Pododermatitis (Bumblefoot): Diagnosis, Treatment, Resolution, and Prevention

Abstract

Pododermatitis is a disease of the integument of the plantar (bottom) surface of a bird’s foot. It can also spread to the dorsal (top) surface of the foot. It is caused by irritation, trauma, poor perching, or overweight. It will become progressively worse unless it is treated aggressively. There are seven stages of progression of the disease; the last is so severe that the bird’s foot might need to be amputated. Treatments consist of medical intervention in the early stages and surgical intervention in the later stages. The sooner the affliction is addressed, the more likely are the chances of full recovery.

Introduction 

Pododermatitis, commonly known as “bumblefoot,” has become a frequently seen disease in companion and aviary birds. “Pododermatitis” is a general term for any inflammatory or degenerative condition of the avian foot. Many times, birds will come into the clinician’s office for a routine annual examination, and the feet will show signs of subclinical or even more serious disease. The condition may range from very mild redness or swelling to chronic, deep-seated abscesses and bone destruction. If caught in the early stages, the underlying, predisposing factors may be corrected, and the disease will often be reversed.

1. Which species of birds are most at risk for developing pododermatitis?

Pododermatitis has been reported in many species of birds, but on a clinical level, it is particularly problematic in captive birds of prey, Galliformes (chickens and turkeys), Anseriformes (ducks, geese, and swans), waders, penguins, and many Psittaciformes (parrots). Of the psittacines, Amazons, budgerigars, and cockatiels are particularly vulnerable to this disease. The condition is frequently described in captive raptors, but it may occur in any avian species, including canaries and finches4. Because footpads are present in psittacines more so than in other species, birds in the parrot family are more likely to suffer from this disease.22

Pododermatitis at Stage 3 on the feet of a finch, side view .

Figure 1. Pododermatitis at Grade II on the feet of a finch(image courtesy Tamara Lowes; used with permission). Note the length of the nails. Long nails have a tendency to catch on fabric and other things in the environment, thus causing trauma to the sores on the feet and forcing the feet to stand in unnatural positions.

Pododermatitis at Stage 3 on the feet of a finch, plantar surface

Figure 2. Pododermatitis at Grade IV on the feet of a finch, plantar surface (image courtesy of Tamara Lowes; used with permission).

K:\All pictures from My drive Oct 17,   2023\Bird med pics\Stage 3 bumblefoot,.JPG

Figure 3. Stage III Pododermatitis. The bands should always be removed in birds if possible. They can create additional paid and damage to the feet. The sore on the tarsometatarsus (heel) of the foot gets additional stress and has become infected (image courtesy Aquarium Store Depot, https://aquariumstoredepot.com/blogs/news/bumblefoot-in-birds)

The scales on the feet are composed of highly keratinized epidermal (the outermost layer of skin) tissue, and this tissue covers the lower leg (podotheca) and foot. The nails/claws are formed by plates of strong, keratinized tissue that enclose the terminal phalanx (last toe bone) of each digit.  It is this keratinized tissue on the plantar surface of the feet that gets quickly worn away when the foot becomes irritated and sore.22

Birds most at risk for developing pododermatitis are obese birds having excess pressure placed on the feet; aged, sedentary and disabled birds; birds with limited mobility; chronically ill birds; and those with any kind of immune system weakness.21

Figure 4. Grade III pododermatitis in a Ringneck Parakeet. This is a result of inadequate perching. The perch appears to be too large, and the weight has been born by the back toes (image courtesy Pin by Tria Connell on Bubu’s Feet | Parrot, Bird, Animals). https://www.pinterest.com/pin/402509285443794473/https://www.pinterest.com/pin/402509285443794473/

1.1 What are the risk factors for developing pododermatitis?

  • Previous foot or leg injury
  • Hard, muddy, flooded, uneven, or rough floor surfaces
  • Damp or unsanitary bedding litter
  • Vitamin A deficiency
  • Overweight
  • Excessively dry skin
  • Lack of activity
  • Excessive activity due to fighting among flock members or guarding behavior (Mainly in chickens)
  • Leg or conformation abnormality
  • Improperly designed perches (plastic, sharp corners, incorrect diameter)
  • Excessive accumulation of feces
  • Poor diet
  • Overgrown toenails

(Poultry DVM Bumblefoot in Chickens 2021 file:///L:/Pododermatitis/Bumblefoot%20in%20Chickens.html)

1.2 Causes or predisposing factors behind the development of bumblefoot

  • Obesity and inactivity, which put more weight on the feet than it can handle. (Poultry DVM Bumblefoot in Chickens 2021 file:///L:/Pododermatitis/Bumblefoot%20in%20Chickens.html)
  • Improperly designed perches: perches that are too small or too large and have no variety of diameter; those that are hard or uneven; dowel or hardwood surfaces; any rough-textured perches such as warming perches, and all concrete perches, plastic perches, those covered in sandpaper or burlap, perches with sharp corners, perches that are too narrow, and perches or spirals made of sisal. (J. Miesle)
  • Hard, coarse floor surfaces, such as cement. These are common in aviaries, zoos, and breeding facilities. In poultry, floors may have hard, muddy, flooded, uneven, or rough surfaces. (Poultry DVM Bumblefoot in Chickens 2021 file:///L:/Pododermatitis/Bumblefoot%20in%20Chickens.html)
  • Poor nutrition and Vitamin A deficiency. Birds need vitamins added to their food. (Some vitamins, such as ©Avi-era (Lafeber) may be added to the water.) If they are on a pelleted diet, reduce and eliminate the pellets. Extra vitamins should not be given until the pellets are eliminated. They should be fed natural, non-pelleted diets consisting of fruits, vegetables, greens, some people foods, and seeds. Sunflower and safflower seeds may be given sparingly. They are high in fat and can lead to hepatic lipidosis (Fatty Liver Disease).  (J. Miesle)
  • Poor husbandry: damp, unsanitary bedding and all substrates. An accumulation of feces and an overall unsanitary environment caused by substrates will lead to fungal and bacterial diseases and are a haven for parasites. Plain newspapers, paper towels, or other paper sources are the only things that should be used. Rope perches and natural wood perches wrapped in fleece or cohesive bandage tape to prevent sores are best. (J. Miesle)
  • Overgrown toenails
  • Stress, hypothyroidism,21 and poor hepatic (liver) dysfunction 5
  • Severe poxvirus lesions with secondary bacterial infections 21
  • Trauma, particularly among poultry:
    • Fighting among flock members,
    • Previous leg or foot injury leading to crippling
    • Frostbite injuries and thermal burns
    • Leg or conformation abnormalities
    • Cracks or worn-away areas and discoloration of the skin
    • Damage to the plantar surface of the foot. Injuries cause lesions to develop on the plantar surface of the phalanges or on the tarsometatarsus. Plantar decubital ulcers (pressure sores) are common. 20

(Poultry DVM Bumblefoot in Chickens 2021 file:///L:/Pododermatitis/Bumblefoot%20in%20Chickens.html)

  • Concurrent illnesses or conditions causing an abnormal standing position
    • Arthritis. Pain in the joints causes the bird to walk on the sides of his feet; in this case, the toes bear most of the bird’s weight.
    • Subdermal infiltrate swelling. The bird in Figure 4 suffered from mycoplasmosis as a result of a staphylococcus infection. He was unable to stand due to a nidus (pocket of bacteria) on the planter surface of the foot.
    • Thickened pads on the bottom of the foot due to scar tissue or previous wounds which have been covered with these pads.
    • Walking on the “heel” of the foot or the side of the foot due to swelling on the toes or center of the plantar surface of the foot. (J. Miesle)

2. The importance of providing the correct perching for the birds

The following perches are known to be detrimental to the plantar surface of the feet and cause pododermatitis in the feet and arthritis in the leg joints. Any of these can be wrapped with fleece or cohesive tape/bandage wrap to vary the diameter of the surface; however, most are round and need to be wrapped with high and low placement of the cushioned wrap.

Many people use Vetrap, but the author has found this tape to collect dirt very quickly, and it is so sticky many birds will not stand on it. Cohesive tape and fleece are better choices of products.

For birds with less serious pododermatitis, wrapping the perches with fleece will give the bird soft surfaces to stand on. For more serious cases, the birds should be kept on towels in bins until they have healed sufficiently to return to the cage. Once there, the perches should be wrapped in fleece. Purchase at least half a yard of fleece and cut several 1-inch strips from it. Wrap the perch from the place closest to the cage bars, overlapping the fleece by half the strips. When you have reached the end of the perch, use a twist tie to wrap around the fleece and hold it on. It will need to be washed at least twice a week, so have extra strips ready to replace them. They wash well in the washing machine. (J. Miesle)

2.1 Perches that are harmful to the bird’s feet and leg joints.

Plastic perches. These are usually too small for the bird, cause the bird to grip hard to stay balanced, and create pressure sores.

Figure 5. Plastic perches. These are usually too small for the bird, causing the bird to grip too tightly to stay balanced; they also create pressure sores (image courtesy ebay.co.uk).

Kroger's tender tape

Figure 6. Kroger’s Tender Tape. This is a cohesive tape/bandage that wraps the perch well without being sticky. It will get dirty, so it must be changed at least once a week. It comes in white and tan. Choose the white tape so you can see soiled areas more easily and change the tape. A similar product can be purchased at the pharmacy with the name “cohesive tape” (image courtesy J. Miesle).

Rough-textured perches.

Figure 7. Rough-textured perches. These include cement, calcium, sandpaper, or warming perches. They irritate the plantar surface of the foot and cause sores and arthritis; they do nothing to keep nails short because the nails do not touch the perch (image courtesy K&H Pet Products Bird Thermo-Perch).

Rough textured perches

Figure 8. Concrete perches should never be used. They irritate the plantar surface of the foot and cause cuts and tears (image courtesy Kathson Bird Perch Parrot Stand Cage Accessories Natural Wooden Stick Paw Grinding Rough-surfaced). 

Sanded perch covers for dowel perches.

Figure 9 Sandpaper perch covers for dowel perches. Not only do they not keep the nails filed, but they also cause sores on the feet and arthritis in the legs. They irritate the skin on the plantar surface, causing small cuts and sores. The owner can remove the sandpaper covers and wrap the perch with cohesive wrap or fleece, making sure to vary the diameter of the wrapped surface. Sandpaper covers also have a tendency to slip on the perch, causing the bird to grip too tightly to maintain balance, leading to arthritis (image courtesy Penn Plax Sanded Perch Covers for Small Birds).

Round dowel perches

Figure 10. Round dowel perches. These will place all the bird’s weight in the same place, and, because they are slippery, they are difficult for the bird to grip, forcing him to grip tighter all the time. Any perch that can become slippery puts additional strain on the muscles of the leg and foot to stay balanced (image courtesy Prevue Pet Products Birdie Basics Wood Perch 10 in).

Figure 11. Hardwood and softer natural wood perches and platforms offer a variety of textures and diameters. Even these can be slippery, causing the bird to grip too tightly. And they are too hard for the bird’s feet. They can be wrapped with cohesive tape or fleece strips for birds with pododermatitis (image courtesy Ebay).

2.2 Platform perches made of wire and wood

Platform perches come in a variety of sizes, shapes, and compositions. They can be found in wood, chrome, and coated wire. They can be a problem if they are not covered in fleece or flannel for all birds, but particularly for the bird with bumblefoot. They should be covered with several layers of soft, padded material, such as a towel, flannel, or fleece cut slightly larger than the platform perch and with a stack of paper towels under the fleece for comfort. These coverings may be held down with binder clips for thinner perches or C-clamps for thicker ones  Never let any bird stand on open wire, as on grids on the bottom of the cage. Cover all wire with paper towels or cloth towels.

Platform perches. These come in a variety of sizes, shapes and composition.

