Fluid-Filled Paw

Hi all - I'm new to the Forum but a very long-time Lab owner. Currently have two Labs, a 10-year-old female named Cleo and a 6-year-old male named Tucker.

For the last 20 months, Cleo's right front paw has been increasing in size with tremendous build-up of clear fluid. When I first noticed it, I took her to my vet (who is an excellent practitioner) and he aspirated some of the fluid inside (which was benign under microscope) and indicated that it was probably the result of some trauma damage - at the time I recalled that during a walk, I inadvertently stepped on Cleo's paw and she yelped...He felt that that may have caused the damge.

Over the last 20 months, she has been back to the vet to continue to check the paw several times. We drain it every month or so, but over the last 2 weeks, the paw has filled with even more fluid and now looks like an elephant foot. Let me add that for these entire 20 months, Cleo has shown virtually no sign of discomfort or pain with the foot, limping only ever so slightly when she walks (probably due to stiffness caused by so much fluid pressure within), but showing no interest at all when we bend it or test for any other injury.

Can anyone shed any light on this condition? I have taken her to two vet orthopedist specialists who claim to have never seen it before. I have asked my vet if it could be lymphedema secondary to the trauma indicated above and he says it does not look like typical LE...Apparently, the pressure is now starting to bother her as yesterday she has taken to opening her paw with her teeth and then licking to releive the fluid pressure within - we have started her on antibiotics to avert any infection.

I am open to any suggestions. Thank you in advance for your help.

Allen

[bett]

what about another type of specialist-a dermatologist?

The skin itself shows no signs of any infection - yet (as I mentioned, we have Cleo on antibiotics becuase she is starting to use her mouth to self-manage the fluid build-up). So, my vet does not think a dermotological consult is necessary.

The fluid that comes out is completely clear and a bit sticky - we thought it was synovial fluid but there is just too much of it and it refills VERY quickly.

Thanks for your suggestion, though.

[judeann]

Sorry for Cleo's trouble-what an unusual situation. Have you tried anything along the lines of applying ice or perhaps wrapping it with an ice pack for 10-15 minutes? Or if a physiotherapist would have any ideas-perhaps some sort of treatment along the lines of e-stim for healing? Just brainstorming here.

Thank you for your concern. I have tried both heating pads and ice-packs and even massage, but the swelling is caused by the fluid buildup, not tissue inflammation. In fact, there is so much fluid pressure, that when we open the paw (using an 18-gauge needle), the clear fluid comes out under pressure, like water coming out of a water-balloon if it is *****ed with a needle.

Because Cleo is not in any pain, the goal of the vets I have seen is to try to find the cause of the problem and why her paw is filling up with fluid so quickly after every draining. There really is no need for palliative care because (most times) she does not even fool around with it. She walks fine on the paw, puts weight on it while in a sitting position, and does not withdraw it when it is manipulated.

If there are any vets out there who may have seen something similar, I would love to get more opinions as to what additional direction we might want to try.

Thanks.

[Patty/Breeder]

I agree you need to find the cause in order to treat and stop the swelling. Elephant foot is scary IMO.

Has your vet been on the phone consulting with any specialists to find answers? This is what my vet would do if her were stumped or dealing with an issue or disease he does not have a lot of experience with.

I wish I had some suggestions but I have no experience with this.

I am glad she is not in pain and think the antibiotics are a good idea. It sounds like it may be long term meds if you can't find the cause so, if that is the case, I would also get her on a live organism probiotic given 2-3 hours before or after a meal. Dosage would depend on mg. of meds and depending on how long she stays on them, I would continue probiotics after meds anywhere from 2-6 weeks.

Hoping you can find the cause of this.

[Patty/Breeder]

PS: Also wondering if culturing the fluid at the lab may give you some answers.

[rbag2blacklabs]

Have you thought about calling a vet collage in your area ?

Yes, I have provided my vet pictures and in conjunctions with his history, he has provided it all to a large, Vet Orthopedic group in the Los Angeles area (this would be the third orthopedist approached, but this group is apparently the top one in SoCal).

My vet is a graduate of the UC Davis Vet School, and pending the opinion of the ortho group above, we will also call upon his contacts at Davis.

