Basisprincipes voor de behandeling en preventie van klauwaandoeningen bij rundvee.

Kreupelheid bij melkkoeien kan aanzienlijke kosten met zich meebrengen, met een gemiddelde van €179 tot €319 per geval, afhankelijk van de pariteit van de koe (Liang et al., 2017). De werkelijke kosten van kreupelheid of klauwaandoeningen worden echter vaak onderschat vanwege de vele gerelateerde kosten, zoals een verminderde reproductie en een verhoogd risico op stofwisselingsziekten.

Preventie, tijdige herkenning van kreupele dieren en een snelle en effectieve behandeling zijn de pijlers voor het behoud van een goede klauwgezondheid en het verminderen van de negatieve impact van kreupelheid op het welzijn van melkkoeien.

In dit artikel geven we in een notendop de basisprincipes weer, voor behandeling en preventie van klauwaandoeningen bij rundvee, die elke dierenarts zou moeten kennen om veehouders en hun dieren te ondersteunen.

Figure 1: overzicht van de meest voorkomende klauwaandoeningen bij melkvee volgens de ICAR-classificatie

Tabel 1: de meest gebruikte bewegingskenmerken bij rundvee. 

Current treatment and alternatives: Infectious foot lesions

Digital Dermatitis (DD or Mortellaro’s disease)

Digital Dermatitis lesions require a similar approach as infected wounds and the treatment protocols should be addressed accordingly:

• Clean and debride DD lesions mechanically with gauze or water to remove manure, debris and any potential biofilm present. This step also facilitates proper lesion stage identification and registration. A hoof spreader is an essential tool to identify lesions in the deeper parts of the interdigital cleft.
• Apply a topical antibacterial product on lesions that are visually considered as ‘active’ (M1, M2 and M4.1).
  • Chlortetracycline, oxytetracycline spray or thiamphenicol spray
  • Chelated copper and zinc gel or spray
  • Salicylic acid (has besides its anti-inflammatory capacity also some antibacterial effects)
• Apply the primary layer of the bandage that is preferably non-occlusive to ensure wound healing and cause minimal trauma to the wound when removing the bandage.
• Cover the primary layer with a large layer of synthetic cotton to prevent constriction of the foot by the tertiary layer. Apply a tertiary layer, generally consisting of a breathable cohesive bandage.
• Optionally a fourth layer consisting of a protective tape can be added to ensure the bandage stays on for the desired period depending on the topical product used. This generally varies between 3-7 days.

Using bandages to treat DD has been shown to be advantageous in multiple field studies.

However, whether or not to apply bandages is primarily guided by managerial factors on a dairy farm. If there is reason to suspect that bandages will not be removed in time by farm staff, then it is advisable to limit your treatment protocol to repeated individual topical antibacterial spraying of active DD lesions.

An appropriate footbath protocol should be put in place as a preventive hygiene measure to control DD in heifers, dry cows and lactating cows. The use of footbaths as a treatment measure yields poor results.

Additionally cows that are lame due to active DD lesions (M1, M2 or M4.1 stages) are likely to benefit from a single parenteral non-steroidal anti-inflammatory drug (NSAID) treatment such as ketoprofen to improve their recovery from lameness by 40% and reduce average milk yield losses by 2,98 kg compared to only using a topical product such as oxytetracycline spray and a wrap (Kasiora et al., 2022).

Interdigital phlegmon (IP)

Treatment success of interdigital phlegmon relies on the speed of therapy after onset of the disease.

Typical clinical signs to look for, are:

• Fever (>39°C) in the acute stage of the disease. 
• Severe lameness on the affected foot (reluctance to bear weight).
• Swelling of the foot (typically bilateral swelling of heel bulbs and swelling of the dorsal part of the foot).

If IP is not treated in time, the skin in the interdigital cleft may burst open and give way to secondary infections by DD or infections of the deeper tissues and/or joints.

Treatment of IP consists of:

• Systemic parenteral antibiotic and NSAID treatment for at least 1 week
  • First choice antibiotics:
    • Penicillin or Cefalexin
  • Second choice antibiotics:
    • Broad spectrum penicillins (such as amoxicillin or penicillin and dihydrostroptomycine)
    • Tylosine
    • Oxytetracycline
    • Tilmicosine
  • Third choice (local regulations may apply before use of these classes of antibiotics):
    • Cefquinome
    • Ceftiofur
  • NSAID:
    • Ketoprofen: every 24 hours
    • Carprofen: every 72 hours
    • Meloxicam: every 48 hours
• Foot check to ensure there are no other lesions present on the affected foot
  • If other lesions are present, treat accordingly
  • Local topical treatment if skin in the interdigital space has rupture
• Follow-up to ensure lesion is healing properly
  • Clinical improvement should be seen within 2 days, if there is no improvement (i.e. cow still lame) then a thorough foot inspection is needed in a foot trimming crush. 

Dynamic & pro-active approach at herd level 

An effective lameness prevention program on a dairy herd relies on multiple crucial measures that require:

• Periodic preventive foot checks:
  These are often scheduled in function of the days in milk. The most common time periods are after peak lactation (around 100 days in milk) and at dry-off. However, these need to be adjusted in function of the lactation cycle of a cow, the type of farm and the environment of a farm. Routine foot checks and trimming need to be performed by a skilled staff member or skilled foot trimmer.
• Continuous lameness monitoring:
  Early lameness detection and prompt effective treatment are crucial to prevent lesions from becoming chronic. Ideally, visual locomotion scoring is performed every 2 weeks by a trained and calibrated observer in an independent manner to maximally reduce bias.
• Effective treatment protocols for lame cows:
  Lame cows should be treated as soon as possible or ultimately within 48 hours after detection. Treatment should be performed by a skilled staff member or external professional with a therapeutic trim, block and NSAIDs. Treatment protocols for IFLs (antibiotics) and NIFLs (NSAIDs) need to be discussed and set in place with the farm veterinary team to guarantee regulated access to the required veterinary products.
• Controlling infection pressure of IFLs and preventing new infections:
  Regular footbathing  or other preventive measures  need to be applied in all lactation stages (lactating cows, dry cows and young stock). Good leg cleanliness  (identified by leg hygiene scores) helps to reduce the spread of IFLs by ensuring dry and clean skin on the feet and legs.
• Optimize and invest in cow comfort:
  Every second a cow is not standing on concrete, is a second she is less likely to develop a foot lesion. Properly adjusted cubicle dimensions and bedding surfaces ensure sufficient lying times and decrease the risk for foot lesions and concomitant lameness. Overstocking should be avoided at all times or kept to a minimum due to the deleterious effect on cow and farm time budgets.
  Optimizing milking times and reducing time out of pen are two other key metrics that can be used to  reduce the forces on a cow’s foot and the subsequent exposure to concrete. 
  Parlour sizes and milking routine should be matched to milking group sizes or vice versa, to ensure time out of pen is kept to a reasonable 50 to 70 minutes per milking.

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