This paragraph describes aspects related to lameness in elephants. Lameness is a visible disruption of the normal locomotion. Diagnostic procedures and treatment options are discribed. Orthopedic shoes can help correcting abnormal posture. Muscle-related diseases can result in abnormal locomotion. This chapter also describes bone fractures, metabolic bone disease and botulism. Sometime injuries due to snares and mines can only be treated by partial leg amputation and the use of a prosthesis. Back to index orthopedic problems Lameness This paragraph describes the aspects related to lameness in elephants. Lameness is a visible disruption of the normal locomotion. Observation of the gait and resting behavior are important. It is therefore advised to make videos from the different locomotion tests that will be performed during the clinical examination. Replaying such a video in slow motion can facilitate making the proper diagnose and also makes it possible to share data with colleagues if additional consultation is useful. Smartphones are very useful for this purpose. African elephant showing signs of lameness. Lameness: Diagnostic procedures Although lameness is considered the most important clinical sign of musculoskeletal disorders in other species, elephants have been shown to rarely express distinct lameness patterns. This might even be the case in severe lesions. Nevertheless, elephants do express specific alterations in their posture indicative of musculoskeletal disorders. These alterations are visually perceptible for the experienced observer (Schiffmann 2021). To diagnose lameness it is important to know the normal locomation of an elephant. This is described in detail in the corresponding chapter. Any abnormal form of locomotion should be regarded is lameness. Usually l ameness is a signal from the elephant that it is suffering of pain. However, abnormal anatomic abberations can also lead to lameness, which not always necessarily leads to pain responses (e.g. slight difference in leg length). If the elephant lifts it head during walking, special attention needs to be paid to the front legs, as this head movement may be usied as an extra manner to bring a painful leg forward. To find out the reason why an elephant displays abnormal locomotion, the clinician needs to follow the following diagnostic steps: Observe the locomotion while the elephant is walking straight from left to right and from right to left, towards the observer and away from the observer, in a left circle and in a right circle. A numerical rating scoring system as described by Turner e.a. (2023) can be a useful tool to evaluate the lameness. A 4-point scale with the following numerical values for each leg was used in this study: 0=clinically sound, 1=stiffness, 2=abnormal tracking, and 4=reluctance to bear weight. The maximum total score per leg is 7 (28 for all 4 legs). Observe the elephant's posture when it is in rest. For more background information about abnormal posture click here . General clinical examination . Check the pads and nails of all feet for cracks, tears, swelling and pain reaction on deep palpation. Try to evaluate the joints by palpation (temperature, swelling pain reaction during deep palpation) and bending/stretching on command. Thermography. Radiography. Click here to read about radiography of the elephant's foot. Depending on the power of the X-ray equipment, joints higher up in the leg can be visualized. Digital equipment greatly improves the image quality. Full blood tests: hematology and chemistry. Walking the elephant from left to right and vice versa will make clear if the elephant is making long steps: the hind foot needs to step into the footprint of the front foot on the same side. It also allows to observe the joints: all joints of each leg should be bent and stretched during every step the animal makes. The rhythm of the steps should be regular. If the elephant feels pain in its right front leg, it will not support on that leg as long as will support on its healthy left front leg. What the observer will see, is that the elephant "falls" on its healthy leg. Usually this is a sign of "weight-bearing lameness" . This form of lameness is usually associated with sole lesions (foreign body, abscess), fracture and the acute phase of osteoarthritis. The second form of lameness is "movement-restricted lameness" , which is seen as stiffness in one or more joints and shortening of the steps made by the affected leg (and mostly in the other legs too). This type of lameness is seen in joint and muscle problems. Most lameness cases, however, are a combination of both forms. The gallery below shows several examples of lameness in Asian and African elephants. Asian elephant displaying several forms of lameness, filmed at normal speed and in slow motion. The animal can bend the joints of the left front leg and puts a lot of its body weight on that leg. At the same time, it lifts both left legs almost simultaneously ("pacing") in contrast to its left legs. The right carpal joint is completely stiff and to bring the right front leg forward, the animal has to bring it in abduction. The right hind leg is lifted abnormally when making a step forward with this leg. Nevertheless, this leg is placed in the footprint og the right front leg (normal), while the left hind legs makes too short steps. The lameness in this elephant was most likely due to multiple degenerative osteoarthritis. 35-yrs-old Asian zoo elephant with signs of severe lameness. All steps of the hind legs land in or even anterior to the footprint of the corresponding front leg. The joints of all but the right hind leg are bending and stretching normally. The knee joint of that leg is stiff. The time during which the right hind leg is on the ground is significantly shorter than that of the other 3 legs. In order to bring the right hind leg forward, the elephant needs to abduct it, lift it by lifting the right part of the pelvis at the same time. No other details about this elephant are known. This elephant may have had a fracture of the right humerus or the pelvis. 28-yrs-old Asian zoo elephant with signs of severe lameness in its right front leg. All steps are shortened. When this condition did not improve after prolonged treatment with several pain killers (NSAIDs and opiates) the elephant was humanely euthanized. At necropsy multiple joints showed severe degenerative osteoarthritis as well as an old, partly healed fracture of the right ulna. 45 yrs-old African zoo elephant with a stiff, left front leg. This leg is brought forward by swaying it in abduction. All steps are shortened and the head is sometimes slightly lifted when the left front leg is swayed forward. NSAIDs were provided but not really with the desired effect. As this condition persisted for a prolonged period, chronic degenerated osteoarthritis is the most likely cause of this lameness. Asian zoo elephant with a stiff, slightly swollen right front leg. This leg is brought forward by swaying it somewhat in abduction. All steps are shortened. According to the zoo staff, this condition disappeared after a period of conservative treatment (reduction of movement periods). The cause of such a temporary lameness could be muscle trauma (e.g. by a blow from a herd mate) or early degenerative osteoarthritis. Asian elephant with very stiff, legs, especially the right front leg (movement-restricted lameness). After bringing this leg forward, the animal "falls" on this leg, which means that supporting on the left front leg is painful, despite the apparently better movement of the joints of that leg (weight-bearing lameness). The distal joints of both hind legs are also limited in their movements, reflecting in shorter footsteps. African elephant displaying joint instability in the carpal joints of both front legs. When the feet are placed on the ground, the distal parts of the legs show a valgus position. Radiographs taken from the same African elephant demonstrated periostal reaction 10-12 cm above the carpal joint, an osteophyte (spur, right red arrow) in the radiocarpal joint (osteoarthritis). The image to the right represents the carpal joint of a healthy African elephant. The first thermography image shows a hot area at the level of the knee joint (upper arrow), suggestive for the presence of an inflammatory proces in that area. The lower arrow indicates another large hot spot. This Asian elephant was used for carrying tourists for many years in Nepal and was chained when she was not at work. The second thermography image shows a high temperature in the area of the right elbow in an Asian elephant with a swollen right front leg, also suggestive for a n inflammation of the joint (I mages: courtesy of Susan Mikota). Degenerative osteoarthritis/ Degenerative Joint Disease (DJD) Degenerative osteoarthritis or degenerative joint disease (DJD) is quite common in elephants of advanced age. Factors that contribute to DJD are : Local infection (e.g. from nail abscess) Poor quality bedding substrate, no comfortable resting possibilities (sand heap) Generalized infection: Mycoplasma have long been mentioned as cause of DJD because it involves multiple joints, often has a shifting lameness (Clark, 1980). Rheumatoid arthritis has also been mentioned without any scientific evidence. However, lack of evidence does not necessarily exclude this form of joint disease. In humans aggravation of rheumatoid symptoms is often correlated to humidity and low temperature. As some keepers have seen a correlation between these environmental factors and pain signals of the elephant, both environmental conditions can better be avoided for elephants kept in captivity. DJD is a chronic arthritis, characterized by loss of healthy carti lage, abnormal synovia, and irregular outline of the joint bones. Cartilage acts as a soft buffer between the bones bordering a joint. When that protective layer becomes thin or has gone, the surface of the bones are exposed to each other, which is the major cause of the pain that is experienced in DJD. In the early phase, the area around the affected joint may be warm. In chronic cases (the majority that is seen by clinicians), the temperature is often normal or even lower than the surrounding area. Synovia is a yellow, viscous, thread-pulling liquid, produced by the joint cartilage (see photo below). It makes it possible for the joints to articulate smoothly. If the cartilage becomes diseased, it will form abnormal synovia with a much lower viscosity (see video below; BBC). The diagnosis of DJD is based on: Symptoms as described above. Some of the following symptoms will be present: lameness during walking, abnormal position in resting position, swollen joint. Locomotion test: see diagnostic procedures above. Palpation: warm joint, painful joint on deep palpation) Thermography: if the affected joint is warm, it will show in the thermographic