My vet has looked at the fluid under microscope and there are no cancer cells, so we have ruled that out (for now)...I mentioned that I thought it might be Lymphedema secondary to trauma, as that would explain the large volume of fluid and the fact that it is progressing up her leg, but it does not reveal the typical "dents" that remain after the skin is pushed in - it's spongy and tight, more like a big water balloon.

All the vets (so far) agree that although unsightly, they don't believe it is dangerous. One of the options my vet is evaluating is to perhaps surgically implant a permanent shunt to allow the paw to continuously drain when the pressure builds up...

Any other opinions are certainly welcome! Thanks.

NOTE: I have attached a picture of her paw.

Allen

[Patty/Breeder]

While I understand that trauma could cause this I don't understand why it has continued for 20 months. That is what would worry me pain or not.

Has there been a suggestion of x-ray or something to maybe see further inside what is going on. I don't know????? MRI maybe. Not sure what means they would use for this.

I am also thinking if this is not a bone or joint issue - why an orthopedist. Is there some other type of specialist that may know more? Not sure what type would handle this sort of thing.

[pattyb]

From the picture, why can't you see the toe nails?

Ahhh Patty...Now you see what I've been up against.

The reason for the orthopedist is that there are no speicalists that deal strictly with the paws - the orthopedist certainly deals with the feet, so the thinking is that they would have the most experience.

Yes, our next step will likely be an MRI to get a better picture of what is going on inside.

It has gone on for 20 months because the original swelling was simply manifested as a larger foot that my vet felt was caused by the trauma - with no sign of pain or discomfort, we elected to treat it very conservatively, as Cleo is a senior dog...the "elephantine" swelling that you now see has only been over the last 3 weeks.

And, you can't see the toenails because the area over her toes is so fluid filled that you cannot see the nails from the top view. I have attached two more pix including a shot from the bottom and you can see her toenails on that one.

Thanks,
Allen

i have experienced 2 similar situations with 2 different dogs, both with different causes.
one dog, Sarah, had intermittent swelling, with very little/no pain, on & off for several months. as she was hubby's primary hunting/competing dog, we had a lot of xrays done--several sets over the months--with nothing seen. her bloodwork was also normal. yet another 'flare-up' [big increase in size] came along...this time the skin split open, a 6'' x 1/8'' long wooden splinter popped about halfway out! vet opened the area up and throughlty cleaned it, problem 100% solved. they explained wood doesn't show well on xrays, and it was probably lying parallel to a bone in there, so unlikely to be seen anyway.
the second dog, Gypsy, had a front foot swell up tremendously [altho not as bad as your pup!]over a period of a few days approx 3 years ago. there may have been a minor injury such as a grandkid stepping on it, not sure.
again we had an xray, nothing, nor was blood work off. a few days later it also split open, & a clear, jelly-like 'fluid' came out...she permitted me to press quite hard on the area to get a lot more of it, & it visibly decreased in size as i did this. after some more days of up & down swelling, some more squeezing, and hot compresses, plus a course of antibiotics 'in case' is has never reappeared, knock wood.
the vet said it is usual for dogs to have a tendency to have them reoccur once they get the first one, it is simply a build-up of their own fluid turning gel-like. i can't remember what he called it right now--sorry.
in view of the hugeness of your dog's foot, and the time it has been there, i think the ''permanent drain'' thing may be the way to go--and hot compresses!

[bett]

that poor doggy! the foot is a bit scary looking to me and i'm so glad she doesnt seem to be in terrible pain
good luck and please keep us informed.

Now we're getting somewhere!

Thank you "queenofthedogs" for your information. That is very interesting about the wood splinter not showing up on xrays, but I have a feeling it would on an MRI. I asked my vet if it could be a foxtail and he said they leave a tell-tale fissure, but we never though about a wood splinter getting in there and the skin closing around it. I am sending your info to my vet as a heads-up!

When I open Cleo's foot to drain it, she too allows me to put quite a bit of pressure from her wrist all the way to her foot so that I can "milk out" the clear fluid - but I wouldn't say it is "jelly-like"...more like very thin oil with a slight tack to it.

Anyone else out there with a similar story?

Thanks,
Allen