Diseases / List of Miscellaneous / Metabolic / Multifactorial Diseases / Disease description:

Ulcerative Pododermatitis in Lagomorphs 

Rabbit hock lesions. Click here for full page view with caption Pododermatitis in a rabbit. Click here for full page view with caption

INFORMATION AVAILABLE

GENERAL INFORMATION

CLINICAL CHARACTERISTICS & PATHOLOGY

INVESTIGATION & DIAGNOSIS

TREATMENT & CONTROL

SUSCEPTIBILITY & TRANSMISSION

ENVIRONMENT & GEOGRAPHY

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General and References

Disease Summary

  • Essentially, ulcerative pododermatitis is a pressure sore that develops in focal areas that are overlying bony prominences. (B600.9.w9)
  • Avascular necrosis occurs on the palmar or plantar aspect of the feet and then this is often followed by cellulitis, abscessation, osteomyelitis and synovitis. (B609.2.w2)
Lagomorphs
  • Ulcerative pododermatitis is a chronic, ulcerative, granulomatous dermatitis on the plantar aspect of the caudal metatarsals and tarsals (occasionally the metacarpals and phalangeal surfaces) seen usually in obese inactive rabbits that are kept on soiled bedding or on grid floors. (B600.9.w9, B601.11.w11, B602.19.w19, B610.23.w23)
  • Deep pyoderma or cellulitis can occur secondary to excessive weight bearing, hard or rough surfaces, or prolonged contact with wet, abrasive, or faeces/urine soaked surfaces. (B609.2.w2)
  • This is a painful and frequently irreversible condition. (B609.2.w2)

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Alternative Names (Synonyms)

  • Sore hocks
    • this is a misnomer because the metatarsals are most commonly affected, not the hocks. (B614.15.w15)
  • Pododermatitis
  • Pressure sores
  • Avascular necrosis of the plantar feet. 

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Disease Type

Miscellaneous / Metabolic / Multifactorial

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Infectious/Non-Infectious Agent associated with the Disease

Secondary bacterial infection:
Causes of ulcerative pododermatitis
  • Normal rabbit physiology

    Digitigrade stance

    • During locomotion, the rabbit will normally bear weight on the digits and claws of the hind feet. (B600.9.w9, B609.2.w2)
    Plantigrade stance
    • At rest, the rabbit will bear weight on the area between the hock and the hind claws. (B609.2.w2)
    • The superficial flexor tendon is under constant tension to enable the rabbit to rapidly spring up and flee. (B600.9.w9)
    • In the natural habitat of rabbits, the claws are able to grip into the earth substrate. (B600.9.w9)
    • Protection of plantar aspect of the feet- rabbits do not have footpads but they usually have a thick covering of fur instead. The skin in this area adheres to the underlying tissue and forms a thin tarso-metatarsal skin pad. (B600.9.w9, B609.2.w2)
    Any condition that disrupts this normal cushioning or digitigrade locomotion may lead to pressure sores forming on the feet. (B609.2.w2)
  • Increased pressure on the plantar aspect of the feet.
    • This may occur due to:
      • obesity.
      • lack of exercise.
      • pain  (e.g. spinal or dental pain) leading to immobility.
      • poor conformation.
      • pregnancy. 
      • decreased weight bearing on other feet.
      • wire flooring- this prevents the rabbit from walking or resting on its claws so the weight is borne by the hock and metatarsus.
      • hard flooring - e.g. vinyl or concrete, prevents the claws sinking in to the substrate so most of the weight is taken by the hock and metatarsus.
      • Shaving or clipping of the fur on the soles of the feet.