image as a hot spot. Radiography: DJD can only be visualized in the smaller joint (digits, carpus, tarsus). More proximal joints are hard or impossible to visualize by X-ray. Affected joints can show a smaller joint space, irregular outlines of the bones (exostosis), osteolysis, dislocation or bone fusion (ankylosis). When an infection of the joint is suspected, aspiration biopsy from the affected joint should be considered for culture and antibiogram and evaluation of the synovia. However, one should be well aware of the risk to introduce an infection. Radiograph and post-mortem photo of the hind foot bones taken from a 21 yrs-old Asian elephant with DJD involving multiple joints. Exostosis and reduced joint space can be seen on the radiograph. At necropsy the ankylosis of the digits and tarsal bones explain why the elephant was unable to bend the joints of his feet. Positive reinforcement training made it possible to provide physiotherapy to an African elephant. Courtesy San Diego Zoo African elephant resting its head on a tree. https://geogypsytraveler.com/wp-content/uploads/2014/01/09-028-Elephant-rest-against-a-tree-Kruger-NP-SA-gfb-knp-fff44-1024x678.jpg TREATMENT OF DEGENERATIVE JOINT DISEASE Acute phase: Rest Head rest* Proper substrate (dry sand) Sand pile for sleeping at night Pain management Corticosteroids: maybe in acute phase? [Dexamethasone (1mg/5 kg BW); Prednisolone (1mg/3 kg BW)] Chronic phase: Head rest* and sand piles Physiotherapy: opportunities for walking exercises, unlimited free access to hydrotherapy (swimming pool) Pain management Weight reduction (if applicable) Correction of abnormal pressure on foot pads Monitor the condition of the lameness on a daily mobility score chart. Pain management: NSAID’s in acute phase (for 5 days as a start) and whenever needed in chronic cases: Firocoxib 0.1 mg/kg BW PO/day (tablet or paste) Meloxicam (0.03 mg/kg BW PO/day) Flunixin (1,1 mg kg BW, PO/IM/IV, BID) Ibuprofen (6 mg/kg BW PO, BID) Phenylbutazone (4,4-8,8 mg kg BW PO/day) Opiates: tramadol (0.5mg/kg PO BID) – combined with NSAID Some of the anecdotally reported treatments for DJD are: Laser Glucosamine/chondroitin Gabapentine (anti-epileptic drug, 1.5mg/kg BID) Acupuncture Stem cells The provision of sand piles is essential for the prevention and treatment of joint problems Correction of unequal leg length: One report describes the use of a rubber sole to correct the abnormal positioning of the right front leg of an Asian elephant, caused by unequal leg length. A thick multiple-layer rubber sole was glued underneath the pad of the animal (figure below A and B) (Johnson 2018). A liquid urethane glue (also used in horses) kept the pads in place for 4 weeks. The elephant was provided with bilateral wedge pads to offload pressure from the fourth nails (C). A rubber sole can probably also be used to protect a very thin sole with a compression sore. Rubber sole Elephant glue-on shoe construction and materials. A. Paper pattern pieces for a whole foot shoe (left), and a partial wedge (right). B. A view of the side of the wedge showing the multiple layers of rubber soling material sandwiched together. C. Shoe bottom with checkerboard tread. D. Top of a used shoe. E. Another view of the shoe showing the medial height. F. Elephant wearing the oblong wedge pad on the bottom of the right foot. Elephant posture standing, before and after shoes. A. Elephant leaning on the left front foot because of asymmetry in leg length before shoes were applied. B. Elephant wearing shoes and standing square. C. Close-up of partial wedge pad on right foot (arrowheads) and elevated shoe on left foot. * Especially in case of joint disease in the fore legs, reducing the weight on these legs is a great relieve to the elephant, as the fore legas and the head form 60% of the total body weight of the elephant. A head rest is just an elevated bar, where the animal can put its head on. Any surface that is strong enough to hold the weight of the head adjusted to the right hight may relieve the pain caused by degenerative joint disease. Muscle-related problems Wound, abscess Lameness may be seen when muscles are involved in (local) infection or traumatic injury. A local infection can be caused by any perforation of the skin by and injection, arrow, gun shot, etc. This may result in abscess formation. When the elephant ahs to sleep on a concrete floor, it may develop a compression sore, that can affect the underlying muscles. Treatment of this kind of lesions includes: Creation of draining Removal of the foreign body Daily flushing of the wound with saline and mile disinfectant (e.g. diluted Betadine or chlorhexidine). In severe cases a systemic antibiotic might be indicated (after culture and sensitivity test) Black leg (Clostridium chauvoei or C. septicum This bacterial infection is described on the web page: Clostridiosis. Click here for further reading. Capture myopathy Cap t ure myopathy or exertional stress is a condition is characterized by severe lameness of all 4 legs. It is caused by a complex alteration of metabolic processes usually associated with capture, transport, restraint or work overload (timber industry). The acid-base and electrolyte balances are disturbed, which results in an acute lameness. It becomes fatal when the heart muscle is affected. The urine turns dark brown due to the presence of myoglobine that is the result of muscle necrosis (see photo). In some less severe cases and when the animal is treated adequately the muscle damage can be limited and the animal may survive. Treatment of capture myopathy: Absolute rest Deep sand layer on floor NSAID’s Easy-chewable forage, chopped Darkened environment Long-acting tranquilization Tendon laxity Tendon laxity (or flexural deformity) refers to a disorder that causes weak flexor tendons. It is not uncommon in newborn horse foals, especially premature ones. This condition usually fixes itself with controlled exercise. The orphan African elephant on this photo seems to suffer a similar condition. The outcome of treatment exercises remained unknown, as the elephant died of non-related problems. Tendon contracture (arthrogryposis) An assumed arthrogryposis was found in a stillborn calf that was delivered by fetotomy after a retention period of 13 months. Both carpal joints were firmly fixated in bent position. Stretching of the joint was only possible after cutting the flexor tendons (as done in the left front leg of the calf on the photo). Click here for the case report. Neurology-related lameness Tetanus Elephants are susceptible to Clostridium tetani. Similar to exertional myopathy, the affected elephant will have stiff legs. External stimuli will result in excitation and aggravation of the muscle contractures. For further reading click here . Botulism Botulism is a paralytic disease caused by the toxines of Clostridium botulinum . In elephants it was first reported in 1962 in a German zoo (Elze, 1962). The diagnosis was based on the successful treatment of the paralytic lameness by the timely administration of botulism antitoxines. In another outbreak 5 out of a group of 6 Asian elephant bulls died of botulism in the course of a few days. It started with a general weakness that became progressively worse. Shivering and mild salivation preceded the inability to stand and properly use of the trunk. For further reading click here . Metabolic bone disease Nutrition-related lameness Metabolic bone disease Metabolic bone disease (rickets, secondary nutritional hyperparathyroidism) has been reported in very young hand-raised elephant calves. It is a caused by an absolute deficiency of nutritional calcium (and vitamin D?), and a imbalance or lack of other minerals (e.g. phosphorus, magnesium) and proteins. There is no evidence about the potential involvement of vitamin D3 deficiency. Elephants up to the age of 9 months are susceptible to this condition, basically during the period that they should be on a 100% maternal milk diet. During lactation the fat concentration in the mother milk increases together with the calcium level ( Abbondanza, 2013) . This means that the calcium concentration in milk replacers must be increased as the calf grows older. Asian elephant calf with a distinct swelling in the left elbow region. Note the abnormal posture of the left front leg (Courtesy: Susan Mikota). Radiograph showing pathological fractures consistent with secondary hyperparathyroidism (Courtesy: Charles Reid in: Fowler en Mikota, 2006). As demonstrated by the CT-scans on these photos, the demineralisation of the growing bones will lead to pathological fractures: one fracture in the distal humerus and one fracture in the distal radius. (Photos of the CT-scans were kindly provided by the Leibniz Institute for Zoo- and Wildlife Research). Treatment and prevention of metabolic bone disease is based on maintaining the right diet (fat, proteins, Ca, P, Mg, vitamin D) and monitoring the blood total and ionized calcium levels, as well as phosphorus and magnesium. It is also recommended to make X-rays of the long bones of the growing calf on regular intervals (2-3 months) to check the bone quality and shape. Sufficient exercise of the hand-raised calf is very important for the development of a strong skeleton. Bone fractures Bone fractures Despite the solid consistency of elephant bones, fractures are not uncommon. Fractures always result in weight-bearing lameness as is clearly demonstrated on the video of the young Asian elephant bull with a fracture of the radius and ulna (Courtesy Dak Lak Elephant Conservation Center). The animal was hit by an adult female. As the distal part of the elephant's foot is missing, it was not possible to apply a splint. Possibly the shortage of the affected leg worked to his advantage, as he was able to walk on 3 legs until the fracture ends had healed. Radiographs taken from the same young Asian elephant. Note the spiral shape and dislocation of the fracture ends of the radius and ulna. The bones healed completely within a 3 months period. Several types of casts and bandages have been tried in elephants that had a fractured leg. Some of them are displayed below. An adult Asian elephant presented at the Lampang Elephant Conservation Center-Thailand with a fracture and dislocation of the left fibula (see radiographs). A cast was made locally, which remained in place for the next 5 months. During this period the elephant stayed with the owner and the cast was changed 3 times. Photos courtesy: Taweepoke Angkawanish This adult Asian elephant was also presented at the Lampang Elephant Conservation Center-Thailand. A fracture of the tibia was suspected and a splint was made just to assist the elephant by reducing full the weight on its affected leg. Photo courtesy: Taweepoke Angkawanish At Pinnawala Elephant Orphanage (Sri Lanka) a radius and ulna fracture in a 2-yrs-old Asian elephant