What's In John's Freezer?

Here now is the promised blog post, which uses the rhino foot mystery pic as a springboard to address a phenomenon that is a bit better known, partly because it is an even worse situation and involving (arguably) even more charismatic critters: elephants.

A rotating movie of a CT scan reconstruction is a good way to kick this off:

This shows the right hind foot of an Asian elephant that had mild pathology; mostly a roughening of some of the bone surfaces that is called osteitis (proliferative bone growth possibly due to infection or other irritation) and perhaps a mild case of degenerative joint disease such as osteoarthritis. But this is nothing compared to the severe cases we’ve observed in other elephant feet, and indeed may not have anything to do with why this elephant died (I’m not sure; I was given very little medical history for this one).

If you want more elephant anatomy lessons, see the videos from the posting on six-toed elephants. I will proceed assuming some basic familiarity with bones of the feet in animals, although you may be just fine even without that.

About 50% of elephants in captivity die from foot disorders of one kind or another. Elephant keepers spend a huge amount of time and energy taking the best care of elephant feet that they can, but a variety of factors including anatomy, biomechanics, exercise, obesity, ground surface, hygiene, “hoof” care including trimming, nutrition, and much more are part of the very complex causal nexus underlying these disorders. Wild elephants get similar problems, too, but less frequently (e.g. in drought periods, I’m told); there are few solid data on this, however.

Onwards, then! I shall present a cavalcade of horrific examples of the kinds of elephant foot pathology that we have observed in specimens that have come through my freezers at the RVC.

Let’s start with what one of our vets might see on examination of a live elephant at a zoo:

This is an x-ray image of the third (on the left) and fourth (on the right) toes of an elephant’s front foot. The RVC (Dr. Renate Weller and myself) have developed protocols to take such x-rays on live elephants.  The anatomy shown here is pretty normal and non-pathological. So with that in mind, check this out; toes four (on the left) and five (on the right), different animal:

Ouch! Digit 4 (“ring finger”) has a proliferation of bone that is characteristic of an animal with osteomyelitis: a flowering of bone in response to infection and painful swelling, probably caused by an abscess on the toe’s sole/nail. This animal was put down because of its unresolvable misery from this disorder. Oddly, we see toe 4 as well as 3 and 5 as the most commonly pathological; toes 1 and 2 seldom are. We’ll be discussing this in a new paper coming out soon; I’ll get back to that another day.

Assuming such conditions don’t resolve, the next place the foot may end up is in The Freezer at the RVC, and then into our CT scanner before we do postmortem dissections and a report on the pathologies so the zoo knows what went wrong. Here’s an example of what we cut off the end of the fourth toe of such an animal:

Just looks like a glob of tissue, right? The joint between two segments of the toe is visible as a pinkish white structure on the right side, with some bleeding on the cartilage where it wore down to the bone surface. But it gets worse. Here is how that same toe bone looked when we cleaned it up (boiling and bleaching away soft tissues):

Here, that same roughened joint surface is visible at the top of the specimen. Two toe bones have become fused together (the bottom one is not visible), encased in a cocoon of lacy, spiny bone. Again, ouch. The next specimen had a different kind of “ouch”- its fifth toe basically shattered:

That toe is almost unrecognizable, having disintegrated rather than proliferated its bony scaffolding. Other specimens may be in less extreme states of pathology but still likely to have been in pain:

The label here says it all; third toe with a cyst where an infection entered the bone.

This one, the end of a third metatarsal, shows degenerative joint disease with a loss of articular cartilage, and holes where abrasion has worn down into the bone and caused bleeding. In contrast, and to give you a breather from the horrors, here is a healthy, younger elephant’s similar joint surface:

Nice white, fresh, shiny cartilage! Ahhh…

But then we dive back into Grand Guignol-level aberrations:

Here we’re looking at the back side of a right hind foot of an elephant, at the level of the ankle joint. The joint capsule surrounding the ankle joint has been cut open in my dissection to expose the terribly pathological, but still somewhat white and shiny, cartilages (middle of the image) which have been abraded (in some regions) but also extended by new bone formation (in other regions) to creep around the back of the ankle. Here, the bone growth was fulfulling a role to limit joint mobility and thereby restrict painful joint motions- the joint was fusing into an ankylosis (no, not an ankylosaur,  but same Greek root). Here is a closer look, removing the tibia and fibula that were at the top of the screen in the above image, and looking down onto the ankle joint surface:

You should be able to more clearly see how the cartilage and underlying bone are not forming a smooth edge, as they should on the talus (ankle bone), but rather an irregular, jagged contour (area to the right of the label). This animal would have been visibly lame, to say the least; elephant ankles can’t move much even in normal animals but this one was even less mobile. We’ve had some specimens where the ankle was so fused it was totally immobile and took a saw to separate the two sides of the joint. Oddly, I haven’t seen an ankylosis like that in the wrist, which in normal elephants is as flexible a joint as the ankle is inflexible.

Pathologies like these sadly aren’t uncommon in elephant feet but zoo/park keepers are doing their best to turn the trend around. Zoo conditions generally were a lot worse 50 years ago. The pictures below document this, from museum specimens we’ve studied (among many others) at the University Museum of Zoology at Cambridge and the Natural History Museum in London. See what pathologies you can spot! Some are from wild-shot animals, reinforcing that foot pathologies are not just a zoo thing. (click to embiggen)

Zoo/park conditions are improving now— in the UK for example, elephants are being moved into more safari park-like environs and given more varied surfaces to walk on or even dig (e.g. sand at Chester Zoo). But because elephants live long lives, and foot pathologies sometimes cannot be reversible (or even detectable, sometimes), any pathologies existing now may well still be evident, or even worsen despite the best care, for decades to come. The lag time for fixing the global problem of elephant foot pathologies is not a short one. I won’t get into the controversy over whether elephants should be in zoos/parks or not, but at least for the short to medium term they are, and we need to make the best of that. The images in this post help show why, and perhaps point a way toward how.