Figures 12. Flat wood perches. These should be covered with at least 2 layers of fleece. These perches can be secured with binder clips or C-clamps. For birds who do not have pododermatitis, paper towels may be placed on top of the fleece for easy cleanup (image courtesy Pevor Wooden Parrot Bird Cage Perches, Amazon).

flat wire perches

Figure 13. Another type of platform perch is the flat wire perch (image 12 courtesy Platform Perches – Just for Pets). These and the wood platform perches are wonderful for the birds, but they too must be covered with flannel or fleece since the wire is very damaging to the feet. The fleece can be secured with binder clips. The owner can put paper towels on the cloths to protect the surface from droppings and make for easy cleanup. Birds with pododermatitis should be standing only on fleece.

The perches should be of various textures, sizes, and shapes so the bird is not standing on the same plantar surface all the time. Natural perches covered in strips of fleece, and rope perches are best. Oval or flat perches attached to the side or corner are better than round ones all the same size.

You can purchase flannel and fleece fabric from any fabric store, places like Walmart, or online. Cut several layers a little larger than the platform to fit and hang over the sides. Do not use paper towels or other types of fabric on perches for birds with bumblefoot due to their rough texture and slipperiness; in addition, both could be easily ingested. When the feet have improved, loose paper towels may be placed on top of the secured ones for easy cleanup. These cloth towels must be laundered daily or whenever soiled, so you will need to cut several. A half-yard or yard of fleece will give you many pieces to work with.

Perches that are both too hard, such as Manzanita perches, and too smooth, such as dowel and plastic perches, sharp-cornered perches, rough pedicure perches, sandpaper and rough-textured/concrete perches should be removed and replaced with rope perches and natural wood perches. Hard perches should be wrapped with a cohesive material such as Kroger’s Tender Tape® or other cohesive tape which can be purchased at a drug store, or wrapped with one-inch strips of fleece. This will provide both padding and changes in diameter when the material is wrapped at varying intervals and thicknesses. Natural perches with different circumferences and textures are good but should be covered with cohesive tape or fleece strips. Birds should be encouraged to perch in different places and varying surfaces. This can be achieved by placing food and water dishes in different areas and changing the position of the favored perches.2

Birds will choose a favorite place within the cage to perch, so whatever perch is in that place is the one they will choose to rest. The place is more important than the kind of perch to a bird; take note of that and put the softest perches there. J. Miesle

2.3 Perches that are beneficial for the birds’ feet and legs.  

Booda rope perches. These come in various diameters and lengths and also in spirals.

Figure 14. Booda rope perches (image courtesy JW Comfy Perches for Birds).

Rope perches are available at some pet stores under different names. These are good for birds who are not afflicted with pododermatitis or have only Grade 1 pododermatitis. These come in various diameters and lengths and also in spirals. They give the feet the soft, comfortable perching they need when they’re on their feet and have minimal flying time. They must be removed and cleaned regularly so the bird is not standing on fecal material or food debris. When they become shredded, they must be replaced. Watch the bird carefully for signs he is chewing and possibly consuming the fibers on the perch. If he is doing that, remove the perch and replace with a natural wood perch covered in fleece. If the bird chews on that, provide only soft, natural wood perches.

Figure 15. Padding perches with foam helps prevent bumblefoot as well as aiding healing in afflicted birds. Be sure to watch for signs of the bird chewing on these. If he is consuming the pieces, remove them and use wood perches (images courtesy Hagen Avicultural Research Institute; used with permission; Burgmann, Symptoms and Treatment of Bumblefoot). 

3. Symptoms of bumblefoot in birds

  • Dark, circular scabs on feet
  • Redness, shininess, and small, red sores on the plantar surface of the foot
  • Abrasions, cuts, tissue damage on the bottom of the foot
  • Swelling and thickening of the skin
  • Lameness and swollen joints in the feet or toes
  • Reluctance to walk, stand, or grasp normally with one or both feet
  • Ulcers on the soles of the feet2, 21
  • Shifting of weight from one foot to the other
  • Picking at the sores on the feet

3.1 Means of infection

There are two ways infection can set it:

  • Through a puncture in the skin of the base of the foot (a talon, a thorn, or a foreign object)
  • Through pressure sores (decubitus ulcers) on the bottom of the foot.9

Healthy tissue in a cockatiel.

Figure 16. Healthy tissue in a cockatiel. Note that the nails are being kept short, but not too short. This is important; the bird could catch his nails on fibrous materials and slip and fall (image courtesy J. Miesle).


3.2 Punctures to the skin leading to bacterial infections

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    Infections may occur when penetrations, such as cuts and sores, happen. Bacteria such as Staphylococcus aureus may enter the skin and cause damage if it has not been observed and treated. 2 Once the wound becomes serious, oral antibiotics, anti-inflammatories, and topical antibiotics will be needed.Celebrex (celecoxib) is the best medication for birds for pain and inflammation.  (J. Miesle)

    Systemic infections that result in decubital lesions or death can occur secondary to bumblefoot and are caused by virulent strains of S. aureus. This bacterium is frequently isolated from the lesions, but the birds will usually not respond to antibiotic therapy alone. These bacterial lesions may quickly lead to digital necrosis and gangrenous dermatitis. Staphylococci are by no means the only bacteria that might be recovered from diseased tissue: E. coliCorynebacterium speciesPseudomonas species, and yeast are frequently cultured from the lesions.10

    3.3 Decubitus ulcers

    Decubital ulcers are open sores on the skin, often covering bony structures. Pressure sores occur because of uneven weight-bearing that leads to damage and devitalization of the skin. Both of these lead to bacterial and/or fungal infections of the skin. Once the process begins, a series of changes is initiated which will eventually damage the tendons of the foot and spread to muscles, joints, and other tissues. It can become a chronic disease, affecting the aortic and mitral valves of the heart and causing endocarditis (inflammation of the heart valves), vascular insufficiency (poor blood flow), lethargy, and dyspnea (labored breathing).9
    4. Additional factors contributing to the development of pododermatitis

    4.1 Malnutrition

    In Psittaciformes and Passeriformes (songbirds), most lesions are believed to be the result of malnutrition. Poor nutrition causes the skin of the foot to become dry, flaky, and hyperkeratotic (developing a thick, outer layer of keratin on the skin). It is thought that dry, hyperkeratotic skin on the feet changes the mechanics of weight-bearing on the metatarsal pads. This condition is also precipitated by environmental deficiencies and systemic disease.4

    Sunflower and safflower seeds have a high-fat content. Too many in the diet can lead to obesity in parrots and other pet birds. Traditionally, parrot diets have consisted of a mixture of seeds, with sunflower seeds being an important part of most diets (50% of the content of a sunflower seed is fat). The increased fat taken on by birds leads to Fatty Liver Disease or Hepatic Lipidosis. Over the last decade, there has been an increase in the number of parrot owners who feed their pets commercial pellets; but this is also not a perfect alternative. Pelleted food contains more fat and protein than the amount most parrots need, and the oils added to the pellets (usually palm and coconut oils) may predispose birds to atherosclerosis (fat deposits in arteries). The heavier the bird, the more weight and pressure it puts on its feet, resulting in the development of pododermatitis. This is aggravated by a lack of flying; birds do not put pressure on their feet while they fly, so birds that do not fly are more predisposed to pododermatitis and obesity.16

    The best diet for birds is one that is high in fruits, vegetables, greens, some people foods, and a moderate number of seeds (except sunflower and safflower.) Seeds contain important Omega 3,6 fatty acids which protect the skin and internal organs. (J.Miesle)

    See Appendix B, p.50,  for a list of foods that are nutritious for birds.

    4.2 Vitamin A Deficiency

    Some forms of pododermatitis are caused or exacerbated by Vitamin A deficiency. Birds that eat only seeds are susceptible to it since seeds are typically low in Vitamin A. This vitamin promotes appetite and digestion and also increases resistance to infection and to some parasites. The most obvious sign of a Vitamin A deficiency is a feather stain above the cere (the fleshy area which contains the nares or nostrils). The staining of the feathers above the cere reflects a discharge from the nostrils. Subtle differences may be seen as far as the color intensity of the cere and feathers and the overall condition of the plumage are concerned. A bird deficient in this vitamin may have pale, rough-looking feathers that lack luster. The cere may look rough instead of smooth, and you may see an accumulation of a yellow, dry scaling on the sides of the beak.2

    Vitamin A deficiency weakens the epithelium (the thin, top layer of skin) of affected birds. Pressure sores, pressure ulcers, or decubitus ulcers occur when the bird is in the same position for a long period of time; the result is uneven weight-bearing. The ulcers are localized injuries to the skin and/or underlying tissues that usually aid blood flow to the soft tissue. The constant friction from the wrong types of perches can pull on blood vessels that feed the skin. Decubital ulceration on the plantar surface of the feet is common in older, obese, nutritionally deficient psittacines.20

    4.3 Limited flying opportunities

    Restricted flight opportunities lead to inactivity and obesity, and these produce excessive pressure on plantar surfaces, the toe pads, and the tarsometatarsus. Erosion occurs, and ulcers and staphylococcal infections develop.20

    Grade I lesions. Note the shiny area on the foot pad.

    Figure 17: Grade I lesions. Note the shiny area on the foot pad (image courtesy Hari; used with permission).


    4.4 Secondary disease

    “Pododermatitis can also take place secondary to infectious or parasitic diseases, penetrating foot wounds or leg injuries that affect normal gait and weight distribution. Epithelial damage that arises secondary to asymmetric weight-bearing on the metatarsal pad causes reduced circulation, microepithelial damage (microcysts: very small, round vesicles containing fluid and cellular debris), local impairment of the immune system, and ultimately, invasion of opportunistic pathogens.”19

    For companion birds, raptors, and other wild birds, pathogenic bacteria introduced at traumatized sites may lead to abscessation (formation of abscesses), osteomyelitis (bone infection), or joint changes.9

    See Appendix A, p. 42, for more information on the treatment of raptors

    4.4.1 Arthritis

    Septic arthritis may also play a part in the development of pododermatitis. Joints may become infected through a direct, penetrating wound or through the hematogeneous route (spread through the bloodstream). Although the infection may be controlled, a decrease in the range of motion of the joint usually occurs.11

    Grade 2 lesions .

    Figure 18: Grade II lesions. Notice the wearing away of the skin on the back toe, continuing into the central pad of the skin (images courtesy Hagen Avicultural Research Institute; Burgmann: Symptoms and Treatment of Bumblefoot; used with permission).

    Grade 3 lesions. Burgmann PM, Symptoms and treatment of bumblefoot in Parrots

    Figure 19: Grade III lesions. Note that the bird is putting his weight on the outside of the foot, causing stress on that toe. This skin on the other toe is wearing away, and the lump on the side of the foot is thickened and swollen (images courtesy Hagen Avicultural Research Institute; Burgmann: Symptoms and Treatment of Bumblefoot; used with permission).

