Editorial Type:
Musculoskeletal System

Effects of intrabursal administration of botulinum toxin type B on lameness in horses with degenerative injury to the podotrochlear apparatus

Santiago D. Gutierrez-Nibeyro Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802.

Search for other papers by Santiago D. Gutierrez-Nibeyro in
Current site
Google Scholar
PubMed Close
 DVM, MS
,
Marcos P. Santos Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802.

Search for other papers by Marcos P. Santos in
Current site
Google Scholar
PubMed Close
 DVM
,
Nathaniel A. White II Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Leesburg, VA 20177.

Search for other papers by Nathaniel A. White II in
Current site
Google Scholar
PubMed Close
 DVM, MS
,
James A. Brown Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Leesburg, VA 20177.

Search for other papers by James A. Brown in
Current site
Google Scholar
PubMed Close
 BVSc, MS
,
M. Norris Adams Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Leesburg, VA 20177.

Search for other papers by M. Norris Adams in
Current site
Google Scholar
PubMed Close
 DVM
,
Alexia L. McKnight McKnight Insight LLC, 258 Heyburn Rd, Chadds Ford, PA 19317.

Search for other papers by Alexia L. McKnight in
Current site
Google Scholar
PubMed Close
 DVM
, and
David J. Schaeffer Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802.

Search for other papers by David J. Schaeffer in
Current site
Google Scholar
PubMed Close
 PhD
DOI:
https://doi.org/10.2460/ajvr.75.3.282
Volume/Issue:
Volume 75: Issue 3
Online Publication Date:
01 Mar 2014
Restricted access
Sign In Reprints and Permissions Purchase Article

Abstract

Objective—To determine the safety and short-term efficacy of intrabursal administration of botulinum toxin type B (BTXB) to alleviate lameness in horses with degenerative injury to the podotrochlear apparatus (PA).

Animals—10 Quarter Horses with degenerative injury to the PA.

Procedures—Degenerative injury to the PA was confirmed with diagnostic analgesia and imaging. Then, BTXB (3.8 to 4.5 U/kg) was injected into the podotrochlear (navicular) bursa of each horse. Three horses were used in a safety evaluation. Subsequently, video recordings of lameness evaluations were obtained for 7 client-owned horses 5 days before (baseline) and 7 and 14 days after BTXB treatment and used to determine the effect of BTXB injection on lameness; 1 horse was removed from the study 8 days after BTXB treatment. Three investigators who were unaware of the treated forelimbs or time points separately reviewed the recordings and graded the lameness of both forelimbs of the horses.

Results—Improvement in lameness of the treated forelimbs was detected at 1 or both time points after BTXB administration in all horses. However, all horses had some degree of lameness at the end of the study. Two horses developed transient increases in lameness 48 to 72 hours after treatment; lameness resolved uneventfully.

Conclusions and Clinical Relevance—Intrabursal injection of BTXB temporarily alleviated chronic lameness in horses with degenerative injury to the PA, without causing serious short-term adverse effects. Further investigation into the potential use of BTXB in horses affected by degenerative injury to the PA is warranted.

Abstract

Objective—To determine the safety and short-term efficacy of intrabursal administration of botulinum toxin type B (BTXB) to alleviate lameness in horses with degenerative injury to the podotrochlear apparatus (PA).

Animals—10 Quarter Horses with degenerative injury to the PA.

Procedures—Degenerative injury to the PA was confirmed with diagnostic analgesia and imaging. Then, BTXB (3.8 to 4.5 U/kg) was injected into the podotrochlear (navicular) bursa of each horse. Three horses were used in a safety evaluation. Subsequently, video recordings of lameness evaluations were obtained for 7 client-owned horses 5 days before (baseline) and 7 and 14 days after BTXB treatment and used to determine the effect of BTXB injection on lameness; 1 horse was removed from the study 8 days after BTXB treatment. Three investigators who were unaware of the treated forelimbs or time points separately reviewed the recordings and graded the lameness of both forelimbs of the horses.

