Horses with solar foot penetration, deep digital flexor tendon injury, and absence of concurrent synovial sepsis can have a positive outcome.
Authors: Schiavo, Cillán-García, Elce, Liuti, Taylor
Journal: Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association
Summary
# Editorial Summary Solar penetrations causing deep digital flexor tendon (DDFT) injuries are typically considered poor prognosis cases, but outcomes may be considerably more favourable when synovial structures remain uninfected. This retrospective review examined 11 horses with concurrent solar puncture wounds, sonographically or MRI-confirmed DDFT damage, and confirmed absence of sepsis in the distal interphalangeal joint, navicular bursa, and flexor tendon sheath. Low-field standing MRI was instrumental in diagnosis, particularly T2 fast spin echo sequences combined with contrast radiography, with the majority of lesions (55%) localising between the distal sesamoid bone and the flexor cortex of the distal phalanx. At minimum 6-month follow-up, 60% of horses (n=6) achieved excellent outcomes and returned to full athletic function including competitive show jumping, whilst a further 40% (n=5) remained sound but had not yet completed rehabilitation—indicating that careful patient selection and strict infection control can support meaningful return to work despite the apparent severity of this injury pattern. These findings warrant reconsideration of the traditionally guarded prognosis for such cases in practice, provided imaging confirms synovial integrity and appropriate antimicrobial and farriery protocols are implemented.
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Practical Takeaways
- •Solar puncture wounds with DDFT injury but no synovial sepsis carry a favorable prognosis for return to athletic work, making conservative management a viable option worth pursuing
- •Low-field standing MRI is valuable for diagnosis and prognostication; use T2 FSE sequences and consider contrast radiography if DDFT lesions are suspected but not clearly visible
- •All affected horses achieved soundness within 6 months, supporting optimistic client communication when synovial structures are confirmed sepsis-free
Key Findings
- •60% of horses (6/11) with solar penetration, DDFT injury, and no synovial sepsis returned to full athletic function within minimum 6-month follow-up
- •100% of horses (11/11) achieved soundness, with 40% (5/11) still sound but not yet returned to full work at follow-up
- •Most common injury location was between distal sesamoid bone and facies flexoria of distal phalanx (55%, 6/11)
- •T2 fast spin echo MRI sequence combined with contrast radiography improved diagnostic certainty for DDFT injuries