    4.5 Contact with tobacco products

    Many affected birds belong to cigarette smokers. Passive inhalation of cigarettes, cigars, pipe smoke, e-cigarettes, marijuana, and other types of airborne drugs not only causes ocular and respiratory disease in birds but also damages the integument. (Marijuana exposure also causes severe depression and regurgitation in birds and should be strictly avoided.) Pododermatitis has been observed in birds handled by smokers as the nicotine residues on the hands of smokers will cause this irritation. If minor, the lesions may spontaneously resolve when the client stops smoking; cleans all the furniture, walls, curtains, and cages; only smokes outside; washes his hands and arms and changes his clothes before handling the bird.8

    The feet and legs should be uniform in texture and color. The feet should have prominent scale patterns on the dorsal and plantar surfaces. Changes that result in the smoothing of the plantar foot surface can instigate chronic and severe foot and leg lesions. One of the common etiologies of foot abnormalities is contact with nicotine sulfate from the hands of cigarette smokers. The feet are particularly vulnerable to fungal diseases due to smoking toxicity.8 Macaws (and other birds with bare cheek patches) may suffer similar dermatitis on their cheek patches following repeated contact with a smoker’s hands and arms and the smoker’s environment.8

    When toxic particulates and gases in the air assault a bird’s respiratory system, skin, and feathers, feather destruction and plucking result. Heat causes the smoke to rise; then, when it cools, gravity brings it back down. The toxins land on the birds, their perches, their cages and cage bars, toys, and food. It is also on the smoker’s hands, arms, clothes, and any other exposed skin— even the hair. If the smoker’s hands are coated with chemicals from holding the cigarette, it is easily transferred to his bird. In one case, an Amazon, who became very sensitive to chemical exposure, began mutilating his feet. The clinician determined the cause to be his perches which were covered with residue from cigarette smoke.14 Even if the smoker takes these precautions, his clothes, the furniture, rugs, curtains, and perches inside and outside the cage will be covered in smoke and ash. It is best for the smoker to stop smoking and have his home professionally cleaned. (J. Miesle)

    Grade 4 lesions.

    Figure 20. Grade IV bumblefoot in a parakeet (images courtesy Burgmann. Symptoms and Treatment of Bumblefoot, Hagen Avicultural Research Institute; used with permission). 

    4.6 Contact with strong cleaners and disinfectants

    These may also be responsible for irritation and dermatitis on the feet. Cleaning liquids should always be dry and rinsed before the bird walks on the cleaned surface. Cleaning products should be carefully chosen so that chemical irritants are not used.8 Air freshener plug-ins and sprays should never be used around birds. They also damage the respiratory system.14 (The best cleaner is white vinegar and water: 2.5 cups white vinegar to 1 gallon water.) J. Miesle

    4.7 Allergens

    The allergy syndrome appears to be more common in the spring, suggesting a seasonal allergy. Seasonal recurrences of the lesions may be prevented by the oral administration of prednisolone about one month prior to the time that lesions typically occur.8
    5. Avian Veterinary Examination by the Clinician, both at home and at the Physician’s Office

    5.1 Physical exam

    A bird’s skin is very delicate, and the skin of the foot reflects the condition of the rest of the dermis. The plantar surface of each foot should be checked daily by the owner, and the clinician should inspect the feet at the bird’s visits. Both owner and clinician should note the condition of the metatarsal and digital pads and look for loss of definition of the epidermis (seen as a shiny, reddened surface), swelling, erosions, ulcers, and scabs. Birds that are crippled from an injury or genetic defect are prone to developing sores on one or both feet due to the stance they must assume. The owner and practitioner must be observant for signs of pain or discomfort.6

    If a bird is lame on one leg, he must bear his weight on the unaffected leg; this, in turn, can lead to pressure necrosis, infection, and subsequent pododermatitis on that foot as well. The clinician should always examine the other leg and foot closely when any lameness occurs. A complete examination, including radiographs, may require that the bird be anesthetized to reduce stress on it.6

    Grade 4 lesions on a cockatiel with arthritis

    Figure 21. Grade V lesions on a cockatiel with arthritis (image courtesy of Julie Burge; used with permission). Note that there is fecal matter on the feet; this can cause additional infection in the already infected skin. 

    Grade 5 pododermatitis in parakeet

    Figure 22. Grade VI pododermatitis in a parakeet. Note that the plantar surface is covered in ulcers, scabs, and pressure sores from being on the wrong kinds of perches. Some areas of the toes are also impacted (image courtesy Burgmann, Symptoms and Treatment of Bumblefoot, Hagen Avicultural Research Institute; used with permission). 

    Grade 5-6 pododermatitis in a cockatiel.

    Figure 23. Grade VI pododermatitis in a cockatiel. Fecal matter is visible on the pads of the feet and toes. The areas impacted by the disease are deeply imbedded in the skin and will bleed easily when the bird is trying grip the perch (image courtesy David Perpinon; used with permission).


    5.2 Testing of the skin

    Bacterial samples will be taken and evaluated at a microbiology lab in order to isolate the offending organism. An antibiotic sensitivity test may help determine the best course of antibiotic treatment to rid the bird of this condition or to manage it in the case of a chronic issue. A blood sample will be taken to check for other possible health conditions. X-rays will reveal signs of infection and will indicate any areas on the joints or bones where there’s been erosion or other damage.21 Skin scrapings or fine-needle aspirates may also be performed. (J. Miesle)
    6. Clinical Grades of Pododermatitis

    Hagen Avicultural Resource Institute definitions: The following classification grades have been lifted directly from the HARI institute website. (All are used with permission from HARI).

    “A classification scheme grading from early clinical signs and progressing to severe lesions has been established. The clinical progression of the disease varies based on the species and the factors that contributed to the infection.”

    Clinical Grades of Pododermatitis5

    Grade I: Desquamation (shedding of the epithelial or skin tissue) of small areas of the plantar foot surfaces is represented clinically by the appearance of small, shiny pink areas and peeling or flaking of the skin on the legs and feet. Initial lesions are recognized as hyperemia (excessive amount of blood). Flattening of the skin of the digital and metatarsal pads is visible. These are the sites of maximum weight-bearing. (Thinning of the plantar surface of the foot with some reddening).

    Grade II: These lesions progress if untreated, and bacteria invade the subcutis, resulting in a scab and mild swelling. (The subcutis is the deeper layer of the dermis, containing mostly fat and connective tissue). Smooth, thinly surfaced, circumscribed areas appear on the plantar metatarsal pads of one or both feet with the subcutaneous tissue almost visible through the translucent skin. No distinct ulcers are recognized. (The thinning of the plantar surface of the foot has progressed to the point that subcutaneous tissue such as tendons can be seen through the skin).

    Grade III:  The sores progress to form a caseous (having a cheese-like texture) abscess with marked swelling and pain. Ulceration of the plantar metatarsal pads occurs, and in some birds, a peripheral callus may form. Ulcers form on the soles of feet with callouses forming around the edges of the lesions. Some pain and mild lameness are present.

    Grade IV:  Infection of the tendon sheaths develops. Corresponding cellulitis tracks toward the intertarsal joint and the digits along with flexor tendon rupture. There is a necrotic plug of tissue present in the ulcer. Most species with ulcers and accumulation of necrotic debris exhibit pain and mild lameness. (Necrosis refers to cell death; the tissue turns black).

    Grade V:  Swelling and edema (cellulitis) of the tissues surround the necrotic debris. The digits of the foot may also be edematous (holding fluid). Necrotic debris starts to accumulate in the metatarsal area, indicating infection of the tendon sheaths. Severe lameness is common, and the entire metatarsal pad may be affected. This is generally a chronic lesion leading to osteoarthritis and septic arthritis of the tarsometatarsal-phalangeal joints. Cellulitis surrounds the area of necrosis, and the foot can be swollen with fluid. Tendon and metatarsal pads become infected; pain and severe lameness are present.

    Grade VI: Necrotic tendons are recognized clinically as the digits swell and the flexor tendons rupture. Ankylosis and nonfunctioning digits are usually present in recovery.  (Ankylosis refers to the stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint, which is usually the result of injury or disease). The digits are swollen and the necrotic flexor tendons on the plantar surface of the foot rupture. Even with treatment, non-functioning digits and joint fusion will be present.

    Grade VII: Osteomyelitis develops. This is a bacterial bone infection leading to the destruction of the bone itself. Bone infection can progress to systemic infection and death.

    Comparison of healthy plantar surface on the right and Grade VII severe case of pododermatitis on the left

    Figure 24. Comparison of a healthy plantar surface on the right and Grade VII severe case of pododermatitis on the left (image courtesy Lauren Thielen; used with permission).

    6.1 Grading discussion

    Grades I to III lesions are common in Psittaciformes and Passeriformes that are on all-seed or over-supplemented fruit and vegetable diets, are overweight, have no exposure to sunlight, or are kept on improper perches. With proper husbandry and nutrition, most cases recover with little medical intervention. The type of substrate and the size, shape and covering material of the perches may all influence the bird’s weight distribution on the toes and metatarsal pads. These affect the amount of skin wear on the plantar surface. For example, a perch that is too wide and flat may cause excessive weight-bearing on the toe pads, while one that is too small may cause excessive weight-bearing on the metatarsal pads.5

    Early grades of pododermatitis show loss of the scale pattern on the foot, redness, and mild swelling. This damage can often be treated with topical softeners, improvement of the diet, and modification of the bird’s environment. Reversal is possible when the disease is at Grades I and II. The earlier the disease is caught, the more effective the treatment will be. The prognosis for the full recovery of lesions of Grade I to III is usually more favorable than Grades IV to VII lesions.5

    Grade III bumblefoot is common in older, inactive birds that are fed inadequate diets. Early lesions (smoothing of the plantar foot surface) and hyperemia (an excess of blood in the vessels supplying an organ or other part of the body, Wikipedia) are frequently missed, and the birds are often not seen by the clinician until this grade. Some birds are not presented until they exhibit a non-weight-bearing lameness. This disease is dynamic and may move from one grade to the next quickly.5

    Damage to the feet in Grades IV to VII usually requires surgical intervention since the changes that lead to infection also reduce the ability of antibiotics to be effective. Debridement of the wound, surgical removal of damaged tissues, and wound bandaging are treatments that are frequently used.5

    Older budgerigars and cockatiels (5-10 years old for budgerigars and 10-20 years old for cockatiels) may have Grade V or VI lesions if precipitating factors are not corrected early. Bone changes and osteomyelitis may be present. Later grades are very serious and life-threatening. Since the development of antibiotic-impregnated beads, veterinarians can treat later grades more successfully than they could before. Amputation is sometimes necessary. Prosthetics may be used for birds such as ducks that cannot survive with only one good foot.5

    6.2 Case Study: Pododermatitis caused by a parasitic bacterium

    The cockatiel, Chico, is one of the author’s birds. In January of 2022, this bird became ill with

    several severe symptoms. He developed a yellowish, raised area on the dorsal area of his one foot, and a sore area on the plantar metatarsal surface of the same foot. The bird was diagnosed with Mycoplasma synoviae, “a Gram-negative parasitic bacteria responsible for causing respiratory tract disease and synovitis” (inflammation in the lining of the joints). (Merck Vet. Manual) (J.Miesle)

    Figure 25. Spring, 2022. The staphylococcus synoviae infection which began the disease, causing the yellow swelling on the top of the foot and the crusty yellow on the formation of the nidus pocket. “The skin is showing some scabbing and flaking, as though it were irritated. The deeper tissues appear to be mildly hyperemic and there is a yellowish infiltrate in the tarso-metatarsal phalanx joint.” (Bob Dahlhausen) (image courtesy J. Miesle).

    Figure 26. Subdermal infiltrates caused a nidus (pocket of infection) on the plantar surface of the foot which made the bird shift his weight onto the side of the foot and the tarsometatarsus (heel). After the nidus was resolved, the skin on the plantar surface barely covered the bones; this led to a pad of tissue developing. Because the pad was so large, he was forced to walk on the side of his foot and toes. Arthritis set in because of his unusual limp and gait (image courtesy J. Miesle).

    The nidus pocket formed on the plantar metatarsal surface of the foot. The scab that resulted during treatment is covering the nidus hole. The pocket is deep under the thin scab and will bleed if the scab is disturbed. The nidus goes all the way down to the bone and is the result of the S. aureus infection. Infections and diseases can cause swelling, scabbing, and yellow crusting in the feet resulting in pododermatitis (image courtesy J. Miesle).

    pododermatitis - nidus

    Figure 27. There were many ailments due to mycoplasma synoviae. It was very painful for the bird. He had very little appetite, and as a result, he lost weight. In addition to the nidus on the center of the foot, more nidi appeared on the toes. These were the first to be resolved. The skin on the toes became thin and fragile (image courtesy J. Miesle).

