Sprung Toe/ligament Injury Ongoing, Chronic, Help?

[Guest Amber]

My 4 year old greyhound Fey has had a problem with a middle toe, right fore, since last August. I think it happened after playing a lot of fetch at the beach. Occasionally - whilst running fast - she would pull up lame and wave her paw in pain, but otherwise, not lame when leashwalking.

 

So I went to the vet and he said x-rays would not tell us much, he thought it didn't seem bad since she recovered quickly (ie she could continue her walk a few minutes after the paw waving); he said to rest for a few weeks and build up exercise gradually.

 

So we've been doing this ever since and she can be quite sound for several weeks at a time, but then she hurts it again running/ball chasing and we're back to square one.

 

So I went back to the vet and had a course of intensive laser on it (it is chronically inflamed and swollen looking) - 5 sessions every 2 days - the swelling seemed to go down a bit but then she hurt it again.

 

So it's got the point where it's really affecting quality of life - playing with other dogs, playing with a ball - anything seems to make it sore again, at the moment.

 

Not sure what to do next. We did try a short course of antibiotics at first but that made no difference. Should I try a long course of ABs in case it is an underlying infection?

 

The only other thing vet could suggest was a steroid injection - but he wasn't that keen on the idea, and it's painful so would mean sedation or anaesthetic. He doesn't recommend amputation, because she also gets corns and he thinks it would set up even more problems.

 

Is it worth going to a specialist vet? I believe it to be a soft tissue ligament injury, my own vet does not think it can be surgically repaired.

 

Expense/insurance is a factor as well.

 

Sorry for the long essay! Between this wonky toe and the corn that we can't get rid of, it's getting us down.

[ramonaghan]

I am in the same boat with my 6-year-old Sweep. We've been dealing with an intermittent limp since last August as well, but only in April were the vets able to isolate it to a middle toe on her left front foot (we suspect it's an old track injury since those two middle toes have always been noticeably twisted, though they never seemed to bother her before this past year). She's currently on Previcox every other day and Gabapentin twice daily. Is Fey on an NSAID and/or any joint supplements? I am really hoping to eventually be able to wean Sweep off the meds, but don't know if that's a reasonable expectation at this point. I share your quality of life concerns, especially given their young ages; it's such a shame when they can't take long walks or run all out anymore. We've tried acupuncture and chiropractic, unfortunately to no avail.

 

Anyway, we've seen two specialists at the same practice--a board-certified surgeon and an orthopedic specialist--and both say it's a challenging case. Treatment-wise, it sounds like they are on the same page as your vet. They have also mentioned the steroid injection as a possibility but have similar concerns as your vet, and they really don't want to amputate except as an absolute last resort, especially because it's hard to be 100% certain it's that toe and only that toe. God forbid they amputate and it doesn't solve the problem. (They mentioned trying a nerve block as a diagnostic, but said it's quite tricky to be sure you're blocking only a single toe.) They want us to try physical therapy first to see if that helps. Sweep's been on restricted activity for a while now, and we suspect she's re-injured the toe more than once over the course of this ordeal because we've let her do too much too soon. So, we are off to our first canine rehab appointment this Thursday. I'm not really sure what to expect; he does underwater treadmill, electrical stimulation, laser therapy, manual therapy, and more...it should be interesting! We're a couple of thousand dollars into this already, so I really hope this will be our solution. I'll report back to let you know what we learn.

Edited June 6, 2016 by ramonaghan

[Guest Amber]

Thanks for your reply and sorry to hear that Sweep is also suffering toe issues. Fey is on Yumove supplements - she does have a tendency towards mild sprains and the vet recommended Yumove, which, to be fair has kept her off the 'wristy' problems.

 

Fey doesn't sound as bad as Sweep - once she has had a few weeks rest period (shortish leash walks) she is sound and can lead walk for over an hour, then build up the off leash running - I actually thought that she was fully OK as she was back to ball chasing etc but following a meet up with a lurcher friend and lots of playing and chasing, a few days later, her toe broke down again.

 

My vet seems to think that it will recover again but will never be 100% . So this does curtail her social life, as I can't really allow her to play 'too much' but it is difficult to know when to step in and leash her up and not allow any more running!

 

I was just reading a couple of articles by greyhound vets online, one recommends an external fixator and the other describes surgical treatment (I just googled 'toe injuries in the racing greyhound' to get these articles up)

[Remolacha]

Conner has a sprung toe which took quite awhile to diagnose. If it is a sprung toe, steroids are NOT recommended. The usual treatments seem to be rest, laser treatments, and pain meds. At Fey's young age, she may recover completely, but for any soft tissue or ligament/tendon injury, the rest period is long. Like, months. That can be hard You can try the NSAIDs/laser/rest treatment, that's not very expensive, and see how it goes.

[Guest Amber]

Thanks - the vet recommends she only gets Metacam if she is actually lame whilst walking - most of the time she is 100% good walking, but if she knocks the toe whilst running and it seems sore then she gets metacam for a few days.