      (B600.9.w9, B609.2.w2, V.w65)

    • Avascular necrosis occurs as a result of this increase in pressure being applied to the skin and soft tissues that are pressed between a hard floor surface and the underlying bones of the feet causing ischaemia and necrosis. (B609.2.w2)
    • The severity and degree of ulceration will vary with the extent of the vascular occlusion. Biochemical changes can occur within the ischaemic skin resulting in release of oxygen free radicals that will damage the endothelium, and also vascular thrombosis that will cause further dermal necrosis. (B600.9.w9)
    • This ischaemia can then lead to sloughing, ulceration and secondary bacterial infection. (B609.2.w2)
  • Plantar feet dermatitis, see: (Bacterial Dermatitis in Lagomorphs)
    • This is common in rabbits that are:
      • housed on abrasive surfaces which increases the shearing forces and the friction on the skin (e.g. carpeting, wire, or Astroturf); (B600.9.w9, B609.2.w2)
      • frequently sat in soiled litter or bedding. (B609.2.w2)
    • Prolonged contact with moist, abrasive surfaces or wire will lead first to loss of hair and then superficial dermatitis, deep pyoderma, cellulitis, then abscess formation. (B609.2.w2)
    • If it is untreated, then osteomyelitis and synovitis may occur. (B609.2.w2)
  • For more information on causes of this condition see the susceptibility section.

Exacerbation of the condition

  • Pain due to necrosis and infection frequently causes the rabbit to become more sedentary. This will in turn, lead to an increase in the amount of time that the weight is borne on the hocks and thus extend the areas of pressure necrosis. (B600.9.w9, B609.2.w2)
  • If a rabbit ends up developing osteomyelitis and synovitis, the tendons can be permanently damaged (the superficial digital flexor tendon can become displaced and slips off the hock) so that it is no longer possible to maintain a normal stance and the rabbit sits back on its hocks permanently. In these cases the damage is usually irreversible. (B600.9.w9, B601.13.w13, B603.4.w4, B609.2.w2, J213.7.w1)

Infective "Taxa"

Non-infective agents

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Physical agents

-- Indirect / Secondary

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References

Disease Author

Nikki Fox BVSc MRCVS (V.w103)
Click image for main Reference Section

Referees

John Chitty BVetMed CertZooMed MRCVS (V.w65); Anna Meredith MA VetMB CertLAS DZooMed (Mammalian) MRCVS (V.w128); Richard Saunders BVSc BSc CertZooMed MRCVS (V.w121)

Major References / Reviews

Code and Title List

B10.45.w47, B600.9.w9, B601.11.w11, B601.13.w13, B602.19.w19, B603.4.w4, B604.5.w5, B606.4.w4, B606.10.w10, B608.21.w21, B609.2.w2, B610.23.w23, B614.15.w15, J213.4.w4, J213.7.w1

Other References

Code and Title List

 

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Clinical Characteristics and Pathology

