection ascending proximally in the limb. (B356.15.w15)
    • Digit amputation is indicated for traumatic hoof injuries, severe penetrations of the sole, sepsis and septic arthritis of the distal interphalangeal joint, septic tenosynovitis of the deep flexor tendon or osteomyelitis of the third phalanx. (J15.8.w2)
      • Digit amputation relieves pain and provides a relatively rapid return to a sound gait, with associated increase in body condition and milk yield. It removes a septic focus and allows good drainage, and is simple to perform. (J15.8.w2)
    • In bovines, severe footrot which is complicated by osteomyelitis and is unresponsive to antibiotic treatment, abscessation with distal interphalangeal joint osteoarthritis, tenosynovitis, infectious arthritis, severe phalangeal fractures and phalangeal joint dislocations, all may require amputation of the digit. (B356.15.w15)
    • Digit amputation is an option for treatment of deep pedal infections in cattle. (B344.31.w31)
    • Where one claw is severely affected with infection penetrating to deeper structures of the foot, such as the flexor tendon, navicular bursa and navicular bone, or pedal bone, amputation of the affected claw may be required. (J15.14.w4)
    • Digit amputation may be used for treatment of septic pedal arthritis in sheep. This involves removal of the third phalanx, navicular bone and the distal one-third of the second phalanx. Return to full use of the limb should occur within four to seven days. (J15.17.w3)
  • Arthrodesis:
    • Permanent arthrodesis, by drilling through the pedal joint and curetting the articular joint surfaces, is an option for treatment of deep pedal infections in cattle. (B344.31.w31)
    • Facilitated arthrodesis is one option for treatment of chronic septic arthritis of the distal interphalageal joint. (J234.12.w3)
    • Placement of an indwelling flushing catheter and joint lavage with hydrogen peroxide solution to produce eventual arthrodesis of the affected joint, may be used in treatment of septic pedal arthritis, and provides greater stability to the foot than does digit amputation. (J15.17.w3)
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Arguments against use of the procedure

  • Digit amputation generally results in earlier culling of cattle. (B356.15.w15)
  • Digit amputation is not suitable for individuals in which both digits of the same foot are affected, in very heavy animals )since breakdown of the remaining digit is likely) or for sepsis of the fetlock joint. (B356.15.w15)
  • Digit amputation results in a persistently poor gait in some animals and is not suitable for all cases. (J15.8.w2)
  • Digit amputation in cattle generally results in a shorter productive life and a poor cosmetic result; heavy individuals generally do poorly following digit amputation and walking on hilly or rocky ground, or slatted floors, is more difficult for individuals with an amputated digit. (J234.12.w3)
  • Arthrodesis is more expensive and technically difficult than amputation; it also requires more postoperative care and a longer time is required for return to previous production levels. (J234.12.w3)
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Signs/Evidence of pain associated with the procedure

  • It is generally accepted that foot surgery such as digit amputation is painful and requires analgesia. (P61.62.w1; J303.12.w1, B356.15.w15)
  • The surgical procedure for arthrodesis and the long process of ankylosis are painful; this results in a relatively slow return to previous production levels if this procedure is used. (J234.12.w3)
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Suggested methods of pain prevention

Use of local and regional analgesia:

  • Intravenous regional anaesthesia (IVRA) is commonly used. (J15.17.w3)
  • Caudal analgesia for surgery on the pelvic feet may be achieved by lumbosacral epidural analgesia using 2 mg/kg lidocaine. (J15.17.w3)
  • Intravenous regional anaesthesia (preferred), regional nerve blocks or a ring block may be used. (B356.15.w15)

Use of general anaesthesia:

  • General anaesthesia may be used for foot surgery, for example where a superficial vein cannot be found for IVRA. (J15.17.w3)

Use of NSAIDs:

Use of NSAIDs should always be considered in individuals undergoing foot surgery. (J303.12.w1)

  • NSAIDs should be used following foot surgery such as:
    • Digit amputation. (J15.1.w1, J15.17.w3)
    • Amputation of a toe granuloma. (J15.1.w1)
    • Removal of interdigital fibroma. (J15.1.w1)
    • Resection of the distal interphalangeal joint. (J234.12.w3)

Correct housing:

  • It has been suggested that following digit amputation, the cow should be housed on a flat surface rather than rough surfaces which are more likely to come into contact with the healing surface and cause pain. (J15.8.w2)
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Reasons why adequate pain relief is not always provided

Reasons why adequate pain prevention may not be provided are described in detail in: Reasons for Failure to Provide Pain Relief. In brief, these include:
  • Attitudes towards pain in animals;
  • Tradition;
  • Failure to recognise pain;
  • Failure to recognise the importance of the adverse effects of pain;
  • Concern about removing possible protective effects of pain [this concern is generally excessive];
  • Concern that providing pain relief may itself stress the animal and have a negative impact on it;
  • Concern that treating pain may interfere with diagnosis;
  • Lack of information about analgesics;
  • Concern about toxicity and side-effects of analgesics;
  • Concerns about the safety and legislative controls associated with some analgesics such as opiates;
  • Economic and practical considerations.
Specific published reasons for failure to provide pain relief for foot surgery are indicated below.
  • It is generally accepted that foot surgery such as digit amputation is painful and requires desensitisation to be carried out. (J303.12.w1, B356.15.w15)
  • Post-surgical analgesia often is not considered following surgical procedures such as digit amputation or joint ankylosis. (J15.8.w2, J234.12.w3)
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Authors & Referees

Authors Dr Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee A.B.Forbes BVM&S.,CBiol.,MIBiol.,DipEVPC.,MRCVS (V.w66)

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