Nov 01 2024 40 mins 2
Pododermatitis Paw-dcast Part 2 – A Surgeon's Perspective
(00:00) Intro - this month, Sue, John and Paul invite EBVS Specialist in Small Animal Surgery, Jakub Kaczmarek onto the platform to discuss the other side of pododermatitis - from the surgeon's perspective.
Chapter 1 – Feet First - A Surgeon’s Take on Pododermatitis
(03:12) John introduces Jakub, highlighting Ursula's recommendation following their fruitful discussion on pododermatitis. He invites Jakub to share his background. Jakub expresses gratitude for the invitation and mentions Ursula as a mentor during his residency in Germany. He discusses their collaboration on pododermatitis, combining dermatology and surgery. Jakub shares his educational journey from Poland, a semester in Vienna, and his internship in Germany, which focused on surgery and dermatology. He currently works in Cologne.
(04:55) John acknowledges Jakub's expertise in dermatology and asks how a surgeon fits into managing pododermatitis in dogs. Jakub emphasises teamwork between dermatologists and orthopaedic specialists, noting the complexity of pododermatitis. He explains that it can arise from both skin-related and conformational issues, necessitating collaboration for optimal care.
(06:16) John enquires about the types of lesions found on dogs' feet. Jakub explains that abnormal weight distribution from orthopaedic conditions, like developmental elbow disease, can cause pressure on specific paw digits, leading to abrasions, inflammation, and even local pyoderma. He describes hypertrophy on the paw's plantar surface, potentially forming "pseudoballs." Chronic irritation can result in excessive licking, leading to severe inflammation, which requires both orthopaedic and dermatologic management.
Chapter 2 - Toes: Lesions and Lameness
(09:25) Sue comments on the dog's paw pad structure, noting that abnormal weight-bearing can lead to skin issues. She asks if this is the pathomechanism for pododermatitis. Jakub agrees and adds that while there are many potential causes, mechanical issues may also contribute. He supports Sue's idea that malalignment and weight distribution lead to abnormal weight-bearing and related problems. Sue clarifies that some cases of pododermatitis have dermatological causes, while others stem from orthopaedic issues. Jakub agrees but points out that breeds like Labrador Retrievers and Bulldogs often have both conditions, complicating the determination of the primary issue. Sue P recalls a study revealing Bulldogs walk on their toes, which could contribute to multiple health issues. She emphasises the need for a multidisciplinary approach. Jakub references a study by Tim Nuttall involving over 160 dogs, noting that factors like body condition and hair type are significant in causing pododermatitis and interdigital cysts. Sue P agrees, linking higher body condition scores to more weight on the front limbs, thus making pododermatitis more common there. Jakub clarifies that while pododermatitis is typically seen more in front limbs, conditions like hip dysplasia can also affect hind limbs. He explains that primary dermatological issues may affect both front limbs, while orthopaedic problems often involve a single limb. Sue P sums up that multiple limb involvement likely relates to skin conditions, while single limb issues could indicate orthopaedic problems. Jakub agrees, adding that orthopaedic conditions like OCD or FCP typically show changes in the affected limb.
(14:53) John revisits Jakub's "top-down or bottom-up" approach, asking how it relates to recognising orthopaedic diseases as triggers for pododermatitis. Jakub explains that common orthopaedic triggers include developmental elbow diseases like OCD and FCP, as well as shoulder OCD, which causes dogs to alter their walking to reduce pain. He notes that patellar luxation often results from underlying angular limb deformities that shift the weight-bearing axis, exacerbating dermatological issues.
Chapter 3 - Surgical Solutions: From Lasers to Collaboration for Better Outcomes
(17:30) Sue asks Jakub to elaborate on triggers, noting that predisposed breeds and age of onset play a role, citing Labradors as an example. Jakub confirms that Labrador Retrievers exhibit these issues, with signs of orthopaedic problems appearing as early as five to six months, and severe cases at four months. He mentions common large breeds prone to orthopaedic problems.
(18:59) Sue asks about the timing of pododermatitis relative to orthopaedic diseases, questioning if lameness in young dogs could precede pododermatitis. Jakub notes that pododermatitis and orthopaedic diseases usually present in older dogs, around two years of age. He hasn't observed significant changes in younger dogs, suggesting it takes time for pododermatitis to develop due to malalignment and weight redistribution. Sue P agrees, noting that in her practice, older dogs often present with pododermatitis alongside a history of earlier orthopaedic problems. She suggests a compensatory mechanism may lead to conditions like interdigital cysts. Jakub agrees, highlighting that dermatological conditions like pododermatitis are painful due to inflammation, which can lead to chronic discomfort. He asks Sue if Labrador owners ever report lameness when presenting dermatological issues. Sue P mentions that owners usually don’t report pain, necessitating probing for details. She reflects on referring a three-year-old Labrador with recurrent interdigital lesions to an orthopaedic surgeon to assess joints. If swelling or crepitus is present, she recommends CT scans and emphasises early intervention. Jakub recalls Sue's 2012 publication linking interdigital lesions with elbow issues. He has observed that treating elbow conditions often leads to improvement in lesions, suggesting that combining orthopaedic corrections with topical treatments could yield better outcomes.
(25:18) John asks Jakub to elaborate on surgical approaches for pododermatitis, including techniques like webectomy and podoplasty. Jakub notes he has not performed podoplasty but has seen it used successfully in severe cases. He prefers laser ablation, as it is quicker and effective when collaborating with a dermatologist who has tried conservative treatments. He recounts streamlining procedures significantly, reducing time from 1.5 hours to 30-35 minutes. Sue adds context, explaining webectomy and podoplasty. She contrasts her cold steel surgery experience with the benefits of laser surgery. Jakub explains that CO2 lasers are more precise and cause less collateral damage than diode lasers. He emphasises the advantages of laser treatment in sealing vessels, which minimises bleeding and post-op pain. He mentions a colleague who leaves wounds open post-surgery, but he prefers using honey treatments for healing.
(34:06) John concludes by praising the collaboration between Jakub and dermatologists like Ursula, highlighting the importance of a multidisciplinary approach in managing complex cases like pododermatitis.
Outro
(37:07) Final thoughts John puts another bizarre question to Sue and Paul.
