Solar Penetration by a Nail.

21st January 2016 Uncategorised 0

This horse was suddenly severely lame after being exercised in the school. Examination of the foot by the owner revealed a nail penetrating the frog and the vet was immediately called. Although the temptation is to pull the nail out of the foot straight away, the owner did exactly the right thing by leaving the nail in place and putting wooden blocks on the foot to stop the nail penetrating further. 

The main worry when anything penetrates the sole of the foot is what vital structures may be affected; these include the deep digital flexor tendon, the digital flexor tendon sheath, the navicular bursa and the coffin joint. If the nail was to hit any of these structures, joint sepsis and possible career-ending lameness can result.

To determine what anatomical structures may be affected, radiographs of the foot were obtained with the nail in place; this allows us to ascertain the position, direction and depth of the penetrating object. This is much easier with the nail in place, hence why we ask that owners leave the nail in situ if possible. We are able to bring digital radiography to your yard, so the horse is moved as little as possible whilst the nail is in the foot. The radiographs below show the 2.5” nail penetrating the sole and heading towards the heel through the digital cushion, rather than towards the more vital structures; this horse was very lucky to have avoided more serious injury.

DP radiograph of solar penetration by a nail LM radiograph of solar penetration by a nail

Once the exact position of the nail was radiographically determined, the solar surface was cleaned thoroughly with pevodine, and the object was removed from the foot. The tract was pared and opened up to allow sufficient drainage, flushed with sterile saline and dressed. The horse received three days of injectable antibiotics and an intravenous regional perfusion (IVRP), which aims to deliver a high concentration of antibiotic to a specific area.