# Metatarsal Fistula



## AngelaA6 (Jan 20, 2013)

So Gunther went to the dermatologist yesterday because I spent (wasted) 5 months on one vet thinking it was an abscess on both rear paws/hocks. I switched to a new vet and the first day he recommended a dermatologist but it was nearly a month wait. Well we finally saw her and he was diagnosed with metatarsal fistulas on both his rear paws. She took a culture of them and I'll find out what antibiotic is the best one for him in about 5 days. He has some antibiotics for them for now and a medicated shampoo/spray and ointment. He was checked for mites and demodex and they came up with nothing. He was checked for demodex at the other vet but she just wanted to make sure.

She also took scrapings of his neck and paws. He has a yeast infection on his neck and an infection (despite constant cleaning and Epsom salt soaks every day) on the fistulas. She thinks he has either food or environmental allergies but we're starting with the food (Royal Canin Hypoallergenic Hydrolyzed Protein PS). He also is on another antibiotic for the yeast and the medicated spray. She thinks it's an allergy due to his history of skin issues for the past 6 months we've been going to the vet (usually 2 times a month unfortunately) and despite coconut oil and fish pills he's still be itchy and dandruffy all his life. She chose not to biopsy it due to the infection and she said due to breed and predisposition for it and the fact it looks exactly like it. We go in for a recheck in a month and hopefully it's just the food and not environmental. We were able to go thanks to financial aid but hopefully he won't need a long list of allergy testing and desensatizing, my pocketbook is hurting from half a year of constant vetting. He's a little sore today from the culture and having to have his paw squeezed. I'm really hoping this is it and I can stop worrying about what it could be.


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## arycrest (Feb 28, 2006)

It's a shame the other vet misdiagnosed the problem and wasted all that time (and money) treating the wrong problem. To be honest, I've never heard of this problem until I read your message. It sounds nasty ... hope you get it under control and he's feeling better soon!!!

Just in case you're interested, I did a search found found this Nov. '13 thread about the same problem: 
http://www.germanshepherds.com/forum/health-issues/362129-metatarsal-fistulation.html


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## AngelaA6 (Jan 20, 2013)

Yeah I looked through and the information was the same printouts the dermatologist gave me


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## huntergreen (Jun 28, 2012)

i hope you are able to resolve these issues. i hope you will keep us updated.


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## AngelaA6 (Jan 20, 2013)

Definitely will. I go back in on the 8th to see how everything is going.


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## AngelaA6 (Jan 20, 2013)

Got the call yesterday on the culture from the dermatologist, they said the infection on the fistulas/paws is a staph infection but was resistant to almost all antibiotics except for cipro. I picked some up yesterday and he's on 1000mg once a day for a month. So his list of medication has shrunk a bit since he's not allowed to have rimadyl with it and he's not on the Primor anymore. He was on it off and on the rimadyl as needed for pain.

1000mg of cipro
200mg of ketoconazole 
Hexadene shampoo baths every other day
Epsom salt soaks every other day
Muprocin ointment twice a day
And miconahex+Triz spray once a day.

He's had to wear a cone since January, boots since December and Epsom salt soaks since December. I really hope once this staph clears up we can start fixing the fistulas.


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## AngelaA6 (Jan 20, 2013)

Oh and the boots are only when we're outside. His feet have stay completely uncovered as much as possible. I find myself having to clean the floor twice a day finding small blood smears. I can't wait for the day he can be a normal dog again.


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## AngelaA6 (Jan 20, 2013)

Update 

We went to the dermatologist for his recheck and it so far was all good news!

The fistulas are no longer infected and have been healing very quickly (the vet said it was due to my dedication yay that made me feel good) and he can stop the cipro in 10 days.

Once he's off the cipro if he starts to chew/lick his paws and they start to look irritated again I have to call and get him in because that means it's not a food allergy and is a enviromental. 

Is it a bad thing I would rather it be a food allergy than enviromental? The heavy testing and desensitising doesn't sound cheap at all.

But either way the cone gets to come off (4 months of wearing a cone and hitting me with it is not fun). He doesn't have to wear boots outdoors anymore and only has to get his paws shampooed twice a week instead of every other day with Epsom salt soaks on days they didn't get shampooed.

He's still on the prescription diet for another month but if the itching doesn't come back we can start the process of trying different proteins  yay I'm so happy this is the most progress we've seen in the past 7 months.


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## AngelaA6 (Jan 20, 2013)

Newest update. Fistulas are gone for now and now we're managing the enviromental allergies to keep the flare ups from happening. 

Gunther gets a weekly bath with a miconahex+triz shampoo as well as mupirocin applied to his toes twice daily. And any spots that look irritated get either mupirocin or the miconahex+triz spray. 

We're not going to challenge his diet as I tried LID and he had reactions still so we're stuck on the Royal Canin Hypoallergenic PS diet.

