Lucy Goose: Surgery for Bumblefoot

*September 2010 Update on Lucy's Bumblefoot Issues:
Lucy was scheduled to return to the veterinarian for surgery on her infected toe. The first surgery went without challenges and follow-up care was meticulous, including the daily cleaning and application of medication to the wound site, followed by re-bandaging. Lucy was moved every day and kept in an exercise pen so that she could be transferred about the yard, away from standing in her own feces. The recommended time to redress the wound was at least three weeks; however, I continued to redress her foot for over five weeks at which time the wound looked nearly recovered, so I removed the bandage. Within days the swelling came back and the wound regained enough swelling that it was nearly the size of the initial infection, so I took her to the veterinarian for more antibiotics and pain medication to administer for a week prior to taking her for a second bumblefoot surgery. Due to financial constraints, I had to reschedule the surgery, but kept giving Lucy antibiotics in addition to making a shoe for her out of a neoprene wetsuit purchased from a thrift store. Within days the swollen bumble began shrinking and was soon on its way to disappearing. No second surgery was necessary. I will soon post a photograph of the shoe I made and some basic instructions on how to create your own. When I told our veterinarian about the shoe and the bumblefoot healing up, he said that I 'may be onto something'.

Bumblefoot (ulcerative pododermatitis) in birds is caused by a small lesion, perhaps from stepping on a sharp object, which becomes infected after bacteria enters the wound. Since birds do not exhibit pus the way we humans do, but instead grow a cutaneous-like mass, a hard ball similar to wax can develop when tissue heals around the wound. This creates a bumble and bumbles can be painful, causing a bird to limp. (If bumbles are left untreated, infection can degrade bone, which may result in the necessary amputation of toes, including joints, and sometimes an entire foot. If left untreated, bumblefoot can cause eventual, and painful, death.) Think of walking around on a marble all day. Even worse, imagine that marble is located beneath a joint. Where the bumble is located can have an effect on treatment and healing time. For example, in the past year there have been two cases of bumblefoot in my flock, both resulting from lesions developed some time last summer, before the substrate in the duck pen was changed to anti-fatigue mats instead of dirt. Even though the seed was planted in these bumbles over six months ago, it took a while for them to become severe enough to require attention. Many small lesions heal on their own.
    The first case of bumblefoot involved Beetle, a Cayuga duck. During routine inspection of her feet it was noticed that she had a hard round nodule that was off to the side of her toe, more into the webbing of her feet than close to a joint. This bumble was large enough to cause Beetle to limp. Treatment, in this case, was performed at home using a sterilized scalpel and tweezers. Before beginning, Beetle's foot was cleaned with soap and water followed by Schreiner's Herbal Solution. Since the bumble wasn't close to any veins and was located on the web part of her foot, there wasn't any blood and a true incision did not have to be made. Instead, I applied the blade to the outside edge of the bumble itself, which dislodged and was easily removed with tweezers. (I will soon upload a photo of the bumble beside a ruler, so you can see what it looked like.)
     After Beetle's at-home surgery the hole that was left where the bumble had been removed, was treated with Nolvasan Antiseptic Ointment. A non-stick wound pad was placed over the site of surgery and her feet were wrapped loosely with Co-Flex -- A Cohesive Bandage By Andover -- and then taped with surgical tape. When applying the bandage it is important to note that the webbed feet of waterfowl need to lie flat, so the bandage needs to be created so that the foot can remain in its natural position. (In photos following you will see an example.) Since birds heal fast, Beetle remained in the house overnight and we inspected her wound the following morning. Again, since the bumble was located on the webbed part of her foot, recovery time was minimal, and with a spray of Cut Heal Multi Care Aerosol Wound Spray (a kind of spray bandage), Beetle was good to go almost immediately. More severe cases of bumblefoot, however, require special handling. Lucy, my Embden goose, required veterinary surgery for a larger bumble located beneath a toe joint.
