pododermatitis in raptors powerpoint april 2013-2...4/5/13& 1& deb$sheaffer,$dvm$...

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Deb$Sheaffer,$DVM$Audubon$Society$of$Portland$$

  General$term$for$any$inflammatory$or$degenerative$condition$of$the$avian$foot.$

  Also$called$Bumblefoot$$  Bumblefoot$might$be$more$appropriate$than$using$term$pododermatitis$because$this$term$infers$the$lesion$is$strictly$dermal$

  Exhibited$by$inflammation,$excoriation,$ulceration,$abscessation$D$usually$of$the$plantar$surface$of$the$foot.$

  Foot$extends$from$intertarsal$(hock)$joint$to$talon$tips$

  In$most$species$of$raptors$foot$is$devoid$of$feathers$

  Thickened$pads$of$dermis$on$plantar$aspect:$$metatarsal$(under$central$area$of$foot)$and$digital$(or$podothecal)$dermal$pads$

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  Dermal$pads$contain$great$concentration$of$lipids$

  Under$dermis$is$fibrous$connective$tissue$and$fat$which$are$attached$both$to$dermis$and$underlying$tendon$sheaths.$

  Tendons$and$tendon$sheaths$are$attached$to$bones$of$phalanges$

**$Not$many$blood$vessels$in$feet$and$toes$**Skin,$fat$pads,$and$connective$tissue$are$the$$only$tissue$between$bones$and$perch.$

Causes$usually$multiDfactorial:$  Ergonomics$  Sanitation$  Infectious$  Nutritional$  Trauma$  Obesity$  Behavior$

$$

In$captivity$often$(always?)$a$management$issue$

  Ischemic$necrosis$of$the$skin$from$bruising$or$unrelenting$pressure$  Inactivity$  Obesity$  Perches$too$hard,$too$smooth,$too$large,$too$small$  Repeated$blunt$trauma$from$slamming$from$perch$to$perch$  Injury$causing$abnormal$stance$$

$  Infection$from$a$traumatic$wound$or$a$wound$formed$

following$ischemic$necrosis$  Unsanitary$conditions$  Punctures$from$exposed$hardware$in$cage$  Hanging$on$side$of$cage$

  Initially$starts$with$inflammation,$primarily$heterophils$and$macrophages$

  As$progresses:$  Increased$fibrosis$  Decreased$vascularity$ Walled$off$pockets$of$infection$

  Chronic$pododermatitis$may$lead$to$infectious$endocarditis,$amyloidosis,$other$harm$

Bacteria$  Staphylococcus,aureus,most$common$bacteria$  S.,aureus,is$common$skin$inhabitant$of$birds,$but$also$can$be$a$contaminant$from$humans$

  Also$can$isolate$Escherichia$coli$and$other$bacteria$from$fecal$material$

  Candida$albicans$

  Complete$history$$  Nutrition,$hygiene,$behavior,$daily$routine,$habitat$

  Examine$perching$  Thorough$exam$

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Thorough$examination$of$foot$may$require$sedation$or$anesthesia$  Look$for$obvious$scabs$or$wounds$  Evaluate$skin$texture,$swelling,$softness$or$hardness$of$underlying$structures$

  Radiographs$$**$if$lesions$are$severe$may$proceed$to$immediate$debridement$and$culture/sensitivity$

  Several$grading$systems,$usually$either$1D3$or$1D5$or$1D7$

  Example:$▪  Grade$1:$Thinning$or$hyperkeratosis$of$skin$with$no$visible$swelling$▪  Grade$2:$Swelling$and$scab$formation$▪  Grade$3:$Severe$form$with$scar$tissue,$abscesses,$extension$into$tendons$and$bones$

  Serial$photos$helpful$

 Management$ Medical$(antibiotics,$pain$relief,$antiDinflammatories)$

  Surgical$  Bandaging$

  Appropriate$perching$  Remove$enclosure$hazards$(i.e.$exposed$hardware)$

  Provide$suitable$physical$activity$  Nutrition$ Weight$management$  Hygiene$(environment$and$bird)$

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 Multiple$perches$  Cleanliness$ Materials$

  Natural$$  Astroturf$  Sissel$

  Should$never$be$smooth$

The$good,$the$bad,$and$the$ugly…$

  Topical$▪  Silver$sulfadiazine$cream$▪  Chlorhexidine$▪  PovidineDiodine$▪  Skin$“tougheners”$:$

