Dog injury, part deux.
August 29, 2010 11:28 AM   Subscribe

My dog has a broken toe. I need help figuring out if her foot needs to be in a cast or not.

So this is a continuation of last week's question. Ultimately, the vet was wrong about a tear to my dog's CCL. She actually broke a non-weight bearing toe (obligatory photo).
She had x-rays on Monday which showed a spiral fracture on her second toe, which is evidently not a weight bearing toe, but still causes her considerable pain. The vet's recommended standard of care is to use a "spoon" shaped splint/cast, wrapped with bandages to hold it in place. The bandage will have to be removed and re-wrapped on a weekly basis for the next four to six weeks, after which time x-rays will be taken again to assess her progress.
All of that is well and good, but then I got on the web and started researching broken toes in dogs, and now I am confused. Many people seem to be of the mind that dog toes, much like human toes, should be left alone to heal on their own. These same people even believe that putting a cast on the dog could do more harm than good (causing pressure sores, blisters, infections, etc.). Most of the people who frequent the forums I have been reading do not appear to be veterinarians themselves, simply concerned and loving pet owners. Post after post (literally, hundreds) claim that casts on dogs are unnecessary and could potentially be detrimental. Is that true?
Furthermore, I have already dropped 700 bones in pup's treatment, which isn't chump change to me. I can expect to spend at least that much more for her additional treatments - all of which I will happily pay - if I am doing the right thing. I almost hesitate to mention what I have spent, but it seems somewhat relevant, especially if I shouldn't be spending anything at all.
For her part, the dog is annoyed by her bandaged paw, but it doesn't bother her so much that she is gnawing at it or that it is causing her any additional discomfort. She is already going up and down stairs and jumping (we try to stop her, but she is quick and really freaking stubborn). She is taking very short, leashed walks to relieve herself and expend a little of her energy. I stopped giving her pain medication, for fear that if her foot didn't hurt her at least a little bit, she could injure herself worse. She does not seem to mind being off the meds, I really would give them to her if she needed them.
Tl;dr takeaway question: Does my dog, who has a broken non-weight bearing toe on her back left paw, need to have her foot bandaged up, or do I leave it unbandaged and let it heal on its own?
posted by msali to Pets & Animals (14 answers total)
 
I think you have already made up your mind and looking for confirmation. Personally, I would let the dog decide. If the dog is active, appears pain(limp) free and continues steady progress I think you have your answer.
posted by rmhsinc at 11:37 AM on August 29, 2010


Not all breaks are equal. When I broke a toe, I couldn't get my doctor-on-call to authorize an after-hours non-life-threatening emergency visit to the ER. He kept insisting that broken toes are nothing, that al they'd do if I saw a doctor was to tape it to the next one over, and I could do that at home.

Six weeks later, when it hadn't healed at all, I finally did go to the doctor and it turns out I really needed a *lot* more than taping for that toe; it was an ugly break. But at that point, it was too late to do things right. It took more than 6 months for the pain to really start to go away, and (8 years later) it's still much larger than the corresponding toe on the other foot. I really wish I'd gone to the ER, or at least to the doctor the next day. And gotten the *right* treatment for that broken toe.

If my vet said a dog's broken toe needs a bandage, I'd go with that.
posted by galadriel at 11:45 AM on August 29, 2010


Can you get a second opinion from another vet?
posted by Solomon at 11:52 AM on August 29, 2010 [1 favorite]


rmhsinc, I have far from made up my mind. I know that there are people who frequent askmetafilter who are veterinary professionals and maybe have experience with this type of injury. I am looking for the valuable opinions and insight that I have come to expect from the green.
Solomon, I already have a call into my regular vet, who is different from the orthopedic specialist that we have been seeing. Hopefully he will give me some additional advice.
posted by msali at 12:29 PM on August 29, 2010


IANAV.

I am going to point out the anatomical reason for stabilizing the fracture, especially a spiral fracture: there are nerves and vessels in the paw, and the bone itself is supplied by nerves and vessels. What you do not want to do is disrupt blood supply or nervous supply to the tissues beyond what has already occurred. Osteonecrosis (bone death), for one thing, is not fun to address.

You also do not want to risk non-union healing--a spiral fx is more likely to result in non-union than other types. A poorly healed fracture isn't just more likely to incur arthritis at that site, it's more likely to trigger arthritic changes in nearby joints.