    K:\All pictures from My drive Oct 17,   2023\Cheek Sept 7, 2023.jpg Black arrow: previous nidus area in center

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      Figure 28. Nov. 2023. The nidus area after some healing has taken place. The sore area is divided into three sections and remains that way to this date. In order to reduce the size of the pad, the author has been massaging the area twice a day with Aloe Vera Gel. This will continue as long as the bird lives. The author uses Aloe Vera Gel for Sensitive Skin from Walgreens. A small amount is mixed with water or distilled water and stirred until a thin gel is made. It is stored in a small container on the shelf (image courtesy J. Miesle).

      7. Treatments for pododermatitis

      Perching, cleanliness, and nutrition need to be addressed.

      • The cage must be kept scrupulously clean using an antibacterial cleaner once a week or more often if it needs it. Clean all areas daily and watch for droppings and food debris as these need to be cleaned immediately.
      • Nutrition: If the bird is on pellets, reduce and/or eliminate them. Replace them with fresh fruits, vegetables, some seeds (not sunflower or safflower as these are high in fat and can lead to Fatty Liver Disease), people foods, seed supplements. Pellets are hard on the kidneys and contain high levels of fat.

      If the owner does not have an avian veterinarian, he may contact the author for recommendations. He may utilize the following instructions. If he does have an avian veterinarian, these instructions may be used in addition to those given by the avian veterinarian.

      C:\Users\Jeannine\Pictures\podo in a parrot, Maria Molina CAcal Grades 1. 2.jpg

      Figure 29. Grade II on right foot, Grade III on left (image courtesy Maria Molina-Gacal; used with permission

      C:\Users\Jeannine\Pictures\podo Maria Molina-Gacal, grade V.jpg

      Figure 30. Grade V pododermatitis (image courtesy Maria Molina-Gacal; used with permission).

      7.1 Treatment of the lesions for all grades

      1. Clean the feet with antibacterial soap and rinse and dry well; apply and massage in the following creams. There are two prescription creams that you can get from your avian veterinarian: Gentamicin Sulfate Cream (©Perigo or ©G&W), and Neomycin and Polymyxin B Sulfates and Bacitracin Zinc Ophthalmic Ointment, USP (©Bausch +Lomb). These may be alternated, and you might eventually find one works better than the other. Alternate these with Aloe Vera Gel for Sensitive Skin from Walgreens. See next paragraph. Ask your veterinarian for recommendations of other ointments or creams you might use. If you are unable to acquire these creams, use the triple antibiotic cream and ointment from the pharmacy.

      Alternate or additional topical therapy if the prescription creams cannot be purchased: Aloe Vera Gel for Sensitive Skin from Walgreens (or a similar gel). Put a small amount in a very small container and add a little distilled water; mix until you get a medium-gel consistency. Begin to massage the feet with a small amount of triple antibiotic ointment, such as Neosporin, followed by the Aloe Vera Gel. Do this treatment two or three times a day. It is available online from Walgreens. Do not use aloe vera plant liquid. It is not sterile and is not as effective as the gel. The addition of VetOmega is highly recommended to add strength and healing to the skin of the feet. See Section 9.5.2 for more information on this product.

      2. Keep the bird on fleece-covered perches for a long time, at least until the feet are completely healed and possibly longer, since some birds have a relapse of the condition. Make sure you remove the fleece strips twice a week and replace with clean ones. They are washable.

      3. If the bird cannot balance well and shows discomfort, place him in a storage bin on several soft towels until his condition improves. Put his food, water, and toys in the bin with him. If he’s flighted, cover with a framed piece of aluminum screening or some other type of open covering. When he’s out of the cage or bin, keep him on soft, clean surfaces at all times. You can put soft towels on the surfaces the bird walks on, such as the top of the cage or on any play areas. Keep him off the floor and all hard surfaces as much as possible.

      7.2 Additional information concerning treatment for less severe cases

      Less severe cases (Grades I and II) may be treated with a combination of environmental and medical methods. Correction of the underlying predisposing factors will often reverse this disease process.

      • Take the bird to the avian veterinarian immediately. More severe lesions (grades III to VII) need to be cared for more aggressively. He will need to determine the extent of the damage to the feet and guide you in their healing. If the veterinarian wraps the feet, find out how often you need to bring him back to have them treated and rewrapped, or ask him to let you change the bandages there so you can do it at home. (If you do not have an avian vet, contact the author so she can help you find one.) Follow the rest of the recommendations below. Do not use a heating pad! Get a prescription for Celebrex (celecoxib). Do not use meloxicam; it is not as effective as Celebrex and can cause digestive difficulties.
      • Make needed changes in diet with the addition of vitamins containing Vitamin A.

      See Appendix B, p. 50, for advisable food choices for these and all birds.

      Less severe cases may go back to rope or natural wood perches when the feet have healed. Perches should be soft. Rope perches are good for general use, and wood perches should be covered with cohesive tape/wrap. Vetrap is undesirable since it is sticky and holds dirt. Cohesive tape/bandage (white) will make it easier for the owner to notice the dirt and change it more often. It is not sticky, and white wrap will show the dirt more easily so the owner will be more likely to change it more often. Never use sisal perches, spirals, toys, or any other type of product. It will damage the feet and can be easily ingested, causing crop impaction.

      See Section 2 for descriptions of perches that should not be used for any birds, but especially the bird with pododermatitis.

      C:\Users\Jeannine\Pictures\pododermatitis, Diane Snuggles Hut  Larson.jpg

      Figure 31. Stage V Pododermatitis. This lesion bled before it was seen by the avian vet and during treatment (image courtesy Diane Snuggles Hut Larson; used with permission).

      7.3 Information for the treatment of more severe cases

      • For birds with more severe pododermatitis, the perches should be wrapped with strips of fleece and changed several times a week. Observation will let the owner know when they need to be changed. Be careful to get the right diameter of perch for your species of bird. They will be larger as long as the fleece strips are on them. Buy at least 1 yard of very soft fleece. Wrap all perches with overlapping, 1-inch strips of fleece held down by short pieces of twist ties on the ends of the perch. Rope perches and natural wood perches should also be wrapped in fleece for the more severe cases. You can wrap any rough-textured perches and dowel perches with fleece. Eventually you will want to remove those and replace them with rope and natural wood perches, although for severe cases, all perches should remain covered in fleece strips permanently due to the probability of relapse.
      • Remove all rough-textured, plastic, dowel, and warming perches. Platform perches must be covered in at least 2 layers of fleece held down by binder clips for small perches and clamps for the larger ones. The perch will be larger with the addition of the fleece. Change it as you find droppings on it. Have clean ones cut so you can replace them as needed.
      • For birds unaffected by pododermatitis: Perches should be soft. Rope perches are good for general use, and wood perches should be covered with cohesive wrap. (Vetrap is undesirable since it is sticky and holds dirt. Cohesive tape/bandage (white) will make it easier for the owner to notice the dirt and change it more often.
      • Provide frequent exposure to partially shaded sunlight. Avoid full sunlight for all birds, but especially for birds with pododermatitis and any illnesses; it will worsen their conditions as the bird will become overheated. Healthy birds should only be exposed to full sun for a very short time; then they should be moved to partial sun and shade.
      • Improve cleanliness. Change the fleece several times a week and clean the cages twice a day.
      • Birds in a bin must be on soft towels and sheets of fleece cut to the dimensions of the bin. They should stay there until the feet are almost completely healed. When they are returned to their cages, all perches should be wrapped in fleece indefinitely.
      • Make necessary environmental changes. Keep the bird room cool, not cold. You don’t want him to chill. The bird’s infection will have raised his body temperature. If he shivers and holds his wings close to his body, he’s too cold.
      • Never use a heating pad under the towels or cage, and never use UV lamps on the bird or his cage. UV Lamps should not be used on any bird or his cage. They will burn the skin and cause cataracts. Only ceiling lamps should be used, if at all, and they should only be on 2-3 hours a day.
      • Apply a topical antibiotic or antimicrobial cream containing steroids to aid in resolving the condition. (See 7.1 for medications used) These should be used with caution to prevent toxicity. Many topical products are available, such as softening agents for dry, scaly feet, topical antibacterial creams for acute inflammation and swelling, and ointments for granulating wounds.20 (Granulated tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process [Wikipedia]).
      • Utilize prescription medication; it may be needed both for healing and pain and inflammation. This should be discussed with the bird’s avian veterinarian. Provide Celebrex (celecoxib) for pain and inflammation. Avoid Metcam (meloxicam); it is a dog and cat medication and causes digestive issues in birds as well as not being as effective as celecoxib.
      • For all levels of disease, the owner must be willing to continue with the treatment at home, possibly for months. He needs to be made aware that some individuals are highly susceptible to recurrences. If the bird does not respond to these changes, or the condition continues to deteriorate, more complex medical treatment will be necessary.20 At that point, you must have a discussion about the bird’s prognosis with the veterinarian. It is of greatest importance to discuss all of the above treatments with your avian veterinarian.

      7.4 Additional treatment of the lesions, Grades III to VII

      If you do not have an avian vet, contact the author so she can help you find one and follow the rest of the instructions below.

      2. Prepare the lesions for treatment at home.

      To prepare the lesions for the topical antibiotics, they need to be thoroughly cleaned. Washing the feet with antibacterial soap is sufficient for Grades 1 and 2, but for Grades 3-7, preparation is more comprehensive. One recommendation involves soaking the affected foot/feet in a shallow dish filled with warm water with Epsom Salts added to it. The recommended strength is about one teaspoon of Epsom Salts mixed in with one gallon of clean, warm drinking water. The Epsom Salts will draw out any toxins. Soak for as long as the bird will tolerate it, at least 5 minutes per foot. Do this twice a day. Soaking the feet will soften and remove any scabs; this allows the lesion to drain any pus and debris. Do NOT remove the scab or other material without soaking it first. Allow the material to fall off by itself. Finally, flush the cavity with diluted hydrogen peroxide to clean the wound out and destroy any bacteria. 2 (Hydrogen peroxide should be diluted at a 1:10 ratio with water. One part HP, 9 parts water.) (J. Miesle)

      3. Transfer the bird to a storage bin of the appropriate size for his species. Prepare the bin by laying down at least 2 soft towels on the bottom. Keep the bird in the bin until the feet are healed. Place a cover on the bin which is partially open for air. A piece of aluminum screening, framed, will work. While the bird’s feet are healing, buy at least 1 yard of very soft fleece. Remove all hard or rough-textured perches from the cage and replace them with natural wood or rope perches. Wrap all perches with overlapping, 1-inch strips of fleece held down by a short piece of twist tie at the end that the bird does not stand on. Make sure perches are the appropriate size for your bird’s species. Cut a piece of fleece (or two smaller pieces) to fit the bin and place them on top of the towels. Make extra pieces to replace the large pieces when soiled. They are washable. Place the bird’s food, water, and toys in the bin. Do not use a heating pad!! The tissue is already hot from being inflamed and/or infected. Have the cage ready for the bird by the time he is ready to go back into it. Do not wait. (J. Miesle)

      4. Clean the feet with antibacterial soap, rinse and dry well; apply and massage in the creams. There are two prescription creams that you can get from your avian veterinarian: Gentamicin Sulfate Cream (©Perigo or ©G&W, and ©Neomycin and Polymyxin B Sulfates and Bacitracin Zinc Ophthalmic Ointment, (USP Bausch +Lomb). These may be alternated; you may eventually find one works better than the other. If you cannot get the prescriptions for these, use the OTC medications in the following paragraph. Get the Aloe Vera Gel from Walgreens and mix a very small amount with distilled water to make a medium-thin gel. Obtain VetOmega as discussed on p. 37. Begin to massage the feet with a small amount of triple antibiotic ointment, such as Neosporin followed by the Aloe Vera Gel. Use only this gel or a similar brand. Do this treatment 3 times a day. You can reduce this to 2 times a day as the skin heals. It is available in-store and online from Walgreens. Do not use Aloe Vera plant liquid. It is not sterile and not as effective. (J. Miesle)

