What is ‘pus in the foot’?

Infection in the foot is by far, the most common cause of acute (sudden), single-leg lameness in the horse. Infection results in painful inflammation and pus (abscess) formation. The hoof is a relatively rigid structure and abscess increases pressure within the sensitive structures, which, like infection or bruise under a human finger nail, is very painful. This condition should be excluded first, in all horses who become suddenly lame on one leg, before other diagnoses are considered.

What causes ‘pus in the foot’?

Infections are caused by one or more of the many types of bacteria which normally live in the environment or on the foot. Infection is introduced most commonly through the sole of the horse’s foot, by a bruise or puncture wound to the sole, by a nail ‘bind’ or ‘prick’ at shoeing, through a hoof crack or by tracking through the white line.

How is ‘pus in the foot’ diagnosed?

Characteristically, lameness develops suddenly, from slight to severe, over 24-48 hours, involving one leg only. When the pain is severe, the horse may sweat and blow and refuse to bear weight on the affected foot. The foot may feel warm and the pulse in the heel blood vessels (digital pulses) may bound.

The shoe should be removed from the affected foot to allow thorough investigation and treatment. A discrete area of pain on the sole can usually be found with hoof testers or sometimes even finger pressure (the horse pulls the foot away in obvious pain).

When the shoe has been removed and the sole cleaned and searched, there may be signs of a puncture wound, crack or area of discoloration at the white line, corresponding to the area of pain. Pressure from hoof testers may cause pus to ooze from the wound. Further searching with a hoof knife usually results in an ooze or spurt of pus and/or gas from the abscess, initially painful but subsequently resulting in dramatic improvement.

Where the abscess cannot be located immediately, the foot should be poulticed overnight, to help the abscess to ‘ripen’ and the foot to soften, before trying again to find the abscess. If the abscess still cannot be found, a radiographic (x-ray) examination of the foot may be made to look for a pocket of pus/gas and to rule out other possibilities, e.g. fractures of the bones in the foot.

Occasionally, in deeper-seated abscesses, the infection may track upwards through the hoof laminae to eventually break out at the coronary band, rather than at the solar surface of the foot. In other cases, infection may track along under the sole ('under-run sole').

How can ‘pus in the foot’ be treated?

As soon as the site of pain is accurately established with hoof testers, the sole should be searched with a hoof knife to locate the abscess (signified by an ooze or spurt of pus and/or gas) and then pared away over the abscess to allow efficient drainage. The hole can be flushed with hydrogen peroxide and/or an antibiotic solution or foot spray and then the foot should be poulticed for 24-48 hours to encourage thorough drainage of pus through the hole.

Tetanus antitoxin must be given, if the horse is not fully vaccinated up to date or if vaccination status cannot be confirmed.

Once the horse is much more comfortable and there is no more drainage of pus, the empty hole is treated with an antibiotic foot spray and the foot is dry bandaged for a further 24-48 hours. The hole is then packed with cotton wool soaked in an antibiotic foot spray until it has healed.

In some more extensive cases, further flushing of the abscess cavity may be necessary over the next 2-3 days.

The horse should be kept in clean dry conditions until the hole is completely healed and then the foot may be re-shod.

How can ‘pus in the foot’ be prevented?

You should pick out and examine your horses’ feet every day. Make sure that your horses' feet are regularly trimmed and shod, by a competent farrier, to prevent hoof cracks.

Treat all puncture wounds, either nail pricks or other accidental injuries, by cleaning them and applying an antibiotic foot spray and poulticing, where necessary, without delay.

Always call your veterinary surgeon to investigate lameness during their early stages, to try to prevent complications such as under-run sole and tracking to the coronary band.

Caution

Make sure that your horses are always fully vaccinated against tetanus, an invariably fatal infection which can gain access through hoof injuries.

The degree of lameness should improve rapidly within 12-24 hours after the abscess is opened and the pus is drained. If this is not the case there may be a more serious problem, requiring more extensive investigations.