Detailed Clinical and Pathological Characteristics

General --

Clinical Characteristics

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Lagomorphs "Hair loss, scaling, erythema and ulceration of the skin on the plantar aspect of the metatarsus. Very occasionally the front feet may be affected too". (B606.4.w4)
Grade I - Early Asymptomatic Disease
  • Loss of hair (which does not usually grow back) on the palmar or plantar aspect of the hocks or feet. (B608.21.w21, B609.2.w2, B615.6.w6)
  • Rabbits do not have protective footpads so once the fur is lost on the weight bearing surface of the foot, the skin becomes susceptible to ulceration and ischaemic necrosis. (J213.7.w1)
Grade II - Mild disease
  • Erythema and swelling with the overlying skin remaining intact. (B602.19.w19, B609.2.w2, B615.6.w6, J213.4.w4)
  • If the disease is recognised at this stage and the underlying cause is treated then progression to ulceration can be prevented. (B600.9.w9)
Grade III - Moderate disease
  • Rounded, focal areas of ulceration and scab formation. (B601.11.w11, B602.19.w19, B604.5.w5, B608.21.w21, B609.2.w2, J213.4.w4)
  • Occasionally the medial plantar artery or vein (which run just under the skin) becomes eroded and the resulting haemorrhage can be quite alarming for owners. (B600.9.w9)
Grade IV - Severe disease
  • Abscess (B602.19.w19, B604.5.w5, B606.10.w10, B608.21.w21, B609.2.w2)
  • Inflammation of the tendons or deeper tissues. (B608.21.w21, B609.2.w2)
  • The surrounding fur may become matted and adhere to the lesion, increasing both the pressure on the skin and the bacterial contamination. (B600.9.w9)
Grade V - Severe and often irreversible disease
  • Osteomyelitis (B601.11.w11, B602.19.w19, B606.10.w10, B608.21.w21, B609.2.w2)
  • Synovitis and tendonitis that leads to displacement of the superficial digital flexor tendon and an abnormal gait and stance (dropped hock). (B600.9.w9, B609.2.w2, J213.7.w1)
Distribution of lesions
  • The point of the hock is particularly prone to pressure necrosis. (B600.9.w9)
  • The skin overlying the central tarsal bone's bony prominence. (B600.9.w9)
  • Metatarsal, tarsal and occasionally, the metacarpal regions. (J213.7.w1)
  • Occasionally the phalangeal surfaces can be affected. (B602.19.w19)
  • Lesions on the front feet are often due to a shifting of the weight from sore back feet to the front feet. (B614.15.w15)
Other clinical findings
  • Due to the pain, there may be:
    • Anorexia (B604.5.w5, B609.2.w2)
    • Shifting lameness and reluctance to move. (B609.2.w2, J213.4.w4)
    • Refusal to breed. (B604.5.w5)
    • Loss of body condition (B604.5.w5)
    • Depression (B609.2.w2)
    • Aggression (B603.4.w4)
  • Obesity (B609.2.w2)
  • If the superficial flexor tendon is displaced then there will be a "dropped hock" appearance that may be mistaken for spinal disease. (B600.9.w9)
  • Anaemia due to blood loss or chronic infection. (B600.9.w9, B603.4.w4)
  • Chronic inflammation can lead to amyloidosis of the kidneys. (B603.4.w4)
  • Death due to anorexia caused by the pain or due to septicaemia. (B600.9.w9, B606.10.w10)

Note: examine the other limbs for musculoskeletal disorders that could have cause a decrease in weight bearing in those limbs and therefore increased weight bearing on the limb affected with pododermatitis. (B609.2.w2)

Incubation

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Lagomorphs
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Mortality / Morbidity

  • --
Lagomorphs Morbidity
  • This condition is very common in commercial rabbits that are housed in tiny hutches or wire cages. (B600.9.w9, B608.21.w21, B609.2.w2)
  • Often seen in house rabbits that are housed on carpets or hard floor. (B609.2.w2)
Prognosis and expected course
  • Grade I: These rabbits will have a lifelong risk of developing this condition so the environmental factors must be closely controlled and the animals monitored carefully. 
  • Grade II and III: Good to fair prognosis but there may be reoccurrence if the husbandry problems are not resolved. 
  • Grade IV to V: Prognosis is grave for return to normal anatomy. Prognosis for the return to a functional weight bearing really depends on the severity of the involvement of underlying bone and the extent of the abscesses. Guarded to poor for complete resolution if both the bone and tendon are involved. Most of these cases will need surgical debridement, sometimes several times, AIPMMA beads and several follow-up visits. Reoccurrence rates are high. If the patient has intractable pain then amputation or euthanasia may be necessary. 

(B609.2.w2)

Pathology

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Lagomorphs
Exudate 
  • A large number of neutrophils in several stages of degeneration. 
  • Other inflammatory cells. 
  • Necrotic tissue. 
Surrounding tissue 
  • Suppurative or avascular necrosis. 
  • Ulceration. 
  • Large numbers of neutrophils.
  • A variable number of lymphocytes, macrophages, plasma cells, and fibrous connective tissue. 
Osteomyelitis
  • Bone resorption 
  • Severe septic arthritis. 

