Flexural Limb Deformities

of the Carpus and Fetlock

in Foals
Earl M. Gaughan, DVM

KEYWORDS
 Flexural deformity  Foal  Carpus  Fetlock

KEY POINTS
 Flexural deformities of the carpus and fetlock can be present at birth or develop with
growth, or secondary to injury or disease.
 Medical and physical treatment directed at stretching the limb deformities to correct
conformation is usually successful.
 In chronic or very severe cases, surgery may be required.
 Failure to respond to treatment carries a poor prognosis for future soundness and
athleticism.

INTRODUCTION

Flexural limb deformities in foals can be characterized as congenital, present at birth,

or acquired, implying that an affected foal had normal limb conformation at birth and
the flexural deformity developed with time and growth.1 A misnomer that has been
associated with flexural deformity of equine limbs at any age is “contracted tendon(s).”
The term “contracted tendons” is misdirected, because tendon tissue does not have
contractile properties; any active “contracture” must be initiated by muscle tissue
proximal to the tendon and tendinous insertion. Congenital flexural deformities in foals
most likely originate from uterine position during fetal development, abnormal devel-
opment of the fetus, or a disease or malnutrition state in the mare. Acquired flexural
limb deformities in foals, before weaning, can occur from postural changes due to
pain in the affected limb (physitis) or developmental orthopedic disease resulting in
pain or abnormal skeletal development. Flexural deformities also can occur secondary
to injury and subsequent disuse of the affected limb. Age and breed-dependent vari-
ability in limb deformities may exist as well.2 Close observation of an individual foal

There are no conflicts of interest or funding sources to report.

Merck Animal Health, 2 Giralda Farms, Madison, NJ 07940, USA
E-mail address: [email protected]

Vet Clin Equine - (2017) -–-

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0749-0739/17/ª 2017 Elsevier Inc. All rights reserved.
2 Gaughan

from birth to weaning and on through final skeletal development is important to adult
musculoskeletal health and potential athletic ability.3
Flexural deformities with joint hyperextension also can occur, resulting in back-at-
knee conformation and/or dropped fetlocks. These deformities are nearly always
congenital and are unlikely to be acquired except in the cases of prolonged contralateral
limb lameness, which is discussed in the article (See Ashlee E. Watts article, “Septic
Arthritis, Physitis and Osteomyelitis in Foals,” elsewhere in this issue). When congenital
laxity is present, it is most commonly the fetlocks and can be only the hind fetlocks or all
4 fetlocks. When the carpi are affected, the fetlocks commonly are affected as well.
Farriery and methods to protect the musculoskeletal structures while the foal “out-
grows” joint laxity are discussed in the article (See Michelle C. Coleman article,
“Orthopedic Conditions of the Premature and Dysmature Foal,” elsewhere in this issue).

PATIENT EVALUATION OVERVIEW

Diagnosis of a flexural limb deformity of the carpus or fetlock is usually straightforward

