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PALMAR foot pain represents an important condition in horses, frequently requiring a broad therapeutic approach, as summarised in a paper by Manfredi and others (2012) on p 643 of this issue of Veterinary Record. Management options range from supportive treatments, in the form of corrective trimming and remedial shoeing, to systemic and local administration of anti-inflammatories, tiludronate, extracorporeal shock wave therapy or, in the most refractory cases, palmar digital neurectomies (Rijkenhuizen 2006). The key to successful long-term management is knowledge of the exact nature of the condition; palmar foot pain is a clinical sign and not a diagnosis. Often defined by the response of the palmar digital nerves (PDN) to analgesia, many different conditions may fall into this category such that this blocking pattern would more aptly be regarded as an indicator of foot pain instead (Schumacher and others 2004, Dyson and others 2005, Murray and others 2006). To name only a few conditions, horses with lameness due to solar bruises, osteoarthritis/synovitis of the distal interphalangeal (DIP) joint, deep digital flexor (DDF) tendinopathy, navicular bone disease or navicular bursitis typically improve greatly when this nerve block is applied, while a partial response might be achieved in horses with collateral ligament desmitis of the DIP joint and more extensive DDF tendon injuries. Advanced diagnostics (with the gold standard being MRI) are …
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