(B609.2.w2)

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Human Health Considerations

No zoonotic potential. (B609.2.w2)

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Susceptibility / Transmission

General information on Susceptibility / Transmission

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Lagomorphs

 

Risk factors
  • Poor anatomical conformation: Some rabbits will sit with their hind legs nearly extended in front of them resulting in a disproportionate amount of weight being taken on the hocks.
  • Large rabbits:
    • Incidence of this condition increases with weight, with more dramatic lesions seen in rabbits 5 kg and larger. 
    • Giant breeds of rabbits
    • Obesity
      • This increases the amount of weight borne by the hocks and also increases the periods that the rabbit is sedentary and thus increases the time spent on the hocks.
    • Pregnancy 
  • Rabbits with long fine fur:
    • Angora rabbits if the fur is clipped from the hocks. 
  • Lack of guard hairs on the palmar or plantar surface of the feet:
    • Rex rabbits
      • Ulcerative pododermatitis is particularly common in Rex breeds, as they have less coarse hair, thus their thin skin is not well protected. (B612.8.w8)
    • Clipping of the feet for surgery 
  • Husbandry problems: 
    • Wire mesh floored cages. This is a very common cause of pododermatitis, e.g. farmed rabbits. 
    • Stainless steel slatted cage floors. 
    • Hard abrasive floor surfaces 
    • Soiled bedding 
    • Abrasive carpeting- seen in house rabbits. 
    • Thumping with the hind feet due to disturbance of rabbits. 
  • Lack of mobility:
    • Small cages
    • Musculoskeletal disease or other painful conditions 
    • Ataxia 
  • Reduced immune competence:
    • Chronic disease 

(B600.9.w9, B601.11.w11, B602.19.w19, B603.4.w4, B604.5.w5, B606.4.w4, B606.10.w10, B608.21.w21, B609.2.w2, B612.8.w8, B615.6.w6, J213.4.w4, J213.7.w1)

Predisposing underlying clinical conditions

  • Musculoskeletal disorders (e.g. spondylosis) or other painful conditions (dental disease, urolithiasis) that:
    • cause the rabbit to become more sedentary resulting in an increase in time spent on hocks; 
    • prevent the rabbit adopting a normal stance during urination resulting in urine scald; 
    • prevent the rabbit eating caecotrophs resulting in accumulation of faeces around the perineal region and feet; 
    • prevent normal weight bearing at rest or normal locomotion, e.g. a condition that reduces weight bearing on the contralateral limb. 
  • Trauma: to the palmar or plantar feet:
    • puncture wounds
    • nervous or stressed rabbits that stamp their back feet. 
  • Urinary or gastrointestinal tract disease
    • can cause polyuria or diarrhoea resulting in urine scald or faecal accumulation around the perineal region and feet. 

(B609.2.w2)

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Disease has been reported in either the wild or in captivity in:

Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

(List does not contain all other species groups affected by this disease)

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Disease has been specifically reported in Free-ranging populations of:

  • --

Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

  • --

(List does not contain all other species groups affected by this disease)

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Environment/Geography

General Information on Environmental Factors/Events and Seasonality

  • The incidence increases in hot, humid weather. (B604.5.w5)

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Regions / Countries where the Infectious Agent or Disease has been recorded

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Regions / Countries where the Infectious Agent or Disease has been recorded in Free-ranging populations

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General Investigation / Diagnosis

