Management of Bumblefoot in Chickens

This article is part of an exclusive NAVC book dedicated to chicken and poultry care and medicine, Poultry in General Practice: Veterinary Medicine for Chickens in Small Flocks. As backyard flocks become more popular and owners seek out preventive and emergency care, general and mixed animal practitioners should be prepared to oversee their basic care and refer cases as necessary.

Pododermatitis is characterized by inflammation and infection of the footpad, most commonly affecting the large central metatarsal pad on the plantar surface and potentially extending to the interpad spaces and interdigital joints. In early stage of pododermatitis, the condition often presents as a small, superficial lesion or mild discoloration of the footpad. Inflammation begins when the epidermis breaks down, allowing bacteria (e.g., Staphylococcus aureus, Escherichia coli) to enter the dermis and cause an infection, leading to abscess formation and swelling. This can result in behavioral changes and varying degrees of lameness. If left untreated, the infection often progresses and eventually extends to underlying tissues, including tendons, bones, and joints.

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Causes and Predisposing Factors for Bumblefoot

The condition is multifactorial. Some of the common contributing factors can be found in Box 1.

Figure 1 Chronic pododermatitis from prolonged exposure to wet manure. If no ulcerations are present, then stage 1 may be assigned. Thorough cleaning of the wounds for evaluation would be the first step to assess the condition. If ulceration with soft tissue swelling and pain are evident, radiographs would be advised to evaluate for tendon and bone involvement. Reviewing flooring substrate, routine litter changes, and body condition score would be part of the evaluation to prevent the condition. Basic treatment for stage 1 to 2 pododermatitis would include husbandry changes, analgesics, and bandaging to decrease pain and allow for tissue healing. Antibiotics may also be selected if deeper soft tissue involvement is evident.

Bumblefoot Species Differences

Although pododermatitis can affect many poultry species, it manifests differently due to their unique anatomical and behavioral characteristics. Ducks are more susceptible because their wet living conditions favor pathogen buildup, making them more prone to infection when the epidermis is damaged. Unlike chickens, domestic ducks do not roost and spend more time on the floor. Additionally, their webbed feet distribute pressure more evenly when they walk. However, this even pressure distribution can lead to more extensive damage on the foot pads, including the plantar surface of their digits, when they are exposed to hard and coarse surfaces (Figure 2). For these reasons, treatment for ducks focuses on maintaining a dry flooring, soft bedding, and a balanced diet.

Figure 2 Severe pododermatitis in a duck. Note the swelling of the plantar surface of the digits. Minimum pododermatitis score of 3.

In contrast, chickens have nonwebbed feet with 3 forward-facing digits and 1 backward-facing digit, which allows them to scratch and perch. Their roosting behavior can contribute to pressure sores if perches are not appropriately designed and maintained. Variable sizes and heights of perches are recommended. The nonwebbed feet of chickens also allow more pressure on their central metatarsal footpads, making this area more susceptible to erosion.

Heavy, broad-breasted turkeys can be a special consideration due to their weight. While the foot structure is anatomically similar to chickens, turkey pododermatitis cases can prove to be very challenging due to constant compression of the soft tissue of the central foot pad. Treatment should be aggressive with flooring substrate management, bandage management, and body condition evaluations to prevent additional damage.

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Clinical Presentation of Bumblefoot

Presenting signs may include limping, ataxia, weight loss, and self isolation. Evaluation for other musculoskeletal and neurologic conditions should be part of the physical examination.

Diagnosis of Bumblefoot

The diagnosis of pododermatitis is primarily clinical but may require additional diagnostic tests to rule out other differential diagnoses. Begin the assessment with a distant examination and, if available for chickens, the use of perches to assess the degree of lameness. Next, perform a thorough examination of the foot, including palpation of the hock joint and interphalangeal joints to assess tenderness, crepitus, and deformities. Examine the metatarsal pad, interpad spaces, and interdigital webs for scratches, redness, warmth, and swelling. Assess the size and extent of the lesions and the presence of abscesses or necrotic tissue. It is helpful to evaluate the degree of swelling by comparing the affected foot to the contralateral foot.

Finally, check for tendon involvement by examining the range of motion and response to palpation. Radiographic imaging is often required to detect osteomyelitis and assess the extent of soft tissue damage to help stage the condition and plan treatment strategies (Figure 3). Fine-needle aspiration, culture, and sensitivity should be warranted, especially in cases that are not responsive to empirical antibiotic treatments and/or used to guide initial antibiotic treatment plan.

Figure 3 An example of stage 3, 4, or 5 pododermatitis in a chicken. This image represents chronic irritation that can lead to infection with swelling of the soft tissues and possible involvement of the tendons, joints, and bone. Radiographic imaging is needed to distinguish these stages, recommend appropriate therapy, and best predict outcome.

