TIBIAL NEUROTOMY 181 



everything. It yields to palliative treatments only to return 

 again. In this event, when the inflammation is chronic and 

 the lameness not too pronounced, tibial neurotomy will make 

 a useless subject useful as long as it escapes serious acci- 

 dental wounds of the unnerved region. There is never any 

 doubt as to the effect of tibial neurotomy on lesions in the 

 sesamoidean apparatus. The pain of this region is always 

 promptly and totally dispatched. It is the sequelae that limit 

 its value. 



In chronic lesions resulting from serious nail pricks, 

 where the navicular synovial has been implicated, tibial neu- 

 rotomy is also strikingly effectual. But like sesamoiditis 

 this lesion must not be in the siege of an active inflammation 

 nor productive of much lameness, if a lasting result is to be 

 expected. These lesions sometimes consist of rather trivial 

 adhesions of the plantar aponeurosis to the navicular bone 

 and navicular ligaments. The integrity, — the strength, — of 

 these affected structures is not greatly impaired, and the in- 

 flammatory process is latent, probably cured. Under such 

 circumstances it is admissible to 'perform the operation, 

 after four, six or eight months have elapsed and the lame- 

 ness still persists. 



Knuckling, that is, constant volar flexion of the fetlock, 

 often exists in the absence of any perceptible lesion. There 

 is no swelling, no pain on manipulation, still the flexion ac- 

 centuates more and more with hard work. Rest and blisters 

 correct the defect only temporarily. The condition returns 

 when hard work is resumed, and very soon becomes chronic 

 and incurable. Once satisfied that this state is not due to 

 spavin or any definite lesion along the course of the tendons, 

 the sesamoids may reasonably be suspected of being the seat 

 of pain that induces the horse to hold the fetlock in volar 

 flexion, and thus gradually cause the tendons to compensate 

 by contracting. Tibial neurotomy, by dispatching the pain 

 responsible for this state, will always gradually correct the 

 deformity. The fetlock will straighten and then soon resume 

 its normal backward inclination. 



Here again the operation does well enough for the pur- 

 pose intended, but unfortunately leaves the subject suscepti- 

 ble to the usual accidents. 



In ringbone tibial neurotomy is not always successful. 

 Sometimes the relief is only partial on acount of the distribu- 

 tion of other sensory nerves, which reach the anterior part 

 of the affected region. In most instances, however, it may 