and based mostly on visual and physical examination determinations. Congenital flex-
ural deformities may offer some challenges to full understanding, as the degree of
deformity may not be readily apparent if an affected foal cannot stand at an expected
time after birth. Therefore, it is important to complete a thorough physical examination
on a neonatal foal, including limb palpation; range of motion assessments for carpus,
fetlock, and digital joints; and observe for standing conformation.
A complete understanding of the systemic status of a foal affected with a flexural limb
deformity is essential for a final positive outcome.1 It is important to understand that the
physical and medical treatments of a flexural limb deformity are not without repercus-
sions for the foal. Immunocompromise of a neonate can be complicated by the impo-
sition of the added stresses of manipulation and medication that may be required to
address limb deformities. Parallel to understanding and monitoring systemic health,
care of affected foals should ensure normal nursing or nutritional behaviors, as well
as avoidance of the complications associated with prolonged recumbency. Failure
of an affected foal to respond to treatment, improve conformation, and to thrive, is often
an indication of continued poor likelihood of a successful outcome.
Congenital flexural limb deformities of the carpi are quite common and are often
self-limiting. However, veterinary evaluation of severity and any need for intervention
are important at the time of postfoaling neonatal examination (Fig. 1). Normal carpal
conformation should be noted as a vertical, continuous association of the ante-
brachium, carpus, and metacarpus. Any cranial deviation or flexing forward of the
carpus, therefore creating an angulation centered at the carpus, should be considered
abnormal. (Any caudally directed abnormal position of the carpus is probably due to
laxity on the flexor surface and should be carefully observed and managed as well.)
Similar to the physical examination of an angular limb deformity centered at the
carpus, the reducibility of a carpal flexural deformity should be determined at first ex-
amination. With a foal standing or recumbent, the metacarpus can be held in the palm
of one hand while the other hand is used to gently place caudally oriented pressure
from the dorsum of the carpus. Palpation of the flexor surface may indicate which tis-
sues tighten. This has been described as a means of determining which tissues are
responsible for the flexural deformity.1 However, specificity may not be obvious
from palpation alone. If the carpal and limb confirmation can be readily reduced to
normal, the flexural deformity is reducible and may be corrected with a conservative
treatment plan. If the attempts to reduce the flexural deformity are not successful,
or a foal cannot stand because of the magnitude of limb deformity, additional
 Flexural Limb Deformities of Carpus and Fetlock 3

Fig. 1. A 3-day-old foal affected with flexural deformity of the carpus. The deformity is not
manually reducible and will require medical and physical treatment.

diagnostic measures and a more aggressive therapeutic plan, which usually includes
splinting, are likely required.
Acquired flexural deformities of the carpal region of young, growing horses are not
as common as deformities in the more distal limb. This appears to particularly be the
case for foals after the first month of life, through weaning, and beyond. Development
of flexural deformity of the carpus, after a foal was noted to have normal carpal confor-
mation at birth, can be the result of weight-bearing adjustment after injury or a reduc-
tion in normal limb “engagement.” Reduced weight bearing can be secondary to the
presence of a painful site in the limb, often in the form of physitis. However, this painful
origin of a flexural limb deformity is much more commonly observed in the fetlock and
distal interphalangeal joint regions than in the carpus.
A structural fault that can create a flexural deformity in the carpal region of young
foals is rupture of the common digital extensor tendon (CDET). Rupture of the CDET
can occur unilaterally or bilaterally. The characteristic observations are a dorsally
flexed carpus accompanied by lateral longitudinal swelling over the dorsal surface
of the affected carpus. The swelling is typically nonpainful and effusive, as excess fluid
is contained in the tendon sheath. Rupture of the CDET appears to occur at the mus-
culotendinous junction, which can be palpated percutaneously and visualized with ul-
trasound. Required treatment is usually minimal and as described. Prognosis for
return to normal is favorable.1 When there is rupture of the CDET secondary to mod-
erate to severe carpal flexural deformity, more aggressive therapy (ie, splinting) might
be required.
Flexural deformities centered at the fetlock can be classified as type 1 or type 2,
depending on severity. Type 1 deformities indicate that the limb at the fetlock is
postured between normal angulation and up to vertical alignment of the meta-
carpus to the phalanges. Type 2 flexural deformity of the fetlock indicates that
4 Gaughan