We're trying to just manage his allergies topically (since I'm not working I actually have the time each day to take care of him) instead of doing the allergy testing as it's quite expensive and not in our budget at the moment but if we can't keep it manageable we'll just have to make it work and do the testing. Also we want to keep him off as many antibiotics and steroids as we can.

We haven't had any more ringworm issues with the weekly baths.

He's also on zyrtec to help manage some itching that he gets in the evening and so far half a pill once a day has helped.

Honestly it's been 10 months of this and now since it's just managing flare ups I'm finally able to breathe. No more blood and drainage from the fistulas or cones for that matter. I'm enjoying it for now since I know we'll end up with bigger flare ups as he gets older. It has been an adventure  I live my puppy and would do anything I can to give him a happy normal doggy life


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## DutchKarin (Nov 23, 2013)

Just a bit of support. I know lots of people are against the royal canine diet but man the hydrolyzed protein food is a god send for me. I think I have a dog with a weak GI track and environmental allergies. I do my best to manage and this food has helped so much. Not that I like giving him such a processed food but better than the alternative. 
Best to you.


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## AngelaA6 (Jan 20, 2013)

Sorry for such a late response! The hydrolized protein has been amazing. No more eye drainage, excessive scratching,ring worm, staph infections and paw licking. I'm not a fan of having him on such a processed diet/vegetarian but if it's working for him I'm not going to complain. I'm still working on enviromental allergy flare ups. He's getting over an eye irritation/verging on infection caused from an allergic reaction from all the wildfire smoke but 2 weeks of erythromycin and it's all better


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## northern74 (Nov 7, 2013)

Hi, just found your text here. We have fistulas again. 

i don`t know what to do anymore...First time they were, when dog was about one year old.
antibiotics helped first, but not anymore...Prednison helped last time. 
But what next? How about food? Should we also try these hydrolised foods?


This dog has also some ear problems, and stomach is very sensitive.

Angela6, i tried to send Private message to you, but i couldn`t.

So, i put here my email, please, wrote to me? 

[email protected]


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## AngelaA6 (Jan 20, 2013)

northern74 said:


> Hi, just found your text here. We have fistulas again.
> 
> i don`t know what to do anymore...First time they were, when dog was about one year old.
> antibiotics helped first, but not anymore...Prednison helped last time.
> ...


Are you seeing a dermatologist? If so I would ask them about possible food and enviromental allergies. Possibly going on a food trial for a month to see if that helps. I also have to give gunther a bath weekly to help with his environmental allergies with a prescription shampoo . My dermatologist believes gunther's fistulas are brought on or aggrivated by his allergies.


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## northern74 (Nov 7, 2013)

We have seen vet who is skin specialist, but she said that this is autoimmune disease, and nothing to do with food.


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## northern74 (Nov 7, 2013)

I tried to send some photos here.
Right now is only one fistula, but these are at the last time when these get really bad.


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## AngelaA6 (Jan 20, 2013)

northern74 said:


> I tried to send some photos here.
> Right now is only one fistula, but these are at the last time when these get really bad.


Yeah those look just like gunther's when they were aggrivated.

It technically is an auto immune disease but some dogs have allergies that trigger the fistulas. Has your vet done any skin scrapings? I also keep mupirocin ointment and miconahex triz spray (in case there's a budding infection) at hand and apply the ointment once a week after his miconahex triz shampoo bath (or hexadene depending on what my vet has in stock). 

The hydrolyzed protein food was recommended for his skin because he gets ringworm ,staph infections and yeast infections that he gets on even limited ingredient diets. We did a scraping and cultures on his fistulas since they were draining and he had a resistant staph infection and the only one it responded to was cipro. 

After having them for 2 years it took about 3 months for them to clear up and I still get some flare ups between his toes but the maintenance routine keeps them from getting infected and tend to go away. 

I wouldn't get stuck on the food allergies if there isn't any typical allergic reactions like yeasty paws, bacterial skin infections or ringworm. Anytime I have bad flare ups I have to call my vet and dermatologist and usually take him in so they can take a look and scrapings to get him on the right medication if needed or a change in maintenance.


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## northern74 (Nov 7, 2013)

Is your dog eating this same food still? What food it is? How about raw food?
No we had some antibiotic/ prednison cream from a vet today.

By the way, is your dog tired when having these fistulas? Mine is so VERY tired, and don`t want to walk . 

He has also another problem, eating moss...And he eats it VERY much!!!

He had some bacteria year ago in these fistulas.

His another ear was just infected. Get some drops.


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## AngelaA6 (Jan 20, 2013)

The food is a kibble but very expensive. It's almost 102 USD for I think for a 23 pound bag and that lasts us about 5-6 weeks.

My dog was never tired when he had the fistulas but he's only 3 years old. I know when he was on prednisone pills it made him extremely tired. 

The moss thing I have no idea. All I can say is work on your "leave it" command and have you told your vet that he has been doing that?