Bumblefoot Differential Diagnoses

Articular gout, arthritis, and tendonitis can initially present similarly to pododermatitis, as patients show varying degrees of lameness. Articular gout is characterized by the buildup of tophi (urate crystals) around joints, which can be diagnosed by aspiration and identification of crystals. Arthritis and tendonitis can result from various causes without pododermatitis. Taking a thorough history, performing a comprehensive physical examination, and using radiographic imaging can help to localize the joint and/or tendon involved to determine the next diagnostic and treatment approach.

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Bumblefoot Staging and Management Approach

Pododermatitis is classified depending on the chronicity, tissue involvement, and severity of the lesions. Accurate staging is crucial for determining the prognosis and appropriate treatment approach, and it helps guide discussion on prognosis and treatment expectations with owners (Table 1).

Figure 4. An example of stage 2 pododermatitis in a chicken. Ulceration of the epidermis with localized inflammation and infection but without gross swelling.

Figure 5. Radiographic image of stage 1 to 2 pododermatitis with soft tissue swelling, localized or no tendon involvement, and no gross bone involvement.

Figure 6. Radiographic images of stage 3 to 4 pododermatitis with severe encrustation and swelling of the central foot pad and deep tissue swelling, resulting in malalignment of the joints, increase of the intra-articular space, and possible synovitis noted.

Figure 7. Additional radiographic images of stage 3 to 4 pododermatitis with severe swelling of the deep soft tissues and increase of the intra-articular space. These images show more advanced “bumble” (abscess) formation with deep soft tissue swelling versus deep ulceration and encrustation of the central footpad noted in Figure 9.6.

Figure 8. Stage 4 pododermatitis with osteomyelitis in the P1 and P2 joints of digit 2.

Figure 9. Osteomyelitis of digit 3 at the tarsometatarsal (P1) joint with fracture of both bones. While treatment options exist for this stage of the disease and success can occur, owners need to be advised of the extended duration and intensity of treatments, as well as diminished rate of success (defined as ability to walk normally without pain).

Figure 10. Stage 5 pododermatitis with severe soft tissue swelling and osteomyelitis with fractures. These images show osteomyelitis in digit 3 (P1 and P2 joints) with fracture of the P1 joint and intra-articular swelling of digit 2 at the tarsometatarsus (P1 joint).

Prevention of Bumblefoot

Preventing pododermatitis involves a multifaceted approach addressing several key factors (Box 2).

Bumblefoot Treatment Options

Depending on the severity and stage of pododermatitis, treatment may involve a combination of conservative and surgical approaches. In addition to addressing any secondary infection, the treatment plan must involve addressing underlying causes, improving the overall health and nutritional status of the birds, and implementing modifications in husbandry to speed up recovery and avoid relapse.

Successful treatment of pododermatitis is defined as a return to the ability to walk without discomfort. This may require use of a multimodal treatment protocol and flexibility in changing treatment as necessary. There is no “one treatment fits all” for this condition, and flexibility with treatment options and dedicated attention to success are paramount.

Treatment failures are often attributed to lack of follow-through with treatment protocols or inability to treat.

Treatment Timeline

Stage 1 and 2 cases may only require conservative treatments and typically involve shorter treatment durations. Chronic and severe cases in stages 3 to 5 may require prolonged treatment that may involve multiple debridement surgeries. In addition to surgical intervention, techniques such as intravenous regional limb perfusion, placement of long-term antibiotic-release beads, and flushing with a fenestrated butterfly catheter may be warranted in some cases and increase the rate of success in treatment.

Conservative Treatment

For early changes in stage 1 cases, modify husbandry practices to address underlying factors, such as redesigning perches and implementing a weight loss plan. For stage 2 lesions with mild localized inflammation and minimal involvement of underlying tissues, management changes and cleaning and soaking the foot with antiseptic solutions to soften the callus may be adequate. If an infection is suspected, topical antibiotics with bandaging may be considered. However, conservative treatment is not effective for stage 2 or higher lesions that involve a penetrating callus or scab.

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Empirical Antibiotic Choices

Table 2 lists some commonly used empirical antibiotic options. Additional choices and dosages are available in poultry formulary resources listed in Chapter 1 of this publication. If possible, perform culture and sensitivity first to determine an appropriate antibiotic plan. In general, the most common bacteria isolated in pododermatitis cases are Staphylococcus species.

Surgical Treatment

Surgical intervention is necessary for debriding caseous cores and necrotic tissues. (See Chapter 5 for anesthesia and analgesia of poultry.)