the fetlock is cranially displaced past vertical and is “over” at the fetlock. This clas-
sification system has been helpful in description as well as for prognosis, as type 2
deformities are much more difficult to correct than type 1.4 Flexural deformities at
the fetlock have been described as the result of “contraction of the superficial dig-
ital flexor tendon,” but as previously described, this is an inaccurate understanding
of the pathogenesis of this type of limb deformity, because tendon tissue does not
contract, and it is more appropriately termed shortening of the musculotendinous
unit.
Congenital flexural deformities of the fetlock are often associated with similar
abnormal conformation in the carpal region. Occasionally, a fetlock deformity will be
observed as a sole entity, but examination of complete limb conformation, in and
out of weight bearing, is important to understand current skeletal status. If a fetlock
flexural deformity can be manually reduced, a conservative treatment plan will likely
be successful gaining normal conformation. If not reducible, the fetlock region will
likely require aggressive physical and medical management, including splinting and
potentially surgical intervention. The conformation of the distal interphalangeal joint
and foot should be carefully noted at this time, as often fetlock and foot flexural defor-
mities can occur in concert.
Acquired flexural deformities of the fetlock in foals between birth and weaning may
not be as common as deformities noted to occur after weaning, during the substantial
and rapid growth phases that occur between months 4 and 14 of a young horse’s life.
Acquired fetlock deformities can occur secondarily to prolonged lack of normal weight
bearing and engagement of the flexural surface tissues in the affected limb (Fig. 2).
This is most often due to pain from the physeal region of the distal radius. This

Fig. 2. A young foal with a flexural deformity of the fetlock. The deformity was acquired
after normal conformation was noted at birth. Medical and physical treatment will be
required for conformation correction and surgical treatment may be required if more con-
servative efforts fail.
 Flexural Limb Deformities of Carpus and Fetlock 5

same phenomenon can occur after an injury or other local, regional, or systemic ortho-
pedic disease.

DIAGNOSIS

Diagnosis of congenital flexural limb deformities is most often defined by physical ex-
amination observations.1 Physical impressions can be augmented by imaging, and
further assessments of an individual foal’s maturity and immune status. Radiographic
assessment of the carpus and fetlock may be indicated if skeletal immaturity is sus-
pected. Radiographic identification of incompletely developed carpal cuboidal, meta-
carpal, phalangeal, or sesamoid bones are covered in the article (See Michelle C.
Coleman article, “Orthopedic Conditions of the Premature and Dysmature Foal,” else-
where in this issue).
Acquired fetlock and carpal deformities may require similar diagnostic efforts to fully
understand the current status of affected limbs and to make the best therapeutic plan.
Radiography, and possibly other imaging modalities, can help understand skeletal struc-
ture and potential sources of the developing flexural deformity. It is important to not limit
the imaging target to the site of the deformity. For instance, flexural deformity of a fetlock,
may have its origin from pain at the distal radial physis. Therefore, complete imaging
studies may include the affected fetlock as well as the distal radial physeal region of
the same limb. Similar consideration should be taken if a septic nidus in the affected
limb is suspected, as pain can certainly originate in such a site, yet it may be distant
from the flexurally deformed portion of the limb. Blood chemistry and cellular analysis
also can be helpful when indicated by physical and imaging examination findings.

PHARMACOLOGIC TREATMENT OPTIONS

The obvious treatment goal for foals with carpal and flexural deformities is to correct
the abnormalities and develop normal and functional limb conformation. Several phar-
macologic treatment options can be considered for a foal with a fetlock or carpal flex-
ural deformity. Perhaps the most common first consideration is directed at creating
relaxation of potential tension forces on the flexor surface of the limb. Intravenous
oxytetracycline (44 mg/kg or 1–3 g in 250–500 mL saline, 1 to 3 times in the first
week of life) has been associated with the chelation of circulating calcium, which in
turn reduces muscle contractility.1,3 The result is less muscular tension on the flexor
tendons and an increased opportunity to stretch the flexor surface and create or return
to normal, correct limb conformation.5 Oxytetracycline also has been associated with
a dose-dependent reduction in matrix metalloproteinase mRNA expression in equine
myofibroblasts, allowing tissue elongation.6,7 Diazepam (0.05–0.44 mg/kg intravenous
[IV])8 also has been administered to reduce anxiety in an affected foal and to second-
arily produce some relaxation in the affected limb. Alfa-2 agonist agents (xylazine
0.1–0.5 mg/kg IV, 0.25–1.0 mg/kg intramuscular [IM]8; detomidine 10–40 mg/kg IV;
1–5 mg/kg IM8) can be administered to sedate a foal and therefore achieve some
short-term musculoskeletal relaxation that can facilitate other, physical manipulations.
Butorphanol tartrate (0.01–0.04 mg/kg)8 can enhance sedation and provide some
short-term analgesia during limb manipulation.
Another pharmacologic consideration is the judicious administration of nonsteroidal
anti-inflammatory drugs (NSAIDs) in an attempt to reduce inflammation and pain that
may be inhibiting a foal from assuming normal conformation.6 The use of systemic
NSAIDs is probably best used in older foals, out of the first month of life; however,
when determined to be appropriate, NSAIDs can be administered safely to neonatal
foals. The use of NSAIDs for foals affected with carpal or fetlock flexural deformity
6 Gaughan

