While this procedure frequently removes the bacterial contamination, there is a high incidence of post-surgical adhesions
and many horses are cured of the infection in their foot but never return to full function.
Dr. Ted Stashak, surgeon at the College of Veterinary Medicine at Colorado State University, describes the street nail procedure
as "radical and the prognosis for complete recovery is guarded."
"An alternative surgical approach," reports Dr. Joel Rodriguez Lugo, surgeon at the College of Veterinary Medicine at Auburn
University, "is to open the digital bursal sac and to insert a small endoscope into that space to lavage the area, clean out
the infection and to remove any damaged tissue."
This is often not an easy procedure and some familiarity with the approach must be developed but many surgeons are embracing
this technique, along with regional antibiotic perfusion, as the currently preferred method of treating septic navicular bursitis.
"We can often achieve the same degree of tissue cleaning and lavage accomplished with a street nail operation," says Lugo,
"but without almost any of the adhesions and other potentially crippling complications of that surgery."
Solidification Parks has had two test cases that solidified his thinking on the treatment of nail punctures in the foot. Both cases involved
horses that inadvertently stepped on 16 gauge needles while at various veterinary schools. Because of economic concerns, the
owners, in both cases, did not opt for bursal sac endoscopy and flushing. The horses were treated only with regional antibiotic
Parks reported that both horses recovered quickly without complications and while he is quick to point out that two cases
are not enough to be statistically significant and that a 16 gauge needle is not the same as an old rusty pasture nail, these
cases have changed his approach to treatment.
Practitioner's standpointFrom the practitioner's standpoint, management of a horse with a nail in its foot requires good radiography, antibiotics and
The field antibiotic regime of choice is intravenous potassium penicillin and gentamicin combined with metronidazole. This
combination provides broad-spectrum bacterial coverage and is generally easy to administer.
An intravenous catheter can be placed in the jugular vein making continued treatment possible. The horse must be evaluated
and the transport decision must be made early.
If the treating veterinarian is comfortable with regional perfusion techniques then the horse may be treated in the field.
Some veterinarians feel that in the acute stages the horse will better tolerate transport to a clinic or referral hospital.
If antibiotic perfusion alone is required then the horse will likely be returned home in a week or so and the horse and client
have been medically and economically served. If the horse's condition worsens however, and a bursal scoping procedure or a
digital tenectomy is needed, then the horse is already at a referral hospital and does not need to be transported; a non-weight-bearing
horse will further complicate the condition and risk compensatory laminitis and other complications.
Post-treatment carePost-treatment care of these horses is important.
Hand walking should be initiated as soon as possible to reduce the risk of adhesions, but good foot support and appropriate
footing is necessary to reduce the sole soreness that will be present around the area of puncture. Be sure to return horses
to exercise that have had an osseous perfusion procedure. The cannula hole drilled into the cannon bone should be treated
like a screw hole for fracture repair. This is a weakened area of bone and will need typically eight to 10 weeks to allow
for complete bone healing. Early return to exercise or even unrestricted turnout can result in spontaneous fracture at the
hole site in some horses.
Dr. Marcella, a 1983 graduate of Cornell University's veterinary college, was a professor of comparative medicine at the University
of Virginia. His interests include muscle problems in sport horses, rehabilitation and other performance issues.