ISSN 2398-2969      

Metatarsal fistulation

icanis

Synonym(s): Focal metatarsal and metacarpal sinus tracts; Sterile idiopathic pedal panniculitis; Deep metatarsal and metacarpal toritis


Introduction

  • Cause: pathogenesis unknown, circulating antibodies to Type I & II collagen in some affected dogs.
  • Signs:
    • Flocculent, possibly mildly painful, swelling in the skin.
    • Bilateral, focal, single or multiple tracts, discharging serosanguinous fluid, ± mild crust, located in both plantar metatarsal skin proximal to the metatarsal pad (± metacarpal skin proximal to the metacarpal pad).
  • Diagnosis:
    • Bilateral symmetric lesions in German Shepherd dog are pathognomic.
    • Fluid cytology: pyogranulomatous ± bacteria (contaminant/secondary infection).
    • Histopathology: deep nodular to diffuse dermatitis with fibrosis and sinus tracts.
  • Treatment:
    • Topical or systemic glucocorticoids.
    • Topical or systemic calcineurin inhibitors.
    • Other immunomodulatory medications.
  • Prognosis:
    • This condition is generally controlled but not cured.
    • Spontaneous resolution has been rarely documented.
A fistula is an epithelially lined, abnormal connection between 2 structures or cavities that are themselves lined with epithelium or endothelium. As these lesions are not lined with epithelium the lesions should be termed sinuses.

Pathogenesis

Etiology

  • Considered generally to be an auto-immune condition:
    • Putative relationship with circulating antibodies to Type I and II collagen.
    • Putative localized form of lupus erythematosus Systemic lupus erythematosus.
  • Proposed absolute deficiency in Vitamin E Vitamin E has been postulated too.

Predisposing factors

General

  • Proposed to be more prevalent in individuals with ‘flat-footed’ metatarsal/metacarpal stance.
  • Most often GSD or GSD crossbreed but has been documented in a Weimeraner and a Greyhound.

Specific

  • GSD especially with direct German ancestry.

Pathophysiology

  • Considered to be an auto-immune condition, although this has yet to be fully defined.

Timecourse

  • Onset young to middle aged adult, then chronic and lifelong.
  • Rare spontaneous resolution has been described.

Epidemiology

  • Significant predisposition in GSD breed and crossbreeds.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Scholz F M, Muse R, Burrows A (2015) Focal metatarsal fistulae syndrome affecting a greyhound dog successfully treated with topical 0.1% tacrolimus ointment. Vet Dermatol 26, 488-490 PubMed.
  • Oliviera A M, Obwolo M J, VanDen Broek A H M & Thoday K L (2007) Focal metatarsal sinus tract in a Weimeraner successfully managed with ciclosporin JSAP 48, 161-164 PubMed.
  • Bergvall K (2004) FC-21 Efficacy of topical tacrolimus ointment for treatment of plantar fistulation in German shepherd dogs. Vet Dermatol 15, 27 doi.org/10.1111/j.1365-3164.2004.411_21.x.
  • Paterson S (1995) Sterile idiopathic pedal panniculitis in the German shepherd dog – clinical presentation and response to treatment in four cases. J Small Anim Pract 36, 498-501 PubMed.
  • Kunkle G A, White S D, Calderwood-Mays M et al (1993) Focal Metatarsal fistulas in five dogs. J Am Vet Med Assoc 202, 756 PubMed.

Other sources of information

  • Scott D W, Miller W H, Griffin C E, Campbell K L (2012) Focal metatarsal fistulation of German shepherd dogs. In: Scott D W, Miller W H, Griffin C E, Campbell K L (eds): Muller and Kirk's Small Animal Dermatology 7th Ed. Philadelphia, PA, USA: WB Saunders, p 605.
  • Nuttall T, Harvey R G, McKeever P J (2011) Metatarsal fistulation of the German shepherd. In: Nuttall T, Harvey RG, McKeever PJ, eds: Skin Disease of the Dog and Cat 2nd Ed. Manson Publishing, London, UK, p 176.
  • Gross T L, Ihrke P J, Walder E J, Affolter V K (2005) Focal metatarsal fistulation of German shepherd dogs. In: Skin Diseases of the Dog and Cat: Clinical and Histopathological Diagnosis 2nd Ed. Blackwell Publishing, Oxford, pp 553-555.
  • Kristensen F (1997) Deep metatarsal/metacarpal toritis in German Shepherds. Proc Annu Meet Eur Coll Vet Derm 14, 194.

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