can assist other treatment modalities by helping to maintain comfort and counter
some of the expected pain that can accompany the physical therapy aspects of treat-
ment. All cautions, of minimal dosing and duration, should be observed to avoid the
potential complications associated with NSAID use in foals. Both intravenous and
oral administration can be performed with success. Ketoprofen (1.1–2.2 mg/kg IV),8
phenylbutazone (1.1 mg/kg, once to twice per day),8 flunixin meglumine (1 mg/kg
once to twice per day),8 and firocoxib (0.1 mg/kg by mouth, after 2.0 mg/kg loading
dose)8 have all produced the desirable effects of reducing inflammation and pain while
addressing flexural limb deformities in foals.1 Gastrointestinal mucosal protectants
should be considered parallel to NSAID administration in foals.1

NONPHARMACOLOGIC TREATMENT OPTIONS

Shoeing and Trimming Considerations
Fundamental practices of protecting the toes, and providing variations of heel eleva-
tion and or toe extension can provide support to efforts to correct conformation in
foals affected with flexural deformities of the carpus and fetlock. The specific indica-
tions and techniques are discussed in the article (See Fred J. Caldwell article, “Flexural
Deformity of the Distal Interphalangeal Joint,” elsewhere in this issue).

Physical Therapy
Mild and reducible flexural deformities of the fetlock and carpus may be amenable to
physical stretching exercises. With a recumbent or standing foal, the affected joint
location can be stretched to, or toward, normal conformation by holding the limb
distal to the affected site and pushing against the affected joint. Several recommen-
dations have been made for how to stretch, but the most effective techniques appear
to apply slowly increasing stretch pressures over extended periods. Stretch to the
point of resistance or resentment by the foal and holding that position for 15 to
30 seconds, followed by relaxation, and then repetition for 10 to 15 minutes 3 to 6
times per day has been successful in correcting mild carpal and fetlock flexural de-
formities in neonatal and very young foals.3 Simultaneous massage of the caudal sur-
face antebrachial musculature may help some foals relax while performing stretching
exercises.

Exercise Management
Normal mare and foal behavior determines that the foal follow the mare, and therefore
the foal may control its own exercise only when it simply cannot keep up with the mare
or stand at all. Therefore, controlling the exercise allowed to the mare, and the foal, is
an important consideration when working to correct flexural limb deformities. Exces-
sive movement and weight bearing on limbs that are painful, or cannot structurally
support body weight, can compound the excessively flexed conformation, and the cy-
cle can become very difficult to reverse. A serviceable rule is to confine a mare and foal
if the foal is made more painful or the flexural limb deformity made worse, with any-
thing more than stall rest.
The converse to rest is certainly a viable option and a successful tool in the correc-
tion of flexural limb deformities. If a foal is determined to be comfortable enough, and
able to tolerate some exercise, then regular, controlled walking can apply the strain of
weight bearing to the flexor surfaces and help stretch a limb toward more normal
conformation. Exercise, when well controlled and tolerated by the foal, can be a sub-
stantial component of flexural limb deformity treatment. When not controlled and
poorly tolerated, exercising an affected foal, can have very negative results.
 Flexural Limb Deformities of Carpus and Fetlock 7

Complementary/Integrative Therapies
Acupuncture may have a serviceable role in the treatment of flexural limb deformities.
If acupuncture can result in local, regional, and systemic analgesia and possibly tran-
quilization, perhaps the benefits of these results can be obtained without the concerns
for pharmaceutical administration. Consultation with a regular practitioner of comple-
mentary/integrative therapies may add another dimension to the treatment ap-
proaches to carpal and fetlock flexural deformities.