was treated by the application of a Robert Jones bandage and a fiberglass cast (Karunarathne, 2017). The bandage and cast were renewed twice. Several sedations were required to put the cast in place. Two weeks after the 3rd cast was fixed, the calf succeeded in removing it, but at that time it was able to put weight on the affected leg with a mild limp. To reduce the pressure on fractured bone ends, it may be helpful to provide a sling in which the elephant can be supported while standing. This is only an option if the elephant is accepting such a device, which needs to be located in a trusted environment outside the reach of other, non-friendly elephants. Some improvisation skill to make such a construction will by useful. It can also be used in elephants that have a joint dislocation or other conditions in which weight reduction on one leg is required. Photo courtesy: Susan Mikota Hydrotherapy Many attempts to treat major bone fractures in elephants have failed, largely due to the animals’ immense body weight. To date, no scientific reports have documented the use of hydrotherapy in such cases. However, at the 19th International Elephant Conservation and Research Symposium of the International Elephant Foundation (Chiang Mai, 2023), Dr. K.K. Sarma, Head of the Department of Surgery and Radiology at the College of Veterinary Science in Guwahati, India, presented several cases of leg fractures in semi-wild and free-ranging Asian elephants. Remarkably, these elephants appeared to choose hydrotherapy on their own, spending extended periods—sometimes several weeks—in water bodies such as lakes or large pools. They would typically emerge only once a day to forage. No splints or orthopedic devices were applied, yet the healing outcomes were striking. Joint dislocation Traumatic joint dislocations have been reported anecdotically. A 3-yrs-old orphan Asian elephant was found in a range country after a bushfire. It was noticed that its right front leg seemed longer than the left one. It was brought up in a zoo in Asia and moved to Europe to become integrated in the EAZA breeding program. Is he grow older, the asymmetry of his front legs worsened and he developed a significant weight bearing and movement-restriction lameness. During locomotion he swayed his right front leg forward. The bull was mildly sedated and examined in a restraint chute. Ultrasonographic examination revealed excessive fluid in the right elbow joint. Radiography failed due to the large size of the animal. To check the stiffness of the left elbow joint, a long rope was tied to the left carpus while in left lateral recumbency. Three individuals tried to stretch that leg; during this attempt, a clear crack was heard while the joint stretched only a few degrees. It was concluded that the joint was severely damaged and partial ankylosis had taken place. The elephant was humanely euthanized. At necropsy a ruptured joint capsule and ruptured ligaments of the right elbow were found. The cartilage showed multiple defects, exposing the underlying bone. Another traumatic joint dislocation was reported from Myanmar (Ann-Kathrin Oerke, 2022). An adult bull got its left hind leg stuck between the fork formed by two trees when it fell down. The capsule and ligaments of the tibio-tarsal joint ruptured and the distal part of the tibia perforated the skin. Treatment was no option and the animal died under miserable circumstances. Severe traumatic leg injuries Too many elephants have suffered traumatic leg injuries due to mine explosions, snares and other forms of poaching. In recent years partial leg amputation has been practiced with some success in Asian range countries. In most cases a prosthesis is needed to enable the elephant to walk. Missing all toes of front leg A 3-4 yrs-old wild Asian elephant bull was found with an old injury on its left front leg. All toes were missing and there was a deep wound on the palmar side of the remnants of that foot. A circular scar was visible about 15 cm from the "pad"; 4 small fistulas were located in the line of this scar, each of them oozing thick purulent exudate. Most of the time (70-90% the animal displayed stereotypical behavior: touching the remnant of its left foot and beating it with its trunk. The animal was brought to a rescue place at the Dak Lak Elephant Conservation Center in Vietnam. During the following months he became accustomed to the presence of humans by positive reinforcement training. The wounds were taking care of by daily flushing with saline and antiseptic (povidone-iodine solution) solutions. Arrangements could be made to make X-rays of the affected leg, which revealed the piece metal wire. During a surgery under general anesthesia (ketamine and xylazine by IM-injection and oxygen supplementation in the trunk), a 20 cm of wire was removed. The incision was made perpendicular on the wire until the scalpel touched the wire. By slightly enlarging the wound the wire was easily removed. The wound was left open and flushed daily during the following weeks (saline and antiseptic solutions). The incision wound healed restless. Three of the 4 initial fistulas closed in the following year. However, one fistula located at the medio-palmar side of the circular scar remained oozing. Seven months after the removal of the wire, there was an opportunity again to inspect the wounds and radiographs were made again. Based on these images osteolysis of one of the carpal bone was suspected. A second surgery was done and pieces of smelling necro-purulent bone material were removed by cutting the affected carpal bone using a bone chisel and bone scraper. A large tunnel between the incision wound and the original wound was created in order to allow easy draining of necro-purulent exudate during the daily flushings. The surgical wound and fistula healed completely. To date (2025) the original wound is still being managed by weekly cutting away excessive horn and daily flushing. The animal can walk reasonably well. The episodes of displaying stereotypic behavior have significantly reduced in frequency and intensity. Several examples of a prosthesis can be found on the internet. Most of the victims lost part of the leg by the explosion of a land mine they stepped on. Chhouk, an Asian elephant in Laos has been living for several years with a prosthetic device (See also : Wildlife Alliance ) Prevention orthopedic problems Prevention of orthopedic problems Management-related factors play a major role in the development of foot problems. Two studies (one performed in European zoos and one in Nort-American zoos) found the following factors influencing one or more orthopedic issues (Wendler 2019; Miller 2016): Enclosure size: the larger the enclosure, the less problems occurred. Bedding: soft bedding reduced the number of orthopedic problems. Floor: a dry floor promotes foot health Time spend outdoor: the longer an elephant spends time in its outdoor enclosure, the better it is for its locomotion apparatus Exercise: adequate exercise by many social interactions reduces orthopedic issues Provide a headrest (see under 'treatment') Nutrition: more brows results in less foot problems. Benz (2005) could not find a correlation between the supplementation of the diet with biotin (vitamin B8) and foot health. Body condition: no negative correlation was found between overweight and orthopedic problems. Elephants that are kept in range countries are facing different management-related issues. Walking large distances on hot tar roads may result in damage to the pad. Elephants working in the logging industry may be more affected by muscle or joint injuries. As many elephants are not trained for foot care, easy-to-treat nail or pad lesions may lead to complications like foot abscesses or osteolysis of the distal phalanges. However, no data are available about the incidence of foot problems in range countries. A separate chapter about regular foot care in elephants kept in zoos can be found here . Stereotypical behaviors like "weaving (or swaying)" may result in excessive pressure on the lateral nails resulting in cracks. This stresses the importance of providing a divers social setting for elephants to live in, mimicking their natural social environment. Training of elephants to allow proper foot care is important to address early problems of foot lesions. Mahouts should have the minimum knowledge and skills to perform proper foot care. In order to monitor the effect of pedicure, it is important to describe the status of the feet. By clicking on the icon displayed below, you will find a document that can be used for this purpose (from EAZA Best Practice Guidelines for Elephants, 2020): Click here to download the foot examination form for Asian elephants Click here to download the foot examination form for African elephants No studies about the prevention of degenerative joint disease have been publish ed. As the cause of this problem in elephants is not known, it is hard take appropriate measures to prevent them. Without hard evidence some more anecdotal statements may still be useful: Provide sand piles for sleeping during the night Stimulate locomotion (free ranging elephants walk many miles per day!) Provide sufficient soft bedding. Further reading: see reference list. References Abbondanza, F.N., Power, M.L., Dickson, M.A., Brown,B. and Oftedal O.T. 2013. Variation in the Composition of Milk of Asian Elephants (Elephas maximus) Throughout Lactation. Zoo Biology 32(3):291-8. Benz, A. 2005. The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Master's thesis, Veterinary Faculty of the University Zürich, Switzerland. Clark H. W., Laughlin D. C., Bailey J. S. and Brown T. McP. 1980. Mycoplasma Species and Arthritis in Captive Elephants. Journal of Zoo Animal Medicine, Vol. 11, No. 1 pp. 3-15. Csuti B, Sargent E.L., Bechert U.S. (Editors) 2005. Book: The Elephant's Foot: Prevention and Care of Foot Conditions in Captive Asian and African Elephants 1st Edition. EAZA Best Practice Guidelines for Elephants. 2020. Click here for full text. Elze K. 1962. Über eine unter dem klinischen Bild van Botulismus verlaufene Erkrankung beim Elefanten. Nord.Vet.-Med. 14 (1) 259-271. Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Hess A. 2022. Lesions found in the post-mortem reports of the Asian (Elephas maximus) and African (Loxodonta africana) elephants of the European Association of Zoos and Aquaria Master's thesis, Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Johnson G., Smith J., Peddie J., Peddie L., DeMarco J., Wiedner E. 2018. Use of glue-on shoes to improve conformational abnormalities in two Asian elephants (Elephas maximus ). J. Zoo&Wildl Med. 49(1): 183–188, 2018. Karunarathne H.P.R.N.S., Bandara M.R.B.N., AbeysingheA.M.N.D.B., Liyanage E.M.E., Rajapaksha R.C., Kodikara D.S. and Dangolla A.. 2017. Fixation of a Radius and Ulna Fracture in an Asian Elephant Calf by Using Fibreglass Casts. Gajah 47 (2017) 40-41. Kottwitz J, Bechert U, Cruz-Espindola C, Christensen J.M., and Boothe D. 2024. Single-dose, multiple-dose, and therapeutic drug monitoring pharmacokinetics of firoxicab in Asian elephants (Elephas maximus ). Journal of Zoo and Wildlife Medicine 55(1): 73–85, 2024. Miller M.A., Hogan J.N., Meehan C.L. 2016. Housing and Demographic Risk Factors Impacting Foot and Musculoskeletal Health in African Elephants [Loxodonta africana] and Asian Elephants [Elephas maximus] in North American Zoos. PLoS ONE 11(7): e0155223. doi:10.1371/journal.pone.0155223. Schiffmann C. 2021. Posture Abnormalities as Indicators of Musculoskeletal Disorders in 12 Zoo Elephants – a Visual Guide. Gajah 53 (2021) 20-29. Turner A., Masters N., Pfau T., Hutchinson J.R., and Weller R. 2023. Development and evaluation of a standardized system for the assessment of locomotor health in elephants under human care. J. Zoo&Wildl Med. 54(3): 529-537. Wendler, P., Ertl, N.,Flügger, M., Sós, E., Schiffmann, C., Clauss, M., and Hatt,J-M. 2019. Foot health of Asiane elephants (Elephas maximus ) in European zoos. Journal of Zoo and Wildlife Medicine 50(3): 513–527, 2019. To page top