1. If available, perform culture and sensitivity testing a few days prior to surgery to determine an appropriate antibiotic plan. A sample may be obtained by fine-needle aspiration or collected aseptically during surgery if necessary.
2. Clean the entire foot and prepare the surgical site aseptically. Administer local anesthetic around the incision site. Sedation or anesthesia may be utilized on a case-by-case basis.
3. The structure and location of any thinner areas of an abscessed area should be evaluated. It is helpful to understand that the deep ventral side of the foot is highly vascularized. If a hard core is present, aggressive debridement is necessary to remove this tissue. Avoiding the vessels and nerves can be challenging.
4. When an abscess is present, a dorsal incision at the thin area of the abscess (frequently between the digits) followed by a ventral incision with blunt dissection used to connect the 2 may be performed (Video 1). Gentle to firm pressure, combined with blunt dissection, may be necessary to remove lytic bone fragments and caseated exudate. This material can serve as a nidus for infection and reduce successful treatment rates.
5. Flush the wound multiple times with 0.5% chlorhexidine solution.
6. Place antibiotic-impregnated beads, such as PMMA (polymethylmethacrylate) and antibiotic-impregnated calcium sulfate (AICS) beads, into the wound. These beads dissolve over time, releasing antibiotic to areas that are not well perfused. Alternatively, consider administering antibiotics through intravenous medial metatarsal regional limb perfusion techniques or placement of a drain flush (described below), especially in cases with deeper tissue and bone involvement.
7. Apply dressing and bandage.

Dressing and Bandaging

Following surgery or in the case of an open wound, bandage the foot to protect the lesion, provide support, and promote healing. It is important to use bandaging techniques that avoid putting pressure on the incision.

1. Cover the incision with hydrocolloidal dressing or medical-grade manuka honey until the wound is completely healed.
2. Bandaging techniques that help relieve pressure from foot pad lesions include:
   1. Donut bandage: Make a donut-shaped cushion with a pool noodle or gauze and strap it on the bottom of the foot to position the hole directly beneath the lesion (Figure 11).
   2. Snowshoe technique: Use a flat-bottomed bandage such as ones made with a foam disk to disperse the weight over a larger surface area (Figure 12).

Figure 11. A donut-shaped cushion made with gauze.

Figure 12. Snowshoe bandage technique: A flat-bottomed bandage made with a foam disk to disperse the weight over a larger surface area. This is an example made for a duck, but this technique also works well for chickens and turkeys.

Postoperative Care

Postoperative care is crucial and may impact clinical outcomes.

• Change bandages daily (at least the first 48 to 72 hours) to assess wound healing and evaluate bandaging techniques. The frequency of bandage changes can be reduced to every 2 to 5 days after the first few days.
• Flush or soak open wounds with 0.5% chlorhexidine, rinse, and reapply medical-grade manuka honey until scabbed. The bandage can be removed once the scab starts to fall off.
• Send the patient home with an oral analgesic (e.g., meloxicam) and oral antibiotics (Table 2).
• The owner should prepare a hospitalization pen to allow recovery and close monitoring. The flooring should be dry to avoid moisture buildup and soiling the bandage.

Regional Limb Perfusion Techniques

In avian species, oral and or injectable antimicrobial penetration may be inadequate due to various factors, such as severe bacterial infections, deep tissue infections, or synovial and joint involvement. The regional limb perfusion technique has become a popular and viable treatment option for administering antibiotics and nonsteroidal anti-inflammatory drugs, especially in cases where systemic antimicrobial and anti-inflammatory therapies alone are ineffective.

1. Place a tourniquet on the pelvic limb, proximal to the location intended for perfusion.
2. Disinfect the skin with chlorhexidine scrub and alcohol.
3. Aseptically catheterize the medial metatarsal vein using a 25-gauge butterfly catheter.
4. Administer the intermuscular systemic dosage of therapeutic agent(s) through the catheter. One study suggests adding enough sterile saline solution to achieve a total injection volume of 3 mL.⁴
5. Flush with 0.3 mL of heparinized saline to ensure the entire dose is administered.
6. After injections are completed, withdraw the catheter and apply a bandage over the injection site.
7. Leave the tourniquet in place for 15 minutes after injection to allow the drug to perfuse into the distal tissues. To avoid hematoma formation, ensure the tourniquet is removed before taking off the bandage over the injection.

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Surgical Placement of AICS Beads

In complex cases, AICS beads can be used to increase antibiotic concentration perfusion to the infected tissue.  Lacqua et al detailed the procedure for the surgical placement of AICS beads in combination with repeated intravenous regional limb perfusion in a duck with septic tenosynovitis and osteoarthritis.¹

Placement of Fenestrated Butterfly Catheter Tubing for Drain Flush

Using a butterfly catheter as an active drain is a practical technique for poultry species in cases where a drain is required to facilitate regular, deep flushing of the wound to aid healing. This technique should be done with sterile technique, under deep sedation or anesthesia. This procedure is outlined in depth elsewhere.⁵ Below is a summary of the process.

