Pododermatitis AKA Bumblefoot

By Jessie Collins

What is it: Inflammatory, infectious or degenerative condition of the foot. Can range from mild swelling and redness to ulceration and potentially cellulitis (bacterial infection underneath the skin) and osteomyelitis (inflammation of bone caused by infection).

Systems Affected: Typically begins as a disorder of the skin, but can progress to affect all of the anatomic structures of the feet.

Genetic: Pododermatitis is not genetic

Species – Age – Gender: Chickens (especially heavy body breeds), waterfowl; all ages are susceptible; both sexes – males possibly more due to increased body weight.

Signs: Pododermatitis can assume a variety of presentations depending on the inciting cause and chronicity. There are three classification levels of Pododermatitis:

• Type I dermatitis – lesions are mild, localized and characterized as either degenerative or proliferative.
  • Degenerative – normal pebbled skin on the plantar surface becomes smooth and thin.
  • Proliferative – hyperkeratosis occurs resulting in “corns” and cracking on the plantar surface.
• Type II dermatitis – bacteria or fungal infections begin often with noticeable inflammation of the toes and feet.
  • Staphyloccocus aureus, Eschericia coli, Pseudemonas spp. and sometimes yeast and fungi.
• Type III dermatitis – changes are typically chronic, infected and involve deeper soft and bony tissues of the foot.

In chronic cases, a static condition can develop in which heavy eschar (dry, dark scab) develops over an ulcer on the plantar surface. Over time fibrous connective tissue can develop under the eschar which may eventually cause significant discomfort and lameness.

Joint effusion and abscessation of soft tissues and joints may also be encountered.

Causes:

1. Acute and chronic trauma – lacerations, puncture wounds and abrasions
2. Poor hygiene – wet/dirty substrate
3. Roosting bars – wrong size, shape or too high
4. Constant contact with hard surfaces
5. Abnormal wear on weight bearing surfaces – obesity, degenerative joint disease, injured legs, etc.
6. Malnourished (hypovitaminosis A)
7. Inactivity

Traumatic injuries to the feet and limbs can create portals for ingress of infective organisms resulting in bumblefoot. Common for bumblefoot to develop in the contralateral foot from the injury.

Diagnosis:

1. Physical exam
2. CBC often shows signs of inflammation
3. Chemistry panel to indicate organ function – amyloidosis (build up of amyloid proteins in the heart, kidneys, liver and other organs) as consequence of chronic bumblefoot.
4. Fine-needle aspiration and impression smears for cytology and culture/sensitivity
5. Biopsies and histology – especially in cases that are proliferative and/or do not respond to treatment as expected.
6. Various imaging diagnostics
7. PCR

Dermatitis, cellulitis, tenosynovitis (inflammation of the tendon sheath), osteomyelitis , and vasculitis with thrombosis are commonly found in bumblefoot cases. Lack of adequate vascular supply dramatically lowers the ability to recover and resolve bumblefoot.

Treatment: Correction of husbandry deficiencies and other predisposing factors is critical.

In mild cases, correction of these may be enough for resolution.

Mild cases where the plantar skin is still intact, protective bandaging and pain medications may be sufficient to reverse the process and allow the skin to heal.

More severe cases where ulceration, abscessation and necrotic tissue are present, surgical debridement is necessary. Debridement needs to be precise and delicate to preserve vital structures.

Wet-to-dry bandages can be a very effective debridement technique – especially in severely infected and necrotic lesions. The goal is to relieve pressure on the lesions and encourage circulation of blood to the plantar structures. Donut shaped pads are often used and incorporated into the bandaging. Great care needs to be taken to avoid creating excessive pressure at the contact points of any pad incorporated into the bandage. Wrapping the toes with soft cast padding can help avoid the development of iatrogenic lesions.

Bandages need to stay clean and dry and should be changed every 24-72 hours or sooner if they become soiled or wet.

In most cases, activity should be encouraged – exercise will help circulation of blood and lymph in the feet.

Birds need to be kept as lean as healthily possible, while being fed a balanced quality feed. Supplement with Vitamin A if necessary (over supplemental can occur – only supplement if there is a confirmed deficiency).

Medications:

• Meloxicam for pain and inflammation
• Antimicrobial creams and ointments
• Antibiotics – based on culture results

Follow-up: Treatment for bumblefoot often takes weeks to months, depending on the severity. Reoccurrence can happen months to years after the first time.

Cases that appear to be healing well will often abruptly worsen, so frequent rechecks are recommended.

Once lesions have resolved, rechecks should occur at monthly intervals for 2-3 months and then every six months.

Complications:

• Degenerative conditions in joints and pelvic limbs
• Systemic amyloidosis
• Chronic bumblefoot are at risk for sepsis and bacterial seeding of visceral organs – hepatic abscessation and development of endocarditis

Prognosis:

• Mild cases – good to fair
• Severe cases – guarded

Treatment of severe cases may take many months and recurrence of disease following apparently successful treatment is common. Severe cases in which septic arthritis, tenosynovitis and/or osteomyelitis is present, the prognosis is poor for complete recovery and euthanasia should be considered.

Step by step treatment:
Inflammatory, infectious or degenerative condition of the foot. Can range from mild swelling and redness to ulceration and potentially cellulitis (bacterial infection underneath the skin) and osteomyelitis (inflammation of bone caused by infection).

When my one year old Oliver Egger, Midge had bumblefoot in 2017, I started with the following treatment:

Soaked every 48 hours for 10-20 minutes in Epsom salt water

Gently scrubbed her feet with an old toothbrush to loosen dirt and scab

Dried feet, sprayed with Vetricyn, let air dry

Applied PRID – PRID is no longer recommended as it can be caustic to skin/tissue

Created padding with gauze and wrapped in vet wrap.

Day 7 I switched to the following treatment:

Soaked every 48 hours for 10-20 minutes in Chlorhexidine solution

Gently scrubbed her feet with an old toothbrush to loosen scab

Dried feet, dipped in iodine solution

Dried feet, applied Bacitracin Zinc and Epsom Salt Poultice

Created padding with gauze and wrapped in vet wrap

I continued the above treatment until day 27 when life happened and we weren’t able to continue with treatment.

I did not dig out the infection, each time the scab came lose, I would gently peel it off.

No home surgery, no digging and we didn’t even complete home treatment and she still made a full recovery.

The vets no longer recommend PRID/Ichthammol as it can be caustic to the skin.

The preferred ointment is Silver sulfadiazine cream (Rx only). OTC preferred ointment would be Bacitracin Zinc.

References:

Blackwell’s Five-Minute Veterinary Consult: Avian

Avian Medicine: Principals and Application

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