This case report describes an open fracture of the mandible in a young Asian elephant, that resulted in a severe infection. The elephant was humanely euthanized. To bone fractures Case report Mandibular fracture Date: 2020 Place: 13th Asian Society of Conservation Medicine Virtual Conference History •Coconut-sized abscess on left mandible •Asymmetric buccal margins •Tongue ulceration •Periodontitis •Endodontitis •Foul-smelling caseous material •Malocclusion Diagnostic results •Radiography 70kVp, 10mAs •Lateral and intraoral bisecting angle •Soft tissue swelling •Callus formation Conclusion: Left sided comminuted fracture at the body of the mandible. Unilateral mandibular fracture on left side → Malocclusion → Failure of 𝑀3 extrusion on right side → Impeded eruption of caudal molar on right side → Abnormal eruption of 𝑀5 on right side → Excessive molar abrasion on the left side → Compromised mechanical digestion of food → Anorexia → Malnutrition Treatment The animal was not a release candidate, and keeping the animal in captivity for a prolonged period nor permanently was not an option. Therefore, the authorities opted for euthanasia. Read the poster To page top

Preventive medicine in elephants include several vaccinations foot care, monitoring for EEHV and tuberculosis and fecal check for parasites Preventive Medicine EEHV Monitoring Fecal check Foot care Tuberculosis γ-interferon testing Tuberculosis DPP tesing Vaccination To page top

Bone fractures are not uncommon in elephants. Radiography is needed for a proper diagnosis. A case of mandibular fracture is described in this chapter. To non-infectious diseases Bone fractures Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Bone fractures Mandibular fracture

ElephantMedicine.info provides information about infectious and non-infectious diseases in elephants, case reports, clinical and laboratory procedures and management guidelines. -Elephant Medicine -Diseases -Treatment -Anesthesia -Dental problems -Tusk repair -Laboratory tests - Hematology -elephant disease treatment -dental problems -locomotion -diagnostic procedures -physical examination -laboratory procedures -reproduction and birth procedures -anesthesia procedure -lameness -pedicure Elephant Medicine Get started A website for veterinarians taking care of elephants Sharing your clinical experience in ELEPHANT MEDICINE with elephant clinicians worldwide This website provides information about elephant diseases, procedures and recommendations. It also includes a collection of clinical case reports, submitted by veterinarians from all over the world. You will find cases that have been successfully treated, but also cases that had a sad ending. Some basic disease information is provided as well as descriptions of clinical and laboratory procedures. The information on this website is subject to changes, as our knowledge about diseases in elephants will grow by sharing our experiences. Veterinarians involved in elephant medicine are encouraged to submit reports of their experiences. Together we can create a platform for the current and next generations of veterinarians. For the benefit of an amazing, but vulnerable species: the elephant. Disclaimer: The content of this website, such as graphics, images, text and all other materials, is provided for reference and educational purposes only. The content is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. The information is based on scientific literature, open source information and anecdotal information provided by trusted sources. You assume full responsibility for using the information on this site, and you understand and agree that the authors are not responsible or liable for any claim, loss or damage resulting from its use by you or any user. Contact

Tusk fractures should be treated as soon as possible. Both conservative treatment and surgical treatment, using a threaded rod and dental filling materials are described. Step by step you are guided through the entire procedure. To tusk fracture By Willem Schaftenaar (DVM) with a big thank you to the dental team of the Colyer Institute in San Diego: Jim Oosterhuis (DVM), Dave Fagan (dentist, and founder of Colyer Institute), Jeff Zuba (DVM, elephant anesthesiologist ), Allison Woody ( board certified veterinary dentist), Fred Pike (DVM, board certified veterinary surgeon) Tusk fracture repair Tusk fractures are not uncommon in elephants, both in the wild as well as under captive conditions. A tusk fracture can be the result of fights, playing with "toys" (e.g. a tire hanging on a chain), digging in the soil or hitting a wall or other heavy objects (e.g. bulls into musth). Fractured tushes in female Asian elephants usually need no treatment, as the dental pulp does not pass the tusk sulcus. However, fractures in tusks are vulnerable for pulp exposure. If not treated in due time, exposed pulp may become infected and become necrotic, finally resulting in the loss of the entire tusk. Cutting the tusk too short may also result in pulp exposure. Sulcus infection after tush fracture If a tush or tusk fractured proximal to the tush sulcus, sharp pieces of the remaining part of the tush or tusk may cause wounds in the sulcus. Treatment consists of removing these sharp edges of the tusk by rasping them off. The sulcus wounds should be treated like a superficial skin wound by daily cleaning and flushing with Ringer's lactate and an antiseptic (e.g. Betadine-iodine or Chlorhexidine 1%). WARNING: if the pulp tissue is exposed, the elephant should be vaccinated against tetanus! Pulp exposure and tusk growth Exposure of the pulp tissue always results in a bacterial pulpitis. As long as sufficient healthy pulp tissue is present in the apex of the tusk, the tusk may continue to grow. However, if the pulpitis is not treated properly, the infection will finally affect the entire pulp and the tusk will become necrotic and will need to be extracted. Treatment of open tusk fractures There are 2 approaches that are being applied as treatment of a fractured tusk: A. Conservative treatment B. Surgically filling the pulp canal A. Conservative treatment of fractures with minimal pulp exposure: daily cleaning and flushing with Ringer's lactate and an antiseptic (e.g. Betadine-iodine or Chlorhexidine 1%). This is not the preferred treatment option as it will often result in a permanent fistula, as shown here on the photo (small black spot). Nevertheless, the pulp canal was closed by newly formed secondary ivory. Conservative treatment of a tusk fracture with exposed pulp tissue, treated conservatively. The pulp canal closed in 3 months, leaving a very small fistula, which luckily that did not cause any clinical troubles during the following (6+) years. B. Surgically filling of the pulp canal The difference with a conservative treatment approach is the active closing of the pulp canal by a dental surgical procedure. This procedure consists of a partial pulpectomy, followed by closure of the pulp canal and will be described below: Tusk repair procedure Until the actual repair procedure will take place, any free hanging pulp tissue should be cut off and the exposed pulp tissue should be cleaned and flushed 3-4 times per day with saline solution. End each session by spraying Betadine solution or Chlorhexidine 1% over the pulp tissue. Antibiotics are usually not required as the wound is open and under control by flushing. However, the elephant should be vaccinated against tetanus. NSAIDs are only needed if the elephant shows signs of pain. The tusk repair procedure should be performed as soon as possible after the tusk fractured. Tusk repair procdure Fractures that are more or less perpendicular to the tusk length axis have better chances to heal than oblique fractures that extend beyond the sulcus. The best chances to heal properly are fractures with a tusk remnant that allows perpendicular shortening through healthy pulp tissue. In the photo shown here the following structures can be distinguished: exposed pulp tissue, the wall of the tusk remnant and the sulcus mucosa. If the remaining pulp tissue is hanging outside the tusk remnant immediately after the fracture, it is very likely that the proximal part of the remaining pulp tissue has detached from the inner tusk wall, which will result in pulp necrosis if not treated immediately after the tusk fractured. If sufficient pulp tissue can be removed to reach healthy tissue, the prognosis of complete healing is better than in case the pulp tissue encountered after pulpectomy is still detached from the inner tusk wall. Pulp tissue that is hanging outside the pulp canal should be cut off as soon as possible. Preparation –Check the equipment list –Prepare the area where the elephant will be treated S tanding sed ation or general anesthesia? Depending on the conditions of the facility, the procedure can be done under : - Standing sedation , using detomi di ne and butorphanol (or xylazine and butorphanol if detomidine is not available). Azaperone can be used as premedication. Xylazine alone has also been used in a range country where detomidine was not available. There must be sufficient access to the working area. Best is to chain the animal to a wall on both legs on the contra-lateral side of the fractured tusk. The use of a belly belt around the abdomen is highly recommended for safety reasons in case the elephant goes down. - General anesthesia is not strictly required, but under certain circumstances it is a good alternative if standing sedation is not an option. Once the animal is secured either in standing sedation or under general anesthesia, the tusk repair can start: Step 1: create sterile workfield 1. Scrub the affected tusk thoroughly using Povidone iodine scrub. 