External Coaptation
External coaptation in the form of a well-padded splint is the most common and reli-
able means of reducing and maintaining complete, or progressive, correction of carpal
and fetlock flexural deformities in foals. Fiberglass casts also can be applied for rigid
coaptation, and can be helpful in the management of flexural deformities, but the need
for removal and replacement typically makes the use of casts cumbersome and
expensive. Splints applied over bandages are simple to produce and place on the
affected limb and control costs when rigid support is desired.
Splints can be made out of various materials. PVC pipe can be cut to length to
customize fit. PVC pipe of 4-inch to 8-inch diameter works for most foals. The author
prefers to cut the determined length of PVC pipe in half, lengthwise, to achieve better
fit of the limb within the interior of a splint; making 2 splints from 1 tube of PVC pipe. It
is recommended to select a diameter of PVC pipe that will allow good fit over
adequate padded bandage material. Although more than 2 splints can be cut from
a single length of PVC pipe, the narrower splints are more difficult to maintain in
desired position and are also prone to bending.
Fiberglass cast tape also can be used to make a custom splint. Appropriate
bandage material should be applied first, typically in Modified Robert Jones fashion.
Cast tape can then be applied in a lengthwise manner to establish the rigid component
of the bandage-splint. Enough cast tape (7–8 layers) needs to be applied such that the
foal is supported, the extension pressures on the limb maintained, and splint breakage
can be avoided. Allowing the cast material to cure, or harden, for at least 20 minutes
before final application to the affected limb can minimize the chances of inappropriate
bending or breakage of the newly formed splint.

GENERAL GUIDELINES FOR SPLINT APPLICATION

Splints should be considered when an affected foal has difficulty standing and moving
normally. Rigid support for a foal that spends excessive time in recumbency can allow
more consistent standing, nursing behavior, ambulation, and better stretch of the
abnormal limb(s).
Splints over bandages are used for mild, moderate, or severe deformities, and the
duration of splinting will be somewhat dictated by the severity of the deformity and the
age of the foal. Many times, the deformity can be corrected with or without the use of
splints, and the use of splints is determined by the individual experiences of the treat-
ing veterinarian and the owner. However, splints are absolutely required when the foal
either cannot or will not stand to nurse with normal frequency and duration.
Best results from splint application are achieved when rigid support is placed on the
flexor surface. The splint should bridge the site of flexural deformity with as much rigid
support proximal and distal as possible, which can assist in gaining mechanical
advantage. Placing the splint on the flexor surface allows for “pulling” the abnormally
flexed site into the rigid column of the splint. This also appears to help the foal adjust to
the rigid, fixed position of the limb and maintain the ability to be ambulatory.
8 Gaughan

HOW OFTEN SHOULD SPLINTS BE REMOVED OR ADJUSTED?

Several recommendations for splint application and management have been made
through the years. This is likely due to individual experiences and several factors, such
as severity of the problem, age of the foal, and the ability of the person responsible for
splint application. An early recommendation was to have splints in place for 6 to 12 hours
and then removed for 6 to 12 hours. This would in turn be repeated until an affected limb
achieves conformational correction.3 Others have recommended 24-hour splint place-
ment followed by a splint and bandage change to evaluate limb health and flexural defor-
mity correction. The key point is that recommendations for removing or adjusting splints
are made to prevent decubital erosion of the skin at splint-induced pressure points. The
other key point in determining the splinting duration is to avoid inducing overrelaxation
and laxity of the splinted joints. For the most common carpal and fetlock flexural
deformities, splints placed on the flexor surface for up to 5 days have been successful.1
The success of the prolonged splint placement is predicated on adequate padding,
placed to avoid movement or slippage and securely fit to the limb and splint. This
appears to help avoid skin erosion and compression wounds induced by a splint.
Bandage-Splint Layers
1 Primary layer: roll cotton or cast padding. Thickness adequate to fill the interior
lumen of the chosen splint material (Fig. 3)
2 Secondary layer: Cotton roll gauze

