Episode 23 - Pododermatitis Paw-dcast (Ursula Mayer)

Pododermatitis Paw-dcast Show Notes

(00:00) John introduces the podcast and Sue introduces Ursula Mayer – the guest on the show.

Chapter 1 - Paw-sibilities – introduction to pododermatitis.

(02:21) John invites Ursula to introduce herself. Ursula discusses her background and passion for pododermatitis, its prevalence, and its impact on dogs' quality of life.

(03:33) When asked to define pododermatitis, Ursula explains that it's inflammation of the paw skin, with a particular emphasis on chronic cases, known as C-PIF. She discusses the various signs to look out for, such as excessive licking, lameness, and specific changes in paw appearance as the condition progresses.

(05:31) Sue talks about the complexity of pododermatitis, and Ursula draws parallels with chronic otitis in terms of the multifaceted factors involved. She emphasises the importance of considering predisposing factors, primary causes including orthopaedic issues, secondary influences, and perpetuating factors in diagnosing and managing the condition effectively.

Chapter 2 - Paw-sibilities - Orthopaedic Influences and Breed Predispositions

(06:57) Sue asks Ursula to explain how orthopaedic diseases can contribute to pododermatitis in dogs. Ursula explains that pain from orthopaedic conditions alters weight bearing, causing dogs to adjust their stance and potentially rub their paws together, leading to inflammation and abnormal walking patterns. She goes on to discuss specific orthopaedic diseases, including elbow dysplasia, hip dysplasia, and arthritis affecting joints such as toes, carpus, tarsus, elbows, hips, and the back. These conditions can disrupt normal weight distribution and contribute to the development of pododermatitis.

(08:35) Sue further illustrates with an example and Ursula emphasizes the importance of referring chronic cases to orthopaedic specialists for thorough examinations and imaging. She acknowledges the complexity of diagnosing older dogs with multiple affected areas, stressing the need for integrated care across disciplines to effectively manage pododermatitis.

(09:56) John asks if this is just dogs and Ursula confirms that while cats can also suffer from pododermatitis, the chronic form discussed, known as C-PIF, predominantly affects dogs and not cats. John then asks about breed predispositions, particularly in relation to posture-related issues in Labradors. Ursula elaborates that certain breeds, notably larger and heavier ones like bulldogs, French bulldogs, and pugs, are commonly affected. Labradors and Golden Retrievers also constitute a significant portion of cases. The characteristics such as short, bristly coats and broad, flat paws, may contribute to their susceptibility to the condition. Ursula notes that even without orthopaedic diseases, these breeds' anatomical traits appear to play a role in the development of pododermatitis.

(12:20) Sue reflects on a study involving bulldogs walking on pressure plates, noting that those without interdigital lesions tended to walk more upright. She emphasises that dogs with flatter feet and heavier builds are more prone to issues due to their posture, suggesting a correlation between anatomical features and pododermatitis. She further discusses how these factors influence investigation and treatment approaches. Ursula agrees, highlighting the significant role of allergies alongside orthopaedic diseases in pododermatitis cases. She notes the complexity in distinguishing between underlying orthopaedic conditions and inherent anatomical predispositions in certain breeds. Ursula shares a case involving a dog initially treated for allergies, later developing orthopaedic issues that exacerbated pododermatitis, illustrating the interplay between these factors.

(14:47) Sue outlines the investigative process, starting with a comprehensive history and dermatological examination, incorporating orthopaedic evaluations based on findings. Ursula explains her approach, emphasising the importance of ruling out issues, particularly Demodex, through rigorous testing methods. She discusses predisposing factors such as weight and breed characteristics, and systematically examines for primary diseases like allergies, orthopaedic issues, and endocrine disorders. Ursula stresses the need to assess secondary infections and carefully inspect paw conditions, especially ventrally, to identify specific dermatological and orthopaedic indicators.

Chapter 3 – Paws-itive outcomes - Diagnostic and Treatment Approaches

(18:24) Sue asks about infection management in pododermatitis cases. Ursula explains that for superficial cases of pododermatitis, she primarily employs topical treatments. However, in chronic cases where deep pyoderma is present, systemic antibiotics are often necessary. She emphasises the importance of not relying solely on antibiotics without addressing underlying factors, as this can lead to recurring infections and antibiotic resistance. In deciding whether to use systemic antibiotics, Ursula considers the overall treatment plan. If surgery such as laser therapy is planned, she may opt against systemic antibiotics. For cases where medical therapy alone may suffice, she stresses the need for culture and sensitivity testing to target treatment effectively and minimise antibiotic use.

