Outcome of palmar/plantar digital neurectomy in horses with foot pain evaluated with magnetic resonance imaging: 50 cases (2005-2011).
Authors: Gutierrez-Nibeyro, Werpy, White, Mitchell, Edwards, Mitchell, Gold, Allen
Journal: Equine veterinary journal
Summary
# Editorial Summary: Palmar/Plantar Digital Neurectomy Outcomes in Horses with Chronic Foot Pain When medical management fails to resolve chronic foot pain, palmar/plantar digital neurectomy (PDN) offers a potential surgical solution—though success depends critically on identifying the underlying pathology before proceeding. This retrospective analysis of 50 horses examined outcomes following PDN, with particular attention to how MRI-identified lesions influenced both short- and long-term results. Ninety-two per cent of horses responded positively to surgery with 80 per cent returning to previous athletic function (median 20 months post-operatively), yet 36 per cent developed complications including residual lameness, painful neuromas, or early recurrence. The critical finding was that horses presenting with core or linear lesions of the deep digital flexor tendon (DDFT) experienced significantly poorer outcomes and earlier recurrence compared to those with dorsal border DDFT lesions or other foot pathology, making these cases poor candidates for denervation. For practitioners managing chronically lame horses, this work underscores the value of pre-operative MRI in case selection: whilst PDN remains a viable salvage procedure for appropriately selected horses with various foot lesions, identifying DDFT core or linear pathology should prompt reconsideration of the surgical approach or realistic expectations regarding long-term soundness.
Read the full abstract on PubMed
Practical Takeaways
- •PDN is an effective option for chronic foot pain unresponsive to medical therapy, with 4 in 5 horses returning to work; however, MRI screening is essential before surgery
- •Do not recommend PDN to clients whose horses have core or linear DDFT lesions on MRI, as these horses experience persistent or recurrent lameness post-operatively
- •Counsel clients that while PDN succeeds in most cases, expect 4-6 weeks of follow-up complications in about one-third of surgical candidates, including neuroma formation
Key Findings
- •92% of horses (46/50) responded positively to palmar/plantar digital neurectomy (PDN) for chronic foot pain
- •80% of horses (40/50) returned to previous athletic use with median lameness resolution of 20 months
- •36% of horses (18/50) developed post-operative complications including residual lameness, neuromas, or early recurrence
- •Horses with core or linear DDFT lesions had significantly shorter pain relief periods and worse outcomes than those with dorsal border lesions or other foot lesions