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$treatment$