Journal of Avian Medicine and Surgery 34(4):381–389, 2020

Ó 2020 by the Association of Avian Veterinarians

Clinical Report

Management of Knuckling in an Ostrich (Struthio camelus)

Using a Custom-Made Orthotic Shoe
Raj Raghav, BVSc & AH, MVSc, Graduate Diploma (Avian Medicine and Pathology), Dipl
ABVP (Avian), Theneyan Mohamed Al Busaidi, DVM, MVSc,
and Jaime Samour, MVZ, PhD, Dipl ECZM (Avian)

Abstract: A 4-year-old female ostrich (Struthio camelus) developed knuckling on its left foot
after a traumatic event. Conservative treatment, rest, and traditional splinting methods failed to
resolve the gait abnormality or improve mobility. A dynamic multicomponent orthotic shoe was
then custom designed and fabricated with an ultra-high–molecular weight, low-pressure
polyethylene polymer (St 1000 DIN16972 TG2) to correct the foot malposition. The affected
foot and leg were wrapped with soft padding and the orthosis was attached and secured by nylon
belts (Nylon PA [polyamide] 6, a semicrystalline polyamide polymer) with self-locking modified
wrench straps. The orthosis immediately prevented knuckling and improved ambulation. After 2
weeks, this shoe was replaced with a modified orthotic shoe of lighter weight to improve kinetics
and ease of use by the bird. The modified orthosis dramatically improved ambulation and was left
attached to the affected leg for 7 more weeks. Thereafter, the bird was able to ambulate
comfortably without the aid of the shoe, even though permanent anatomical changes to the
affected leg seemed to restrict its speed of locomotion. The ostrich had another unfortunate
traumatic event 10 weeks later, the result of which was knuckling on the contralateral (right) foot.
After routine medical and supportive care, the orthosis was then applied to the right foot for a
period of 9 weeks. During this period the bird was able to ambulate well, despite having to support
the bulk of its weight on the previously affected left limb. At the end of 9 weeks, the orthosis was
removed, and the bird was able to ambulate without aid, although the bird’s speed of locomotion
was considerably reduced. After recovery of its leg problems, the ostrich was confined to a
relatively small paddock for the rest of its life.
Key words: knuckling, peroneal neuropathy, orthosis, orthotic shoes, avian, ostrich, Struthio
camelus

Clinical Report ungulates, and different species of free-roaming

birds, as well as a kennel and cattery. The bird
A 4-year-old female ostrich (Struthio camelus)
weighed 81 kg and was fed a diet of fresh grass,
was referred to the Al Wasl Veterinary Clinic,
commercial pellets (ostrich feed pellets, Agrivita
Dubai, United Arab Emirates (UAE), with a 24- Feed Solutions, Abu Dhabi, UAE), hay, and
hour history of recumbency and knuckling of its berries. Approximately 24 hours before referral,
left leg after a traumatic event. The ostrich had the ostrich had been attacked by a juvenile male
been reared singly and was allowed to roam freely lion (Panthera leo) that was being walked on a
within the premises of a private facility that had a leash on the grounds, resulting in a soft-tissue
large collection of animals, including lions, tigers, injury on its right flank. Medical care was provided
by the primary care veterinarian. The bird was
From the Al Wasl Veterinary Clinic, PO Box 75565, Dubai, anesthetized with a combination of zolazepam
United Arab Emirates (Raghav, Al Busaidi); and Wrsan,
hydrochloride and tiletamine hydrochloride (4 mg/
Wildlife Division, PO Box 77338, Abu Dhabi, United Arab
Emirates (Samour). kg IM; Zoletil, Virbac, Carros, Provence-Alpes,
Corresponding Author: Raj Raghav, falcon_vet@ France), and the wound was cleaned, debrided,
yahoo.co.in and surgically apposed. The bird was then

