EverAfter's Therapy Farm

EverAfter's Therapy Farm

Monday, August 18, 2014

Pododermatitis (Sore Hocks) in Rabbits

If our bunnies are outside we have them in runs, pens, kennels or hutches, if they have wire bottoms they have plastic protecters on the area they spend the most time, we also have lots of fresh cut dry grass covering the cage floor, or large pieces of wood for them to lay or sit on. You can also use grass mats. Keep their nails trimmed, so they can not only be well balanced on their feet but also so they do not cut themselves when they scratch themselves. -- Please read the articles below!!!!!

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Pododermatitis is a skin disease and a musculoskeletal problem, whose origin is multifactorial. Adult rabbits are more often affected than young rabbits, larger breeds more than smaller. The major cause is trauma, due to the pressure on the sole caused by running on rough and/or abrading floors (e.g. rough carpets, tiles, vinyl or wire flooring of cages), more rarely by regular thumping of anxious or nervous rabbits. Poor hygiene in the cage can be a further cause for pododermatitis.

MediRabbit
Flemish giant rabbit putting weight on his hocks, instead of toes.

Genetics play a role too. Rabbits belonging to the Rex breed have feet padded with short soft fur that brings little protection. In Angora rabbits, shaved for their hairy coat, hair must never be shaved away from the bottom of their feet. Some rabbits also have a wrong physical body position. Instead of putting weight on the toes (rabbits are digitigrades); they place weight on the metatarsus and hock. Others position their hind feet wrongly, by stretching them too much to the front. In both cases, an enormous pressure is exercised on the hock, leading to pressure sores, ulcers and abscesses.

The various causes all lead to a decreased blood circulation in the hind limb, more rarely in the forelegs. Lack of oxygen supply (ischemia) causes tissue necrosis. A pressure sore is formed, which can develop into an ulcer or an abscess. The infection spreads to deeper located tissues, which can lead to the infection of the lymphatic nodes, the bone (osteomyelitis), or general sepsis. At this stage, the condition is very painful, and the rabbit will avoid walking, becomes incontinent for both urine and feces. Reduced movement reduces proper blood circulation in the limbs. A vicious circle is thus created, and the general condition of the rabbit decreases rapidly.

In cases where the bone is affected, the ligaments and the tendons can be displaced, which leads to permanent invalidity. This condition is easily recognized by the special gait of the rabbit, with a refusal to put pressure on its toes, and use of hocks instead.

Diagnosis

It usually starts with a hairless spot on the sole. The skin is thickened, inflamed and red, with necrotic tissue in the middle of the wound. Ulcers and abscesses can be present. The bacterial infection can be accompanied by the presence of purulent white paste-like pus. If the wounds remain untreated, the infection will spread to the inner tissues and can lead to the infection of the lymphatic system, the bone (osteomyelitis) or general sepsis. The rabbit is usually restless, with a decreases appetite and weight loss.

Paula Carter
MediRabbit

Naked skin of the sole of hind feet in rabbits. Left: a healthy foot with a line of naked pinkish skin is found when combing to the side. Right: rabbit suffering from pododermatitis.

Clinical signs

The clinical signs and the behavior of the rabbit are usually enough for a proper diagnosis. In the case of bacterial infection is present, cultures of samples taken from the infected area can help confirm the presence of either Pasteurella sp. or Staphylococcus aureus, but other bacteria have also been found. It is thus highly recommended to do a bacterial cultured, accompanied by aantibiotics sensitivity test.
When pododermatitis is left untreated, the condition will progress.
·           Stage 1:    alopecia on the sole, due to compression of the hair follicles in the dermis, accompanied by a thickening of the skin (epidermic hyperplasia and parakeratosis, or abnormal keratinization of the skin). No bleeding is observed.
·           Stage 2:    the skin is thick and shows epidermic hyperplasia and parakeratosis. Small bleeding is observed. Appearance of a callosity. The rabbit suffers pain at this stage.
·           Stage 3:    naked, thick and hard skin, with crusty hyper and parakeratosis. Pressure sores may develop. Necrotic tissue is observed in the dermis. Healing is extremely difficult at this stage.