2. Cut off the tip of the fractured tusk using a giggli wire. Keep the soft tissue out of reach of the giggli wire!!! 3. If present, remove all abnormal (black) ivory using the Dremel. 4. Clean and brush the area (tusk and face) with soap and Betadine scrub. Flush with Betadine solution and alcohol (70%). 5. Cover the surrounding, disinfected skin with a sterile surgery sheet (secure with duct tape) 6. Put on surgical gloves and suit. Step 2: filling the pulp canal 7. Cut off 20-50 mm of the pulp tissue (depending on the diameter of the open pulp canal). If any pulp tissue has been pulled out when the tusk fractured, it is assumed that it has been separated from the tusk wall and when it snapped back in, it probably pulled in bacteria. So even if the pulp looks fresh when doing the pulpectomy, i.e., bacteria could be lurking way up the wall of the canal that you can't get to. This is a challenging part of the procedure. The pulp tissue has a rubbery consistency and needs to be cut with very sharp instruments (curved scissors and scalpels). High-speed cutters used in hip replacement procedures in dogs (Acetabular Reamer) have been used . Depending on the diameter of the pulp canal, a decision needs to be made either to fill the pulp canal at this point, or to bring in a threaded rod to stop the bleeding. If the pulp diameter is less than 5 mm, one can decide to skip the threaded rod method (skip steps 8, 9, 13 and 14). A threaded rod should be used in any pulp canal diameter larger than 5 mm. In that case, follow the entire procedure as written below. 8. Drill the pulp canal out to a perfectly round hole at the proper size, which corresponds with the diameter at the end of the drilled hole. 9. Tap threads into the wall of the tusk so that you have full threads of the plug in the tusk, PLUS, at least 2-3 cm of tusk wall above the plug. 10. Stop bleeding by compressing the pulp tissue gently with epinephrine-impregnated gauze (for several minutes). 11. Fill in the canal with Calcium Hydroxide or calcium hydroxy apatite with a push rod, which mixes some with the blood, and occasionally stops the bleeding for a short time. Other calcium sources that have been used successfully are: Calcium hydroxy-apatite paste (made at location by mixing powder with chlorhexidine or sterile water) and milled and sterilized Portland Cement. 12. Once the canal is full, clean out the calcium from the threads (usually the blood is oozing thru by then). 13. Screw in an inert plug. Plugs of different materials have been used, ranging from hardware store drain plugs made of PVC, ABS, polyoxymethylene to even brass. Sizes have ranged from 5-50mm diameter. The blood acts as a lubricant when the plug is screwed in. It also forms a nice clot next to the plug to aid in the formation of the dentin bridge. 14. The plug needs to be recessed at least 10 to 20 mm so tusk repair material can be placed over it. 15. Then flush the small remnant of the pulp canal with Chlorhexidine 1%. 16. Flush again with saline solution. 17. Let dry (if needed, use a hair dryer) 18. ETCHING: rub an etching agent on the dentin wall of the pulp canal (cotton-tip) for max. 15-30 seconds. 3M™ Scotchbond™ Universal Etchant Etching gel is a good choice; phosphoric acid (H3PO4 37,5%) or hypochlorite (NaOCl 3%, bleach) are alternatives. 19. Let dry again; use a hairdryer to reduce drying time. 20. Close the pulp canal with glass-ionomer cement. Fill the canal, but leave 5 mm for the composite. 21. Clean the cut-off side of the tusk or sand it with sandpaper. 22. Apply etching (15-30 sec), rinse again and apply bonding for composite application (e.g. Scotchbond Universal Etchant Etching gel (H3PO4 37,5%) and Scotchbond Universal Adhesive). 23. Cover the cement and surrounding area with a layer of dental composite self-curing or light curing, depending on availability of UV-light source (e.g. Tetric Evo Ceram/MIRIS/Filltek/…). 24. Cover the entire cut-off side of the tusk with epoxy glue for extra protection. 25. The tusk will then gradually wear down and the time the wear reaches the plug, the dentin bridge will have formed. At that point, the plug will usually pop out and if needed the hole can be again filled with your favorite tusk repair material. Final stage of tusk repair showing 5 different layers Photo gallery Right tusk fracture in a 5-yr old Asian elephant bull. No attempts to fill the pulp canal were done, resulting in a bacterial pulpitis. By daily cleaning and flushing the deeper part of the pulp remained healthy, resulting in continuous growth of the tusk for at least 2 years. In the end, t he conservative treatment resulted in complete necrosis of the tusk Tip of the fractured tusk and pulp of the same 5 yr-old Asian elephant bull Left tusk fracture in the same 5-yr old Asian elephant bull with the same development course as the left tusk (tusk necrosis) Tusk fracture in a 9-yr old Asian elephant bull that was successfully repaired. See also case report. Tusk fragments of the same 9 yr-old Asian elephant bull. Tip of the tusk after it was sawn off using a giggli wire. During sawing off the tusk tip, the sulcus was lifted using an elephant hook in order to prevent the giggli wire cutting into the skin. When the tusk tip was removed, a large crack filled with dirt became visible. A 'Dremel' hand tool with an extension cable was used to clean out the dirt from the crack. The diameter of the pulp canal was approximately 5 mm. Hence, no threaded rod was used to fill the pulp canal. Etching of the inner tusk wall was done by swapping hypochlorite on the inner surface. The hypochlorite was rinsed off with saline solution. After a layer of calcium hydroxy apatite was applied on top of the pulp, the pulp canal and the cleaned crack were filled with glassionomer cement, the tusk surface was sealed with dental composite. Despite the fact that it was still growing, this tusk of a 26-yr-old Asian elephant bull was extracted several years after it was fractured. These photos show the completely sealed pulp canal by a naturally forme dentin bridge. The decision to extract the tusk is questionable. List of equipment Instruments G iggli wire + handles Plyer to cut off the gigli wire Dremel + extension cable 20 ml syringes (1, 2, 5, 20 and 40 ml) Nail brush Tooth brush Surgical tool set: scissors (1 curved 1 straight) surgical clamps scalpel handle no.3 + blade no.11 sharp spoon Sterile dishes to prepare dental restauration products. Hair dryer High-speed cutter/acetabulum reamer Electric drill Drills (several diameters) Thread makers (several diameters) Threaded (nylon) rods (several diameters) . See text above) Disposables Surgical gloves Surgical suit Surgical drapes Steri le cotton tips Betadine solution (10%) Betadine scrub Ringer's lactate (or Saline solution) Chlorhexidine 1% Etching products: 3M™ Scotchbond™ Universal Etchant Etching gel or Hypochlorite (3%) Calcium hydroxy-apatite powder (to make a paste) or milled and sterilized Portland cement or calcium hydroxide. Glass-ionomer cement Bonding fluid for dental composite (light curing) Dental composite 2-component epoxy or acrylic resin Cotton tips Non-sterile cotton gauze patches (10x10) to cover the eyes Sterile cotton gauze patches (10x10) Leucoplast Duct tape Sand paper Equipment list To page top

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Locomotion problems in elephants are usually symptoms of degenerative joint diseases and lesions of the pad or nail. This chapter describes (1) the diagnosis of orthopedic problems (observationa and video recording, radiology, thermology), (2) nail issues, (3) sole/pad issues, (4) degenerative joint disease and some miscellaneous problems related to lameness. Continue Orthopedic problems This chapter consists of the following paragraphs: Normal features of the locomotion system Sole-related clinical problems Nail-related clinical problems Lameness / abnormal locomotion Prevention of orthopedic problems Radiography elephant foot Elephants do not often show signs of lameness. Nevertheless, orthopedic problems are quite common. A survey about the causes of death in the European studbooks of African and Asian elephants over 5 years of age, revealed that in 12% and 30% respectively of the cases, orthopedic problems played a major role in the cause of death (Hess 2022). The most frequently reported problems are related to the feet, joints and muscles. A special issue is the occurrence of metabolic bone disease in bottle-raised young elephants. Normal features of the locomotion system Normal featurs Anatomical features of the skeleton The elephant has some special features that distinguishes them from other mammals. The long bones are massive, lacking the typical bone marrow cavities. Instead, the long bones of elephants are completely filled with dense cancellous bone, where hemopoiesis is taking place. In the standing elephant, the angles of the joints are almost straight. The neck is relatively short. Figure 1: Asian elephant (Green Hill Valley, Myanmar). Figure 2: African elephant skeleton (Veterinary Faculty Utrecht University, the Netherlands) Foot anatomy terms Front foot = fore foot = manus Hind foot = rear foot = pes Phalanges = toes = digits Pad = sole = slipper Palmar = front pad Plantar = back pad Carpus = wrist Tarsus = ankle Nail = horn wall + nail pad horn Fat cushions Each foot of the elephant is equipped with a large subcutaneous cushions which play an important role in distributing forces during weight bearing and in storing or absorbing mechanical forces. One study about these cushions in the African elephant was published by Weissengruber in 2006 . In both the forelimb and the hindlimb a 6th ray, the prepollex or prehallux, is present. These cartilaginous rods support the metacarpal or metatarsal compartment of the cushions. None of the rays touches the ground directly. The cushions consist of sheets or strands of fibrous connective tissue forming larger metacarpal/metatarsal and digital compartments and smaller chambers which are filled with adipose tissue. The compartments are situated between tarsal, metatarsal, metacarpal bones, proximal phalanges or other structures of the locomotor apparatus covering the bones palmarly/plantarly and the thick sole skin. Within the cushions, collagen, reticulin and elastic fibres are found. In the main parts, vascular supply is good and numerous nerves course within the entire cushion. The high concentration of sensory receptors such as Vater–Pacinian corpuscles within the cushion and Meissner corpuscles in dermal papillae of the adjacent skin might rank an elephant’s foot among the most sensitive parts of its body. Together, the mechanical and sensory functions of the feet enhance the ability of elephants effectively to move through and analyse their physical environment. The micromorphology of elephant feet cushions