The basis of nonsurgical management involves either stall rest to reduce excessive uneven loading of the carpal and tarsal region and/or the application of external coaptation to assure axial loading of the skeletally immature cuboidal carpal and tarsal bones and prevent the development of local cartilage destruction and osteochondral fractures. Either splint bandages or tube casts are used for this purpose.
2. Stall rest
Foals with marked angular limb deformities located in the carpal and/or tarsal region that show normal ossification of the cuboidal carpal and tarsal bones are prevented from excessive pasture exercise and therefore kept in a box stall. No bandages are applied to prevent the development of laxity of the periarticular structures. These deformities correct without any additional treatment usually within 2-3 weeks. Follow up radiographs are encouraged.
The same foal 2 weeks later. While the foal was kept in the stall the periarticular structures have gained in strength and are now able to maintain normal axial configuration.
3. Splint bandages
Application of splints
Foals with dysmature cuboidal carpal and tarsal bones (or incomplete ossification thereof) are best managed with splint bandages. It is important to not include the phalanges into the bandages. The foals are easily restrained by picking them up and laying them in lateral recumbency on a mattress. For the carpal region PVC pipes split longitudinally in half with half moon shaped pieces cut out in the carpal region to allow for greater width of this region, work well. The splints are applied to the caudal/palmar aspect of the limb. For the tarsal regions PVC pipes are pre-shaped with a blow torch to fit the cranial/dorsal aspect of the distal half of the tibia and proximal half of MtIII.
The splint bandages are changed every 3-4 days. In a foal where all four limbs need splint bandages the foal needs to be assisted to raise and lay down every few hours. Also it is important to provide good bedding or occasionally drapes and a heat pad. An alternative is to splint two limbs during the day and the other two during the night.
Splint bandages have the advantage that they are light and can be easily changed. Tube casts are more difficult to apply and are more cumbersome to change. Splint bandages are more economical than tube casts and less prone to pressure sore development.
Commercial splints are available on the market that are adapted to the foal’s anatomy.
The progress of ossification is followed radiographically at 2-week intervals. Once ossification is adequate the splint bandages are exchanged with normal light bandages for 1-2 weeks. At that point the foal can be placed back on pasture exercise.
The image shows: Dorsopalmar radiographic view of the left carpal region,: 2-week follow up radiographic views of the same limbs showing progress in ossification and lateromedial radiographic view of the left tarsal region in a prematurely born foal at one week of age.
2-week follow up radiographic views of the same limbs showing progress in ossification
4-week follow up radiographic views of the same limbs showing adequate ossification. The splint bandages were not applied anymore.