MediRabbit

Flora, a young female Rex rabbit suffering from pododermatitis on the front feet (left) and hind limbs (right).

 Treatment

The treatment of pododermatitis needs to be on two levels:
Find the cause of pododermatitis, which includes a thorough examination of the environment where the rabbit is living and improve it, a reduction of weight in case of obesity, accompanied by increased exercise possibilities.
It is recommended to clip the hair around the wound, so that it cannot reach the wound anymore but remains long enough to protect the rest of the foot sole. The wound needs to be disinfected, e.g. with povidone-iodine, after which a antiseptic cream can be used. Good results were obtained with the following antiseptic products:
-  Salicylic acid 0.006%;
-  Mupirocin 2%;
-  Neomycin 2%;
-  Manuka honey;
-  HEALx cream;
-  Calendula/Echinacea 5% gel (Powervet®, Switzerland).
The use of systemic cephalosporin or azythromycin have proven efficient in the treatment of abscesses that developed secondary to pododermatitis. The antibiotic treatment should be done over a longer period of time, eventually for lifetime.
If pododermatitis is accompanied by pain, analgesic should be administered to the rabbit, e.g., meloxicam, which can be used over a longer period without appearance of side effects in rabbits. The reduction of pain usually encourages the rabbit to move more, which is on its turn beneficial for the blood circulation of the wounded leg. If this is not the case, soft massages of the limbs can help activate blood circulation in the affected limbs.
Bandaging the feet may be helpful. This can be by mean of a liquid plaster that produces an impermeable layer while allowing breathing of the skin. Regular bandaging material can also be used, but must be changed regularly to avoid infection.
Rabbits are skillful bandage removers. It is therefore sometimes useful to make a wire according to the size of the foot. This metal tube can be filled with padding material, e.g. cork, in such a way that the wounded area is left unperturbed and without pressure.
Ulcerative pododermatitis is often difficult to treat and recurrence is common.

Linda Baley and Claudia Misceo

Bambi, a 5 year old female Rex rabbit suffering from pododermatitis on the hind limbs, demonstrating bandaging of her hurt feet with soft padding and elastic adhesive bandage.

Sore Hocks in Rabbits



Ulcerative Pododermatitis in Rabbits


Ulcerative pododermatitis, or bumblefoot, is a bacterial infection of the skin; specifically, the skin of the back feet and hocks -- the part of the back leg that rests on the ground when a rabbit sits. Because of the location and characteristic symptoms, this condition is also referred to as “sore hocks.”

If left untreated, ulcerative pododermatitis can deteriorate to include deeppyoderma -- severe inflammation with pus filled lesions, and deep cellulitis -- severe inflammation of the deep cellular and connective tissue. Exposure to harsh and wet surfaces, or moist surfaces which keep the tissue of the foot pads soft can predispose a rabbit to developing sores on the feet.

Once a deeper infection has set in, many other health conditions can arise in the rabbit. Synovitis (swelling of the joint tissues) often follows, progressing to osteomylitis (infection of the bone marrow), and mosteonecrosis, which results in the loss of blood supply to the bones, eventual bone tissue death and breakdown of the bones.

Symptoms and Types


The signs and symptoms of ulcerative pododermatitis are usually graded from Grade I to Grade V, depending on the severity of the disease.

  • Grade I  – Rabbits in this stage of the disease have a milder form of the disease and may experience some hair loss and other early symptoms on the bottom surfaces of the rear feet
  • Grade II – Rabbits with this mild stage of the disease will experience hair loss on the feet or hocks, and may also experience swelling and redness on the feet and hocks
  • Grade III – In this moderate stage of ulcerative pododermatitis the rabbit is more likely to experience broken skin, ulceration and possibly scab formation which may provide an opportunity for infection
  • Grade IV – During this severe form of the disease the rabbit is likely to have an abscess, a pocket of infection, and inflammation of the tendons or deeper tissues within the hind limbs of the body
  • Grade V – At this stage of the disease the rabbit is likely to experience severe symptoms of ulcerative pododermatitis, including osteomyelitis or bone marrow infection, swelling of the joint tissue (synovitis), and possibly inflammation of the tendons (tendonitis), which can all lead to an abnormal walk, stance and posture
  • Other signs and symptoms may include an unwillingness to walk, which is largely associated with discomfort and pain, obesity, nervousness, and inability to eat