resembles that of digital cushions in cattle or of the foot pads in humans but not that of digital cushions in horses. Copied illustration of the foot anatomy from Weissengruber et al., 2006 (doi: 10.1111/j.1469-7580.2006.00648.x Normal locomotion Elephants predominantly support on their pads (foot soles). The nails are not used to force locomotion. This is nicely demonstrated in the slow-motion video below (BBC). During walking the head of the elephant shows minimal movements. If there is any form of lameness, especially in one of the front legs, the animal might use its head to facilitate the movement of the front leg in cranial direction. In the absence of orthopedic problems, the hind feet are placed cranial to the foot step of the front foot on the same side. This is clearly demonstrated in the slow-motion video of African elephants in the Namibian desert below (BBC) and the normal-speed video of an adult Asian elephant bull in Vietnam. Elephants can't trot, canter, gallop or jump. They always walk in normal gait. When they walk slowly, their speed is approximately 4 km/h (2.5 miles/h). However, they can reach a speed of 25-60 km/h (16-25 miles/h) over a short distance. The hind foot is placed in the foor print of the front foot or even slight more cranial. Normal anatomical features of the elephant foot Usually the forefeet of the Asian elephant have 5 nails and the hind feet only 4. The African elephant has 4 nails on the forefoot and 3 on the rear one. The weight of the body is evenly distributed over the toes by means of a thick cushion , placed between the sole and the phalanges (photo African elephant foot Kruger National Park, South Africa). The digits form a ±45° angle with the sole, as shown in the radiograph below (Fowler and Mikota 2006). This photo shows the longitudinal section of the elephant foot with the sole, nail, phalangeal bones, cushion and tendons. Note the short distance between the nail and the distal phalangeal bone (Fowler and Mikota 2006) The nails are numbered medial to lateral. If there are 4 nails in front they are numbered 2,3,4,5. The bones don’t change – there are always 5 digits so digit 1 is still there but there in no associated nail. In Asian elephants there are typically 4 nails on the rear foot so they are numbered 2,3,4,5. The African elephant's toes are numbered 5,4,3,2 (front) and 5,4,3 (rear) respectively. This diagram shows the bones of the front foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) This diagram shows the bones of the hind foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) Radiograph of the left front foot of an Asian elephant, showing the phalangeal bones P1,P2 and P3 (Fowler&Mikota 2006) Sixth toe The elephant has unique cartilaginous structures in the feet that are thought to have a stabilizing function. In the front foot the structure is is called a prepollex. It attaches between the first carpal bone and the first metacarpal bone and extends to the sole. In the hind foot it is called a prehallux. A recent study has claimed that this structure should be considered a sixth toe because over time the tissue becomes hard like bone. The healthy sole The sole (pad or slipper) of the elephant's foot is a thick cornified but flexible integumentory structure, with a surface relief that looks almost similar to the skin. It is important to respect this surface when performing pedicure. The thick sole must protect the elephant from penetrating trauma by foreign bodies. A healthy sole is maintained by providing a dry environment. Long periods in muddy and humid circumstances can lead to sole injuries and even sole detachment. The photos show the nicely structured sole of a (dead) wild African elephant (Kruger National Park, South-Africa) and the sole of a captive Asian elephant. The sole of the elephant foot should have a minimum thickness of 2 cm. This can be measured by ultrasound examination. Its surface should be rough with a distinct relief. The growth of the sole epithelium is from 0.5 to 1.0 cm per month. If the sole does not wear sufficiently, it becomes thickened, and because the thickening is seldom uniform, defects are produced that lead to pocket formation and overgrowth, which sets the stage for infection. The healthy nail The nail consists of two parts: the wall and the sole part, which are connected at the sole side. This junction is an important area where infections can emerge if its integrity has been severed by excessive abrasion on hard floors (concrete stable, tar roads) or wrong pedicure. This connection site is comparable with the so-called 'white zone' in hoofed mammals. The white line (or white zone) structure is illustrated in the figures and photos below (Benz, 2005). The nails should be shorter than the pad, without cracks and U-shaped. The skin in between 2 nails should be clean and flexible. When there is hyperkeratosis in this area, this may cause discomfort to the elephant as the hard hyperkeratotic tissue acts as a foreign body by pinching the interdigital skin an dirt can accumulate into the interdigital space. There should be room for at least one finger between 2 nails. The thermographic images of a healthy nails shows a regular distribution of the temperature dispersed over the entire nail. Like in hoofed mammals, the nails are connected with the underlying phalanges by lamellae or horn leaflets. Benz (2005) describes the different parts of the nail: a: corial part of the horn wall: cuticle area b: lamellae (horn leaflets) c: white zone d: sole horn Cuticle and sweat glands The cuticle of the nail is the keratinized skin at the junction with the nail. They should be soft and flexible. This is a vulnerable area as microorganisms may pass this natural barrier after (micro)trauma. The elephant seems to maintain the cuticles by rubbing them gently against objects. Elephants that are kept in moist, muddy conditions, are likely to develop problems with the cuticles. They may overgrow and become hardened when they dry, resulting in cracks and infection. During pedicure, one should be well aware of the protecting function of the cuticles and never remove more than necessary. References Benz, A. 2005. The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Master's thesis, Veterinary Faculty of the University Zürich, Switzerland. Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Hess A. 2022. Lesions found in the post-mortem reports of the Asian (Elephas maximus) and African (Loxodonta africana) elephants of the European Association of Zoos and Aquaria Master's thesis, Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Schiffmann C. 2021. Posture Abnormalities as Indicators of Musculoskeletal Disorders in 12 Zoo Elephants – a Visual Guide. Gajah 53 (2021) 20-29. Weissengruber, G.E., Egger, G.F., Hutchinson, J.R., Groenewald, H.B., Elsässer, L., Famini, D. and Forstenpointner, G. (2006), The structure of the cushions in the feet of African elephants (Loxodonta africana). Journal of Anatomy, 209: 781-792. https://doi.org/10.1111/j.1469-7580.2006.00648.x To page top

Nail issues in elephants are common and usually need treatment. Pedicure should be part of the management procedures. Untreated nail cracks can result in osteoarthritis of the phalangeal joints. Radiography procedures are described in this chapter. Back to index orthopedic problems Nail lesions The most common nail lesion is the crack , perpendicular to the ground. These cracks are often the result of overpressure on the nail tip, when the nail is longer than the sole. In that situation, each step the elephant makes results in heavy forces on the nail tip during the phase when the elephant unwinds its foot. As demonstrated clearly in the slow-motion video below, the tip of the elephant's nails hardly touches the ground. When the nail becomes too long like in the Asian elephant nail in this photo, the excessive pressure on the nail edge can cause a small crack that enlarges over time if not properly treated. Cracks in the nails of an African elephant When left untreated, these cracks will become larger and can affect deeper structures, resulting in an abscess , pododermatitis or even osteomyelitis of the phalangeal bones. If only the horn-producing tissue is involved, we usually call this a pododermatitis. When the infection is trapped in the underlying tissue, an abscess can easily develop. Onychia is an infection or trauma to the horn lamellae of the nail, which may result in complete loss of the nail. Pododermatitis in the nail of an African elephant. Note the excessive wear of the sole. Nail abscess with osteolysis in an Asian elephant. Nail abscess with complete loss of the 2 distal phalanges osteolysis in an Asian elephant. If phalanges are affected as the result of a deep nail abscess and pododermatitis, the recommended treatment of such an osteitis is the surgical removal of the affected bones. Click here to read more about this treatment. More examples of nail abscesses (photos: Susan Mikota). Treatment may take a long time, requiring multiple pedicure sessions, daily cleaning and foot soaks (click here for foot soak information) Traumatic onychia in an Asian elephant. Complete nail loss due to traumatic onychia in an Asian elephant. Diagnostic procedures nail lesions Use your eyes: check if there is any visible lameness. Describe the visible lesions. Use your hand: does the affected area feels warm? Is it painful when pressure is applied? Use your nose: if there is a wound, try to identify the smell of necrosis. Take a swab for bacterial culture. Additional diagnostic steps: If there is a deep lesion: radiographs should be taken to look at the integrety of the underlying bony structures (phalanges and phalangeal joints). Thermography may help to identify if the affected area has a higher temperature than the surrounding tissues. Radiography of the elephant's foot Radiography foot A powerful portable X-ray machine (100 kV or more) is required to visualize the bony structures in the elephant foot. Digital plates largely increase the quality of the image. It is important to work under safe conditions. Under free contact management , the fore foot can be positioned on a stand for the oblique palmar-dorsal shooting direction. The angle required for visualization of the phalangeal joints is indicated in the images below. Oblique palmar-dorsal image of the hind foot under free contact management condition (Mumby et al 2015) Positioning for the oblique dorsal-plantar image of the hind foot, this foot can be can be positioned on a stand (Mumby et al 2015). A different approach is required when working under protected contact management . The elephant needs to be trained to position its legs on a horizontal bar of the training wall. It should also be accustomed to the proximity of the X-ray-machine, the plate and the protective clothing of the operators. Lateral shooting position of