Interesting that you should cover this today. Our dog, Emma, came home from our winter snow shoe trip with a limp. We assumed it was from jumping off snow banks and a sprain. when the limping didn't stop in a timely fashion, we brought her to our vet here in Florida. After taking out some of the fluid, she suggested surgery. There were some cells of question. That was last week. So far, so good. Bandage came off today. She left the bandage alone, but is more than interested in the sutures now that they are exposed Foot looks good. I don't anticipate any worries about the new way her foot is. Doc raises hunting dogs that compete, so is cognizant of how they need their feet to swim, etc. Would I go right to surgery after reading your article? In this case, no. I trust the vet. What I have learned in life is that you "hire" the best minds you can find and respect their opinion. If you don't respect their opinion, then why bother with them in the first place?

Carolyn February 25th, 2009 09:40:22 AM

Winnie started limping this summer while we were up at the cabin. She had a small ulceration on one of her toe pads, which I'd hoped would resolve itself when she went back to city-dog life, but every time she had a run at the dog park she opened it back up. In November, it started growing, which scared me, so we had it removed. It turned out to be a canine papilloma growing off one of her toe pads. The constant abrasion from using the foot kept irritating it and causing more and more tissue proliferation until she couldn't avoid walking on it. She healed up fine after the surgery, but I sure was happy when the two weeks of alternating between using the e-collar and yelling "stop licking your foot!!" were over...

Megan February 25th, 2009 09:53:37 AM

Carolyn: Cancers of the foot can be very nasty. If there is any evidence that this may be more than an interdigital cyst/furuncle, biopsy (or complete removal) is definitely indicated.

I would never second-guess your vet, by the way. Many veterinarians go straight to surgery because they're very good at it. At the last conference I attended, however, it seems the dermatologists are leaning very heavily towards medical treatment if at all possible--not surgical. 

That said, I'm so glad Emma is doing well!

Dr. Patty Khuly February 25th, 2009 10:29:11 AM

I've never heard or seen such a thing. What about laser removal?

anna February 25th, 2009 11:37:04 AM

Anna: At issue is more the permanent "uni-toe" (two toes together, flipperlike) than the actual inflammation.

As to the use of the laser: After standard scalpel surgery it actually looks good, very little inflammation and bleeding, etc. (which is what lasers help prevent). After a few days under a bandage with a heavy dog bearing weight--not so much.

I'm sure laser surgery might be more appropriate for those docs who are accustomed to using it for all manner of surgeries, but there's no reason to believe that lasers would improve the odds of a fast outcome. 

Dr. Patty Khuly February 25th, 2009 12:01:34 PM

hmm we've done all of the above...and still continue in addition with wraping said foot and sticking it in a boot...but alas it's still there. If I'm lax with wrapping or forgo the boot a few times it usually opens and starts to ooze. Once the oozing starts I get the licking and we go back to "all of the above again." My vet and the dermatologist are still in the "no need to cut it out" phase and try a different antibiotic etc. Let's see this has been going on since early Dec. How long should one wait before insisting on surgery? I guess I'm also concerned about the wound healing process post surgery since it's been painted as a long and difficult process. Of course the vets don't have to deal with the daily issues associated with the maintenance of the furuncle that has been to me "a long and difficult process."

Mcappy February 25th, 2009 12:33:09 PM

Mcappy: Such a fine point! How long before slicing it out? Four things to keep in mind:

1) If the underlying disease has not resolved (the allergies, the weight, the self-trauma, etc.), there's no reason to believe that cutting it out will help as much as you might hope. 

2) If it hasn't improved with all your careful ministrations over the past 3.5 months, it's more than likely that the underlying issues have not been resolved--though that's obviously not true in all cases. 

3) Either way, our goal is to protect the foot at (almost) all costs if it means that losing its integrity means orthopedic issues (or other unintended consequences) later.

4) You can always cut it out later, but you can never get back the perfect foot once you do. Waiting up to five (!) months might be best--seriously.

