Interesting foot x-rays for additional interpretation, anyone?

[AzDuck]

Hi Everyone

Instead of typing out a long-winded story, I'll just bullet point the major happenings with my girl "Farrah" and her mystery foot ailment.
-First noticed in June of this year
-Originally thought it was bumblefoot and treated her with TMS suspension.
-Swelling actually began to increase, and bumble was ruled out after no lesions expanded nor appeared. She had, however, lost weight and become feverish
-An "exploratory surgery" was done to try and isolate a possible foreign body after the first set of rads looked suspicious to my friend (a vet), who brought her portable machine over
-While applying pressure on one of the incisions I made to her foot, a large amount of whitish purulent material was released
-She was started on a 14-day course of Baytril 100mg/mL; 0.18mL PO: SID (injected by syringe into nightcrawlers for additional protein) and left relatively open for the duration of healing.
-A month went by and she was limping far less severely, had gained weight back, and seemed to be feeling just fine. She was however still gimpy, so I called my friend back out for follow up rads or another "surgery"
-Upon exam vet found what she thought to be a complete separation of the medial digit of the foot where it attaches to the tarsometatarsal
-After follow-ups rads (*attached to this post*) it was apparent that the medial digit is basically "floating" and the joint has been obliterated (my guess is from some form of osteomyelitis during the first flare-up of symptoms). On days she seems "extra limpy"

I am now faced with the following options:

-Leave it be, let her learn how to balance and walk without the use of that inner digit. I want to do this, as I want to make sure she is as comfortable as a can. She does not appear painful on palpitation of the area and its surrounding tissues. My friend noted that even with surgery, she will always have that little hitch in her giddyup just due to the mechanics of their legs. I have meloxicam suspension at my house if she seems painful.

-Operate. Do a relatively simple amputation of the medial digit (sedated though of course). I say "simple" because it is already free-floating in the foot. I worry about stress and post-surgical infection though.

Thank you all so much!

Ashley

 

[TheOddOneOut]

Poor girl!

 

[Daphne_loves_mealworms]

I think I’m on team “let it be” as long as everything seems quiet. I think that having that digit, as imperfect as it is, would still help with balance. I don’t think the risk of additional sedation or full general anesthesia + the additional trauma of amputation would be worth it at this point. However, is there still swelling around the joint? Was a culture ever done?

 

[HollowOfWisps]

If it still swells up at times, causes a medium-high amount of pain or is an infection risk I would amputate. I don't think it's fair if she is in extreme pain (even with pain meds) or if there is a risk of another infection to just let her be. I think it would be easier to prevent a post-surgery infection then another one spring up on you from letting it be. However, If there is no risk of further infection, it does not swell and it causes minimal pain I would let her be.

 

[AzDuck]

Poor girl!

I know! All my duckies are my life, and I just wish I knew what she did so I could eliminate the chance of another one of them doing it. I work so hard to “risk-proof” their personal yard and pools, but apparently not well enough

 

[AzDuck]

I think I’m on team “let it be” as long as everything seems quiet. I think that having that digit, as imperfect as it is, would still help with balance. I don’t think the risk of additional sedation or full general anesthesia + the additional trauma of amputation would be worth it at this point. However, is there still swelling around the joint? Was a culture ever done?

Thank you I’m all about avoiding anesthesia and additional trauma at all costs, and have also wondered if the digit itself is offering additional stability. I’m going to have one of the small animal vets I work with call a radiologist friend of hers and see if he has any insight. I’m willing to do whatever will help her the most in the long run. She has such a fighting spirit and is so sassy and special to me.

 

[AzDuck]

If it still swells up at times, causes a medium-high amount of pain or is an infection risk I would amputate. I don't think it's fair if she is in extreme pain (even with pain meds) or if there is a risk of another infection to just let her be. I think it would be easier to prevent a post-surgery infection then another one spring up on you from letting it be. However, If there is no risk of further infection, it does not swell and it causes minimal pain I would let her be.

The severe soft tissue swelling that was present in the July radiograph I included in the photo set above (the V/D view labeled “farrahjuly”) has luckily not returned since releasing that pus and treating with the course of enrofloxacin. Her limping was also WAY decreased for a few weeks up until yesterday. I’m hoping it is just an acute onset from her jumping out of the pool in a weird way or running around too much.
That being said, I think I’ll see if the NSAIDs help her, and if they do, I’ll know it is a painful situation and look towards going forward with the amputation

Thank you for your input. Sometimes I just need the reassurance that I’m doing what I can and am not way off base.