Results—Improvement in lameness of the treated forelimbs was detected at 1 or both time points after BTXB administration in all horses. However, all horses had some degree of lameness at the end of the study. Two horses developed transient increases in lameness 48 to 72 hours after treatment; lameness resolved uneventfully.

Conclusions and Clinical Relevance—Intrabursal injection of BTXB temporarily alleviated chronic lameness in horses with degenerative injury to the PA, without causing serious short-term adverse effects. Further investigation into the potential use of BTXB in horses affected by degenerative injury to the PA is warranted.

Contributor Notes

Supported in part by Solstice Neurosciences LLC.

The authors thank Steve Sermersheim, Dr. Sushmitha Durgam, and Dr. Isabella Horn for technical assistance.

Address correspondence to Dr. Gutierrez-Nibeyro (sgn@illinois.edu).
Cover American Journal of Veterinary Research
American Journal of Veterinary Research
Publication Date:
01 Mar 2014

  • 1. Baxter GM, Stashak TS, Belknap JK, et al. Navicular disease/syndrome. In: Baxter GM, ed. Adams and Stashak's lameness in horses. 6th ed. Hoboken, NJ: Wiley-Blackwell, 2011; 475–491.

    • Search Google Scholar
    • Export Citation

  • 2. Dyson SJ, Murray RC, Schramme MC, et al. Current concepts of navicular disease. Equine Vet Educ 2011; 23: 27–39.

  • 3. Pleasant RS, Baker GJ, Foreman JH, et al. Intraosseous pressure and pathologic changes in horses with navicular disease. Am J Vet Res 1993; 54: 7–12.

    • Search Google Scholar
    • Export Citation

  • 4. Dyson SJ, Murray RC, Schramme MC. Lameness associated with foot pain: results of magnetic resonance imaging in 199 horses (January 2001–December 2003) and response to treatment. Equine Vet J 2005; 37: 113–121.

    • Search Google Scholar
    • Export Citation

  • 5. Sampson SN, Schneider RK, Gavin PR, et al. Magnetic resonance imaging findings in horses with recent onset navicular syndrome but without radiographic abnormalities. Vet Radiol Ultrasound 2009; 50: 339–346.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 6. Bowker RM, Rockershouser SJ, Linder K, et al. A silver-impregnation and immunocytochemical study of innervation of the distal sesamoid bone and its suspensory ligaments in the horse. Equine Vet J 1994; 26: 212–219.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 7. Bowker RM, Linder K, Sonea IM, et al. Sensory innervation of the navicular bone and bursa in the foal. Equine Vet J 1995; 27: 60–65.

  • 8. Bowker RM, Linder K, Van Wulfen K, et al. Anatomy of the distal interphalangeal joint of the mature horse: relationships with navicular suspensory ligaments, sensory nerves and neurovascular bundle. Equine Vet J 1997; 29: 126–135.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 9. Bowker RM. Innervation of the equine foot: its importance to the horse and to the clinician. In: Floyd AE, Mansmann RA, eds. Equine podiatry. St Louis: WB Saunders Co, 2007; 74–89.

    • Search Google Scholar
    • Export Citation

  • 10. Dressler D. Clinical applications of botulinum toxin. Curr Opin Microbiol 2012; 15: 325–336.

  • 11. Costa J, Espirito-Santo C, Borges A, et al. Botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev 2009; 1: 1–25.

  • 12. Wong SM, Hui AC, Tong PY, et al. Treatment of lateral epicondylitis with botulinum toxin: a randomised, double-blind, placebo-controlled trial. Ann Intern Med 2005; 143: 793–797.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 13. Babcock MS, Foster L, Pasquina P, et al. Treatment of pain attributed to plantar fasciitis with botulinum toxin A: a short-term, randomised, placebo-controlled, double-blind study. Am J Phys Med Rehabil 2005; 84: 649–654.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 14. Singh JA, Mahowald ML, Noorbaloochi S. Intra-articular botulinum toxin A for refractory shoulder pain: a randomized, double-blinded, placebo-controlled trial. Transl Res 2009; 153: 205–216.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 15. Anderson S, Krug H, Dorman C, et al. Analgesic effects of intra-articular botulinum toxin type B in a murine model of chronic degenerative knee arthritis pain. J Pain Res 2010; 3: 161–168.