the right front foot of an Asian elephant under protected contact. The angle of the beam depends on which phalanges need to be visualized. To avoid superposition and depending on the selected phalanges, the beam should have a more or less oblique direction. (Courtesy Rotterdam Zoo). Oblique dorsal-plantar shooting position of the left rear foot (Courtesy Rotterdam Zoo). Click here to view the radiograph. Oblique palmar-dorsal shooting postion of the right front foot of an Asian elephant under protected contact. Note that the X-ray machine is positioned upside down (use a support block to protect the electric wires)! (Courtesy Rotterdam Zoo and Emmen Zoo). Click here to view the radiograph. Lateral shooting postion of the left hind foot of an Asian elephant under protected contact (Courtesy Rotterdam Zoo). Click here to view the radiograph. Some examples of radiographs of the distal part of the right front leg of a 24 yr-old female Asian elephant at Rotterdam Zoo (the Netherlands) are shown below. The elephant is under standing sedation for an unrelated reason. Lateral shooting position of the right front leg (distal part of the radius and ulna, Courtesy Rotterdam Zoo). Click here to view the radiograph. Anterior-posterior shooting position of the right radio-carpal and ulnar carpal joint AP front leg (Courtesy Rotterdam Zoo). Click here to view the radiograph. Posterior-anterior shooting position of the right radial-carpal and ulnar-carpal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral position of the right carpal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right foot (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Posterior-anterior shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Stereo radiography A technique, which is called stereo radiography can help interpreting the X-rays. Two radiographs of the same areas are made each of them taken 10 cm more lateral from the other. Digital images were converted to bitmap (BMP) format to preserve image quality. The 3D stereoradiograph images can be constructed using special software (Bentley 2021). The images can be viewed with red-cyan 3D glasses. Illustration of how 3D stereoradiograph images are produced. (a) Original radiograph that provides the ‘‘left’’ image for the 3D Anaglyph software. (b) Paired radiograph used for ‘‘right’’ image. (c) Completed stereoradiograph that has been inverted with red-cyan settings applied. (Bentley 2021) Thermography of nail lesions Thermographic imaging can be used to measure the absolute temperature and the difference in temperature between the lesion and its surrounding tissues. Below a severe case of a nail abscess-related osteomyelitis and osteolysis of Ph4 in an old Asian elephant bulls is shown. The thermografic image shows a low temperature of the skin that covers the affected are. This is suggestive for a large necro-purulent process. The thermographic image shown here demonstrates the low temperature of the skin covering the abscess, associated with deep lesions of D4 of the left front leg of an Asian elephant bull, involving a lot of necrosis and complete loss of the distal phalanx of the toe. On radiology this bone is completely missing and the distal part of the toe shows an irregular surface: Osteomyelitis and purulent arthritis of the Ph3-4 joint of D4. Treatment nail lesions Treatment of nail lesions Pedicure is usually the treatment of choice in cases of nail lesions. There are a few principles to be respected in pedicure: Use proper equipment Always remove all abnormal horn tissue (undermined, infected) and loose nail flaps. Make the transition from healthy horn to the deepest point of the lesion as smooth as possible. Directly adjacent to the lesion, the horn must be flexible and as thin as a piece of paper. Permanently check this flexibility by gently pressing the area where just cut away the horn. The most important pieces of equipment needed for pedicure are 2 hoof knives (left and right handed), a scalpel and a sharpening stone for hoof knives, preferably with round edges (see photos above). Just with hoof knives alone, most of the clinical pedicure treatment can be done. A scalpel can be useful when very small pieces of horn are to be removed adjacent to a lesion. A horse hoof rasp is a useful tool to shorten the nail and remove excessive horn from the sole. Care should be taken NOT to make the nail edges round, what is often practiced (see below). A strong nail brush is needed for cleaning the nail prior to pedicure and a smaller brush can be used to remove dirt from areas that cannot be reached by a large brush. Small wood carving knives can be used when thin layers of nail horn are to be removed (similar to the use of a scalpel). Pedicure equipment Very often the tip of the nails are made round by rasping the corners. There is no justification for doing so rather than a cosmetic one. However, one should avoid to remove tissue from the nail wall/nale sole junction (comparible to the "white line " in the horse hoof) as this junction is a very important barrier against infiltration of dirt and pathogens. So the advice is: do not file the nail corners to leave the entire white line in tact. Situation before a pedicure session of a deep nail crack Situation after a pedicure session of a deep nail crack Pedicure around a (deep) crack serves 2 main purposes: Draining of infected area Removing pressure on the wound, which enables the regeneration of destroyed horn lamellae. In order to achieve both goals, the deepest point of the crack has to be freed from covering horn. One should start making the horn wall thinner at a distance of several centimeters from the lesion and continue the pedicure towards the deepest point in a gradual way. Each nail crack should be considered as being a wound, because the crack has usually damaged the horn lamellae. When the pedicure has reached the wound area, it is of utmost importance that the edges bordering the wound are made as thin and flexible as possible. Check this by pressing your finger on the horn adjacent to the wound. Large cracks usually need to be treated in several sessions. Bleeding may occur when the lamellae are cut, which is no direct reason to worry! Pain reactions of the elephant will tell the operator when the session should be stopped and continued a few days later Cuticle lesions The cuticles form a natural barrier against dirt and pathogens. When they overgrow the nails, this protective barrier is weakened and infiltration of microoganisms may result in lesions in the horn lamellae underneath the nail (onychia). Sweat glands are embedded in the cuticles. Overgrown cuticles may become hard and crack or form interdigital callus. When abnormal horn tissue blocks the sweat glands, fluid pockets may be formed. This can be a painful process and needs to be treated. Minor cuticle lesion in a African elephant, which may be connected to a deeper lesion underneath the nail. Explorative pedicure is probably needed to find the cause (Courtesy: Barcelona Zoo) Extensive overgrown cuticles with feathering and interdigital callus formation (Fowler & Mikota 2006) Interdigital callus formation in an Asian elephant (Courtesy: Susan Mikota) Sweat glands are present in large numbers in the cuticles. When the cuticles are overgrown, they may form pockets in which the sweat-fluid may accumulate ("blisters"or "blebs"). When cutting in such a fluid-filled pocket, the contents may squirt out (see video; courtesy: Susan Mikota). Careful (!) trimming of the cuticles is only indicated when they have overgrown the nail (Courtesy: Susan Mikota) Applying oil on the cuticles will make them softer and may resolve the problem of cuticle overgrowth in most situations. Example of a pedicure procedure of a pododermatitis in conjunction with a cuticle lesion in an African elephant (courtesy Barcelona Zoo) Pododermatitis in the nail of an African elephant. Note the excessive wear of the sole and the large defect of the cuticle. Second step: follow-up the necrotic tissue and find the connection with the cuticle defect. Note that a large part of the nail was undermined, causing the cuticle defect. First step in pedicure: making the horn on each side of the lesion thinner and removing necrotic tissues. By frequently removing all necrotic tissues and keeping the edges of the wound thin, the horn lamellae can produce healthy horn again. SUCCESSFUL TREATMENT OF DIGITAL OSTEITIS BY INTRAVENOUS REGIONAL PERFUSION OF CEFTIOFUR IN AN AFRICAN ELEPHANT (Loxodonta africana ) (Dutton C.J., Delnatte P.G., Hollamby S.R., and Crawshaw G.J. Journal of Zoo and Wildlife Medicine 48(2): 554–558, 2017) A 41-yr-old African elephant (Loxodonta africana) presented with a swollen third digit of the left forelimb and a 2-cm hole in the pad. Corrective trimming, topical treatments, and an oral antibiotic resulted in apparent resolution; however, it reoccurred after 4 mo. Radiographs suggested bone lysis in the third phalanx, with the primary differential diagnosis being septic osteitis. Flushing with metronidazole solution and intravenous regional perfusion (IVRP) of the foot were commenced. A tourniquet was applied just above the carpus, an interdigital vein was identified by ultrasound, and into this vein 2 g (20 ml) of ceftiofur sodium solution, followed by 60 ml of heparinized saline, was administered. The foot was kept raised for 25 min and then the tourniquet was removed. IVRP was repeated every other day for 70 treatments over 6 mo. Healing occurred, which was confirmed radiographically. IVRP offers an excellent treatment modality in a well-trained elephant. SURGICAL REMOVAL OF INFECTED PHALANGES FROM AN ASIAN ELEPHANT (Elephas maximus ) Gage, L. Blasko D, Fowler M.E. and Pascoe J. Joint Conference AAZ/WDA/AAWV After unsuccessful antimicrobial treatment of an osteitis in a 40 yr-old Asian elephant, surgical removal of the affected phalanges resulted in the complete healing of the foot. Click here to read the report. Digital osteitis treatment Literature Bentley C.E., Cracknell J.N., Kitchener A.C., Pereira Y.M., Pizzi R. 2021. Improved diagnosis of foot osteoarthritis in elephants (Elephas maximus , Loxodonta africana ) using stereoradiography. Journal of Zoo and Wildlife Medicine 52(1): 67–74, 2021. Dutton C.J., Delnatte P.G., Hollamby S.R., and Crawshaw G.J. 2017. Successfull treatment of digital osteitis by intravenous regional prefusion of ceftiofur in an african elephant (Loxodonta africana) . Journal of Zoo and Wildlife Medicine 48(2): 554–558, 2017). Gage, L. Blasko D, Fowler M.E. and Pascoe J. 1995. Surgical removal of infected phalanges from an asian elephant (Elephas maximus ). Joint conference AAZV / WDA/ AAWV . Mumby, C., Bouts, T., Sambrook, L., Danika, S., Rees, E., Parry, A., Rendle, M., Masters, N. and Weller, R. (2013), Validation of a new radiographic protocol for Asian elephant feet and description of their radiographic anatomy. Veterinary Record, 173: 318-318. https://doi.org/10.1136/vr.101696 . Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. To page top

