An Epidemiological Investigation of the Aid of Magnetic Resonance Imaging in Determining Long‐Term Prognosis for Soundness Following Palmar/Plantar Digital Neurectomy for Chronic Foot Pain
Authors: Wylie C.E., Payne R.J., Bathe A.P., Greet T.R.C., Head M.J., Boys‐Smith S.J., Powell S.E.
Journal: Equine Veterinary Journal
Summary
# Editorial Summary Palmar/plantar digital neurectomy (PDN) remains a contentious treatment for chronic foot pain, yet there is limited evidence comparing outcomes when the procedure is informed by advanced imaging versus clinical diagnosis alone. Wylie and colleagues conducted a retrospective review of 109 PDN cases with a 72.5% follow-up response rate (79 cases), stratifying outcomes between 52 horses diagnosed via MRI and 27 diagnosed clinically, with median follow-up periods exceeding 24 months in both groups. Success rates were remarkably similar: 78.9% of MRI-guided cases and 73.1% of clinically diagnosed cases achieved their intended use, whilst exercise maintenance persisted for approximately 25 months in both cohorts, with comparable complication rates (neuritis and neuroma occurring in small numbers across both groups). Notably, both catastrophic complications requiring euthanasia—including deep digital flexor tendon rupture and solar prolapse—occurred exclusively in the non-MRI group, though the sample size precludes drawing firm conclusions. For practitioners, this suggests that whilst MRI may provide diagnostic clarity and potentially identify cases at higher risk of serious sequelae, clinical case selection for PDN remains reasonably effective, though the absence of imaging should perhaps prompt heightened vigilance for degenerative changes that might predispose to life-threatening complications.
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Practical Takeaways
- •Palmar/plantar digital neurectomy achieves comparable long-term outcomes (~75-80% return to intended use) whether or not MRI diagnosis was obtained beforehand
- •MRI may help identify cases at risk for serious complications post-PDN, though sample size was small; consider it for risk stratification rather than as a gatekeeper to surgery
- •Expect median exercise maintenance of 24-25 months post-PDN; counsel owners appropriately on realistic timelines and potential for neuritis/neuroma as longer-term complications
Key Findings
- •78.9% of horses with pre-operative MRI achieved intended use compared to 73.1% without MRI, with no statistically significant difference (P>0.05)
- •Median exercise maintenance was 25.2 months for MRI-diagnosed cases and 24.0 months for non-MRI cases, with no significant difference
- •Both catastrophic complications requiring euthanasia occurred in the MRI-negative group (DDFT rupture and solar prolapse)
- •Overall success rate of 78-88% for return to intended exercise level regardless of MRI diagnosis