      5. Once the feet have healed, the bird may be returned to his cage. He will have to be on fleece-covered perches for a long time and possibly permanently, since some birds have a relapse of the condition due to the skin having been compromised. Make sure you remove the fleece strips twice weekly and replace them with clean ones. Check the fleece daily for any signs of fecal material on them. You will eventually be able to change them just once a week. Replace the fleece weekly if there are no open sores, blood or fluid coming from the wounds. Replace the fleece as needed if these exist. Keep a close eye on the condition of the fleece strips. (J. Miesle)

      7.4.1. Dressings and bandaging

      The severity, type, and path of infection will direct treatment. No matter what, the owner should keep the bird’s feet sanitized and tailor the living environment to both promote healing and to eliminate destructive perches and surfaces.21 (Installing rope perches and wrapping all perches with fleece are the best ways to provide soft surfaces). Oral antibiotics and antibiotic ointment will control the infection. Bandaging may be recommended in order to reduce the opportunity for pathogens to enter the wounds. In more severe cases, surgery (including debridement of abscesses) will help to save the feet, and life, of the bird. 2 Antibiotics will be essential in resolving infection, and the bird can be kept comfortable with pain and anti-inflammatory medication. 21 (Celecoxib [Celebrex] is the best anti-inflammatory and pain medication for birds; do not accept meloxicam as it is not meant for birds and is not as effective as celecoxib. It also has gastrointestinal side effects that celecoxib does not have. (J. Miesle)

      Medical therapies include the application of topical agents in order to toughen the plantar skin of the foot. Softening agents are also helpful in cases in which the epithelium has become thin. Antimicrobial and anti-inflammatory creams and ointments and hypertonic footbaths provide infection and inflammation control. 5 (Hypertonic refers to a solution with higher osmotic pressure than another solution. If a cell is placed in a hypertonic solution, water will leave the cell, and the cell will shrink [Merriam-Webster.])

      Once the wound is clean, apply liberal amounts of antibiotic ointment as prescribed by the veterinarian, and then carefully wrap the foot or feet with gauze; this will keep the cavity clean and the ointment in place and prevent the bird from chewing on it. If the pododermatitis is in the very severe category, a ball bandage may need to be adhered to the foot. The lesion needs to be cleaned and ointments reapplied twice a day until the feet appear healthy.2

      A ball bandage is one option for management of a closed toe fracture

      Figure 32. A ball bandage is one option for the management of a closed-toe fracture or severe pododermatitis (image courtesy Dr. Ariana Finkelstein, Lafebervet). This type of bandage is frequently used for raptors who are in captivity due to their inability to be released in the wild. They develop pododermatitis from being in enclosures which have concrete floors or hardwood and often, poorly designed perches. (J. Miesle)

      6. In severe cases, a hydroactive (combined with water) dressing may be used Hydration sometimes helps to reduce the concentration of toxic substances in the tissue’s dressing and can be used to facilitate healing of the wounds [Merriam –Webster]). Hydrophilic dressings mix easily with water. Moisture-vapor, permeable dressings, or hydrocolloids (a substance that forms a gel when mixed with water) dressings should be applied topically to enhance wound healing for open, granulating wounds or post-operative incisions. Applying a topical antibiotic and bandaging to the feet with sufficient padding to reduce and better distribute pressure on the plantar surfaces is required in many cases. The types of bandaging methods may include simple toe bandages, interdigitating (between the toes) bandages, and ball bandages. Bandaging of affected tissues may go on for several months until the bird responds to the new diet and environmental deficits have been corrected.5

      Initially, the bandage may require daily changing. The frequency of bandage changes can be reduced as the wound becomes less exudative (producing fluid) especially in inflamed tissue. Once granulation tissue forms at the edge of the ulcers, scabs should be removed by the clinician, and the lesions should be kept clean to facilitate healing.5

      7.4.2 Therapy for severe lesions

      Therapy should include:

      • Cleansing and treating the wounds daily with multimodal medications and changing the bandages daily
      • Treating the wounds locally by using the antibiotic-impregnated matrix; antibiotic-impregnated beads are implanted into the wound
      • Administering systemic antibiotics parenterally (other than by mouth) in the beginning followed by oral dosing
      • Prescribing anti-inflammatory analgesics to provide pain relief. NSAIDs (non-steroidal anti-inflammatory drugs; e.g., celecoxib) or synthetic opioids may be used as needed. Celecoxib (Celebrex) is the preferred medication for inflammation and pain in birds. (J. Miesle)
      • Testing for systemic infection in more advanced cases of decubital ulceration (bedsores or pressure sores)
      • Performing a complete blood count at the discretion of the avian veterinarian.
      • Taking swabs regularly from within the abscesses for fungal and bacterial cultures. E. Coli, Staphylococcus, and Candida albicans are commonly isolated pathogens.5

      7.5 Goals for managing advanced pododermatitis

      Advanced bumblefoot is diagnosed by analyzing the necrotizing abscess on the plantar surface of the foot. Depending on the location and chronicity of the abscess, infection may or may not extend to neighboring joints, tendon sheaths, and bones.10

      The goals of advanced bumblefoot treatment are:

      • To reduce infection, inflammation, and swelling
      • To establish drainage as needed
      • To begin antibacterial topical and oral therapy to eliminate underlying pathogens
      • To manage the wounds in order to promote rapid healing
      • To initiate surgical intervention when needed
      • To ensure an adequate diet, and
      • To address environmental deficiencies.5

      Grade VI Pododermatitis in a four-year-old budgerigar with a straight perch in his cage for years

      Figure 33. Grade VII Pododermatitis in a four-year-old budgerigar with a straight perch in his cage for years (image courtesy of K. Gerbaga Özsemir; used with permission).

      This will be accomplished by:

      • Correcting any perching and bedding issues
      • Adjusting nutrition as needed
      • Correcting potential husbandry issues; cleaning and disinfecting the bird’s enclosure in order to eliminate injuries and stresses associated with those
      • Correcting the bird’s diet when it is found to be lacking sufficient Vitamin A, (Essential Fatty Acids, and other important nutrients). Vitamin A injections are an option. Recommendations will be made by your avian veterinarian or through research to supplement the diet to increase vitamin A.
      • Increasing exercise and adjusting the diet of all ill birds; adjusting the diet of obese birds for weight loss as needed.
      • Addressing bacterial infections, whether localized in the wound area or systemic. Cephalexin antibiotics have been used successfully in cases that involve infection that has spread through the body.
      • Treating and dressing any wounds or ulcerations that are present to encourage healing
      • Using surgical treatments, natural healing products, therapeutic lasers, and even acupuncture as needed. These are determined by the extent to which the pododermatitis has progressed and the recommendation of the avian veterinarian.21

      See Appendix C, p. 55, for information on laser treatments for pododermatitis.

      Grade VII bacterial pododermatitis

      Figure 34: Grade VII bacterial pododermatitis. This lesion usually develops following pressure necrosis with a subsequent bacterial infection (image courtesy Harrison: Clinical Avian Medicine, 2006).

      7.6 Surgical treatment of advanced cases

      Advanced cases may warrant surgical debridement (cleaning and cutting away of dead tissue) of fibrotic and exudative material as well as attempts to close the wound with sutures. Debridement should be approached cautiously since hemorrhaging can occur. Surgical excision of the abscess or amputation of a severely traumatized digit or even the foot may be indicated.5

      Surgery is often necessary to repair damage to the tendons and ligaments. This is a long, slow process, and it may take months before the feet are healed. Even after healing is complete, the foot may still be tender for several weeks. Preventing trauma and maintaining the patient on a soft footing is important to avoid recurrence. (Birds should be kept on soft towels in storage bins during this time and not in their cages.) Waterfowl should be returned to the water as soon as possible to prevent further damage.5

      Treatment for Grades IV to VII should include drainage, irrigation, and closing of the wound when the infection has been resolved. The prognosis is fair. Treatment for the lesions must be vigorous, and the prognosis is guarded.5

      8. Consequences of neglecting to provide treatment for pododermatitis

      If the bird owner notices the formation of these sores, initiates veterinary treatment, and makes positive changes to the bird’s living environment and diet, the prognosis for healing is good. However, without veterinary attention and environmental improvements, the sores typically turn into painful abscesses, which enable opportunistic pathogens (usually S. aureus) to breach the surface of the thinning skin.21

      8.1 Pain, arthritis, and infection

      The pain from these lesions causes increased weight-bearing on the unaffected foot, forcing the bird to bear its weight disproportionately. As a result, many birds suffer from bilateral pododermatitis. The plantar location of the lesion is constantly under forces of pressure, movement, and contusion (bruising); in addition, the bird’s feet are constantly exposed to contaminants.9 These birds are prone to arthritis as well, and this disease only worsens with time.21

      Celecoxib should be provided for any birds experiencing pain and inflammation for any reason. It is far superior to meloxicam and has fewer side effects.

      “Infectious pododermatitis with gross swelling of a foot in a snowy owl

      Figure 35. “Infectious pododermatitis with gross swelling of a foot in a snowy owl. The central scab was removed, and a large amount of liquid pus was present within the foot” (image and text courtesy B. Speer: Current Therapy in Avian Medicine and Surgery).

      Figure 36. “After debridement and application of a topical ointment and dressing, an interdigital bandage was applied as well as a custom-fitted silicone shoe” (image and text courtesy B. Speer: Current Therapy in Avian Medicine and Surgery).

      8.2 Necrosis, lameness, and decreased quality of life

      In due time, the infection encroaches upon joints in the feet and bones in the legs, and surrounding tissues become necrotic. Ulcers may form on the feet, and the bird may become progressively lame.21 “Birds beset by advanced and untreated bumblefoot can become so systemically infected that their lives are unsustainable.21 If left untreated, the lesions lead to crippling deformities, sepsis, and poor quality of life.9 Bacterial infections that begin in the pads of the foot can ultimately lead to a bird’s death. Many surviving birds endure chronic abscesses and the amputation of a leg.21 Unless the condition is treated, the infection will eventually eat into the bone and travel to other parts of the body. This is a painful condition that can lead to death.21

      8.3 Osteomyelitis involvement

      If systemic infection and pain can be controlled, the above therapy may be attempted. If the disease state becomes extreme, osteomyelitis occurs, and the prognosis for recovery decreases dramatically. The owner must be forewarned that the therapy will be of a long duration, and the prognosis is poor. The owner and practitioner will need to discuss the ethics of such long, continuous treatment when the degree of disease is so advanced that the bird cannot stand without severe pain. Euthanasia will need to be considered under such circumstances.20

      8.4 Limb amputation

      If a bird has had a pelvic limb amputation, it is possible that pododermatitis will develop in the opposite leg. These birds benefit greatly from having soft, wide, padded perches and platforms provided for them. (Even better, they should be in bins on soft towels so they don’t have to try and perch.) It is also possible that the wounds will be so severe that they do not respond to medical or surgical therapy, and the second foot or leg will need to be amputated. Euthanasia must be discussed if that occurs.6
      9. Prevention of pododermatitis

      Pododermatitis is easier to prevent than it is to treat. Bumblefoot may be prevented by taking the proper steps to ensure that the bird’s living conditions are correctly designed, it is given a nutritious diet, and its cage and all play areas are kept scrupulously clean. Prevention of pododermatitis involves constant vigilance for early signs of hyperkeratosis, baldness, flaking of the skin of feet and legs, redness or swelling. Early correction of the underlying causes will avert future severe disease.19

      K:\All pictures from My drive Oct 17,   2023\Bird cages\20220108_213752.jpg

      Figure 37. If a bird’s case of pododermatitis is severe, it would be helpful to house him in a “flat,” wide cage. (The term “flat” is used by manufacturers and sellers to distinguish it from the square and tall cages.) These are especially nice for handicapped, aged, or ill birds, not just for those with bumblefoot. A small, fleece-wrapped rope perch or natural perch can be placed in one of the front corners, close to the floor of the cage, once the bird’s condition has improved. Yaheetch® and Chewy® carry these cages, among other companies.

