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Lameness involving the distal limb usually has a traumatic origin. Most often, acute and severe lameness can be attributed to a severe concussive force, entanglement or entrapment of the lower limb within a fence or handling device, or foreign body penetration of the skin with invasion of deeper structures. Young cattle are predisposed to joint sepsis due to hematogenous spread of bacteria from the umbilicus, digestive tract, or lungs in times of general immune compromise [11].

Joint sepsis often presents as severe lameness of several days' duration. Many cases will not respond to broad‐spectrum antibiotics administered by the owner. The animal will have an elevated heart rate and usually an elevated rectal temperature. Thorough examination should be performed under appropriate restraint, preferably on a hydraulic tilt table. Radiographs should be performed to detect any concurrent fractures. Both systemic and local antibiotics via vascular perfusion should be administered. In severe cases, joint lavage must be considered. In these cases, it may be difficult to lavage the joint space due to fibrin accumulation within the joint. Fibrin deposition seems to increase with subsequent flushes, and in those cases that are slow to respond to treatment, arthrotomy or arthroscopic surgery may be the only option to remove the fibrin deposits from the joint. Surgical drain placement is not advised due to the risk of contamination even with proper bandaging. In cases where there are financial constraints and osteomyelitis is already present, aggressive curettage of the area may be the only alternative. Active lavage can be incorporated with sterile bandaging to provide continued protection, although compression bandaging may suppress desired drainage [12]. When there is marked reduction in exudate coming from surgical wounds, polymethyl methacrylate (PMMA) beads impregnated with an appropriate antibiotic might be considered for placement in the remaining joint space. When the beads are used, the goal is joint ankylosis, which cattle seem to take well. When wounds no longer need attention, it is best to immobilize the limb in a cast, with consideration to using transfixation pins. Cattle tolerate the process well as long as a support bandage protects the contralateral limb. Due to the expense of these procedures, clients may only elect to have these procedures done for cattle with high economic or emotional value.

Figure 16.19 Sole view of interdigital fibroma. Notice the ulceration that has occurred due to contact with the ground.

Sequestra should be surgically removed. Most often, these occur on the lateral aspect of the metatarsus and are directly related to trauma from kicking a hard object like a gate or post or entrapment of the limb within a confined space (Figure 16.20). On presentation, most cattle with a sequestrum will have an associated draining tract. Surgical removal can be performed under vascular anesthesia and sedation while the animal is restrained in lateral recumbency unless there is extensive bony proliferation that should also be removed, in which case general anesthesia should be considered. A surgical drain should always be incorporated in the closure, as there is virtually no way to close the entire dead space after removal of the sequestrum. The drain should be removed four to five days after surgery and recovery may take up to two weeks.

Figure 16.20 Sequestrum formation of the lateral cortex of MTIII in a yearling.

Sepsis of the superficial and/or deep digital flexor tendon is usually due to traumatic injury (laceration of the caudal pastern or heel bulb area) or due to extension of deep infection from a chronic hoof rot lesion. Parenteral antibiotics alone will not resolve this problem; surgical drainage is performed and a drain placed from the pastern, through the tendon sheath and above the dewclaw. Extensive and chronic sepsis may require complete resection of the superficial and deep flexor tendons, after which partial closure with packing and drain placement is a must. Active or passive lavage may be provided, with several bandage changes required to resolve the issue. The drain should be removed in five to seven days. Apply a hoof block to the non‐affected claw and cast the limb to the carpus or tarsus to alleviate pain and allow better ambulation. After four weeks the cast may be removed. Some deep digital flexor tendons may spontaneously rupture after treatment, which will cause the patient to walk on the heel bulb.