Fig. 3. Adequate, properly applied cotton padding placed to support PVC splints to address
bilateral carpal flexural deformity.
 Flexural Limb Deformities of Carpus and Fetlock 9

3 Elastic tape: Evenly applied to avoid irregular compression and distal bandage
slippage
4 Splint
5 Elastic tape to secure splint to the bandage material
6 Wear-resistant tape (duct tape): optional, but can help improve the duration of the
bandage-splint and produce a moisture barrier
Padded bandage should extend proximal and distal to the extent of the splint. This
can help reduce splint migration and potential skin injury from the splint.
Splint for a carpal flexural deformity:
1. Splint length should reach from the elbow to the proximal sesamoid bones at the
fetlock. Leaving the digit free to move and bear weight can assist the splint in appli-
cation of extension forces. The splint must be well secured to avoid distal migration
and need for adjustment or replacement.
Splint for fetlock flexural deformities:
1. Splint length may be variable. Often a full limb splint (from elbow to ground surface)
can be best for rapid correction. An alternative is a splint that reaches from prox-
imal metacarpus to the ground.
2. The foot should be exposed for weight bearing.
3. Additional padding should be placed between the splint and the palmar surface of
the pastern. This will help push the digit dorsally and maintain extension strain. With
the assistance of the foot in weight bearing, this splint support will have better suc-
cess than full splint coverage of the fetlock and digit.

Dynamic Splints
Dynamic splints are designed to place forces that act to stretch the limb such that
correction of flexural deformities can be corrected. These splints have been applied
to angular limb deformities and some veterinarians also use them for flexural defor-
mities in young foals. The splints are designed to place contact and pressure in mini-
mized fashion on specific locations on the limb depending on the deformity being
addressed. Adequate padding on compressed sites is vital to avoid decubital lesion
development.3

COMBINATION THERAPIES

Best results in correction of flexural limb deformities of the carpus and fetlock are likely
obtained using external coaptation, physical therapy, and pharmacologic treatments
in combination. The administration of oxytetracycline and an analgesic agent can
enhance the ability of a bandage-splint to place an affected limb in more normal
conformation. This treatment combination can maintain limb position while the desired
flexor surface “stretch” occurs and also enhance the foal’s discomfort. Close attention
to the systemic health of the foal is crucial for overall success, as this is a stressful time
for an affected foal at a life stage that can be negatively affected by these imposed
stresses.

SURGICAL TREATMENT OPTIONS

Surgical treatment of flexural deformities of the carpus and fetlock is not

commonly indicated or required in young foals. Most affected individuals respond
to analgesic medication, muscle relaxation, physical therapy, splint application, or
combination therapy. Young foals appear readily responsive to more conservative
10 Gaughan

measures directed at stretching affected limbs to achieve conformation

correction.
Rarely, flexural deformities of the fetlock may require surgical treatment. Proximal
check desmotomy can allow some improved ability to improve fetlock angulation to-
ward normal. With increasing severity, fetlock flexural deformities may benefit from
also performing a distal check desmotomy at the same time as transection of the prox-
imal check ligament.9 Typically, continued utilization of an external splint will be
required to correct fetlock conformation after surgery.
Flexural deformities of the carpus require surgical treatment even less frequently
than those of the fetlock. Transection of accessory ligament to the superficial digital
flexor tendon and/or the tendons of the ulnaris lateralis and the flexor carpi ulnaris
may release the restrictive forces on the flexor surface of the carpus and allow limb
straightening.1,10 Transection, or release, of the retinaculum that forms the carpal ca-
nal may allow some improved response to rigid external splintage. As a sole treatment
procedure, carpal canal release is not likely to result in correction of carpal flexural
deformity.