General Information on Investigation / Diagnosis

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Lagomorphs Clinical signs
  • Diagnosis can be made based on the clinical signs. (B601.11.w11, B610.23.w23)
  • For displacement of the superficial digital flexor tendon: observe the gait of the affected rabbit (dropped hock), and flex the hock (extension of this joint is impaired) and observe the toes (no longer maintained in a flexed position). (B600.9.w9)
Radiography
  • Affected limb: 
    • This is necessary in determining the extent of the bone involvement and thus the treatment plan and prognosis. (B602.19.w19, B609.2.w2)
    • Osteomyelitis carries a poorer prognosis and will need prolonged treatment. (B609.2.w2)
  • Skull: useful in ruling out dental problems that could be causing pain and a reluctance to ambulate or groom. (B609.2.w2)
  • Whole body: for ruling out other causes of pain (e.g. arthritis, problems with the contralateral limb, urolithiasis)
Ultrasonography
  • Used in determining the underlying causes, the organ systems affected, and the extent of the disease. (B609.2.w2)
Culture and sensitivity
  • A sterile, deep sample from the affected tissue and/or from the exudate. (B609.2.w2)
  • Culture for aerobic and anaerobic bacteria and then base the antibiotic therapy on the sensitivity results. (B602.19.w19, B609.2.w2)
Aspiration
  • There may be a thick creamy or caseous, white exudate in rabbits that have a secondary bacterial infection. 
  • High nucleated cell count. 
  • Mainly degenerative neutrophils with a lesser number of lymphocytes and macrophages. 

(B609.2.w2)

Biopsy

  • This is necessary if there is a mass lesion present to rule out granuloma, neoplasia, and other causes of masses. 
  • Sample should ideally contain both abnormal and normal tissue in the same specimen. 
  • The sample should be submitted for histopathology and culture. 

(B609.2.w2)

Complete blood count (CBC)

  • Normal or there may be a relative neutrophilia, lymphopenia. Total white blood cell elevations are not often seen in rabbits with abscesses.

(B609.2.w2)

Related Techniques
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Similar Diseases (Differential Diagnosis)

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Lagomorphs

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Treatment and Control

Specific Medical Treatment

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Lagomorphs
  • The aims of treatment are to relieve pressure on the affected area and treat any secondary infection. (B600.9.w9)
  • It is necessary to resolve the underlying cause (disease or husbandry problems) of this condition for long term success. (B609.2.w2)
  • Many cases of this condition are incurable but may be alleviated with medical therapy. (B600.9.w9)
ANTIMICROBIAL THERAPY
  • As a general rule in the treatment of bacterial skin conditions in rabbits, marbofloxacin, Enrofloxacin, or Trimethoprim sulfa are useful for non-suppurative infections and may be given orally. However, purulent infections respond better to the penicillin related compounds. Amoxycillin, Penicillin G, and Cephalexin are safe as long as they are not used orally. These antibiotics must always be administered parenterally. (P601.1.w1)
  • Choice of antibiotic should ideally be based on the results of culture and sensitivity tests. (B609.2.w2, J213.4.w4)
  • Duration of therapy depends on severity of infection: 
    • Four to six weeks minimum to several months / years. (B609.2.w2)
  • Enrofloxacin (J213.4.w4)
    • 5-20 mg/kg orally or by subcutaneous or intramuscular injection every 12-24 hours. (B609.2.w2)
  • Trimethoprim sulfa (J213.4.w4)
    • 30 mg/kg orally every 12 hours

If anaerobic infection is suspected:

  • Chloramphenicol
    • 50 mg/kg orally every 8 hours. (B609.2.w2)
    • Avoid human contact with this drug due to potential blood dyscrasia. (B609.2.w2)
  • Metronidazole
    • 20 mg/kg orally every 12-24 hours. (B609.2.w2)
  • Azithromycin
    • 30 mg/kg orally every 24 hours alone or in combination with Metronidazole (at the same dose as quoted above). (B609.2.w2)
      • Note: dosing interval can be increased to every 2 - 3 days once loading has occurred. (V.w65)
  • Penicillin G (J213.4.w4)
    • 40000-60000 IU/kg by subcutaneous injection every two to seven days. (B609.2.w2)
Contraindications
  • Oral antibiotics that select against the Gram-positive bacteria:
    • Penicillins, macrolides, lincosamides and cephalosporins. (B609.2.w2)
    • These may cause a fatal enteric dysbiosis and enterotoxaemia. (B609.2.w2)
Topical products
  • Dermisol cream (B603.3.w3)
  • Silver sulfadiazine cream (B602.19.w19, B603.3.w3, J213.4.w4)
  • Mupirocin Calcium (Bactroban cream). (B603.3.w3)
Antibiotic impregnated poly-methyl methacrylate (AIPMMA) beads
  • These beads can be used to fill the defect in feet that are severely diseased. The wound must be surgically debrided and flushed prior to insertion of beads. (B603.3.w3, B609.2.w2, J213.4.w4)
  • They release a high concentration of the antibiotic into the local tissues for several months. (B609.2.w2)
  • Selection of the antibiotic should be based on the results of culture and sensitivity tests and is limited to those antibiotics that are known to elute appropriately from the bead to the tissues. (B609.2.w2)
  • Successfully used antibiotics include:
  • Beads must be inserted aseptically with any unused beads being gas sterilised prior to their future use. (B609.2.w2)
  • Leave the beads in the incision site for a minimum of two months or they can be left in indefinitely. (B609.2.w2)
ANALGESIA
Acute pain management 