Colic is a condition that is often seen in elephants. This page describes the symptoms of colic and connects to several case reports To non-infectious diseases Colic Compiled by: Willem Schaftenaar Definition of colic Colic can be defined as a symptom of pain in the abdomen. Elephants that suffer of colic can show a variety of symptoms, ncluding: Frequent looking at the abdomen. Touching the abdomen with the trunk. Hitting the abdomen with the trunk. Throwing sand or water towards the abdomen. Throwing sand or water over the backside. Restlessness. Vocalization. Standing with open mouth. Frequently going down and standing up. Lifting a hind leg, supporting it on an object. Kicking a hindleg in the direction of the abdoemn. Bilateral bending the hind legs. Straining. Additional symptoms that may occur simultaneously: increased respiratory rate, increased heart beat, bloating. To colic case reports Causes of colic Gastro-intestinal tract: One of the most frequent causes of colics in elephans is sand impaction. Enteritis, gut spasms, constipation and tympany can also cause colics. Peritonitis. Torsio mesentericum. Abdominal organs: Although not reported in elephants, all abnormal conditions in abdominal organs can cause colics (inflammation, abscess, tumor). The elephant has no gall bladder, but gall stones stuck in the biliary ducts might result in colic. Reproductive tract: Normal parturition. Abnormal parturition. Herniation of the uterus. Large leiomyoma. Urinary tract: Calculi in the urethra. Herniation of the urinary bladder. Bladder stones. Treatment Text to be provided Diagnostic results Text to be provided To page top

Elephant feet in zoos need regular inspection. This chapter describes in 6 steps foot care can be addressed. Attention is paid to the nails, the pad, sole, cuticles andd the normal appearence of a health elephant foot. Regular foot care in zoo elephants: a practical guidance Written by Christian & Linda Schiffmann Definition Regular foot care means the functional trimming of an elephants distal limb in order to avoid overgrowth of the corresponding structures (nail, pad, cuticle). Aims Avoid overgrowth and prevent subsequent alterations. Keep the foot structures in physiological shape in order to ensure the foots physiological function (in particular physiological weight bearing and distribution). Figure 1. Conditions to be avoided through regular foot care: a) overgrown nails; b) overgrown pad; c) narrow interdigital space; d) overgrown and frayed cuticles Preconditions & tools Conditions and tools required: comfortable position for elephant and keeper/vet (Fig. 2), adequate light conditions, tools (Fig. 3), time and staff (at least two persons). Figure 2 . Proper positioning of the front (a) and rear foot (b) under the conditions of protected contact. Note: The custom-made constructions (in figure 2a) out of steel, in 2b) out of steel & wood) are facilitating a position enabling access to every aspect of the foot. Figure 3. Appropriate tools for regular foot care: a) rasp, b) hoof knives in various shape, c) swiss hoof knife, d) side cutter pliers Note: This compilation is only exemplary and should not be considered complete. A multitude of further tools can be helpful in foot care. Foot trim There are four steps of trimming in accordance with the four critical structures of the elephant foot: the nail the pad the interdigital space the cuticle The sequence of these steps is not mandatory, although a systematic approach is strongly recommended. Step 1 Shorten the solar nails, rasp the surface of the horn wall and bring the nail in its specific shape. What you go for (solar part): Figure 4. The solar aspect of the nail shortened as far as possible: 1. To avoid weight bearing in standing position. 2. The color and consistence of the solar horn are indicative of the appropriate depth. The deeper you go, the paler & softer the nail tissue becomes. Stop at a level where the solar horn is still firm upon palpation and no bleeding occurs. By trimming carefully, you will recognize the small vessels shining through the solar horn before bleeding occurs. (figure 4a: P4 in right rear of a female Asian elephant, 39yrs; figure 4b: right front foot of a female Asian elephant, 41yrs). What you go for (cranial part): Figure 5. The superficial layer of the entire horn wall removed in order to detect discolorations indicative of underlying issues and to avoid attachment of the cuticle. Keep the nail in its physiological shape by rasping/cutting the lateral/medial aspect accordingly (see also Step 3 on the interdigital space). (P4 in right front foot of a female Asian elephant, 39yrs) Tools: rasp, hoof knife, Swiss hoof knife, (angle grinder) Step 2 Check the pad and reduce thickness if required (and if feasible with respect to the nails). What you go for: Figure 6. Trimmed pad with a pattern of sulci present (a). The latter have been cleaned to ensure there is no debris or undetermined tissue remaining. In a well-worn pad, only few sulci may be prominent (b). (Figure 6a: right rear foot of a female Asian elephant, 39yrs; figure 4b: left rear foot of a male Asian elephant, 36yrs) Tools: Swiss hoof knife, hoof knife, (angle grinder) Step 3 Clean and widen the interdigital spaces (both the solar and the cranial aspect) What you go for: Figure 7. A wide, clean and dry interdigital space in both the solar (a) and cranial (b) aspect. (Figure 7a: P3/P4 of the right rear foot of a female Asian elephant, 41yrs; figure 7b: P3/P4 of the left rear foot of a female Asian elephant, 37yrs.) Tools: hoof knife, rasp Step 4 Shorten the cuticle and remove debris and dirt from the nail bed. What you go for: Figure 8. Evenly trimmed cuticle and clean nail bed area. (P3 of the right front foot in a female Asian elephant, 41yrs.) Tools: hoof knife, side cutter pliers Step 5 Check all structures while the elephant is standing and walking. In particular make sure that the nail wall is not weight bearing while standing and the unrolling during the walking phase is smooth. In case you are not happy with the result, go back to Step 1-4 depending on your observation. Figure 9. After completion of a foot trim, take the time to check thoroughly every structure while the elephant is standing and walking. Be particularly focused on the weight distribution. (left rear foot of a female Asian elephant, 39yrs.) Step 6 Accurate documentation of each individual elephant´s foot condition is strongly recommended. Doing so will enable reevaluation and confirmation of progress also in case of alterations with extended treatment periods. Species-specific example documentation forms have been provided by Benz (2005). Additionally a more objective approach to score and monitor foot health has been reported more recently (Ertl et al. 2020). In addition, we recommend the photographic documentation of each nail and the pad as part of the routine health monitoring (example given in Fig. 10). Figure 10. Comparative documentation by photographs of each individual nail and the pad after a regular foot care session. (left rear foot of a female Asian elephant, 39yrs.) Practical notes: -Always keep your tools clean and sharpened. -When trimming the nails, consider the specific shape of each nail and the corresponding differences between front and rear foot. -Trim the lateral edges of the nails carefully to avoid bleeding. -In case of bleeding: keep calm and ensure disinfection with a wound disinfectant (e.g. chlorhexidine or povidone iodide). -Keep in mind that foot trimming might not always be fun for the elephant. Therefore, do your very best to make the procedure as comfortable as possible for the elephant and make use of positive reinforcement training (Fig. 11). Figure 11. Foot care tools ready for use. Note: A variety of rewards can be very helpful in a training approach based on positive reinforcement. Additional recommendations to continuously ensure foot health in zoo elephants: -Do twice daily thorough pressure washing of the distal limb covering the four critical structures (nail, pad, interdigital space, cuticle) in order to reduce the negative impact of urine contamination. Elephant urine is a keratolytic substance and may cause significant alterations particularly in the pad. This negative impact can be heavily reduced through a consistent pressure washing routine. In addition, this routine ensures daily monitoring of an elephants foot conditions. -Conduct daily inspection of all foot structures (ideally after pressure washing) -Encourage wearing of the foot structures through natural behaviors: walking on abrasive sufraces, digging, processing of browse/branches (Fig. 12). -Avoid extended standing on hard substrates (e.g. feeding places, night quarters). -Provide soft substrates for lying rest of adequate duration. Figure 12. Digging in a sandy substrate enables a very natural wear & peeling of the horn wall, the interdigital space and the cuticles. NB We mention the angle grinder here only in parenthesis because we strongly recommend to use this tool very cautiously. Due to the high power of the angle grinder, only experienced persons will be able to use this tool in accordance to the individual foot. In addition it has been speculated whether the occurring heat may have a negative impact on the tissues (Wendler et al. 2021). Based on the aforementioned reasons, we recommend the use of an angle grinder exceptionally for experts experienced in foot care. Nonetheless, if applied correctly, this tool can be practical and efficient. In particular it can significantly shorten trimming time which is critical in geriatric elephants suffering from degenerative joint disease or in individuals with limited attention span to maintain a trimming position for an extended duration. The same would be valid for elephants in early training status, but with foot conditions requiring immediate treatment. To reduce heat development through the grinder, an adjustable rotation speed and a serrated washer with appropriate grain size (“40” corresponding to a metric size of the grains of around 0.62mm) are of utmost importance. References Benz A (2005). The elephant´s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Veterinär-Anatomisches Institut der Vetsuisse-Fakultät. Zürich, Switzerland, Universität Zürich. Inaugural-Dissertation. Ertl N, Wendler P, Sós E, Flügger M, Schneeweis F, Schiffmann C, Hatt JM, Clauss M (2020) Theory of medical scoring systems and a practical method to evaluate Asian elephant (Elephas maximus ) foot health in European zoos. Animal Welfare 29:163-176. Wendler P, Ertl N, Flügger M, Sós E, Clauss M, Hatt JM (2021) Foot care in Asian elephants (Elephas maximus ) in European zoos. Der Zoologische Garten 89:103-119.