Dr. Patty Khuly February 25th, 2009 01:26:55 PM

Back in December my 8 year old,80lb Shepherd mix, Boomer, had two bumps under the skin on his right hind leg. When I took him to my vet, the vet found a small growth between his toes on his right front paw. The growth was mobile underneath the skin, and wasn't pink or anything. I went ahead and had all the lumps taken off surgically, as the vet said it would be best, and the vet was apprehensive to cut into them, saying he was afraid of having them get worse. The biopsies came back clear,and Boomer did fine after the surgery, but he did lick his paw a lot. He is apparently immune to the 20 dollar spray that is supposed to keep him from doing so! (UGH) I'm about to have surgery on him again to remove two tiny little skin tags on his eyelid and a new growth near his elbow that will be removed. My vet says some dogs around his age start to get lumps and growths, and it isn't always cancer. But I'm confused...do I take the chance and dismiss them as "old age growths" or do I have them taken off and biopsied as he gets them? Any thoughts?

Kara February 25th, 2009 02:03:43 PM

Kara: It's always safest to have them removed and biopsied--as long as they're not in a delicate area. Cytology is acceptable for most but I'd always prefer a "punch" biopsy if removal is problematic. The exception is the lipoma, which gives us so much trouble. Here's a post on those common old-age lumpy-bumpies.

Dr. Patty Khuly February 25th, 2009 03:14:55 PM

I had a dog who got these periodically. It was a long time ago, so I don't recall if we just treated topically, or also gave antibiotics. They would go away, then return, one at a time. I finally discovered that a tree in my backyard was dropping very small (approximately 1" long), very sharp, round bristly things (I think it was a pine tree, but these didn't seem like pine cones). When I focused on continuously searching for and removing all of these that I could find, she stopped getting interdigital cysts.

Mary Straus February 25th, 2009 04:02:38 PM

Umm, yeah, lots of experience with these, including rescue dogs with them literally between all toes. ( I should have taken his picture)

I've never opted for surgery. if it's a dog with an unknown history, we scrape for pododemodecosis. Even if there are no mights, we might use a course of ivomec.

Lancing sometimes helps, even if the mass feels solid. If the foot is soaked and the wound gently massaged open daily, it's astonishing what sometimes pops out. 

Not a big fan of antibiotics as the best case is for them to come to a head. Tea tree oil seems to make them get a move on. The old stand by for soaking them used to be vinegar and water douche.

Many seem to involve ingrown hairs or blocked sebacious glands. Or foreign bodies. They always will work out the top of the foot, never the bottom.  But any treatment used topically is applied top and bottom to the foot. My vet and I have had good luck with the rock hard ones with incising them (with local anesthetic) most of their length and quite deeply. Then I do the daily betadine soaks/massages to reopen the wound. Once, after six days, a beautiful green grass seed popped out, nearly four months after the last of the green had disappeared from the grass.

Dogs with persistent IDCs get a change of diet, then an allergy panel and a thyroid test. The only ones we can't seem to ever really knock down completely are the dogs with auto-immune issues or chronic, pernicious yeast issues

JenniferJ February 25th, 2009 04:51:57 PM

whoops, "mites" I mean

JenniferJ February 25th, 2009 04:54:24 PM

JenniferJ: Autoimmune diseases (like pemphigus or lupus) are sometimes cited as the cause for these furuncles. Sure, it's possible (after all, allergies can be considered an auto-immune disease if you think about it). But I've always thought that a rare red herring––at least in the absence of other lesions.

Dr. Patty Khuly February 25th, 2009 05:02:40 PM

No argument.  It's been a long day. Autoimmune was an incorrect choice of words. Immune compromised was what I was aiming for. 

The president of our rescue has a little bitch that she and I saved maybe 7 years ago. Eyes, ears, feet, skin. KCS, chronic recurrent yeast, staph and toe cysts that come and go. With maintenance she is very comfortable but has never been a candidate for adoption. Her immune system just does not function well. (we know where she came from and let's just say, the family tree does not fork)

But last year I took in an olde english bulldogge with cysts between most toes and a nearly lethal staph infection. He scaped out clean for mites, even on his feet. After 12 weeks of tailored antibiotic treatments, baths, worming and a good diet, everything cleared up but his IDCs. A call to the dermatologist and then a visit did no good. A biopsy did not show much beyond inflammatory process. 

After a lot of head scratching it was decided to give him a course of ivormectin in case he did have a few mites and the cysts were an allergic reaction. Within days there was improvement and after six more weeks, they were gone.

When I saw the dog and his new owner in January at our annual rescue parade, I asked how his feet were and if he'd had any recurrence of cysts, they didn't even know such things existed!