See also: Treatment and Care - Analgesia

  • Analgesics are necessary to treat the pain of the actual condition and also to improve the rabbit's mobility if it has an underlying painful arthritic or spondylitic condition. (B600.9.w9)
  • Butorphanol (Opiate analgesic)
    • 0.1-1.0 mg/kg by subcutaneous, intramuscular or intravenous injection every 4-6 hours. 
    • May cause profound sedation. 
    • This is a short-acting drug. 
  • Buprenorphine (Opiate analgesic)
    • 0.01-0.05 mg/kg by subcutaneous, intramuscular or intravenous injection every eight to twelve hours. 
    • This is a less sedating and longer acting drug than butorphanol. 
  • Morphine (Opiate)
    • 2-5 mg/kg by subcutaneous or intramuscular injection every two to four hours. 
    • More than one to two doses can cause gastrointestinal stasis. 
  • Oxymorphone
    • 0.05-0.2 mg/kg by subcutaneous or intramuscular injection every eight to twelve hours.
    • More than one to two doses can cause gastrointestinal stasis. 
  • Meloxicam (NSAID)
    • 0.2 mg/kg by subcutaneous or intramuscular injection every 24 hours. 
  • Carprofen (NSAID)
    • 1-4 mg/kg by subcutaneous injection every twelve hours. 

(B609.2.w2)

Long term pain management
  • NSAIDs 
    • These drugs have been used for short or long term treatment in rabbits to reduce inflammation and pain:
      • Meloxicam
        • 0.2-0.5 mg/kg orally every 24 hours. (B609.2.w2)
        • This is useful in patients with spondylitic or arthritic conditions and may be used for prolonged periods. (B600.9.w9)
      • Carprofen
        • 2.2 mg/kg orally every 12 to 24 hours. (B609.2.w2)
SEDATION
  • Light sedation:
    • Midazolam
      • 1-2 mg/kg by intramuscular injection. 
    • Diazepam
      • 1-3 mg/kg by intramuscular injection.
  • For deeper sedation and longer procedures:
    • Ketamine (15-20 mg/kg by intramuscular injection) and Midazolam (0.5 mg/kg by intramuscular injection). 

(B609.2.w2)

ALTERNATIVE TREATMENTS

  • 50% dextrose or honey
    • Used successfully as a topical abscess treatment after surgical debridement. (B600.9.w9, B609.2.w2)
    • They have bactericidal properties and promote formation of a granulation bed. (B609.2.w2)
    • Fill the abscess cavity with gauze soaked in honey or dextrose. (B609.2.w2)
    • Remove the old gauze from the cavity before instilling a fresh gauze. (B609.2.w2)
    • The treatment often needs to be continued for weeks. (B609.2.w2)
    • Effectiveness varies and will depend on disease severity and owner compliance. (B609.2.w2)
CONTRAINDICATIONS

Corticosteroids

  • Systemic or tropical preparations may severely exacerbate an infection. (B609.2.w2)
Related Techniques

 

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General Nursing and Surgical Techniques

