Most Footpad Injuries Heal Easily
Intricate reconstruction may be required for multiple pads

We tend to take our dog's feet, toes and pads for granted, but those intricate tissues are vital for his movement and comfort. Injuries to the foot may damage bones, skin or the important pads on the bottom.
Veterinarians use splints, pins or plates to mend broken bones. Their healing requires skill and a bit of luck. Sometimes it's best for your dog if the broken toes are amputated. Most dogs do just fine without all their toes, especially if the toe needing amputation is one on the side of the foot.

Tough Tissues
Some of the most difficult injuries involve the pads. They have a unique combination of tough protective tissues and vascular cushions – thick areas of blood vessels and connective tissue — to stand up to the rigors of weight bearing.
"The pads have an excellent blood supply, and most pad injuries heal well with bandaging, suturing or both," said John Berg, DVM, a surgical specialist at Cummings School of Veterinary Medicine at Tufts University. "However, more severe injuries, for example those involving multiple pads, can require fairly sophisticated reconstructive techniques and can occasionally even necessitate amputation."
Injuries on the top of your dog's paw aren't as serious as those on the bottom. On top, the veterinarian may stretch the skin or use grafts to cover open wound areas. Creative plastic surgery techniques that require unusually shaped incisions, such as the Z-plasty, help make the most of the available skin. In a Z-plasty, the surgeon raises two adjacent skin flaps and transposes them. The scar is longer than the original but less tight.
If one or two pads are severely traumatized but the others are undamaged, your veterinarian may recommend amputation of the affected toes. An amputation would remove the bone, associated connective tissues and include the pad for that toe if any pad tissue is left. If your dog has lost or damaged three or more footpads on one foot, he may be a candidate for amputation. However, veterinary surgeons may suggest attempting grafting procedures if possible. This may necessitate referral to a board-certified veterinary surgeon.
A skin graft won't hold up to the stresses of walking and weight bearing, so grafts must be taken from other footpads. Luckily, dogs have a "spare" footpad, called the carpal pad, on their front leg at the level of the wrist. Some dogs will have additional pads associated with dew-claws on their front or rear feet.

Complicated Techniques
The surgical techniques involve freeing up the footpad and transfer-ring it to the damaged area. You can't simply remove the pad tissue from one area and plug it into an-other area, though. It's important to maintain the blood vessels that nourish the pad tissue as much as possible. Otherwise, the tissue will die and the graft won't take. To accomplish this, the pads being transferred remain connected to the limb by a pedicle of skin — a stalk of tissue connecting parts of the body — creating a "pad flap," which the surgeon rotates into its new position in the damaged area.
"Pad flaps often result in pads that don't have quite as much cushioning ability as normal pads, but they're tough enough to allow dogs to bear weight on them without wearing out, and without causing pain," said Dr. Berg, chair of the Department of Clinical Sciences at Cummings School.
Very often, a dog with a severe paw injury will be sent home with a bandage or splint to keep the paw immobile while healing occurs. If your dog has had surgery or other work on the bottom of the foot-pad, he'll need to avoid bearing weight on that area for from three to eight weeks. He may have a large splint, a bulky bandage or even an external fixation device to keep any pressure off those delicate tissues as they heal.
The veterinarian may prescribe antibiotics and pain medications. Expect to have some recheck appointments to be sure the paw is healing properly. Once the splints or bandages are removed, your dog may need some physical therapy to slowly restore the muscles and mobility in his paw. Swimming or slow walks on smooth surfaces can help restore normal use of his paw.

Debra M. Eldredge is in private practice in New Hartford, N. Y

FROM: CUMMINGS SCHOOL OF VETERINARY MEDICINE AT TUFTS UNIVERSITY