Acquired Flexural Limb Deformities – A common encounter amongst working equids

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To give you a better understanding of the cases SPANA vets treat, I have included a short case study on a commonly seen problem in working equids.

Acquired flexural limb deformities account for approximately 1/8th (12.5%) of cases presented at our centres, and unlike cases commonly seen in sport horses, working equids tend to manifest the disease at a later stage in life (3 years old and over) and with established hoof deformities and clinical signs of chronic flexor tendon tendinitis.

Due to previous diagnostic limitations in SPANA centres, all presented cases were treated conservatively, with aggressive hoof trimming, toe extensions, heavy bandaging, oral non steroidal treatment and daily controlled exercise. In the last 18 months, some centres have had ultrasound machines and digital radiographic equipment donated, enabling our veterinarians to work up the cases more thoroughly and reach a more accurate diagnosis with subsequent better targeted treatment and a more accurate prognosis.

Below was a case presented to our team in Marrakech, during one of our visits to the SPANA centre, earlier this year. This 6 year old donkey had manifested progressively deteriorating left hind limb lameness, likely triggered by tendonitis of the superficial digital flexor tendon (SDFT). The owner had hoped the lameness would resolve spontaneously with 5 months of unassisted turn out. During such rest period, the donkey instead developed a Grade II flexural contracture to both hind limbs, and severe deformity of the hooves.

After 5 months of turn out this donkey was presented at the SPANA centre

When presented to the SPANA centre, an in depth lameness examination was done, including radiographs and an ultrasound of both hind distal limbs. There was no obvious subluxation of the distal and proximal interphalangeal joints nor of the metatarso-phalangeal joint. Mild osteoarthritis of all joints was present but not relevant to the presenting lameness. An ultrasound image of the left hind flexor tendons revealed a hyperechoic area at mid cannon level of the SDFT, as well as narrowing in diameter and increased echogenicity of the accessory ligament of the deep digital flexor tendon (ALDDFT) bilaterally.

Due to the severity of the flexural contracture a sequential tenotomy (of the ALDDFT bilaterally and SDFT on the left hind) under general anaesthesia was performed (using Ketamine and Xylaxine in a TIVA standard protocol), as well as corrective hoof trimming and toe extensions. The donkey was recovered with distal limb bandages which were changed every third day and gradually reduced in thickness and stiffness during the subsequent 3 weeks. He was also placed in a controlled exercise regime and non-steroidals (oral phenylbutazone) were administered throughout the 3 weeks.

Conservative measures are of paramount importance in all these donkeys.

Post surgical tenotomy with a bespoke toe extension.

Despite the contracture resolving completely after 3 months of rehabilitation, a mechanical lameness persisted in the left hind limb, likely due to adhesions between the flexor tendons which were ultrasonographically visible.

Nevertheless this little donkey was sound enough to return to work and continue to support his owner.

Read Part 1: SPANA - For the Working Animals of the World Here.

Dr Francesca Compostella DVM MRCVS
Veterinary Director

After gaining her veterinary degree from the University of Padua (Italy) in 2006, Francesca trained for five years in America, Scotland and England; completing a surgical residency in 2012. She worked as an equine surgeon in south east England before joining SPANA in London as a veterinary advisor in 2014, leading teams in providing free veterinary care to working animals and training local vets and students. She was appointed Director of Veterinary Programmes in February 2015. She has contributed and published articles on equine surgery and medicine and is a contributor to the latest Equine Atlas of Diseases. She is actively involved in research and a reviewer for the RCVS Veterinary Evidence Journal.

Graduated veterinary volunteers can get a small taste of some of the work we do by enrolling in placements in our centres in Morocco. This is an ideal placement for new graduates with a strong equine bias, as our centres in Morocco receive primarily working equids. You will work under the supervision of our Moroccan team, and will be hosted within our humble, yet clean and safe facilities, where you can share experiences with other international and local veterinary volunteers and taste some of the local spicy cuisine! Please visit our website: or email us at for more information.

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