Causes


There are many causes for ulcerative pododermatitis, including pressure sores where the soft tissues of the limbs of the rabbit become lodged or trapped between bone and hard surfaces. Too much friction and exposure to constant moisture, especially on the hind feet, and exposure to urine or feces can also subject the feet to ulcerative pododermatitis, especially in animals with weakened immune systems or those that sit in soiled litter. Rabbits that are obese, or those that get too little exercise are at risk due to the amount of pressure placed on the foot surface, and/or the amount of time sitting in one place. Rabbits that thump their feet excessively are also at an increased risk of developing skin problems with the surface of the foot pad and hock.

Some rabbits develop ulcerative pododermatitis secondary to a bacterial infection, such as that caused by Staphylococcus aureus. Other common infections includePasteurella multocidaProteus spp.Bacteroides spp. or Escherichia coli.

Diagnosis


Your veterinarian will need to rule out abscesses and infection that are associated with other trauma or fractures. X-ray imaging can provide detailed diagnostic images of the bones, allowing your veterinarian to determine how involved the bony structures in the body are, so that an estimate can be made for prognosis. Typically, rabbits with bone infections have a poorer prognosis and require longer treatment than those with milder stages of the disease.

An ultrasound examination can help rule out other causes for pain and discomfort as well, and can provide a better estimate of how extended the infection is, and whether it has invaded the surrounding skin, tissues and joint fluid.

Treatment

Early treatment for ulcerative pododermatitis involves outpatient care for relieving redness, swelling, and discomfort. Later stage care may involve inpatient treatment, including surgical procedures to remove dead skin and tissue on the feet and hocks. The use of long-term antibiotics and pain control medications is sometimes warranted for severe causes of ulcerative pododermatitis.

Eating is important during treatment to prevent the weakening of the gastrointestinalsystem and overgrowth of unfavorable bacteria in the gut. A wide selection of fresh greens, including collard greens, spinach, dandelion greens, parsley, etc. is necessary.

 

Living and Management


It is critical that your rabbit receives proper care for this condition, including the appropriate medical and post treatment care, and a clean living space that is free from wire flooring, and is kept clean and dry. Wire flooring can be harsh on a rabbit's feet, causing calluses or small abrasions that can quickly become infected. Your rabbit should only have a smooth, soft, dry floor on which to rest, with thick bedding for sleep. It is especially important in humid environments to make sure that your rabbit's floor space is kept free of moisture, since a damp floor provides an ideal environment for skin problems and bacteria growth, and humid conditions do not allow for rapid drying (e.g., spilled water, or urine on floor).

A poor prognosis is likely for patients with severe disease, so early care is recommended and encouraged. Since recurrence is common, it is critical to seek veterinary assistance at the earliest signs of discomfort, before the infection has a chance to become complicated. It is also important to consider the financial and time constraints of treating a disease that will involve, in many cases, a commitment of time, emotional, and financial resources.

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Pododermatitis (Sore Hocks) in Rabbits