381
382 JOURNAL OF AVIAN MEDICINE AND SURGERY

When physically examined on presentation at

the referral hospital, the bird was found to be in
sternal recumbency, but bright, alert, and respon-
sive. The bird was reluctant to stand up on its own
and exhibited knuckling of the left foot when
trying to stand (Fig 1). The site of injury on the
flank appeared unremarkable, with no other
injuries or abnormalities detected on the external
physical examination. When the bandage was
removed from the left foot, the left metatarsopha-
langeal joint was found to be rigid, painful, and
hyperflexed. Cutaneous sensation along the limb
distal to the hock had remained unaffected, and
the withdrawal reflex was still present. The bird
had resumed eating but was able to void feces and
urine only when helped to a standing position.
Fecal and urine samples looked grossly unremark-
able, and a fecal sample tested for the presence of
parasites was negative on microscopic examination
of a direct smear.
To facilitate a closer inspection of the affected
foot, the bird’s head was covered with a black
hood, and it was anesthetized as previously
described and assisted into sternal recumbency.
Blood samples were collected from the jugular vein
for a complete blood count (CBC) and plasma
biochemical profile (VetScan Avian/Reptilian Pro-
file Plus, Abaxis, Union City, CA, USA). The bird
was administered fluids (normal saline 500-mL IV)
mixed with a multivitamin–amino acid supplement
(2 mL IV; Hemo-15, Vetoquinol) and treated with
thiamine (2 mg/kg IM q7d for 21 days; T 500,
Jaapharm, Woodbridge, Ontario, Canada) and
vitamin E/Se (0.06 mg/kg q7d for 21 days; Vitesel,
Norbrook Laboratories, Corby, Northampton-
shire, UK), in addition to the antibiotic and anti-
Figure 1. A 4-year-old, female, 81-kg ostrich exhibiting inflammatory therapy initiated by the primary care
knuckling of its left foot after a traumatic injury on its veterinarian. The left leg and foot were rebandaged
right flank followed by prolonged recumbency. Note the with a layer of soft cotton padding and self-
ineffective bandage applied on the affected left foot. adhesive bandage supported on the caudal aspect
with a rigid polyvinyl chloride (PVC) ‘‘gutter’’
administered antimicrobial medication (oxytetra- splint to try to extend the joint and reduce
cycline, 10 mg/kg IM q2d for 14 days; Alamycin knuckling. On recovery from anesthesia, the bird
LA, Vetoquinol, Lavaltrie, Quebec, Canada), was still unable to stand up from a sitting position
intravenous fluids (lactated Ringer’s solution 10 without assistance, but once standing, was able to
mL/kg) and anti-inflammatory medication melox- ambulate a few steps slowly on its own, using the
icam (0.5 mg/kg IM q24h for 7 days; Metacam, splint as a crutch. The bird keepers were instructed
to assist the bird to a standing position and
Boehringer Ingelheim, St Joseph, MO, USA). On
encourage movement at 3–4-hour intervals while
recovery from anesthesia, the bird was unable to
keeping the bird confined to a small protected
stand up from a sitting position and knuckled on paddock.
its left foot when assisted to a standing position. The results of the CBC and plasma biochemical
The primary care veterinarian bandaged the area profile were unremarkable, except for moderately
distal to the left tarsus with soft cotton padding increased activities of creatine kinase (1345 U/L;
and referred the case. reference range 688 6 208 U/L) and aspartate
 RAGHAV ET AL—MANAGEMENT OF KNUCKLING IN AN OSTRICH 383

Figure 2. Dynamic multicomponent orthotic shoe with 3

parts connected by hinges, allowing flexion only in one
direction.