I realize they are a frustrating pain to deal with, I know of one dog who was tested out to be allergic to cedar. The family had a cedar tree in the back yard. The tree left, was replaced by a redwood, and the dog is walking sound for the first time in years.

I've been very lucky. My dogs have rarely been afflicted and it's always turned out to be foreign bodies, which are the easy fix.

Years ago I heard about someone irradiating them. Not sure if it worked.

JenniferJ February 25th, 2009 07:17:01 PM

You know, sometimes the Ivomec just works, dammit! 

Irradiation? How exciting! You know you've got a difficult disease when all manner of therapies get thrown at it. 

Dr. Patty Khuly February 26th, 2009 03:55:21 AM

Thank you for your reply, Dr. Khuly! I am going to have Boomer's surgery on Monday, and have the skin tags on his eyes and the growth on the elbow removed. My vet as never offered to aspirate the lumps before, he's just recommended they come off. Maybe in future if he gets a small lump again, I'll ask about aspiration, as I'm scared to death of him being continuosly put under anesthesia. I've total trust in my vet, and Boomer really likes him and seemed unscathed by the last surgery. Hopefully it will go as smooth as last time! I've been coming to your site for a while and just wanted to thank you again for all you do for the pet loving community!

Kara February 26th, 2009 06:30:13 AM

"You know, sometimes the Ivomec just works, dammit!"  There's such a push to limit use of antibiotics these days and yet there's a cumulative burden effect that is often ignored.  I favor antibiotics, antivirals, antiparasiticals, etc., etc. because animals and humans carry a level of all manor of critters with them and reducing the overall burden allows the body to direct it's efforts and fixing what's left.  I think that's why sometimes certain things like Ivomec "just work".  I'm also convinced this overall burden is what often underlies what gets diagnosed as autoimmune because it exhausts the immune system which then just plain misbehaves.  And, IMO, that type of diagnosis is just plain lazy.

"According to the Merck Veterinary Manual (which every pet owner should own, IMO)"  Haha, made me laugh.  Mentioning that I own one has become one of my tests for Vets.  If they cringe or roll their eyes, we definitely aren't going to get along.

PJBoosinger February 26th, 2009 12:43:37 PM

aggressively treating with a broad-spectrum antimicrobial, as well as keeping the dog on allergy meds, finally cleared up her two front feet.

the back feet are still giving problems, but we'll see.  they look better -- just not fully healed up like the front two!

The dog's a Lab mix with food allergies.  Not overweight, though!

Laura February 26th, 2009 12:59:50 PM

I swear my dachshund had one of these a few years ago. We went to two vets (first the emergency vet, which in my town is the swishy high tech 24/7 hospital). They were utterly perplexed,  prescribed an off label steroid drop to massage in (yeah, right, he was in so much pain from this angry red bump that there was no massaging going on) and a high dose antibiotic. After several days with no improvement,  we went to our  regular vet.  Again, no real answers - I mean, the term "interdigital cyst" would have given me some peace of mind. Honestly, everyone involved (2 vets, 2 vet techs) acted as though they had never seen such a thing. before.  Anyway, the regular vet took a needle biopsy, which caused the the cyst to drain and basically dry up on its own. To this day, has never come back.  If it does, I'm asking for the biopsy early on just in case!

Btw, huge fan of your blog. Thanks for all the info and insights!

Meredith February 26th, 2009 05:36:46 PM

Our Anatolian, Dante, had one of these furuncles -- it seemed to appear out of nowhere, and it only took a day for the dog to lick it until it was open and bleeding. We treated it with pred and Atarax, and it quickly shrunk, but after we stopped the meds it came right back and we opted for surgery. Recovery was quick and without incident (that was about three years ago). This same dog had a cutaneous histiocytoma on his inner ear flap about a year prior, and we also treated it with pred and Atarax before again opting for surgery. I think a contributing factor in Dante's case is some sort of environmental allergy, as opposed to a food issue... his food never changes, but a couple of times a year he's prone to breaking out in odd rashes or getting itches in odd spots (like on his forelegs). I had no idea there were so many treatment options for this, because our vet recommended surgery with no hesitation.