  Tinctures$of$camphor$or$benzoin$  Liquid$bandages$

▪  PreparationDH$▪  Herbal$preparations$▪  Others$

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  Antimicrobials$  Should$be$based$on$culture/sensitivity$  BUT$early$use$is$important$to$ward$off$abscess$formation$so$will$often$start$antibiotic$pending$Culture/Sensitivity$results$

  Antibiotic$choice$considerations:$  Often$involve$Staph.,species,so$provide$G$+$coverage$

  Feet$have$contact$with$fecal$material$so$provide$GD$$coverage$

  Need$good$penetration$to$tendons$and$bone$  Character$of$bird$may$dictate$antibiotic$frequency$and$route$

  AntibioticDimpregnated$polymethyl$methacrylate$beads$  Implanted$directly$into$the$bumblefoot$lesion$following$surgical$debridement$

  Antibiotic$infuses$into$the$tissue$for$weeks$or$months.$

  Can$make$your$own$or$purchase$

  Control$pain$and$inflammation$▪ Pain$relief$▪ Butorphanol$$1D2$mg/kg$PO$or$IM$every$6D12$hours$

▪ AntiDinflammatory$▪ Metacam$0.2D0.5$mg/kg$PO$or$IM$every$24$hours$

  Early$surgical$debridement$probably$improves$recovery$rates$in$cases$where$there$is$necrosis$and$infection$

  Remove$all$necrotic$or$infected$tissue$  Flush$with$sterile$antiseptic$or$antimicrobial$solutions$

  Primary$closure$may$not$be$possible$  Bandage!$

  PressureDdiverting$bandages$  Adapt$to$anatomy$and$habits$of$bird,$foot$lesion$location,$shape$and$severity.$

  Examples:$▪  Padded$▪  Ball$bandages$▪  Casts$▪  Thermoplastic$shoes$▪  Donut$ring$

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Ball$bandage$$

▪  Make$“ball”$of$stacked$gauze$sponge$and$clench$bird’s$foot$around.$Foot$is$then$wrapped$in$Vetwrap$

▪  Disadvantages$▪  Shifts$more$weight$onto$other$foot$▪ May$still$have$pressure$on$metatarsal$pad$▪  Cannot$monitor$foot$

Ball$bandage$

The$real$ball$bandage!$▪  Hollow$rubber$ball$with$top$cut$off$▪  Notches$for$toes$cut$out$▪ Wrap$foot$in$similar$way$to$ball$bandage$▪  Advantage:$takes$all$pressure$off$metatarsal$pad$▪  Disadvantages:$

  Same$as$Ball$Bandage$

$

  Donut$$ Made$from$cotton$cast$padding$  Place$with$middle$(hole)$placed$over$wound$ Wrap$foot$with$Vetwrap$

  Foam$disc$ Made$from$firm$polypropylene$foam$(swimming$pool$noodle)$

  Hole$cut$where$wound$is$ Wrap$foot$with$Vetwrap$

PressureDdiverting$bandages$  Finnegan$

  12$year$old$male$Peregrine$Falcon$  In$captivity$since$a$nestling$  Deformed$left$foot$  Used$as$education$bird$on$site$and$taken$to$offDsite$programs.$

  Out$on$glove$at$least$once$daily$  In$warm$months$is$flightDtrained$

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 Management$  Perching$ Weight$control$  Exercise$  Nutrition$

  Surgical$ multiple$

 Medical$management$ Multiple$antibiotic$trials$based$on$culture$and$sensitivity$

  Last$culture$grew$out$S.$aureus,$resistant$to$all$antibiotics$except$Chloramphenicol$

 Weekly$foot$“scrubs”$and$topical$herbal$salve$with$bandage$

  Bandaging$  Finnegan$has$NEVER$been$without$a$bandage$on$his$bumbelfoot$foot.$

  His$“good”$foot$is$sometimes$bandaged.$  Have$used$casts,$boots,$balls$ Weekly$bandage$change$if$foot$looks$good;$more$often$if$flare$up.$

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  Podermatitis$is$a$multiDfactorial$condition$  Management$needs$to$be$tailored$to$species,$cause,$severity,$nutritional$and$weight$management,$exercise,$infection,$etc.$

  Prevention$easier$than$treatment$