Companion Animals June 03, 2011|Print
Rabbit Hocks
Introduction
Pododermatitis, also referred to as sore hocks, is a common illness in rabbits. Pododermatitis is a condition where the hind feet near the elbow area or hock of the rabbit begin to show signs of infection. The surface of the hock that regularly receives pressure from the body is where rabbit owners are most likely to see the effects. The severity of the condition also depends on the breed of rabbit. For example, rabbits with short or thin fur on the hocks, such as Rex rabbits, tend to develop the condition more easily than rabbits with longer hock fur, such as a Holland Lops.
Causes
There are a variety of causes leading to pododermatitis. Rabbits that are routinely overfed will become overweight and put more and more pressure on their hind feet. This pressure on the hocks causes pain and irritation that leads to sore hocks.
This condition is worsened if the rabbit does not have a solid surface on which to sit. Even rabbits with a healthy weight need a solid surface in one-third of their cage to help relieve the discomfort that is caused by wire flooring.
Rabbits that are kept in too small of a cage will be unable to move around. This immobility will contribute to the onset of sore hocks.
In addition, pododermatitis is also caused by dirty housing conditions. These cages are breeding grounds for bacteria. Bacteria will easily be in contact with the hocks of the rabbits in the cage.
If the integrity of the hocks is failing, introduction of bacteria can lead to a severe infection.
In some circumstances, sore hocks can be caused by overgrown toenails. Nails that are not trimmed regularly will cause an imbalance in a rabbit’s feet. This imbalance will create specific pressure points that lead to the onset of pododermatitis. Extremely long nails can also curl to the point where they can puncture the pads of the feet, causing pain and discomfort.
Signs
Compared to other health problems in rabbits, pododermatitis is relatively easy to detect. Indicators of the condition include:
• Red or swollen feet
• Refusal to move around cage
• Extremely sensitive or sore hind feet
• In severe cases, ulcerations on feet
Prevention
The best way to prevent pododermatitis is to keep your rabbit healthy and fit by providing a proper diet, cage, and exercise plan for your rabbit.
  • Prevent obesity: Rabbits should be fed a balanced diet and grass hay. Consider factors such as age, reproductive activity, and health condition when measuring feed portion to avoid overfeeding the rabbit. Overfeeding will lead to unnecessary weight gain that will put excessive pressure on the rabbit’s feet. Grass hay is lower in protein and calories than alfalfa and will be better for adult rabbits.
  • Cage: Cages should provide a roomy, clean, and dry environment for a rabbit. When preparing a hutch for your rabbit, you should provide one square foot of space per pound of rabbit. This minimum standard will help ensure your rabbit has enough room to move around. Urine and feces should frequently be removed from the cage to avoid growth of bacteria that can increase the severity of a sore hock infection. Cages with wire bottoms should always include a section that provides solid flooring. The recommendation is that this section cover one-third of the entire cage floor. See also: Housing your Indoor Rabbit
  • Exercise: Rabbit owners should provide their rabbits with supervised exercise periods. Letting your rabbit run around in a fenced-in yard is the perfect way to provide exercise time. Exercise time is also an opportunity to interact with your rabbit and strengthen the bond you have with your rabbit.
Treatment
If you find that your rabbit has developed pododermatitis, you should take the rabbit to a veterinarian as soon as possible. This condition is extremely painful for a rabbit, so owners should act promptly when they first notice the illness. To treat sore hocks, a veterinarian will clean the affected area with a wound cleanser and administer an antibiotic to stop the infection. The main goal in treatment is to keep the area as clean as possible and to medicate the rabbit according to your vet’s instruction. Use of a zinc ointment when signs first appear may prevent progression of the disease.
Lisa Karr-Lilienthal, Ph.D. & Amanda Young - University of Nebraska-Lincoln
Related content
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Treating Sore Hocks in Your Companion Rabbit

by Dana Krempels, Ph.D.
University of Miami Biology Department
"Sore hocks", a condition in which the sole of a rabbit's foot becomes raw and inflamed, can be caused by a number of different problems, including
  • Improper flooring - Rabbits need soft, preferably malleable flooring that will mimic the natural texture of the earth as much as possible. Wire flooring that doesn't have sufficient support underneath is not appropriate, as it can cause the foot to bow unnaturally. (Wire flooring with proper support is all right as long as you have a clean litterbox and soft bedding on top of it.) Wood, tile, or linoleum flooring can also be problematic, as it doesn't allow the foot to bend the way it does when it's pushing off against earth or grass. Cages with slick plastic bottoms are especially bad for a bunny's feet and joints. Lack of traction can cause painful problems in the pelvic and pectoral joints, leading to arthritis, and even "splayleg."
    An indoor rabbit needs soft cotton mats with rubber backing to provide enough traction for healthy locomotion.
  • Obesity - A rabbit with too much weight on her body will often not be able to stand correctly, and may put unnatural pressure on points of her feet that are not meant to support much weight. This can cause sores.
  • Arthritis or other skeletal problems - Pain from arthritis in the pelvis or spine--or skeletal pain for any other reason--can cause a rabbit to posture in an unnatural way, resulting in pressure on delicate points of the feet.
  • Insufficient fur padding on the feet - Any cause of fur loss on the soles of the feet (e.g., mange, friction from improper flooring, contact allergies etc.) will deprive the rabbit of the natural padding she needs to protect her feet. Rabbits have little or no fat padding on the bottoms of their feet; they rely almost exclusively on a thick pad of wool to protect them from impact and friction. (NOTE: Some rabbit breeds, particularly Rex rabbits, have very fine fur that doesn't hold up well to friction. These breeds seem particularly prone to sore hock problems.)