1. Prepare the butterfly catheter. Cut off the needle adapter from the butterfly catheter. The tubing should be formed to have a loop of approximately 15 to 20 cm.
2. Incise the foot. Make 3 small incisions on the dorsal side of the foot: one lateral and proximal to the swollen site, followed by a distal incision, then another proximal incision on the contralateral side. These will be used accordingly to insert the tubing; pull the tubing through, make a loop, and reinsert; and exit the tubing from the foot, respectively.
3. Use forceps to insert, grasp, and reinsert the tube. The tip of a pair of straight, blunt, locking forceps is pushed through the distal incision to exit the proximal incision using blunt dissection. The cut end of the tube is grasped and pulled through the incisions. A loop, approximately the length of the digit, is made with the tubing. The forceps are then inserted through the contralateral proximal incision to the same distal incision. The forceps are used to grasp the cut end of the tube and reinsert it into the distal incision and pull it through the proximal contralateral incision while leaving a loop at the distal end (Figure 13A).
4. Check length of the tube ends. The tube ends (both cut end and syringe adapter end) should extend in length beyond the scaled shank of the bird to allow tying of the open end and coiling of the syringe adapter end in bandaging. The tubing should be movable through the incisions at this time.
5. Prepare for the drain. A syringe containing 0.5% chlorhexidine or sterile saline should be attached to the adapter and used to flush the tubing.
6. Fenestrate the tubing. Fenestrate the tubing by sliding the tube through the incisions and making small incisions along the portions that will remain internal in location. This will allow fluids to be forced through the fenestrations into the internal soft tissues and drain through the incisions. Move the tubing to allow alignment of the fenestrations with the most affected internal areas. The loop should remain at the level of the skin to remain visible and accessible (Figure 13B).
7. Flush the wound. Fluid should flood the soft tissues and drain through the incision sites. The tubing can be slid or moved between the incision sites to allow for direct placement of the fenestrations. Test the flushing action within the affected site.
8. Anchor the tubing. Secure the tube to prevent movement and maintain location of the fenestration sites. Use 3 single, small, nonabsorbable sutures. These can be placed through the tubing at each incision and attached to the skin. Finally, tie off the cut end of the tube upon itself at the level of the scaled area of the leg shank and secure with a small piece of tape for bandaging (Figure 13C). Repeat flushing action for accuracy.
9. Prepare for bandaging. The incisions should be left partially open to allow proper flushing  and drainage of fluid. Any extra tubing at the cut or syringe adapter ends can be folded upon itself and the syringe adapter placed in an easily accessible location. A final bandage is placed to secure the tubing and keep the apparatus and wound clean.
10. Maintain the wound. Periodic unwrapping and flushing of the drain with sterile water, dilute chlorhexidine, or an antibiotic solution should be done. Frequency of this procedure depends on the severity of the condition and should diminish as healing occurs (ranging from twice daily to every other day). The area should be dry before bandaging is replaced.
11. Relay aftercare instructions to owner. If the patient is not hospitalized, instructing the owner on how to flush the drain at home and to monitor for signs of infection, blockage, or irritation around the insertion site are necessary. Treatment may last for 1 to 2 weeks with the intention of allowing healing from the deeper portions of the infection to the external skin. If signs of infection, increased pain, or reaction at the drain placement sites are noted, removal of the drain will be necessary. Rechecks should be made weekly and if any of the signs listed above are reported. Removal of the drain will require cutting the tied end of the tubing and pulling of the drain from the dorsal incision site. Sedation is recommended. 

Figure 13 Placement of a fenestrated butterfly catheter tubing for use as an active drain flush.

Treatment Success Rates

Stage 1 and 2 cases can generally be treated with great success provided management of causative factors can be addressed (e.g., weight, environment). More advanced cases require aggressive surgery and medical interventions that can require weeks of active treatment. Successful treatment cannot be guaranteed and management of owner expectations for treatment success in advanced cases is advised. Follow-up visits are strongly recommended.

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Indications for Euthanasia

Euthanasia should be considered in cases with stage 4 and 5 lesions with extensive and irreversible osteomyelitis and/or arthritis in which aggressive treatment is not an option, and in cases where the bird demonstrates severe, unmanageable pain and its quality of life is significantly compromised. This includes situations where owners are unable to provide postoperative care and debilitated birds are at a higher risk of being bullied by others.