(20:17) John questions Ursula about the approach to treating infections and determining underlying causes simultaneously. Ursula explains her concurrent approach, emphasising the urgency in addressing both infections and underlying conditions early on to improve the dog's quality of life.

(22:17) Sue asks about anti-inflammatory therapy options in pododermatitis and the efficacy of non-steroidal anti-inflammatories (NSAIDs) versus steroids, cyclosporine, tacrolimus, and anti-pruritic drugs like oclacitinib and lokivetmab.. Ursula details her approach, highlighting the need for potent anti-inflammatory agents in severe cases of pododermatitis. She explains that while drugs like oclacitinib can alleviate itching, they may not sufficiently address inflammation. For cases requiring robust anti-inflammatory action, Ursula often starts with systemic steroids and cyclosporine simultaneously, gradually tapering off steroids once cyclosporine takes full effect. She stresses the challenges and side effects associated with long-term steroid use, advocating for cyclosporine as a viable long-term treatment despite its delayed onset of action. Ursula discusses transitioning to topical therapies like tacrolimus or non-thinning glucocorticoids as conditions improve, aiming to minimise reliance on systemic medications over time.

(25:16) Sue asks about the complexities faced by Ursula when treating animals with multiple conditions. Ursula acknowledges the multifaceted nature of these cases, stressing the importance of weight management as a foundational step due to its lack of side effects. She emphasises the need for collaboration with orthopaedic specialists to address underlying orthopaedic diseases like elbow dysplasia early on. For pain relief and inflammation management in the feet, Ursula initially uses systemic steroids and cyclosporine, with a cautious approach to long-term steroid use.

(27:05) Sue asks about prioritising orthopaedic surgery to correct primary causes like ununited coronoid process before addressing pododermatitis. Ursula acknowledges this strategy, noting that while surgery can eliminate chronic factors perpetuating pododermatitis, the outcomes vary depending on the case's severity and the owner's preferences. She explains that surgical intervention in the paws may provide faster relief, especially when orthopaedic conditions are severe. However, she also highlights the challenge of reversing long-standing paw conditions even after correcting the primary cause. Ursula emphasises the importance of timing and individualised treatment plans tailored to each patient's specific needs and responses.

(29:14) John enquires about the feasibility of surgical procedures for pododermatitis in general practice versus referral settings. Ursula explains that surgical suitability depends on the general practitioner's expertise in dermatology, orthopaedics, and surgical techniques. For interdigital web surgery using traditional methods, like cold steel, she mentions the challenge of post-operative management due to necessary rigid bandaging. She contrasts this with CO2 laser surgery, highlighting its advantages such as reduced bleeding, pain, and swelling post-surgery due to sealed lymphatic and blood vessels and nerve endings. Ursula notes that CO2 lasers offer precise, fine-tuned tissue removal while preserving healthy dorsal skin, promoting healing by second intention without sutures. This approach aims to restore normal paw anatomy, crucial for long-term health. Ursula cautions against using diode lasers due to their higher collateral heat damage potential, unsuitable for delicate pododermatitis cases requiring precise tissue control.

(33:49) Sue summarises the distinctions between podoplasty and CO2 laser techniques: podoplasty involves excising interdigital tissue and suturing toes, whereas CO2 laser surgery delicately removes scar tissue and abnormal follicles, crucial for preventing recurrent infections. Ursula elaborates on using CO2 lasers in both painting and cutting modes depending on tissue conditions, emphasising its efficacy in restoring paw health through precise, controlled tissue removal.

(35:03) John concludes the discussion and Ursula emphasises the significance of regular examination of paw pads, especially in predisposed breeds or suspected allergic patients, urging veterinary professionals to involve owners in observing early signs like erythema. She stresses the value of early referral when cases become challenging, highlighting proactive management as key.

(37:52) Sue and John wrap up with their thoughts on this month’s guest, before John asks the team a question that’s been bugging him all episode…