Lacerations of the heels or palmar/plantar pastern in horses can result from overreaching with the hindfeet or from trauma due to contact with objects (metal sheeting, wire fence, etc). These lacerations range from superficial (just through the skin) to a depth at which bone, synovial structures, or tendons or ligaments are affected.
Depending on the extent of the wound medially or laterally, the palmar digital neurovascular bundle may also be involved in heel bulb lacerations. Thorough probing of the wound is indicated, as well as centesis of synovial structures that are in close proximity, which can include the distal interphalangeal joint (DIP joint, or coffin joint), proximal interphalangeal (pastern) joint, navicular bursa, and digital flexor tendon sheath. Involved synovial structures should be treated like any septic synovial structure.
Because there is excess skin motion in the heel bulbs, if the wound is left open to heal by second intention and bandaging, the healing can be slow and excessive granulation tissue (proud flesh) can develop. Suture repairs are also prone to dehisce because of this excess skin motion.
Placing the horse in a foot cast (up to the level of the distal aspect of the fetlock joint) for 2–3 weeks is recommended for any full-thickness heel bulb laceration and generally results in a good outcome.