Leigh-Ann February 27th, 2009 02:49:46 AM

Leigh-Ann,

I've seen hystiocytomas between toes, initially they look just like an IDC. Sometimes you can tell by the sweet decomp smell that hystiocytomas develop.

 I watched a friend battle a hytiocytoma on a dogs foot for nearly 6 months, until the nail bed was involved and then a surgeoun was brought in because resection required reonstruction to save the toe. If I have any inkling at all that it is anything but a simple (hah!) toe cyst, it's off to my vet. If it's not a cyst/furuncle, it gets biopsied and/or removed pretty darn quick!

JenniferJ February 27th, 2009 10:40:34 AM

JenniferJ, I hope Dante never develops another histiocytoma for a variety of reasons, but now I can add to that list, "I don't want to have to sniff his feet".

Leigh-Ann March 1st, 2009 12:44:28 AM

I'm simultaneously grossed out and fascinated by that photo. What are these things? Is it liquid inside or is it a solid mass? Or both? And is there a way to check for them? Just check between toes when bathing? My dog has very furry feet, and I fear this may become my new obsession.....
Just 2 weeks ago a friend found a "bump" between her dog's toes and the dog had to have 2 toes removed along with the bump because it turned out to be cancer! I didn't think much of it at the time beyond the obvious 'cancer' scare, but how often do these cysts turn out to indeed be cancer?
*wringing hands*

CreatureofHabit March 2nd, 2009 04:54:25 AM

Our lab has suffered through 3 bouts of these. The first furuncle appeared in January 07; discovered he had demodex, treated with Ivomec and antibiotics; also went to better food. Imagine our surprise when it returned the following January (same treatment, but the antibiotics included Rifampin) and, and now this January. Once again on antibiotics, betadine foot soaks, and will go through allergy testing next week. We've grown to anticipate this winter issue, and thinking salt for ice might be a culprit, have had our Eli wear sled dog booties whenever he goes outside. Not sure that is helping. Interesting comment on the dog allergic to cedar...we have cedar wood chips. But I would think the problem would persist all year, as the chips (and everything else outside) are covered w/snow beginning in Dec. I'm hoping we can get to the bottom of this soon, so he won't have to suffer again next year!

Jana M March 31st, 2009 05:47:48 PM

Going through this with my 4 year old, 72 pound female black Lab right now.  She a hunter, and we do drills and exercise every day, so she's in extraordinarily good physical condition.  The first lump showed up as a hairless bump on top of one of her toes (rear paw), and a smaller, second one shortly after that.  I initially thought "hot spots" and treated them acordingly.  When they continued to grow, in we went to the vet who did a needle aspiration, found lots of bacteria and inflammatory stuff and prescribed antibiotics and Betadine (diluted) foot soaks in addition to topical antibiotic cream.

At the follow up visit one week later, it had not improved adequately, so the vet opened the lumps and cleaned them out, finding not only the "gunk" you'd expect, but also impacted loose hair.  She removed all that stuff and inserted a drain which was left in for 2 days.  Continuing the antibiotics, it began to improve, but a week later, a new sopt appeared between the toes adjacent to the larger of the two original lumps.  I opened the new one, drained it and then squeezed the original one, also getting more gunk out of it.  I then cleansed everything with Betadine and applied antibiotic cream to the area (which I'm now doing twice or three times a day).  I'm also continuing the antibiotics for an additional week.  Everything seems to be improving again.

My dog has pretty severe allergies, and takes antihistamines twice a day, along with a weekly antigen injection for her allergies.  Obviously, we've done the allergy testing, have tried many different food changes and just about everything else anyone could think of.  She is mostly comfortable, exhibits no signs of pain, and her focus and field work remain top drawer.

I'm not sure what I expect to hear back from this very long post, but perhaps someone out there has something positive or constructive to say to us.  Thanks.

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Three weeks ago my Pomeranian Hank, was treated for interdigital cysts between his toes. The Vet put him on Simplcef for 10 days and he seems to be healing nicely. My concern is we tried a new groomer this summer and Hank has never had this condition before now. He has Addison's Disease and also has hypothyroidism and is 9 years old. He is to a degree somewhat health challenged, but I homecook all his meals and supplement with Vetri-science multi-vitamin and mineral supplement, a quality probiotic yogurt, omega 3 fish oils and sea kelp. Is my boy doomed for this condition becoming chronic to him?

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