aminotransferase (350 U/L; reference range 131 6

31 U/L).1 Although splinting the limb was found
to aid locomotion, it was neither considered
effective nor a viable long-term solution for the
presenting problem. Prognosis was deemed to be
guarded to grave if the knuckling was left
uncorrected. Tenotomy and other corrective sur-
gical options were considered to be too risky,
unreliable, or impractical on the basis of the size
and weight of the bird, and amputation of the
affected toe was not considered to be a viable
Figure 3. The orthosis on its left limb enables the ostrich
option for the same reasons. Considering the lack described in Figure 1 to ambulate without knuckling.
of alternative options and the experience of the The orthotic shoe uses the body weight of the bird,
authors in similar cases with smaller avian species, loading along the limb, to stretch the
the decision was made to custom-design an metatarsophalangeal joint by collapsing the orthosis
orthotic shoe for the distal limb that would stretch along the hinges posteriorly.
the metatarsophalangeal joint, improving laxity
and extension of the tendons and thereby correct- the final design of the shoe. The shoe was
ing the knuckling problem for a period of time. manufactured after extensive stress testing of the
The basic premise of the orthosis was to keep the material at the factory (Al Naseeb Machine Spare
metatarsophalangeal joint in extension, with the Parts Manufacturing LLC, Ajman, UAE) and was
shoe rigid enough to prevent further flexion of the available for use within 2 weeks (Fig 2). The
joint while allowing extension of the joint depend- orthotic shoe, along with the nylon belts and the
ing on the weight loading on the limb. The final wrench straps, had a total weight of 7.5 kg.
design of the orthosis involved a dynamic multi- The bird was anesthetized, as described earlier,
component shoe made of 3 parts connected by and the area from the proximal tarsometatarsus up
metallic hinges, with a central rectangular trough to the digits was covered with a thick layer of soft
to accommodate the limb and a ‘‘roll-on’’ front cotton padding overlaid with a self-adhesive
end. The material chosen for the shoe was an ultra- bandage (3M Vetrap bandaging tape, 3M, St Paul,
high–molecular weight, low-pressure polyethylene MN, USA). The orthosis was then attached to the
polymer (St 1000, DIN16972 TG2, Wefapress, plantar aspect of the limb at 7 points with nylon
Vreden, Germany). Nylon PA 6 belts (nylon straps and set in place with self-locking modified
polyamide 6, RTP Company, Winona, MN, wrench straps. Once the patient recovered from
USA) with modified self-locking wrench straps anesthesia, the ostrich was able to stand up from a
were used to attach the orthosis to the limb. sitting position on its own, and within the next 2–3
Complete measurements (length, width, height, hours, was sufficiently balanced to take a few steps
and diameter) of the third and fourth digits, as well forward without assistance. The metatarsophalan-
as of the distal metatarsus of the bird at different geal joint appeared stretched during standing and
levels, were taken from the right (normal) foot for the bird was able to walk without knuckling (Fig
384 JOURNAL OF AVIAN MEDICINE AND SURGERY

Figure 4. A modified lightweight orthosis that replaced Figure 5. Permanent anatomical changes, including
the original orthosis on the left limb of the ostrich reduced extensibility and altered angularity of the
described in Figure 1. metatarsophalangeal joint on the left leg of the ostrich
in Figure 1, once the orthosis was removed. Note the
3). The situation continued to improve over the increased weight distribution to the distal phalanges of
the third digit of the left leg.
next few days until the ostrich was able to get up
and move about on its own, although at a very
slow pace. to the straps. The pressure-induced lesions were
treated with a moisturizing topical cream (Be-
After 2 weeks, the original shoe was removed
panthen, Bayer AG, Leverkusen, Germany). Once
and replaced with a modified shoe of lighter weight
the orthosis and bandages were removed, the bird
(made from the same material with slight design
was able to get up and walk around at a reasonable
changes, but weighing only 4.5 kg) (Fig 4),
pace without any evidence of knuckling. Perma-
employing the previously described anesthetic nent anatomical changes were evident at the
protocol. The modified shoe resulted in noticeable metatarsophalangeal joint of the left leg, particu-
improvement in the bird’s ease and speed of larly a reduced extension and altered angularity of
ambulation. All medications were discontinued at the joint, leading to a significantly increased weight
this point. The bandage under the orthosis was distribution to the distal phalanges of the third
changed once after 3 weeks under anesthesia, as digit (Fig 5). However, knuckling had been
described previously, to replace the soft padding corrected, and the bird was able to ambulate in a
and self-adhesive wrap and to monitor for any relatively normal manner. At this time, the ostrich
trauma to the leg at the pressure points created by was moved to a much larger protected paddock for
the nylon straps. The bird was able to get up and further exercise and enrichment, which contributed
ambulate normally within the paddock and its to further improvement in its gait and speed of
appetite remained normal. At the end of 7 weeks mobility.
wearing the modified shoe, the orthosis and After a further period of 10 weeks, the bird had
bandages were completely removed. The superfi- another unfortunate traumatic encounter in which
cial layers of the skin were dry, with some eschar it was attacked by 2 guard dogs that had entered
formation over the pressure points corresponding the paddock unnoticed. This encounter resulted in
 RAGHAV ET AL—MANAGEMENT OF KNUCKLING IN AN OSTRICH 385