    • Search Google Scholar
    • Export Citation

  • 16. Krug HE, Frizelle S, McGarraugh P, et al. Pain behavior measures to quantitate joint pain and response to neurotoxin treatment in murine models of arthritis. Pain Med 2009; 10: 1218–1228.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 17. Cui M, Khanijou S, Rubino J, et al. Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain 2004; 107: 125–133.

  • 18. Hadley HS, Wheeler JL, Petersen SW. Effects of intra-articular botulinum toxin type A (Botox) in dogs with chronic osteoarthritis. Vet Comp Orthop Traumatol 2010; 23: 254–258.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 19. Huang PP, Khan I, Suhail MS, et al. Spinal botulinum neurotoxin B: effects on afferent transmitter release and nociceptive processing. PLoS One 2011; 6: 1–14.

    • Search Google Scholar
    • Export Citation

  • 20. Ishikawa H, Mitsui Y, Yoshitomi T, et al. Presynaptic effects of botulinum toxin type A on the neuronally evoked response of albino and pigmented rabbit iris sphincter and dilator muscles. Jpn J Ophthalmol 2000; 44: 106–109.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 21. Singh JA. Botulinum toxin therapy for osteoarticular pain: an evidence-based review. Ther Adv Musculoskelet Dis 2010; 2: 105–118.

  • 22. Seyler TM, Smith BP, Marker DR, et al. Botulinum neurotoxin as a therapeutic modality in orthopaedic surgery: more than twenty years of experience. J Bone Joint Surg Am 2008; 90: 133–145.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 23. Lew MF. Review of the FDA-approved uses of botulinum toxins, including data suggesting efficacy in pain reduction. Clin J Pain 2002; 18:S142–S146.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 24. Jeynes LC, Gauci CA. Evidence for the use of botulinum toxin in the chronic pain setting—a review of the literature. Pain Pract 2008; 8: 269–276.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 25. Carter DW, Renfroe JB. A novel approach to the treatment and prevention of laminitis: botulinum toxin type A for the treatment of laminitis. J Equine Vet Sci 2009; 29: 595–600.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 26. Wijnberg ID, Schrama SE, Elgersma AE, et al. Quantification of surface EMG signals to monitor the effect of a Botox treatment in six healthy ponies and two horses with stringhalt: preliminary study. Equine Vet J 2009; 41: 313–318.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 27. DePuy T, Howard RD, Keegan KG, et al. Effects of intra-articular botulinum toxin type A in an equine model of acute synovitis: a pilot study. Am J Phys Med Rehabil 2007; 86: 777–783.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 28. Adam-Castrillo D, White NA II, Donaldson LL, et al. Effects of injection of botulinum toxin type B into the external anal sphincter on anal pressure of horses. Am J Vet Res 2004; 65: 26–30.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 29. Lee JH, Lee SH, Song SH. Clinical effectiveness of botulinum toxin type B in the treatment of subacromial bursitis or shoulder impingement syndrome. Clin J Pain 2011; 27: 523–528.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 30. Dyson SJ. Radiological interpretation of the navicular bone. Equine Vet Educ 2011; 23: 73–87.

  • 31. Busoni V, Heimann M, Trenteseaux J, et al. Magnetic resonance imaging findings in the equine deep digital flexor tendon and distal sesamoid bone in advanced navicular disease—an ex vivo study. Vet Radiol Ultrasound 2005; 46: 279–286.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 32. Sherlock C, Mair T, Blunden T. Deep erosions of the palmar aspect of the navicular bone diagnosed by standing magnetic resonance imaging. Equine Vet J 2008; 40: 684–692.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 33. Ross MW. Movement. In: Ross MW, Dyson SJ, eds. Diagnosis and management of lameness in the horse. 2nd ed. St Louis: Elsevier-Saunders, 2011; 64–80.