      9.1 Choosing the right size cage

      Cages should be large enough to accommodate several different types of perches. They should be neither too large nor too small. A cage that is too large will find the bird at the top of the cage, at the highest perch, and staying there most of the time, not taking advantage of the other perches, toys, and food and drink in the rest of the cage. Macaws placed in these huge, double-wide cages rarely move around; they are sedentary for the most part. An appropriately sized cage will benefit the bird by giving him a reason to move about the cage in search of toys and food. If the cage is too small, the bird will not be able to open and spread his wings or move around the cage easily. The idea that the cage should be as large as you can afford is not a good one. The bird feels lost in such a large cage. The ideal size is one that is large enough to be roomy and hold several toys, yet small enough for the bird to feel comfortable and not overwhelmed by the additional unnecessary room in a huge cage (J. Miesle).

      Cages should contain horizontal bars for climbing; these will help prevent trauma to the foot pads from vertical bars which need to be gripped to slide down. Care should be taken to make sure that the wire is smooth and contains no sharp places which could puncture or scratch the feet. Even powder-coated cages may contain sharp points which could damage the feet. Any rough places should be found and smoothed over with a file19 (J. Miesle).

      The idea that a cage should be as large as one can afford is not a good one. It should be large enough to be roomy and small enough for the bird to feel comfortable and safe.

      J. Miesle

      For birds housed in wire enclosures, the walls of the enclosure should be designed with horizontal bars or solid barriers to minimize the tendency for hanging from the wire. Never house birds in galvanized wire structures. Birds will chew on that type of wire and fall ill with metal toxicosis. Selection of proper perch size, shape, and covering for a particular species of bird is very important. 19 (The reader should discuss this with his avian veterinarian (J. Miesle).

      .C:\Users\Jeannine\Pictures\20231124_101031.jpg

      Figure 38. Another flat or wide cage. As you can see, soft towels are placed on the top, and food and water dishes can be placed close to the bird’s favorite spot on the cage—in this case, the front left corner. There are several larger pieces of fleece inside the cage on the front right corner for extra softness. And there is a small rope perch on the left front corner, close to the floor of the cage. (In this case, the affected bird never stands on the front left perch, so it is not wrapped in fleece; other birds who visit like to stand on that perch.) The bird with pododermatitis should have any perch in the cage he stands on wrapped in fleece. There are three soft towels on the floor of the cage and toys on the sides and back. The cockatiel whose images were used for Figures 24-27 is on the top of the cage. Make sure the towels come all the way to the edges and sides (image and text courtesy J. Miesle).

      C:\Users\Jeannine\AppData\Local\Microsoft\Windows\INetCache\Content.Word\20231124_100700.jpg

      Figure 39. Another option, especially for a bird that is elderly or compromised with other health conditions, is to place the bird in a bin on soft towels. This will give him the comfort and security he needs to heal. This bird is blind and cannot fly. This is where he sleeps at night to avoid night frights. The cockatiel in Figure 35 and two other handicapped birds sleep in bins as well. During the day they are out and in wide cages for naptime (image and text courtesy J. Miesle).

      The author’s bird in a bin with towels layered for softness. When arthritis becomes very painful, foot sores are present, so placing the bird in a bin on towels is preferable to keeping him in the cage. (An alternative to the bin is a wide cage, as in Figure 35.) There are no bars, multiple towels will protect the feet, and the bird will move about much more easily. Food, water, and toys may be placed in the bin with the bird. As long as the bird’s condition is severe, there should not be any perches in the bin or wide cage.

      Do not use a lamp or heating pad for these birds. For birds with bumblefoot, the additional heat from a heating pad or lamp is contraindicated because it will aggravate the condition, making any inflammation, infection, or irritation worse. Heat lamps should never be used on any bird’s cage, attached to the cage or shining into the cage. It will damage the eyes and skin and overheat the bird (J. Miesle).

      Stage VI pododermatitis

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        Figure 40. Grades VI pododermatitis; These sores are necrotic and oozing (image courtesy Brisbane Bird Vet; used with permission). (https://www.facebook.com/ParrotTrustScotland). Note that the skin has pulled away on the right foot, back digit.

        Grade VII infectious pododermatitis in a chicken

        Figure 41. Grade VII infectious pododermatitis in a chicken. This bird’s staphylococcus infection is destroying the skin, making it impossible for the skin to be sewn together (image courtesy Farmer’s Weekly).

        9.3. Sanitation and substrates

        These can be a problem. The wire grid, or any other wire, should never be the surface that any bird stands on, whether it be the floor of the cage or aviary or a platform. It can damage the feet and cause cuts and bruises. Hard or wire flooring that the bird with pododermatitis stands on should be covered with soft towels to protect the feet, facilitate a more comfortable surface on the floor, and speed the healing process. The grids on the bottoms of the cages of a bird with bumblefoot should be covered with two layers of soft towels without anything on top of them, even paper towels.

        The grids on the bottoms of non-affected birds’ cages should be covered with either a towel covered with paper towels or just several layers of paper towels in order to prevent cuts, scratches and any other types of damage to the feet. 

        Birds should never stand on grids or wire. Any surfaces an affected bird touches should be carefully sanitized and kept clean, and they should always be very soft (J. Miesle).

        Proper hygiene is of the utmost importance in preventing bumblefoot.

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          • Cages and perches need to be cleaned and disinfected daily to avoid contamination from fecal matter and bacterial growth on surfaces and in food.
          • Soft foods should be removed within two hours to prevent bacterial growth. Soft or fresh food can be placed on paper towels to make cleanup easier.
          • Wipe down any surface that fresh foods have been on as soon as the food has been removed to prevent bacterial growth.
          • Seed, food, and water cups should be checked frequently during the day for droppings and debris.
          • Food and water cups need to be cleaned daily and replaced with fresh food and water as needed.
          • The grates and trays of the cage must be cleaned daily since many birds spend time on the bottom of their cages where they may come in contact with the droppings. Soft towels and/or paper towels on top of them on the grates (or trays if there are no grates) will make clean-up easier.
          • All play areas must be kept very clean. Any play surface is a potential source of bacterial and fungal pathogens that could invade the surface of the bird’s feet. T-stands, toys, and anything the bird stands on must be kept scrupulously clean
          • Be aware of the possibility of parasites in the cage and/or on the birds. These will make the pododermatitis condition worse.
          • Droppings, regurgitation, and soft foods should be cleaned up immediately to prevent consumption, reinfection, and transmission of disease.
          • Care must be taken to choose a cleaning product that will not harm the healthy or damaged tissue. All cleaning products need to be dry before allowing the bird to stand on them.3
          • White vinegar (2 ¼  cups to a gallon of water) is a good cleaning liquid. Make sure it too is dry before the bird walks on it.

          Do not use substrates on the bottom of the cages. These include nut shells, wood chips, grains, corn husks, moss, pine cones, soil, and bedding made for reptiles and small mammals—any type of bedding. These not only provide opportunities for bacterial and fungal spores to grow, but they also put dust into the air that harms the bird’s breathing and makes it impossible for the owner to observe the droppings. Substrates are also harmful to the humans and other pets in the house. Use plain newspaper, and place it where the bird cannot reach it. (J. Miesle)

          9.4 Proper nutrition

          Nutrition is extremely important. Many affected birds are primarily seed-eaters. Feeding a balanced diet of some seeds (very few sunflower and safflower seeds since they are high in fat and can lead to Fatty Liver Disease), fresh fruits and vegetables, greens, and some human foods is critical. Provide fresh water for drinking daily. Proper nutrition often will prevent or even reverse early bumblefoot in Psittaciformes. The diet should be corrected to promote needed weight loss for obese birds and to increase general nutritional balance, with emphasis on the replacement of Vitamin A precursors.13,20 Providing Vitamin A injections if needed and foods high in Vitamin A will prevent more damage to the feet. A quality vitamin and mineral supplement is very important. Avi-era (Lafeber) and Missing Link are the best ones. Vitamin and mineral supplements should not be given to birds who are on a pelleted diet. These birds should be weaned off the pellets and onto fresh, natural foods. (J. Miesle)

          9.4.1 The harmful effects of excess protein

          Excess protein, when stored in the body, promotes the growth of internal bacteria which are excreted through the skin. In areas where there are feathers, those feathers will usually absorb the protein. In bare areas, such as the feet–and in some birds, the face– these bacteria will present themselves as pink, red, and then blue “calluses.” These most often show up on the bottom of the feet; however, they may also appear on the top or on the tips of the toes, above or under the bird’s toenails. It is important to reduce the protein in the bird’s diet to stop the progression of this condition. 2 Pellets contain a high amount of protein—another good reason to remove pellets from the diet. (J. Miesle)

          9.4.2 The benefits of vitamins, minerals, and supplements

          Birds require supplemental vitamins and minerals to aid in the prevention of bumblefoot and improve the immune system to prevent other diseases. Birds require Vitamin A and biotin (a B-complex vitamin) supplementation to ensure healthy skin development.  Deficiencies in these vitamins may result in pododermatitis and focal hyperkeratosis (plantar corns). Bird owners should provide multivitamins, minerals, and essential fatty acids/amino acids supplementation to prevent these diseases.12 VetOmega will provide the essential fatty acids/amino acids to the bird’s diet. (J. Miesle)

          For the affected bird with Grades III to VII, initial injections of Vitamins A and the addition of B-complex vitamins and Vitamin D3 are advised; in addition, oral supplementation of multivitamin/mineral/essential fatty acid/amino acid preparations is recommended.

          Your avian veterinarian may also want to provide those injections to birds with Grades I and II pododermatitis. 1,12,16 ©Avi-era Vitamins and ©Missing Link minerals are excellent choices for vitamin and mineral supplements. Avi-era and Missing Link, and all other vitamins and minerals, should be placed on the food. They can also be mixed with a little water and given via oral syringe. Make small amounts as these need to be discarded at the end of the day. You do not want to give too much to the birds; there are health issues for the bird that ingests too many vitamins and minerals. The paper, Nutritional Requirements of Companion Birds, explains the danger of hyper- and hypovitaminosis. Birds with pododermatitis should be given a small amount each day, alternating, until the bumblefoot has healed, then go to the same schedule as non-afflicted birds. For non-affected birds, a small amount 3 days a week is sufficient. If you provide both Avi-era and Missing Link, alternate them.

          Omega 3 and 6 essential fatty acids may be added in the form of ©VetOmega, available through your avian veterinarian or directly from Dr. Scott Echols. This product provides all your birds with the oils it needs for healthy skin and feathers and to protect the internal organs. This link will allow you to order it yourself if your veterinarian does not carry it. Encourage him/her to begin to offer it to his clients. (J. Miesle)
          https://www.vetomega.com/?fbclid=IwAR330QUDMPrtHY-rzR6AMrMg- vbPWPf_SmcfmA36qt_q4LpjpM5t0K0wYuAet

          9.5 Exercise

          Exercise will aid in preventing and healing pododermatitis; the bird who is allowed to fly will spend less time on his feet, and that will give the feet some relief from constantly standing. Make sure everything he stands on is soft! Allow the bird out-of-cage or out-of-bin time frequently throughout the day so that he can fly and strengthen his legs; this will take the pressure off the feet. Exercise will also aid in lowering the obese bird’s weight.11 If the bird does not fly, allow him to walk on the floor, but only if the floor has soft coverings like carpeting, towels, blankets, or rugs. Walking on sofas or beds is another good place for him to exercise. Many of these birds have some arthritis, and exercise will benefit them. Many birds with pododermatitis have developed arthritis before the sores on the feet are even discovered (J. Miesle).
          Conclusion

          Pododermatitis is a disease that is easily preventable with the proper environment and nutrition. In the early grades, it is somewhat easy to control, and reversing the disease process is possible. In later grades, however, it becomes increasingly more problematic to treat and can, eventually, lead to permanent crippling and even death; therefore, the bird owner is advised to be continually vigilant, observing the condition of the bird’s feet on a daily basis. At the first sign of a lesion or bruise on the foot, the diligent owner should take the bird to the avian veterinarian for diagnosis and treatment. When treatment and changes in diet and husbandry are initiated early in the disease, the chance of recovery is very good. The owner should change or cover the perches immediately so the disease does not become progressively worse. It is essential that the owner be attentive in caring for his birds.