Hmmm does he get ear infections often? Gunther still gets them every couple months even though I clean them weekly but it's usually after running through some big bushes that get stuff in his ears. 

How long have you been seeing your skin specialist? I've only been seeing my dermatologist for 7 months and while we have some what of a maintenance plan I still know we're far from done with each other. Fistulas can come and go but the best we can do is try to get rid of them when they show up and try to keep them away.

I also forgot to add for about a month I was washing gunther's paws with the hexadene shampoo (or miconahex triz shampoo) every day as well applying the miconahex triz spray once a day on the fistulas and between toes (had to put his cone on so he wouldn't lick it off) as well as mupirocin twice a day on the fistulas and between paws. 

All I can say is if you've spent a long time with your specialist and haven't seen any improvements it may be time to find a new one. Like I said in my first post, I wasted like 5 or 6 months with the wrong vet and 2,000 dollars. I just don't want to see someone else struggle financially since all the meds and once to twice a month vet visits can get very expensive. I'm happy when I get to go a month without seeing the vet (we're going on almost 2 months right now!).


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## northern74 (Nov 7, 2013)

Maybe we should go to another vet. 

my dog has some hormonal issues too.  We try at first chemical castration.

I don`t know where this tiredness is coming.. Pain...Maybe.


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## GLENDAPC (Feb 27, 2020)

AngelaA6 said:


> Are you seeing a dermatologist? If so I would ask them about possible food and enviromental allergies. Possibly going on a food trial for a month to see if that helps. I also have to give gunther a bath weekly to help with his environmental allergies with a prescription shampoo . My dermatologist believes gunther's fistulas are brought on or aggrivated by his allergies.


FORZA10, an italian company makes 3 top different foods for skin issues and I've read a lot of people have gotten good results for your specific condition from the SKIN and SENSITIVE SKIN PLUS grain free foods, chewy carries all 3 different kinds, can't hurt. I'm going to order it for my dog right now. Best wishes for a full recovery.


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## AngelaA6 (Jan 20, 2013)

Hey everyone,
A final update on Gunther. He responded well to cytopoint injections since his itching did get worse as he got older and it helped tremendously with the fistulas. With the injections we were finally able to ditch the boots except for on hot summer days or salty snowy days.
He didn't have any unmanageable flare ups up until this October. We did a cytopoint injection which usually cleared up his skin/eye issues for anywhere from a month to three months. This time unfortunately he didn't respond and then his fur started falling out in clumps. I tried for about 3 weeks with weekly baths and ointment but nothing was working anymore. The vet had warned me in July that we were at the QOL stage in July so when he started having trouble eating last week (difficulty swallowing) we knew it was time. The vet had also warned me that the cytopoint does suppress the immune system and when a dog has cancer (we found a small lump on his side) it can make the cancer spread faster but the quality of life with the injections far outweighed the negatives. I never thought I'd see him get past 7 with his Lupus and fistulas and allergies but we made it to 9. I miss him terribly and he was my heart dog and my baby. I finally get to bring his ashes back home today and let his brothers (Panzer the Berger Blanc Suisse and Simon the Black Mouth Cur) sniff and welcome him back home. I just want to say thank you to everyone here, this site was a wealth of knowledge as a first time GSD owner.


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## OrangeFruit1645 (10 mo ago)

I’m so sorry for your loss. I just came across your thread when searching about metatarsal fistulas- which our vet thinks he may have. He is just 1 year old and we are still waiting on culture results. Your thread was helpful for me. May Gunther rest in peace. My condolences.


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## mapip4 (7 mo ago)

OrangeFruit1645 said:


> I’m so sorry for your loss. I just came across your thread when searching about metatarsal fistulas- which our vet thinks he may have. He is just 1 year old and we are still waiting on culture results. Your thread was helpful for me. May Gunther rest in peace. My condolences.


 My 4 year old german shepherd has been dealing with the same problem, months of swelling and bleeding followed by months of testing, cultures, xrays etc. Once he was diagnosed by his dermatologist, we put him on Cyclsporine modified. His wounds cleared up in a week! He has been on this medication for 6 weeks now and we are going in for a recheck in about 2 more weeks. Look into this medication and talk with your vet. Hope this info helps.


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## OrangeFruit1645 (10 mo ago)

mapip4 said:


> My 4 year old german shepherd has been dealing with the same problem, months of swelling and bleeding followed by months of testing, cultures, xrays etc. Once he was diagnosed by his dermatologist, we put him on Cyclsporine modified. His wounds cleared up in a week! He has been on this medication for 6 weeks now and we are going in for a recheck in about 2 more weeks. Look into this medication and talk with your vet. Hope this info helps.


Thank you so much! We are waiting for the dermatologist consult. So far, the wound healed with appropriate antibiotics and looks fine now. Will find out more about long term management when we get the consult.


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