    • Search Google Scholar
    • Export Citation

  • 34. Definition and classification of lameness. Guide for veterinary service and judging of equestrian events, in Proceedings. Am Assoc Equine Pract 37th Annu Conv 1991;19.

    • Search Google Scholar
    • Export Citation

  • 35. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.

  • 36. Bassage LH II, Ross MW. Diagnostic analgesia. In: Ross MW, Dyson SJ, eds. Diagnosis and management of lameness in the horse. 2nd ed. St Louis: WB Saunders Co, 2011; 100–135.

    • Search Google Scholar
    • Export Citation

  • 37. Aoki KR. A comparison of the safety margins of botulinum neurotoxin serotypes A, B, and F in mice. Toxicon 2001; 39: 1815–1820.

  • 38. Hsu TS, Dover JS, Arndt KA. Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol 2004; 140: 1351–1354.

    • Search Google Scholar
    • Export Citation

  • 39. Mahowald ML, Krug HE, Singh JA, et al. Intra-articular botulinum toxin type A: a new approach to treat arthritis joint pain. Toxicon 2009; 54: 658–667.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 40. Bertone AL. Noninfectious arthritis. In: Ross MW, Dyson SJ, eds. Diagnosis and management of lameness in the horse. 2nd ed. St Louis: WB Saunders Co, 2011; 687–688.

    • Search Google Scholar
    • Export Citation

  • 41. Schoonover M, Jann H, Blaik M. Quantitative comparison of three commonly used treatments for navicular syndrome in horses. Am J Vet Res 2005; 66: 1247–1251.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 42. Bell CD, Howard RD, Taylor DS, et al. Outcomes of podotrochlear (navicular) bursa injections for signs of foot pain in horses evaluated via magnetic resonance imaging: 23 cases (2005–2007). J Am Vet Med Assoc 2009; 234: 920–925.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 43. Gutierrez-Nibeyro SD, White NA II, Werpy NM. Outcome of medical treatment for horses with foot pain: 56 cases. Equine Vet J 2010; 42: 680–685.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 44. Denoix JM, Thibaud D, Riccio B. Tiludronate as a new therapeutic agent in the treatment of navicular disease: a double-blind placebo-controlled clinical trial. Equine Vet J 2003; 35: 407–413.

    • Search Google Scholar
    • Export Citation

  • 45. Smith MR, Wright IM. Endoscopic evaluation of the navicular bursa: observations, treatment and outcome in 92 cases with identified pathology. Equine Vet J 2012; 44: 339–345.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 46. Holowinski ME, Solano M, Maranda L, et al. Magnetic resonance imaging of navicular bursa adhesions. Vet Radiol Ultrasound 2012; 53: 566–572.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 47. Maher O, Davis DM, Drake C, et al. Pull-through technique for palmar digital neurectomy: 41 horses (1998–2004). Vet Surg 2008; 37: 87–93.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 48. Jackman BR, Baxter GM, Doran RE, et al. Palmar digital neurectomy in horses: 57 cases (1984–1990). Vet Surg 1993; 22: 285–288.

  • 49. Keegan KG, Dent EV, Wilson DA, et al. Repeatability of subjective evaluation of lameness in horses. Equine Vet J 2010; 42: 92–97.

  • 50. Fuller CJ, Bladon BM, Driver AJ, et al. The intra- and inter-assessor reliability of measurement of functional outcome by lameness scoring in horses. Vet J 2006; 171: 281–286.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 51. Keegan KG. Mechanisms of objective lameness analysis, in Proceedings. 2009 Am Coll Vet Surg Vet Symp 2009;109–112.

  • 52. Dressler D, Adib Saberi F. Botulinum toxin: mechanisms of action. Eur Neurol 2005; 53: 3–9.

Advertisement