          References:

          1. Axelson D. Avian Dermatology. In: Practical Avian Medicine: The Compendium Collection. Ed: Heidi Hoefer. Veterinary Learning Systems, 1997. p. 200
          2 Beauty of Birds. Bumblefoot. https://www.beautyofbirds.com/bumblefoot.html
          3. Clubb S, Flammer, K. The Avian Flock. In: Avian Medicine: Principles and Application SPIX Pub., Inc. p. 50, 56-58
          4. Cooper J.E., Harrison G. Dermatology. In: Avian Medicine, Principles and Application. SPIX Pub., Inc. P. 632
          5. Degernes L. Trauma Medicine. In: Avian Medicine, Principles and Application. SPIX Pub., Inc. 2006. p. 425, 426
          6. Doneley R, Harrison G, Lightfoot T. Maximizing Information from the Physical Examination. In: Clinical Avian Medicine, Spix Pub., Inc. p. 190, 404
          7. Doneley R., Smith B., Gibson J. Use of a Vascular Access Port for Antibiotic Administration in the Treatment of Pododermatitis in a Chicken. J Avian Med Surg 29 (2) 130-135, 2015.
          8. Dumonceaux G., Harrison G. Toxins. In: Avian Medicine, Principles and Application. SPIX Pub., Inc. 2006. P. 1047, 1048
          9. Ford S., Chitty J., Jones M. Raptor Medicine Master Class. Proc Assn Avian Vet 2008 p. 173-190
          10. Gerlock H. Bacteria. Avian Medicine: Principles and Applications. SPIX Pub., Inc. p. 967
          11. Helmer P., Redig P. Surgical Resolution of Orthopedic Disorders. In: Clinical Avian Medicine. SPIX Pub., Inc. p. 771, 772
          12. Koski M. Dermatologic Diseases in Psittacine Birds. In: Seminars in Avian and Exotic Pet Medicine, Vol. 11, No. 3 (July), 2002. p. 120
          13. McDonald D, Harrison G. Nutritional Considerations. In: Clinical Avian Medicine. SPIX Pub., Inc., 2006 p. 117
          14. Miesle J. The Effects of Tobacco Use on Avian Species. In: Facebook group The Science of Avian Health FileAcademia.edu, IVIS website. 2017
          15. Olsen J. Anseriformes. In: Avian Medicine, Principles and Application. SPIX Pub., Inc. 2006. p. 923
          16. Perpinon D. Obesity in Parrots. The Veterinary expert.  http://www.theveterinaryexpert.com/parrots/obesity-in-parrots/
          17. Ritzman T. Therapeutic laser Treatment for Exotic Animal Patients, Round Table Discussion. AAV J Avian Med Surg 29 (1):69-73, 2015
          18. Samour J. Management of Raptors. In: Clinical Avian Medicine. SPIX Pub., Inc., 2006, p. 923
          19. Sander S, et al. Advancement Flap as a Novel Treatment for a Pododermatitis Lesion in a Red- tailed Hawk. J Avian Med Surg 27(4): 294-300, 2013.
          20. Schmidt R, Lightfoot T. Integument. In: Clinical Avian Medicine. SPIX Pub., Inc., 2006, p. 403, 404
          21. Turner C. Bumblefoot in Birds. Wagwalkinghttps://wagwalking.com/bird/condition/bumblefoot
          22. Van Sant F. The Integument: The Largest Organ System of Birds. Proc Assn Avian Vet 2014

          Appendix A: Treatment of raptors, poultry, and waterfowl

          In captive raptors, bumblefoot is a common medical condition, even though it is never seen in the wild. Some raptor species appear to be more susceptible to this condition than others; falcons present with this frequently, but it is rarely seen in hawks. It is a result of poor nutrition, obesity, inadequate perches, lack of exercise, poor blood circulation to the foot, and cardiovascular changes at the end of the hunting season.18

          Penetrating wounds or bruising of the feet may be predisposing factors in raptors and waterfowl. Grades I to III lesions may not be discovered in raptors; most are not seen until they have more severe lesions.4

          In captivity, raptors are prone to bruising and abrasions on the plantar surface of the feet from jumping from a hard perch onto another hard surface, such as a stone floor and from hanging from cage wire by their feet, or being forced to stand on hard perches or cement. Any soft tissue or orthopedic injury involving one leg or foot may cause excessive weight-bearing and secondary pododermatitis on the contralateral foot (the foot on the other side.) 5

          Overgrown talons cause improper weight distribution on the plantar surface of the foot, especially in falcons, or self-inflicted puncture wounds of the metatarsal pad. Other traumatic injuries to the foot which can lead to bumblefoot include bite wounds from prey, punctures from thorns or quills, and trap injuries.5

          From Dr. Bart Huber, Animal Medical Center of Corona, California

          https://www.facebook.com/amcofcorona/

          Radiographs of a chicken with severe pododermatitis brought on by a fracture which caused the bird to stand in a way which put undue pressure on that foot.

          “Once the bone has been invaded, chances of a cure are almost zero. Now, there is a newer product, Kerrier beads – Kerrier.com – where we buy this sterile kit and can make antibiotic impregnated Plaster of Paris beads that we implant into the affected foot (or where the patient has a bone infection.) The issue in the past is that there was not sufficient circulation to get enough antibiotics via the blood stream to the lesion. With these, the lesions are packed with antibiotics, increasing the healing rate. It does not get rid of the arthritis from the damaged bone, but it does give us hope. Sadly, most of these back yard birds end up getting euthanized.”

          C:\Users\Jeannine\Pictures\Huber 4 yo old rooster - 4.jpg C:\Users\Jeannine\Pictures\Huber 4 yo old rooster - 3.jpg

          C:\Users\Jeannine\Pictures\Huber 4 yo old rooster - 2.jpg C:\Users\Jeannine\Pictures\Huber 4 yo old rooster - 5.jpg

          C:\Users\Jeannine\Pictures\Huber 4 yo old rooster - 1.jpg

          A close-up of an x-ray of a bird's arm

Description automatically generated

          Figure 42-49. Pododermatitis caused by a fracture in the leg. This is an example of the disease being caused by an injury above the foot, not on the foot directly. Dr. Bart Huber has kindly allowed us to use these images.

          The author expresses her gratitude to Dr. Huber for his generous permission to use these images.

          A bird’s inactivity in an enclosure, limiting its ability to fly, is a contributing factor. In a study by P.T. Redig (Ford: Raptor Medicine Master Class), raptors that were housed outdoors and were able to exercise did not develop bumblefoot, regardless of their perching surfaces. The group that was maintained indoors on the same diet developed bumblefoot irrespective of the perching material.5

          For large birds and raptors housed in wire enclosures, the walls of the enclosure should be designed with horizontal bars or solid barriers to minimize the tendency for hanging from the wire. The selection of proper perch size, shape, and covering for a particular species of bird is very important. Perches wrapped with hemp rope or covered with Astroturf work well for most raptors. Falcons do best on flat shelves or block perches covered with short Astroturf or cocoa mats. Strict sanitation of the facilities and feet is important to minimize bacterial infections. Liquid bandage products work well for minor skin cracks or torn talon sheaths in raptors.5 The feet should be massaged with a healing product, such as coconut oil or Aloe Vera gel (see 7.1)  (J. Miesle).

          Red-tailed hawk

          Figure 50. Red-tailed hawk at Wild Care in Eastham, MA. “One talon had to be removed due to a serious infection in the feet. He is on ball bandages. The caregivers are optimistic about his ability to be returned to the wild” (image courtesy Cape Cod Capecast). 

          In most cases, treatment involves the surgical removal of scabs and adjacent necrotic and purulent (pus-filled) tissue, followed by suturing to achieve healing by first intention (the wound is held together by a blood clot or sutures). Sometimes antibiotic-impregnated beads are placed within the wound cavity to improve the rate of healing. If the opening is larger, sutures are used along with hydrocolloid dressings to promote healing.18

          Bumblefoot infection has spread across both of this bird’s feet

          Figure 51. Grade VII “Bumblefoot infection has spread across both of this bird’s feet. The areas affected look blackened” (image courtesy The Veterinary Expert; used with permission).

          A discrete bumblefoot lesion, showing typical positioning at the weight-bearing position on the base of the foot

          Figure 52. Grade VI “A discrete bumblefoot lesion, showing typical positioning at the weight-bearing position on the base of the foot.” (image courtesy The Veterinary Expert; used with permission). (Discrete refers to a single lesion that is localized as opposed to a diffuse lesion in which there are multiple lesions present)

          Chickens cope incredibly well with legs bandaged

          Figure 53. “Chickens cope incredibly well with legs bandaged! This bird has had surgery for bumblefoot. The bandages cover the surgical site as well as allowing pressure relief to the feet whilst the area in question heals” (image courtesy The Veterinary Expert; used with permission).

          “Captive waterfowl are also at increased risk for developing this condition because of their heavy-bodied nature and the amount of time they spend standing on rough, hard surfaces around pools or pens. Waterfowl may suffer penetrating wounds and bruises on the feet which lead to pododermatitis.”15 Caring for waterfowl frequently involves changing the dimension, shape, and surface of the enclosure, adding adequate swimming areas, and keeping everything very clean.20

          A silver gull with a tibiotarsus fracture on its right leg

          Figure 54. “A silver gull with a tibiotarsus fracture on its right leg (Larus michahellis) His solid left foot, burdened with more weight than normal, resulted in pododermatitis” (image courtesy Kübra Gerbaga Özsemir).

          “Pododermatitis is common in poultry. VAPs (Vascular Access Ports) are more commonly used in mammalian patients but are sometimes used to treat avian patients requiring long-term intravenous therapy or serial blood collection. Vascular Access Ports offer the advantages of ease of access, reduced trauma and handling of the patient, and the accurate delivery of large volumes of tissue-irritating drugs. Although this technique is used for mammals, it is still considered a novel treatment for avian species.” 7

          Grade VI bumblefoot foot in a buzzard

          Figure 55. Grade VII bumblefoot foot in a buzzard (Buteo buteo). This bird had been shot and had developed severe arthritis of the tibiotarsal joint of the contralateral limb. The wounds oozed blood as well. The bird was emaciated and had a heavy worm burden. Excessive weight bearing on the healthy leg, coupled with malnutrition, is likely to have resulted in the lesions depicted (image courtesy World Wide Wounds).

          Grade VI pododermatitis in a chicken

          Figure 56. Grade VII pododermatitis in a chicken (image courtesy Monica Talbett; used with permission).

          Grade VI pododermatitis

          Figure 57. Grade VI pododermatitis. The chicken’s foot before surgery (image courtesy of The Chicken Chick).

          The chicken’s foot four months after surgery

          Figure 58. The chicken’s foot four months after surgery (image courtesy The Chicken Chick).