    The problem can be painful, and if not treated properly, can progress to very serious conditions such as bone infections. A rabbit with sore hocks should be examined and treated by a good rabbit vet, especially if there are open sores that might need antibiotics or other medical intervention.The following diagrams show how you can safely wrap your rabbit's feet in special "booties" that will protect the bare areas of her feet to prevent sore hocks, if she is showing signs of fur loss on her soles.
    IF THERE ARE OPEN SORES ON YOUR RABBIT'S FEET, DO NOT WRAP THEM AS SHOWN BELOW UNTIL YOU HAVE HAD THE SORES EXAMINED AND PROPERLY TREATED BY AN EXPERIENCED RABBIT VETERINARIAN. OPEN SORES MAY NEED TO BE TREATED, AND THE FEET RE-WRAPPED, DAILY. WRAPPING AN OPEN SORE WITHOUT TREATING IT APPROPRIATELY CAN RESULT IN SERIOUS INFECTION.
    Do not attempt this wrapping procedure without the guidance of a good rabbit vet who can check on the rabbit's progress and change the wrapping and medication as necessary!


    Step One. Obtain a generous wad of "spare" rabbit fur from a healthy rabbit who has been shedding. (A fine-toothed flea comb can be useful for allowing you to gently harvest the extra fur.) Roll it between your palms until it forms a soft, spongy, but firm mat of "felt" that's about 2" x 2" x 1" (deep). Other types of padding are NOT recommended, as they tend to compress into hard mats that may do more harm than good. Please DO NOT TRY THIS until you are able to get some shed rabbit wool! Cotton, gauze, or any other padding just do NOT work as well as The Real Thing.
    Step Two. Cut a strip of VetWrap self-adhesive bandage, about nine inches long and two inches wide. Take this strip and cut it into an "H" shape, as shown in the diagram below. Leave about one inch UNCUT in between the "H" cuts, as shown. This uncut portion will cover the rabbit's heel.


    Step Three. While one person firmly holds the rabbit belly up, the other should press the felt pad against the sole of the foot, gently folding as much of the rabbit's own foot fur over the bare spot as possible. Holding the fur in place, position the VetWrap as shown below:

    Step Four. Being careful not to wrap too tightly (you should be able to insert your a tongue depressor between the bandage and the leg, and not have it stick), wind the vet wrap above and below the hock (ankle), as shown. You may have to try this a few times, as the felt pad can be slippery, and the VetWrap hard to handle.

    Step Five. The "almost finished" bootie should look like this:

    Step Six. When the rabbit bends her ankle, the VetWrap on the top of her ankle can bunch together and cause painful pinching. To prevent this, you must carefully excise a small "window" (either diamond or circle-shaped) out of the wrap on top of her ankle, to prevent this! Use blunt-tipped scissors, and be extremely careful to cut away the bandage one layer at a time so you don't accidentally cut the rabbit!

    Step Seven. Be sure to check the foot carefully several times over the next few hours to make sure there's no swelling or redness. If there is, you've wrapped it too tightly! Unwrap it immediately, let the foot "rest" for a while, and then try again.
    Conversely, if wrapped too loosely, the bandage could spin around or slide up the leg and bunch up against the ankle or knee. Practice and careful observation of what works will lead to a "bootie" with the proper tension.


    This style of wrapping rabbit feet with bare spots (NOT open sores) should keep the rabbit comfortable for a good while, but we generally re-wrap and re-pad every week or so. If the pad or bandage becomes wet or soiled, change it immediately, as you don't want an already compromised foot soaking in water (or worse!).
    Eventually, you should see a return of normal fur growth. While your vet is treating the problem that caused the sore hocks in the first place, there's no need to leave those cute feet unprotected. GOOD LUCK!

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