 

We have tried the rest and the laser protocols, but unfortunately it just keeps recurring. The vet says even if he told me to leash walk her for 10 months no running, it could still happen again .. I'm really reluctant to leash walk for months on end, as that's a long time in a dog's life (and when she had another dislocated toe last year I was really strict, no running for 8 weeks and she started getting clusters of partial seizures, I feel the poor quality of life/exercise related to additional stress and contributed to the seizures).

Edited June 6, 2016 by Amber

[ramonaghan]

Sounds like you were able to get a diagnosis fairly quickly, which helps! For the longest time, we didn't know what we were dealing with (neck, shoulder, foot?), so we've had several x-rays done. She'd recover after a couple of days of an NSAID, so we'd just let her resume her normal activity. She'd be good for a few weeks, and then start limping again, until we reached the point in January where she never fully recovered after a couple of days of snow zoomies. She can also be quite dramatic at the vet and whines when they touch her anywhere (she even screamed when they put her on the scale once ), so it's been challenging to pinpoint what hurts. I'm hopeful now that we have a good working hypothesis that the more targeted therapies will help.

 

Conner has a sprung toe which took quite awhile to diagnose. If it is a sprung toe, steroids are NOT recommended. The usual treatments seem to be rest, laser treatments, and pain meds. At Fey's young age, she may recover completely, but for any soft tissue or ligament/tendon injury, the rest period is long. Like, months. That can be hard You can try the NSAIDs/laser/rest treatment, that's not very expensive, and see how it goes.

 

I didn't know this about steroids--good to know, thank you! Is that specific to "sprung toe" (my vets have never used that term specifically) vs. any other soft tissue injury in a toe? I'll ask about this when I see them again.

[dmdsmoxie]

Make sure the nail is cut back.

 

I know some trainers swear by Zheng Gu Shui. I am not a trainer so I can't say how good this is, but it is suppose to promote healing. They use it on everything from broken toes to ligament problems.Perhaps others on here have used it and can tell you how it worked for them.

[Guest Amber]

Hi, well vet has not used the term 'sprung toe' but I think that is what she has. He noticed right away that the toe was swollen (I hadn't noticed this and actually thought it was her old wristy problem come back). He is a really good vet and doesn't do unnecessary procedures, I trust him to make the right decisions.

 

He was not keen on steroid injections, as he said it can reduce swelling but not fix the actual problem. I think the injections I read about just now online were with a sclerosing agent, to stabilise the joint (if I understood that right)

 

ETA good point about the nails, I'll need to do that. Also, I've been using the Zheng linament on and off for several months...difficult to say if it helps, or not.

Edited June 6, 2016 by Amber

[greysmom]

I know not everyone agrees, but it may be time to consider amputation of the toe to give her long lasting pain relief. If this is a chronic condition that you cannot get healed, and there is no outlook for it being pain-free by any other means, an amp would provide that. It's a relatively easy surgery with a relatively quick recovery time - about two weeks for both my toe-amp dogs and they were back to nearly normal. Both of them never had any follow-up issues and very soon were running and playing again.

[Remolacha]

Sounds like you were able to get a diagnosis fairly quickly, which helps! For the longest time, we didn't know what we were dealing with (neck, shoulder, foot?), so we've had several x-rays done. She'd recover after a couple of days of an NSAID, so we'd just let her resume her normal activity. She'd be good for a few weeks, and then start limping again, until we reached the point in January where she never fully recovered after a couple of days of snow zoomies. She can also be quite dramatic at the vet and whines when they touch her anywhere (she even screamed when they put her on the scale once ), so it's been challenging to pinpoint what hurts. I'm hopeful now that we have a good working hypothesis that the more targeted therapies will help.

 

 

 

I didn't know this about steroids--good to know, thank you! Is that specific to "sprung toe" (my vets have never used that term specifically) vs. any other soft tissue injury in a toe? I'll ask about this when I see them again.

My vet (actually his chiropractor, who specializes in canine sports medicine ) just said that about the sprung toe, so I don't know if it would apply to other injuries.

[Guest Amber]

I know not everyone agrees, but it may be time to consider amputation of the toe to give her long lasting pain relief. If this is a chronic condition that you cannot get healed, and there is no outlook for it being pain-free by any other means, an amp would provide that. It's a relatively easy surgery with a relatively quick recovery time - about two weeks for both my toe-amp dogs and they were back to nearly normal. Both of them never had any follow-up issues and very soon were running and playing again.

Ive been thinking the same but she also gets corns so the vet did not recommend removing the toe, as the change of balance could produce corns on the remaining toes. We have a corn on the other front foot for the same length of time that I can't get rid of. Both conditions are as bad as the other

[Guest Sportingfields]

Would therapaw booties keep the toe more stable when playing outdoors?

[Guest Amber]

Hi, thanks - she wears a boot on her corny foot, a softer one than Therapaw called Walkers Boots, which she doesn't mind wearing at all but I find that the boot goes flying off if she is running hard. I tried her with a 'sportier' version of the boot (harder sole) and she didn't like it, also wouldn't stay on?

 

I notice in one of the articles here, the vet talks about strapping up a partially healed toe for racing, but don't know how to do that.