the bird having a lacerated bite wound on the

caudal aspect of the distal tarsometatarsus of the
same (left) leg that had previously been treated.
The case was initially managed by the primary care
veterinarian who sutured and bandaged the wound
and started antibiotic therapy with ceftiofur
crystalline free acid (20 mg/kg IM q2d for 14 days;
Excede, Zoetis, Parsippany, NJ, USA) and admin-
istered anti-inflammatory medication meloxicam
(0.5 mg/kg IM q24h for 7 days). However, the bird
was knuckling again, this time on the right foot
(which was previously normal), and the case was
again referred to the Al Wasl Veterinary Clinic.
Immediately, the modified orthotic shoe was
applied onto the right leg (as previously described).
However, the bird had difficulty standing up from
a sitting position, apparently from a combination
of the pain of the bite injury on the left leg, the
recently acquired mild anatomic deformity of the
left metatarsophalangeal joint, and the presence of
the shoe, now attached to the right leg. With some
physical assistance and support, the bird was able
to get up and slowly walk around on its own
without any knuckling of either foot, with its
general condition and ability to walk improving
over the next few days.
However, after 7 days, the bird started losing its
appetite and had some soft tissue swelling around
the bite wound on the left leg. The bird was
anesthetized (as described previously), and blood
was collected from the right jugular vein for a CBC
and biochemistry profile. While anesthetized,
radiographic images (lateral and oblique dorso-
palmar projections) of the left distal tarsometatar-
sus and the metatarsophalangeal joint were ob-
tained with a portable radiography unit (XDR5
veterinary digital radiography x-ray system, VetZ,
Isernhagen, Germany). Results of the CBC re-
vealed a moderately elevated total leukocyte count
(15.1 3 103/lL; reference range 5.5 6 1.9 3 103/lL)
with a mild heterophilia (72%; reference range 63%
6 8%), whereas aspartate aminotransferase (270
U/L) and creatine kinase (1122 U/L) were again
found to be elevated on the biochemical profile.1
Assessment of the radiographic images revealed
osteitis and periosteal reaction of the distal
tarsometatarsus with mild arthritis of the meta-
tarsophalangeal joint (Fig 6A and B). On the basis Figure 6. (A) Oblique dorso-palmar projection
of these findings, clindamycin (50 mg/kg q12h for 4 radiograph of the distal left tarsometatarus and
weeks; Dalacin C, Pfizer, Sandwich, Kent, UK) phalanges of the ostrich described in Figure 1 showing
was added to the antibiotic regimen. Bandage areas of periosteitis (white arrow) and mild arthritis
changes were carried out regularly at weekly (black arrow). (B) Lateral projection radiograph of the
intervals on the soft-tissue injury affecting the left distal left tarsometatarus and phalanges of the ostrich
described in Figure 1 showing osteitis and periostitis
leg and at 3-week intervals on the right leg (to
(black arrows).
change the soft padding for the shoe). Within a
386 JOURNAL OF AVIAN MEDICINE AND SURGERY