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Lagomorphs
NURSING CARE

Caging on soft, dry bedding

  • This by itself may be effective in early disease (alopecia and erythema only). (B609.2.w2)
  • A deep bed of clean hay, pine shavings or soft shredded paper over a surface that is padded (a thick towel or foam rubber placed under newspaper) and can be completely cleaned and dried. (B600.9.w9, B609.2.w2)
    • A deep layer of peat moss can be used for bedding as it reduces friction and shear forces and draws away excessive moisture from the skin. It also gives the claws a surface to grip into. (B600.9.w9)
    • Synthetic fleece and absorbent hospital pads provide a good padded surface. (J213.4.w4)
Bandaging/dressings
  • Any ulcerated areas of skin should be kept clean and dry. Wet bandages should be replaced immediately. (B600.9.w9, B609.2.w2)
  • Liquid bandages (e.g. Nu Skin, Germolene) can be effective; these can be painted onto the lesion. (B600.9.w9, J213.7.w1)
  • Protective bandages may be advantageous but a lot of rabbits will remove them. Pad the surrounding area and not the ulcer; this will relieve the pressure on the affected area. Protective bandages will usually need to be changed daily as they will quickly become soiled. Try to avoid any padding slipping out of its original position as this will increase the pressure on the ulcer. (B600.9.w9, J213.7.w1)
  • Trim the fur surrounding the ulcer so that it is not extending over the wound but do not clip it all the way down to the skin as it is needed to take the weight of the rabbit and thus relieve the pressure on the ulcer. (B600.9.w9)
  • After debridement, a wet-to-dry bandage should be applied initially until a healthy granulation bed has formed. (B609.2.w2)
  • Silver sulfadiazine cream may also be effective after debridement, with bandaging on top of the cream. (B609.2.w2)
  • Light dressings such as Tegaderm are useful to protect the weight-bearing surfaces on the feet. (B602.19.w19)
  • The interval between bandage changes increases with improvement in the lesion. (B609.2.w2)
  • Once the area is healing, the hock can be protected by a lighter covering e.g. a sock. (B606.10.w10)
Toe nail trimming if the nails are overgrown. (B604.5.w5)
Activity level
  • Restrict activity until there has been adequate healing of the tissue. (B609.2.w2)
  • Long term:
    • Encourage activity as prolonged inactivity can cause or exacerbate pododermatitis. (B600.9.w9, B603.3.w3, B609.2.w2)
    • A bonded companion is useful for encouraging activity. (B600.9.w9)
    • In dry weather, a lawn is a good surface for exercise as it is clean and compliant. (B600.9.w9)
Feeding
  • It is very important that the patient continues to eat throughout treatment. Anorexia will often lead to gastrointestinal hypomotility, microflora derangement and overgrowth of pathogenic intestinal bacteria. (B609.2.w2)
  • See: Treatment and Care - Supportive Care & Nursing
  • Correct underlying obesity with gradual dietary modification: increase the fibre and lower the carbohydrates. (B600.9.w9, B603.3.w3, B609.2.w2)
SURGICAL TECHNIQUES

Surgery is generally not recommended for this condition because the rabbit has minimal skin on the metatarsus and attempts to manipulate it can worsen the condition. However, the curettage of devitalised and infected tissue can be successful in some cases but the underlying cause of ulcerative pododermatitis must be addressed. (J213.7.w1)