 

Does anyone know or has anyone tried any of the treatments mentioned in these articles?

 

http://www.mikeguilliard.co.uk/id15.html

 

http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0ahUKEwiustK4spTNAhVHJsAKHTbDBkYQFggiMAE&url=http://agva.ava.com.au/sites/default/files/private/Dr%2520DesFegan_Toe%2520injuries.pdf&usg=AFQjCNGqLDOnEfp8238vWlGxT8bEzldetQ

 

Thanks!

[ramonaghan]

Just wanted to follow up after Sweep's physical therapy appointment today: she had a cold laser session and massage on her toe tendons, shoulder, and neck (the latter two areas because the toes are affecting her gait slightly and making them sore). We were also given instructions on how to do the massage at home. The PT suspects tenosynovitis in one or both middle toes and thinks this will help increase blood flow and thus promote healing. I know you've tried laser treatments, but how about therapeutic massage? He also mentioned the Assisi loop as a possible treatment (we had one session a few months ago in conjunction with acupuncture/chiro but didn't really pursue it since we weren't sure where the problem was at that point), so perhaps that is another option for Fey. We did not see our actual vet today so I didn't ask about the injections/surgical options.

[Guest Amber]

Thanks for the update -hope the laser and PT helps Sweep. Is she also on restricted exercise for a prolonged period (ie no off leash running?).

 

Fey has given up on sprinting for just now. I let her off leash today and she just pottered around like a 12 year old greyhound, not a 4 year old! All she did was a slow canter. So even though she is not limping at walk, I guess the toe must be quite sore, since when she is sound, she will usually do the typical greyhound sprint for 20 seconds when let off leash.

 

I emailed my vet with the links that I posted above, and asked about seeing a specialist. He says the first thing is to x-ray and to manipulate the toe under anaesthetic to find out which joint the problem is in and to see if any fractures or bone chips. So we will do that next week. After that, he'll look into finding a specialist.

 

Edit: just looking up tenosynovitis. Seems to be a sort of bacterial infection, is Sweep on antibiotics? This is interesting, because my friend's lurcher also hurt her toe, or at least it was swollen and painful when running and fetching (same as Fey). Her vet x rayed straight away , gave a steroid injection and gave a long course of strong antibiotics. This reduced the swelling and she was OK for several weeks, but then it flared up again and she was on a 6 week course of antibiotics...for a deep seated infection in the bone.

 

Fey was given 1 week's worth of a-b s at first, didn't make any difference, but maybe the course was not long enough? It is a pretty big swelling on her toe. Will try to put a photo up!

Edited June 9, 2016 by Amber

[ramonaghan]

Thanks for the update -hope the laser and PT helps Sweep. Is she also on restricted exercise for a prolonged period (ie no off leash running?).

 

She's been on restricted exercise for most of the past few months; only in the past couple of weeks have we started letting her into the yard off-leash. So the PT actually wants to see how she does if we try gradually increasing her activity level. We're to start by lengthening her walks by 2-3 minutes over the next week. (She's allowed to run, but she probably won't, as she becomes a lazy slug in the summertime due to the heat and humidity.)

 

Edit: just looking up tenosynovitis. Seems to be a sort of bacterial infection, is Sweep on antibiotics? This is interesting, because my friend's lurcher also hurt her toe, or at least it was swollen and painful when running and fetching (same as Fey). Her vet x rayed straight away , gave a steroid injection and gave a long course of strong antibiotics. This reduced the swelling and she was OK for several weeks, but then it flared up again and she was on a 6 week course of antibiotics...for a deep seated infection in the bone.

 

Fey was given 1 week's worth of a-b s at first, didn't make any difference, but maybe the course was not long enough? It is a pretty big swelling on her toe. Will try to put a photo up!

 

I think tenosynovitis can be *caused by* infection, but from what I gather the condition is like "tendonitis plus"--the tendon sheath is inflamed as well as the tendon itself. In Sweep's case it was most likely caused by an injury that has been re-aggravated over time, or it's possible arthritis is contributing although nothing has showed on multiple x-rays over several months. It is definitely interesting about your friend's lurcher, though, and it sounds like infection is a question worth revisiting with Fey's vet.

[moofie]

I would ask for an orthopedic specialist consult now if its been ongoing issue so long tbh

Edited June 9, 2016 by moofie

[Guest Amber]

Thanks. My vet is going to x ray soon and then refer me to a specialist. I do think sometimes though specialists like to do their own x rays and I wouldn't want to have to do all that twice over. But OTOH it would be kind of odd to refer without first doing an x ray. My vet thought that the toe would heal naturally and that because she isn't lame on it whilst walking it wasn't a severe injury. But it's chronic so hopefully something can be done.

 

Experimental little run at the beach today and she was kind of limping a little bit for a few minutes afterwards. Then walked fine after. Same old thing. Will keep her on lead walking now until we get more info.

[Remolacha]

Sometimes specialists want to do their own x-rays, sometimes not. I've had both situations. I am glad you are getting a referral. Since this has become chronic, a specialist seems indicated. Good luck.