Neurectomy for treatment of hindlimb proximal suspensory desmopathy

Hindlimb proximal suspensory desmopathy carries a guarded to poor prognosis of return to function for horses. More than just an injury but appears to have some aspects of a compartment syndrome disorder where increased pressure in the tissues around the ligament is trapped and causes further pain and damage to the tissues. This paper supports earlier work on the usefulness of neurectomy and fasciototmy for the treatment of hindlimb proximal suspensory desmopathy / desmitis. One thing the paper does not address is some report that a percentage (25%?) will continue to deteriorate following the procedure and so should be monitored for worsening pathology.
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Outcome following neurectomy of the deep branch lateral plantar nerve and plantar fasciotomy for hindlimb proximal suspensory desmopathy in western performance horses: 21 cases
Vet Surg. 2020 Dec 16.
Authors
Dane M Tatarniuk 1 , Jacqueline A Hill 2 , Rolf B Modesto 3 , Tamara M Swor 1 , Stephanie S Caston 1 , Kevin D Kersh 1
Affiliations

1 Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa.
2 Littleton Equine Medical Center, Littleton, Colorado.
3 Brown Equine Hospital, Somerset, Pennsylvania.

PMID: 33331004
DOI: 10.1111/vsu.13552

Abstract

Objective: To report the outcome of horses used in western performance disciplines after deep branch lateral plantar neurectomy/fasciotomy surgery for hind limb proximal suspensory desmopathy (PSD).

Study design: Retrospective analysis.

Sample population: Twenty-one client-owned horses.

Methods: Medical records were reviewed (2009-2019) for horses involved in western performance disciplines that had been treated with deep branch lateral plantar neurectomy and plantar fasciotomy for lameness due to hind limb PSD. Follow-up was obtained by reexamination and/or verbal interviews with owners >2 years postoperatively.

Results: Sixteen quarter horses and five paints were used for western pleasure (14/21), barrel racing (2/21), cutting (1/21), steer wrestling (1/21), working cow horse (1/21), team roping (1/21) and reining (1/21). A median duration of 8 months was required before horses were able to resume training or athletic work. Nine horses were able to return to a similar or higher level of athletic use, nine horses returned to a lower level of athletic performance, and three horses could not return to intended function. Owner satisfaction with outcome after the procedure was high (16/21), average (3/21), and low (2/21).

Conclusion: Deep branch lateral plantar neurectomy and plantar fasciotomy allowed most horses to resume some athletic function as western performance horses.

Clinical significance: These results provide evidence of potential outcomes when considering surgical treatment of hind limb PSD in western performance horses.