week, the bird’s appetite returned to normal and flexors of the hock and the extensors of the digits.8
the edema around the bite injury on the left leg had Any trauma or injury to the nerve or its branches
resolved. After 4 weeks, the wound on the left leg might result in an inability to extend the digits,
had completely healed and the ostrich’s ability to resulting in knuckling. In ostriches, thick muscu-
ambulate had considerably improved. A CBC and lature exists over the proximal end of the
biochemistry panel submitted at this time were tibiotarsus, and lateral recumbency with extra
within normal limits. pressure on this area, even for a short duration
The orthosis was maintained on the right leg for of less than 1 hour, can cause compression and
a total of 9 weeks, after which it was removed. ischemic edema of the peroneal nerve, which
Compared with the left leg, no permanent ana- predisposes the bird to knuckling.9,10 Ostriches
tomical changes were observed in the angularity are capable of staying in sternal recumbency for
and extensibility of the metatarsophalangeal joint hours, and this kind of nerve injury could have
once the orthosis was removed. Eschar formation been prevented on both occasions if the bird had
and ischemia over the pressure points where the been closely observed and assisted back to sternal
straps contacted the leg were also minimal because recumbency at the earliest opportunity. Further-
of the improved padding with the second applica- more, the provision of adequate soft padding with
tion of the orthosis. The bird was able to ambulate foam or air mattresses is recommended when adult
normally without knuckling or limping on either birds are anesthetized for longer durations to
leg. However, the speed of ambulation was prevent any iatrogenic damage to the peroneal
considerably reduced and the bird could no longer nerve.9
run fast, so it was thereafter confined to a large In general, peripheral neuropathies are difficult
protected paddock. to correct in most species of animals with
conservative management alone.3 Surgical meth-
Discussion ods to correct knuckling, including desmotomy
and tenotomy, in mammals are reported to be only
This report describes the first documented case partially successful in most cases2,3 and was not
of successful management of knuckling in an expected to be successful in a bird of this size and
ostrich with the use of a custom-designed orthotic weight. Amputation of the toe or the limb was not
shoe. Knuckling is a commonly observed condition considered a viable option. PVC gutter splints have
among mammals,2,3 especially large animals (eg, long been used in foals11 to correct knuckling, and
horses), where it refers to a flexed state of the such a splint was used temporarily with this
fetlock joint with contracted flexor tendons leading ostrich, but its rigid design failed to extend the
to contact of the palmar surfaces of the joints and metatarsophalangeal joint sufficiently and was not
digits with the ground while walking. It is less expected to correct knuckling. Although such
commonly documented among birds, although it splints and casts are easy to procure and apply,
has been observed to occur in different species of they need to be attached very tightly to the leg and
passerine birds,4 as well as ostriches,5 after often result in pressure sores on the integument.
neuropathologic conditions. Knuckling in birds Additionally, their rigid design does not allow for
may result from damage to both the central and progressive extension of contracted joints. Also,
peripheral nervous systems and can result from these PVC gutter-splints need to be frequently
either upper or lower motor neuron lesions.6 removed and replaced, with the leg left unban-
Knuckling may also occur as a result of injury to daged for a few hours prior to reapplication each
the spinal cord or the sciatic nerve or its branches, time, so that an adequate blood supply can
especially the peroneal nerve, and may be associ- infiltrate the integument. It was therefore decided
ated with exertional (capture) myopathy.7 to custom design a dynamic orthosis that would
In mammals, the diagnosis of peroneal neurop- keep the metatarsophalangeal joint progressively
athy is usually based on the case history and the extended and thus improve the laxity of the joint as
presenting clinical signs.3 In this bird, knuckling in well as maintain flexor tendon extension.
both instances was attributed to peroneal nerve Currently, prosthetics and orthotics are being
compression resulting from pressure exerted on the used more frequently and effectively in veterinary
lateral aspect of the stifle while the bird sat in medicine.12 Whereas prosthetic devices are de-
partial lateral recumbency, favoring the opposite signed to replace missing limbs or body parts,
side that was injured on each occasion. The orthotic devices are designed to support, protect,
common peroneal (fibular) nerve arises from the and improve the functionality of an injured limb
ischiatic nerve and provides innervation to the through selective application of forces over a
 RAGHAV ET AL—MANAGEMENT OF KNUCKLING IN AN OSTRICH 387

period of time.13 Reports are numerous on the weight without compromising overall strength.
successful use of both beak prostheses12,14 and Strength was ensured by stress testing at the
limb prostheses15–20 in avian medicine. Even manufacturer’s facility against a stress of up to
though veterinarians have often used various types twice the body weight of the bird. The modified
of orthotic splints to correct knuckling and ‘‘curled orthosis also had better grip on its sole (owing to
toes’’ in birds,4 a paucity of properly documented increased serrations on the sole) and therefore
publications4,19 present this topic in the avian allowed much smoother ambulation and less
literature. slippage on grass.
The principle behind the design of the ostrich In ostriches, the integument on the dorsoplantar
orthosis was to use a dynamic multicomponent aspect of the tarsometatarsus and digits is thick-
orthotic shoe connected by hinges that sought to ened with large cornified nonimbricated scutes.9
stretch and extend the metatarsophalangeal joint. Mild pressure sores were observed on these scutes
This design used the force exerted by the body during bandage changes and were more evident
weight of the bird, loading along the limb, to when the second orthosis was permanently re-
stretch the metatarsophalangeal joint over a period moved from the left foot at the end of 9 weeks.
of time by collapsing the orthosis along the hinges, Although the lesions were found to be quite
opposite the direction of knuckling. The orthosis superficial in this case, pressure sores can poten-
also took inspiration from the equine farrier tially cause ischemic damage to the deeper soft
literature and had a ‘‘roll-on rocker shoe front’’ tissues. Hence, the points of contact should be
similar to the ‘‘rolled-toe’’ and ‘‘rocker-toe’’ shoes closely monitored when orthoses are attached to
used to facilitate break over and correct knuckling limbs with tight straps for prolonged periods of
in horses.21 This configuration allowed the shoe to time. Ideally, such orthoses/splints should be
gently roll back as the limb loaded with the body removed for a few hours, then reapplied to
weight of the bird, thereby bringing the dynamics improve integument blood circulation and de-
of the orthosis into play. crease the severity of pressure sores that may
The material chosen to manufacture the orthosis develop over such contact points.11 However,
(St 1000) was a strong, lightweight, relatively optimum removal and reapplication of the orthosis
inexpensive plastic polymer that allowed for could not be done in this case owing to practical
significant friction at contact surfaces to prevent difficulties with the restraint of the bird during
slipping. Nylon PA6 straps were chosen for their bandage changes.
strength and their adaptability to be attached with When the orthosis was permanently removed
self-locking modified wrench straps. It was evident from the left foot, the anatomical conformation, as
that the use of materials of such high tensile well as the weight distribution pattern of the digits
strength could possibly result in pressure sores at on the left limb, was permanently altered. The
the points of contact with the strapping material; metatarsophalangeal joint was still not fully
hence, extreme care was taken to bandage the feet extended, although there was no more knuckling
with multiple rolls of soft cotton padding material. or any form of limping. The distal phalanges of the
The bird was able to stand on its own and third digit were bearing relatively more weight than
ambulate without knuckling soon after application in the normal limb. In ostriches, the dermal pads
of the original orthosis. However, the total weight on the plantar surface of the digits are very thick,
of the orthosis was found to hinder the bird’s with the epidermis consisting of tightly packed
ability to stand up from a recumbent position. The vertical rods of cornified tissue. Deeper to these
palmar surface of the first orthosis was also pads are paired tubular plantar fat bodies enclosed
considered too smooth, resulting in a tendency to in a fibrous capsule that aid in absorbing pressure
slip on grass. The modified orthotic shoe was and weight distribution during locomotion.9 In the
therefore designed with similar overall measure- ostrich limb, the weight distribution during loco-
ments, but with a semicircular (instead of rectan- motion is uneven, with the larger digit bearing
gular) central trough to achieve a better fit and a more weight, especially in its distal phalanges while
significantly reduced overall weight. The metallic walking.22 This inequality is even more pro-
self-locking wrench straps were replaced with nounced when walking on loose sand.23 Conse-
normal plastic straps in a couple of places where quently the bird was expected to cope reasonably
the loading stress was considered minimal to well with its altered limb biomechanics over a
further reduce the weight of the shoe. Moreover, period of time. Nevertheless, because of these
areas were identified on the shoe where holes could anatomical and functional changes, the bird was
be punched and thickness decreased to reduce ambulating slower than normal and was unable to
388 JOURNAL OF AVIAN MEDICINE AND SURGERY