          Appendix B: Food choices for affected birds J. Miesle

          Vitamins should always be given to birds unless they are on a pelleted diet. These birds should be taken off pellets and put on a more natural diet. Avi-era and Missing Link are good choices for vitamins. They can be purchased online or at some bird shops. If only one is fed, feed 3 times a week on food, not in water. If both are fed, alternate.

          These foods are appropriate for other small birds like budgies, lovebirds, and medium and large birds as well. It is recommended to purchase everything separately and make your own mix. Don’t buy from big box stores or dog/cat pet stores. These stores may have had the food sitting in warehouses for months or even years. Even if they sell birds, they buy from the big box stores. With bird-only stores, they buy quality, and you don’t run the risk of having contaminants like mold, animal droppings, and saliva in the food that you would with food from other sources.

          Don’t hesitate to eat with your bird. Many birds will start eating good foods if fed at the table with the owner and/or other birds. It’s a great bonding time.

          Cereals:

          • Sugar-free cereals, like Wheat, Rice, and Corn Chex; some like it moistened with a little rice, almond, or other non-dairy milk.
          • Flakes, like Wheaties, Total, and cornflakes; Cheerios and other low-sugar cereals are good. Some may have small amounts of sugar, which is OK, but if sugar is among the first 3 ingredients, the food will have too much sugar in it and should be avoided.
          • Flax seed—available at grocery stores, only for small birds.
          • Low-sugar granola, e.g., Quaker Puffed Granola, Blueberry-Vanilla Flavor. It has small freeze dried blueberries in it.

          Other foods:

          • Nutriberries and Avi-cakes; these are labeled as treats, but they are not. They are nutritious foods. They come in three sizes.
          • Kaytee parakeet Forti-diet Honey Treat Bars for small to medium size birds. Break them up and give a small amount per day. Don’t just put the whole thing in the cage. Some of these birds will eat nothing else if allowed. Parakeet bars do not have sunflower or safflower in them, but the larger sizes do. https://www.chewy.com/kaytee-forti-diet-pro- health-honey/dp/122876.
            Available at Chewy, Amazon, and Petco, among others.

          Seeds

          • Parakeet seed instead of cockatiel or other seeds for mid-sized birds. They are the same, except that cockatiel includes a lot of sunflower and safflower, both bad for the liver. Read the ingredients on everything you buy.
          • Oat groats: Some grocery stores carry it. Great Companions, Amazon, and Shiloh Farms do. Shiloh farms has good quality and price. Whole Foods or other similar stores may carry it. Amazon carries some good-quality groats. Do not buy anything that is cheap; it isn’t worth it.
          • Red and white/yellow proso millet: These are small seeds, so only small birds would eat them.
          • Nuts are good for larger birds, but only feed tree nuts. Avoid peanuts and all peanut products. They usually contain mold spores. Those small black spots on the shell and nut are mold spores, and mold can be in the peanut products at the store.

          White/yellow proso millet is available at some grocery stores or over the internet. Morning Bird carries red and white proso millet. Red is a particular favorite of cockatiels.

          https://morningbirdproducts.com/collections/bird- seed, https://www.morningbirdproducts.com/products/morning-bird-red-proso- millet?_pos=1&_sid=937075e06&_ss=r
          https://www.shilohfarmsmarket.com/ https://www.shilohfarms.com/

          NEVER BUY SEEDS FROM NON-AVIAN PET SHOPS OR BIG-BOX STORES. THEIR SEEDS ARE STORED FOR MONTHS OR LONGER AND MAY BE CONTAMINATED WITH ANIMAL DROPPINGS OR OTHER DIRT, AND WILD ANIMALS MAY HAVE EATEN FROM THE PACKAGES.

          Millet sprays:

          • Amazon, Nemeth Farms, has two bluebirds on top of millet. From “Bird Dog” Excellent quality. Available in 1 lb. bags, 5 lb. boxes, and 25 lb. boxes. It’s quite expensive, but you get what you pay for. There is very little waste, and the sprays are full and fresh. It looks like this:

          https://www.amazon.com/Nemeth-Farms-Parakeet-Natural- Healthy/dp/B001LK91O4/ref=sr_1_2?keywords=spray+millet+for+birds&qid=1567312878&s=ga teway&sr=8-2
          https://www.amazon.com/Nemeth-Farms-Parakeet-Natural- Healthy/dp/B0068RFAFO/ref=sr_1_1?dchild=1&keywords=nemeth+farm+millet&qid=16088633 59&s=pet-supplies&sr=1-1

          These websites have changed to offering the millet in 1-pound bags, not the 5 and 25 lb. boxes. Another distributor in Amazon carried it. and found the 5 and 25 lb. boxes. Here is the link: https://www.amazon.com/Pesticide-Nemeth-Supplement-Cockatiels-Finches- 5lbs/dp/B001LK91O4/ref=sxts_rp_s_sp_1_0?content-id=amzn1.sym.497ddbaf-dbdc-4a61-b204- 33f5c59012b2%3Aamzn1.sym.497ddbaf-dbdc-4a61-b204- 33f5c59012b2&crid=2UGGL33HCZTNM&cv_ct_cx=millet%2Bspray%2Bfor%2Bbirds&keywords=millet% 2Bspray%2Bfor%2Bbirds&pd_rd_i=B001LK91O4&pd_rd_r=143c599f-3eb0-442a-a40b- 8c6cb500d950&pd_rd_w=xCxPs&pd_rd_wg=9ywgo&pf_rd_p=497ddbaf-dbdc-4a61-b204- 33f5c59012b2&pf_rd_r=D8V565J9WBVWKQZSVSQK&qid=1669429901&sprefix=millet%2Bspray%2B% 2Caps%2C73&sr=1-1-5985efba-8948-4f09-9122-d605505c9d1e&th=1

          • Buckwheat seeds and groats. Meijers sometimes carries it, best price at Shiloh farms. https://www.shilohfarms.com/buckwheat-groats-organic/
          • Zupreem fruit-flavored pellets for cockatiels and medium-sized birds, Chewy carries them; a few a day if they like them. It’s not for a nutritional benefit; simply if they like them.
          • Kaytee Fruit and Veggie mix and Fruit Mix for Parakeets, and other parakeet mixes. Chewy, Petco, or Amazon.
          • NO GRIT, EVER, FOR PSITTACINES BIRDS! Only birds that eat their seeds whole use grit; Psittacines (birds in the parrot family) do not. They shell their seeds. Birds like canaries, doves, and pigeons only need a very small amount; more should only be added when that amount is gone. Otherwise, they can develop crop impaction.

          Human foods:

          • Rice, pasta, mashed potatoes, sweet potatoes, couscous, scrambled egg, applesauce (a real favorite, and a way to get fruit into them). It’s also a good way to train them to take food and medications from an oral syringe. Human foods are OK as long as they are not fatty, fried, or breaded. For more protein, baked chicken breast, ground beef, roast beef are good, and from the deli, roast beef and chicken slices and low sodium ham are good. Usually, only the larger birds eat meat, but some smaller ones will try it. Some of the author’s cockatiels eat meat.
          • Tomato sauce (plain or mildly spicy), for spaghetti or on ground beef, small amounts
          • Peas, corn, and other vegetables such as fresh green beans, asparagus, cauliflower, and broccoli, all lightly steamed or cooked are good. Cauliflower and broccoli can be given raw but there’s more nutritional value in them steamed. Even though the “raw diet” is popular right now, it is not always good for them. Most vegetables need to be cooked to release their nutritional value, and some birds have digestive issues when fed raw vegetables.
          • No raw sweet potatoes! Serve only the fleshy meat inside; no seeds, stringy parts by the peel, or the peel itself.
          • Never feed yams. Don’t confuse yams with sweet potatoes. These are toxic to birds. (This information from T. J. Miesle, Food Chemist.)
          • Whole Foods, and similar stores, have different seeds and grains. Some they like; some they don’t. Try different foods with them. They love couscous, and other grains may be found in these types of stores.
          • Whole grain bread. Oat-nut is a favorite. Quality white bread is good in small amounts-many like their bread toasted.
          • Soft cheese, like American cheese, occasionally. No other types since some have mold on them (like blue cheese).
          • No dairy products, or rarely. I know many people like to give yogurt, but yogurt is dairy; if you give it, give small amounts and infrequently. They can’t digest lactobacillus.

          Organic: “Organic” is not really different from regular food. Every state has different rules and regulations about what farmers can and can’t use on their crops. And many of the foods we get are imported, where there are no regulations. Finally, once the food leaves the farm, there is no control at all as to what happens to it. It is handled by many middlemen between the farm and your table. (T.J. Miesle)
          Appendix C: The use of lasers in the treatment of pododermatitis

          In 2014, ten veterinarians met during an Association of Avian Veterinarians conference to discuss the use of therapeutic lasers in treating avian and other exotics patients. Lasers are being used in veterinary medicine with positive clinical results, and low-power therapeutic lasers have proven effective for the treatment of wounds, reduction of inflammation, and modulation of pain. 17 The results of the discussion are as follows:

          • All of the attending clinicians had used therapeutic laser treatment with birds and other exotics in their clinical work.
          • These uses included:
            1. Healing wounds that have resisted previous therapies
            2. Painful conditions
            3. Wounds and skin infections
            4. Postsurgical incision treatment
            5. Osteoarthritis
            6. Pododermatitis
            7. Any inflammatory condition or traumatic lesion.7

          When asked about the kind of response they observed with therapeutic laser treatment compared to routine care, the practitioners responded positively:

          Their responses included:

          • Improvement in cases of pododermatitis; some with dramatic improvement
          • Faster healing time
          • Decrease in the severity of wound cases
          • Improved mobility in orthopedic cases
          • Accelerated healing time, particularly in the dermal wound healing of the foot.
          • Improvement in a chicken with bumblefoot, both in improved weight-bearing and decreased inflammation after just one treatment.
          • Reduction of the bacterial colony in a wound
          • Increased tolerance of the treatment; some are even able to relax a little during the treatment.7

          Laser treatments on avian and other exotics patients

          Figure 59. “A cockatiel, with a chronic, long-term self-mutilation site, responded to his one session two weeks ago and received another one just in case. We had performed a complete set of appropriate tests on him over the last two years, including bloodwork and radiographs, as well as a removal and biopsy of the affected skin to rule out damaged nerves” (image courtesy Vanessa Rolfe, The Bird and Exotic Hospital; used with permission).

          A discussion of the advantages and disadvantages of therapeutic laser treatment in avian patients yielded the following results:

          • The benefits:
            1. An increase in the level of healing for pododermatitis patients
            2. An adjunct to medical therapy alone
            3. Improved speed of treatment and response time, leading to less stress on the patient and better recovery and survivability of the patient.17
          • The drawbacks:
            1. Difficulty in objectively determining the effectiveness or success of the laser treatments
            2. The lack of specific protocols for the use of the laser
            3. The large amount of misinformation or disinformation being spread, which serves to confuse the clinician
            4. The lack of scientific studies in the literature about laser use. Those that are published sometimes have limited access, so clinicians may not have been able to read them and thus may not feel comfortable with their use.17

          All concluded that the advantages significantly outweighed the disadvantages. Although lasers have been used for some time by veterinarians, they have not been used as long by avian and exotic veterinarians. All agreed that the differences between avian tissue and mammalian tissue warranted a more careful study of the techniques involved and results gleaned from such use, and far more care needs to be taken when applying laser treatment to birds.17

          Photo of author

          Jeannine Miesle

          Jeannine Miesle, M.A., M.Ed, Allied Member, Association of Avian Veterinarians is an important contributor to Beauty of Birds. Jeannine has done considerable writing, proofreading and editing for journals and newsletters over the years. She had taught English and music in the schools and presently is an organist at Bethany Church in West Chester, Ohio. She also administrates a Facebook group, The Science of Avian Health.

          Jeannine takes in rescued cockatiels and presently has twelve birds. When they come to her they remain as part of her flock.

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