Debridement, lancing and flushing
  • This is a painful procedure and must be carried out under general anaesthetic. (B609.2.w2)
  • It will only be successful if the underlying cause is addressed and pressure on the area can be reduced. (B600.9.w9)
  • Debride all the visibly necrotic tissue to allow healing by secondary intention. (B600.9.w9, B601.11.w11, B609.2.w2)
  • Abscesses in rabbits require more than just simple lancing and draining. The thick exudates do not drain very well and the abscess is highly likely to reoccur - curettage is necessary. (B609.2.w2)
  • Incise skin that is non weight bearing and curette all the visible exudates then flush copiously. (B600.9.w9, B609.2.w2)
  • Repeated debridement and flushing are frequently required, sometimes even daily. (B609.2.w2)
  • Treat as an open wound: debride and flush the wound daily initially, decreasing to twice weekly and then weekly as healing occurs. (B609.2.w2)
  • Irrigate the wound with a dilute antiseptic solution (povidone-iodine (Iodophors) or Chlorhexidine) every day until a healthy granulation bed develops, followed by a silver sulfadiazine cream until there is re-epithelialisation. Apply soft, padded bandages after debridement and change them as soon as they become wet. (B609.2.w2)
  • Remove any nidus of infection / foreign bodies. (B609.2.w2)
  • If the foot is extensively diseased or abscessed then antibiotic-impregnated poly-methyl methacrylate (AIPMMA) beads can be used successively to fill the defect. (B601.11.w11, B603.3.w3, B609.2.w2)
  • Honey is a useful alternative. (B600.9.w9)
  • Notes:
    • It may be necessary to refer the patient to a specialist if the AIPMMA beads or surgical expertise is not available. (B609.2.w2)
    • Pain relief and long term systemic antibiotics are also needed. (B609.2.w2)
Surgical skin flaps
  • Unlike in some other species, there is insufficient skin overlying the metatarsus in the rabbit to close the skin deficit that is created by the ulcer. The skin is naturally adherent to underlying tissue in this area and attempting to move it around will be likely to make matters worse. (B600.9.w9)
    • Sliding the skin from the top of the foot to cover the deficit in the sole will produce inadequate covering - the skin from the top of the foot is not appropriate for the function required. (V.w65)
Amputation
  • If there is severe osteomyelitis, mid femoral amputation of a hind limb could be an option but this may be precluded by presence of bilateral disease. (B601.11.w11, B603.3.w3, B609.2.w2)
  • However, if one limb is amputated, there will be an increase in weight bearing on the remaining limb and this will result in an increase in risk of developing ulcerative pododermatitis. (B609.2.w2)
Related Techniques
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Preventative Measures

Vaccination --
Lagomorphs --
Prophylactic Treatment

--

Lagomorphs Owners should be advised not to trim the fur pads over the hock (which can predispose the rabbit towards pododermatitis). Instead, the feet can be washed in warm water. (B606.10.w10)
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Environmental and Population Control Measures

General Environment Changes, Cleaning and Disinfection --

Environmental

  • Soft compliant dry floor surfaces
    • Rabbits do not have footpads and so need this type of surface to protect their feet. In nature, rabbits are mainly on a compliant surface of grass and dirt, and in captivity they need soft dry bedding to be provided. (B603.3.w3, B609.2.w2)
  • Provide a separate litter box and a hide box or bed
    • This will decrease the amount of time the rabbit spends sitting on soiled litter. (B609.2.w2)
  • Clean the soiled litter daily. (B604.5.w5, B609.2.w2)
  • Avoid wet bedding: e.g. spilled water bowls, rain. (B609.2.w2)
  • Adequate nutrition: guard against obesity. (B604.5.w5)
  • Encourage exercise
    • Provide sufficient space for exercise as this will decrease the amount of time that the weight is borne on the hocks. (B603.3.w3, B604.5.w5, B609.2.w2)
  • Avoid excessively humid and warm environments: as this may lead to a thinner coat and therefore a less dense fur pad on the foot. (B604.5.w5)
  • If wire floors must be used, then ideally provide resting boards that are slightly larger than the rabbits "footprint". A commonly recommended wire floor is "one-half inch by 1-inch 14-gauge non-woven welded wire". (B604.5.w5)
Diet Prevent obesity by providing a high fibre and low carbohydrate diet. (B603.3.w3, B609.2.w2)
Population Control Measures --
Lagomorphs
  • There may be an inherited tendency towards sore hocks (B604.5.w5, B606.4.w4) so select and only breed from rabbits that have dense fully furred footpads. (B10.45.w47, B604.5.w5)
Isolation, Quarantine and Screening --
Lagomorphs --
Related Techniques
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