     Lucy went to the vet a week ago for a limp and swollen toe joint. Also her leg began to turn a yellowish hue. She underwent seven days of treatment with Baytril antibiotics and was given the painkiller Metacam for a couple of days. Nearly all of the swelling went down and by the fifth day Lucy was no longer limping; however, on the seventh day it was apparent that further care was required as Lucy was limping again and the area around her joint remained enlarged. (See photo both top and right.) Yesterday's visit to her veterinarian, Dr. Ponti, confirmed that, since the inflammation went down and the circumstances were more visible, Lucy had bumblefoot. The poor goo!
     Lucy was kept inside overnight, restricted to water only until the next morning when the surgery was scheduled. Surgery took place this morning. Following are step-by-step photos, though not particularly detailed, taken with the camera on an Android phone. I think you will get the basic idea of what bumblefoot surgery entails.
Lucy knows her way around Dr. Ponti's office after her visit the previous day, and another time when she had an eye injury and received a referral. When I approached the driveway to the office, she let out a grunt of irritation, I think because she knew where we were--birds have an excellent recognition system, otherwise how would they follow flight paths so well? She was supposed to spend the night, but after familiarizing herself with the office and the kennel area, decided she was NOT going to spend the night in a concrete floored jail cell. (Those are her exact words.) So, she was taken home and brought back in the morning.
     The first step in Lucy's surgery was administration of gas to put her to sleep. Most people are not allowed in the office to view this part of the procedure, because they tend to become startled when their pet jerks around during the going to sleep phase and this can cause upset in the surgery room. Lucy is a sweet, mild tempered goose, so there wasn't much to putting her to sleep, though they had to raise the level of gas a couple of times, because she kept waking up. 
     After gas, next came intubation--the insertion of a tube down Lucy's throat to maintain an unobstructed airway so she could breathe well during surgery. Her foot was cleaned thoroughly with solution that appeared to be iodine and a tourniquet tied around her right ankle, just above her thumb-toe to reduce blood flow. (This is since the bumble was deep and tissue had healed around it, making it prone to bleeding, unlike Beetle's situation.) Blue paper surgery shrouds were placed around Lucy's foot. Then Dr. Ponti began surgery using a scalpel.
     In the photo to the left Lucy lies calmly after administration of gas, cleaning of her foot, and insertion of a breathing tube. She is now prepped for surgery to her bumblefoot.
     Waterfowl are not the only creatures to develop bumblefoot, pet rats, mice, guinea pigs, etc. develop infections from walking on wire-bottom cages. Raptors such as falcons, eagles, owls, and hawks also develop the condition. Here is a web site from Tufts University that includes a plethora of information about avian diseases, including a photograph of severe bumblefoot:
Beginning to cut out Lucy's bumble:

Pulling chunks of the bumble out of Lucy's foot:

The tourniquet:

Cauterizing the wound:

A donut was cut in the padded bandage material to cushion her foot:

Remember, when bandaging bird feet, make sure they can stand naturally
once the bandage is on. Notice how Lucy's webs are spread wide as the
bandage is secured:

The finished foot. I was cautioned to not think all of the tape is
excessive, rather it is a necessity:

Though she's groggy, Lucy's ready to go home:

After Care      
   Following surgery Lucy's bandage must be changed at home at least once per day. She must be kept off of feces as much as possible. (Those of you who care for waterfowl know how difficult this can be.) Therefore, Lucy will spend her time in the back yard, on the grass, and not in the pen with the other ducks. She receives 1.5 CC of Metacam for pain, once per day and a dose of Baytril antibiotics, which must be refrigerated. Both of these medications are in liquid form.  
     Bumblefoot can be difficult to treat, so it is not unreasonable to consider that surgery may need to be repeated at some time in the future. Dr. Ponti explained that there is a sort of 'seed' in the bumble and if that infection is not removed, the pus can form around the seed again, resulting in bumble re-growth.
     For more information on bumblefoot, search Google for cases presented in raptors as there is much more information than what is available for waterfowl.