run fast. In ostriches, the metatarsophalangeal tendons to almost near-normal functionality, even
joint and the proximal phalanx are elevated from in larger species of birds.
the ground and are important for transforming the
kinetic energy and gravitational potential energy Acknowledgments: We thank all the professional,
technical, and administrative staff, past and present, of
into the elastic energy of muscle-tendon units
both Al Wasl Veterinary Clinic Dubai and the
required for efficient locomotion at higher Veterinary Science Department of the Wildlife Division
speeds.22,23 It is therefore conceivable that the at Wrsan for their invaluable help and support over the
speed of locomotion will be considerably reduced years. We also thank Ms Lre Van Rooyen and her staff
when the joint is compromised. Additionally, when for taking excellent care of the ostrich during the
ostriches run, weight loading on the proximal treatment period.
phalanges of the third digit, as well as the distal
phalanx of the fourth digit (which acts as a References
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have been compromised in this case.22 This In: Carpenter JW, ed. Exotic Animal Formulary. 4th
inability to escape from predators might have been ed. St Louis, MO: Saunders/Elsevier; 2013:350–351.
a factor in the bird getting attacked a second time. 2. Ghurashi MAH, Bakheit AH, Abakar JA, et al.
That the bird was able to get up, support weight, Surgical approach for the treatment of foot
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orthosis to correct knuckling. Although the dog 4. Duerr RS, Purdin GJ, Bowers V. Small-bodied
bite injury on the left leg developed complications, birds. In: Duerr RS, Purdin GJ, eds. Topics in
including osteitis, the bird responded to antibiotic Wildlife Medicine: Orthopedics. St Cloud, MN:
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6. Bennett RA. Neurology. In: Ritchie BW, Harrison
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GJ, Harrison LR, eds. Avian Medicine: Principles
On the basis of our experience with this case, we and Application. Lake Worth, FL: Wingers Publish-
recommend that orthotics should be applied as ing; 1994:728–729.
soon as possible to correct knuckling in ostriches in 7. Ward JM, Gartrell BD, Conklin JR, Battley PF.
an attempt to prevent permanent anatomical Midazolam as an adjunctive therapy for capture
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be sufficient to correct knuckling in both instances. Medicine. Vol 2. Palm Beach, FL: Spix Publishing;
In summary, this report describes the successful 2006:957–989.
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