Executive Editor: Jörg Auer

Authors: Jörg Auer

Phalanges Proximal phalanx, Angular Limb Deformities

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Glossary

General considerations

Angular limb deformities can be managed conservatively, by growth acceleration, growth retardation, or in severe or late diagnosed cases by combining these techniques.
Once the growth plate has closed, correction can only be achieved by a corrective osteotomy technique.
Selection of one or the other technique is usually by personal preference.
Growth acceleration provides a better cosmetic result in most cases.

Nonsurgical management
Main indication Skill Equipment
Only for deformities of the proximal phalanx Basic surgical experience, no specialized skills Basic equipment only


Foals with angular limb deformities in the presence of normal ossification are not surgical candidates. Also foals born with incomplete ossifications are treated conservatively.

The image shows: Dorsopalmar radiographic view of the carpus and lateromedial radiographic view of the tarsus in a prematurely born foal. The cuboidal carpal and tarsal bones are incompletely ossified.

Growth retardation
Main indication Skill Equipment
Only for deformities of the proximal phalanx Basic surgical experience, no specialized skills Basic equipment only


Growth retardation should be performed as early as possible in the life of the foal, especially if the deformity is located in the distal McIII/MtIII because longitudinal growth in this location ceases at about 3-4 months of age. In cases where the deformities are located in the distal radius or tibia respectively, the procedure can be postponed for some time. However the deformity should be constantly observed visually and at intervals radiographically.

The image shows: Bilateral carpal valgus deformity.

Note: manipulations of growth can only be performed as long as the longitudinal growth potential is present.

Note: in a case with severe angular limb deformity growth acceleration and growth retardation procedures can be combined on the same limb to achieve a faster and occasionally more complete correction. This may be especially beneficial towards the end of the growth period such as in a 2-3 months old foal with a marked McIII/MtIII deformity.

The detailed description of the procedure is described in the Metacarpals/Metatarsals module.

Growth acceleration
Main indication Skill Equipment
Only for deformities of the proximal phalanx Basic surgical experience, no specialized skills Basic equipment only


Manipulation of growth either by retardation or acceleration should be performed as early as possible in the life of the foal, especially if the deformity is located in the distal McIII/MtIII because longitudinal growth in this location ceases at about 3-4 months of age. In cases where the deformities are located in the distal radius or tibia respectively, the procedure can be postponed for some time. However the deformity should be constantly observed visually and at intervals radiographically.

The image shows: Bilateral carpal valgus deformity.

Note: manipulations of growth can only be performed as long as the longitudinal growth potential is present.

Note: in a case with severe angular limb deformity growth acceleration and growth retardation procedures can be combined on the same limb to achieve a faster and occasionally more complete correction. This may be especially beneficial towards the end of the growth period such as in a 2-3 months old foal with a marked McIII/MtIII deformity.

The detailed description of the procedure is described in the Metacarpals/Metatarsals module.

Corrective osteotomies
Main indication Skill Equipment
Only for deformities of the proximal phalanx Highly experienced and skilled surgeon Full specialized surgical and imaging resources


The main indication for a corrective osteotomy is the correction of congenital deformities or post traumatic or post infectious acquired deformity.
Normally these will occur in foals, though occasionally and adult will have an acquired deformity as a result of degenerative joint disease of the fetlock joint that requires correction for comfortable weight bearing.

There is no predictable configuration to the injury. It varies with each presentation in each patient. Therefore the principles must be adapted to the deformity present in the patient.
Surgical treatment is most frequently for preservation of breeding capabilities but in selected deformities, if a joint is not involved, horses can resume athletic activities after correction.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.3 2013-11-20