I know a dog about the size of your girl who broke one phalanx (toe bone) of its second digit on the front paw (ftr, on the forelimb, that toe IS weight-bearing) before being rescued and adopted, and it had healed badly. Now the entire digit and paw is distorted from the 3rd phalanx (where the claw is) to the carpus (wrist). He's a young dog, but he already has other stiffness and arthritic changes showing up.

If you're already seeing an orthopod, I'd be inclined to take the recommendation to bandage pretty seriously indeed. I suspect your GP will confirm that.
posted by Uniformitarianism Now! at 12:34 PM on August 29, 2010 [1 favorite]


In most cases, it is best to splint the broken toe, as far as I am aware.
posted by biscotti at 12:44 PM on August 29, 2010 [1 favorite]


I just looked at your pix...are you in Ohio and taking her to OSU? I know at least one of the orthopedic clinicians there, and she's fantastic.
posted by Uniformitarianism Now! at 12:57 PM on August 29, 2010


Uniformitarianism Now! That's awesome that you saw her on that rug. That picture was actually taken in Virginia Beach, at my sister-in-law's house. My husband's ENTIRE FAMILY went to OSU for either undergrad or grad. We live in Chapel Hill, NC.
posted by msali at 2:15 PM on August 29, 2010


I'm not your vet. If the ortho specialist is telling you that the fracture needs casting, it probably does. When you go to your RDVM, see if you can get a copy on CD of the radiographs that the ortho took. The xray machines they have are often better than what a regular clinic might have. They are also better at positioning in general, since it really is their specialty.

As with many things, when it comes to casting toes the pendulum of opinion swings depending on the current research. Long term prognosis will depend mostly on the fracture itself, as they can be very different.

In order to save some money, see if you can supply the casting materials, or have it recast at your local vet (check first to see if it will be cheaper).

Good Luck!!
posted by Nickel Pickle at 2:17 PM on August 29, 2010 [1 favorite]


Sorry for the presumption--what ever you do I hope you feel comfortable with the decision.
posted by rmhsinc at 3:22 PM on August 29, 2010


Hee! Just wondering. I only know one of the orthopedic clinicians in the department, but I thought 'hey, might as well check.'

There are probably* some pretty good vets in the Triangle area, too. I suppose.... ;)

*I'm kidding. There are many excellent practitioners and specialty hospitals in North Carolina, and NCSU has a great veterinary program and teaching hospital.
posted by Uniformitarianism Now! at 8:50 PM on August 29, 2010


Follow up:
Raina had her foot rebandaged today. It actually took two times to get it right. Evidently, our ortho vet is very mindful of pressure sores and blisters under the cast, so they try very hard to get the casting/bandaging right. He has been fantastic, and answered any question I have had.

I talked to both vets (our regular vet is really old school) about some of the conflicting evidence I had seen, and both were quick to point out that there are certain bone breaks that they wouldn't splint or cast, but that in Raina's case, there is really no other option. Given her age, size and the type of break, if it were to heal improperly if left on its own, she could be lame with arthritis in a matter of years.

I knew that we would face health and wellness issues with our girl when we adopted her from the shelter. But this is the first dog I have ever had, I have raised a child and had cats up to this point. With a child, the standard of care seems fairly cut and dried, unless they have a rare illness or injury. Thankfully, my son grew up healthily, and we never had to face any questions of whether we were doing the right thing or not. I was convinced that as far as his health was concerned, my son received the very best treatment available to him, whatever the problem.

My dog is a trickier beast, and I am coming to discover that dog owners themselves, who obviously love their dogs very much, can come by opinions and be somewhat strident about them. I need to learn to navigate the tricky waters of dog ownership and online communities dedicated to dog ownership.

Thanks everyone for their help. I can't really mark anything as best answer, so I am favoriting the comments I found helpful.
posted by msali at 5:06 PM on August 31, 2010


Glad to hear about Raina--it sounds like she's getting great care, and I wish her a fast recovery.
posted by Uniformitarianism Now! at 5:22 PM on August 31, 2010


Update number umpteen!

Raina got her foot unbandaged for the last time last night! Her x-rays are clean. The only damage to her paw was a pretty serious abrasion this last week where the cast had rubbed. It wasn't so deep as to cause infection, but we are keeping an eye on it. Two more weeks of leashed walks (of increasing length), then we should be back to normal.

Again, thanks to all for your responses. I am so happy that my girl is all healed up properly.
posted by msali at 5:44 AM on September 18, 2010


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