TREATMENT RESISTANCE/COMPLICATIONS

Persistence with physical therapies, including splintage, supported by appropriate

pharmaceutical utilization, is typically met with good results. Readily establishing cor-
rected limb conformation can result in a favorable expectation for an affected foal to
return to its expected athletic future. Decubital pressure erosion of the skin is the most
common complication of splint application in foals; therefore, careful splinting and
appropriate and well-padded bandage management is very important. If correction
is not obtained with conservative therapies, surgical treatment can be attempted
and may improve the opportunities for successful resolution of flexural conformation
faults. Failure to correct carpal and fetlock flexural deformities should be an indication
to reevaluate diagnostic observations. Congenital abnormalities, like arthrogryposis,
can be difficult to correct and can mimic simple flexural deformities.
Severe, irreducible congenital flexural deformities may not respond to physical,
medical, or surgical treatment and can be difficult to correct. Staged treatment is often
required, as rigid splint application or cast utilization may not be possible in the early
stages. Foals with severely deformed limbs often are coincidently affected with sys-
temic weakness, immunocompromise, and potentially other concurrent disease. It
is essential to address these systemic challenges as a priority while the flexural limb
deformities are treated. Weakness may assist limb conformation correction with phys-
ical therapy (stretching). If an affected limb cannot be placed in external supports, the
frequency of physical therapy may need to be increased to 4 or more times per day. A
foal that responds to both systemic medical treatment and to physical therapy may
allow splint placement and more typical therapies for flexural limb deformities. A
foal that does not respond to treatment, such that splint placement cannot be accom-
plished, and maintains severe limb deformity, carries a poor prognosis for limb correc-
tion and perhaps survival. Secondary musculoskeletal injury can occur as well when
the primary flexural deformity does not improve (Fig. 4). Protracted incomplete
response to treatment, or complete failure of affected limbs to respond, is likely a
poor indicator for survival as well.

EVALUATION OF OUTCOME AND LONG-TERM RECOMMENDATIONS

It is uncommon for a young horse to experience recurrence or complications of flex-

ural deformities of the carpus or fetlock once correction has been obtained. When
 Flexural Limb Deformities of Carpus and Fetlock 11

Fig. 4. A lateral radiographic projection of the distal limb of a foal. The film indicates sub-
luxation of the distal interphalangeal joint after a fetlock flexural deformity failed to
respond to treatment.

these deformities are corrected by the time of weaning, long-term recommendations

essentially become those of typical management of a young horse with a continually
developing musculoskeletal system. As the rapid phases of skeletal growth begin, and
a foal ages toward and after weaning, the discomfort of physitis can occasionally
cause the carpal region to bow forward and some “carpal shaking” can be observed.
If unaddressed, this postural change can result in recurrence of carpal flexural defor-
mity. Careful observation, timely administration of NSAIDs, and control of exercise
usually prevent this conformational change from becoming a persistent problem.
Generally, the prognosis for foals affected with carpal and fetlock flexural deformities
is favorable for a return to athletic expectations when limb conformation is initially
corrected.

SUMMARY

Foals can experience congenital flexural deformity of the carpus and/or fetlock. Foals
also can acquire these deformities between birth and weaning as consequences of
abnormal skeletal development, rapid growth, and/or pain, which can affect weight
bearing. Early recognition and accurate diagnostic understanding can lead to timely
and successful treatment. Physical therapies, both “in hand” and with bandages
and splintage can support affected limbs while conformation correction occurs. Med-
ical assistance to reduce muscle strain, and reduce pain and anxiety can assist the
12 Gaughan

physical management tools. Foals that respond well and develop normal conformation
are considered likely to have normal expectations for future use and athleticism. Foals
that do not respond, or incompletely respond to treatment, will not likely have a normal
future due to conformational constraints that can be complicated by continued growth
and use.

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