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  Abstract: A Chow Chow dog had completely chewed off her left metacarpal paw pad after a surgical removal of a piece of glass 4 years prior to the first appointment. The wound had remained open and non-healing during this time. Various standard medical procedures to heal the wound had failed. After living with this open wound for 4 years, the dog’s owner consulted our clinic to treat the wound using extracorporeal shockwave therapy (ESWT). After three preliminary and two follow up ESWT sessions the wound was closed and the metacarpal pad was fully regenerated.

  Four years prior to the first appointment at our extracorporeal shockwave therapy clinic under Nordic-Health Clinics in Spain, the Chow Chow had injured her left metacarpal paw pad by stepping on a piece of glass which penetrated and lodged deep into the pad. The glass remained unnoticed for a while but it was later removed with a subsequent inflammation and swelling of the pad. The inflammatory swelling became unmanageable and the veterinarian decided to administer multiple drainage punctures into the wound in a circle around the pad perimeter to drain the pus and the pad was bandaged. Over time, the dog pulled off the bandages and subsequently licked the wound continuously. This was not prevented by means of a physical obstruction, such as an Elizabethan collar. Eventually the dog managed to chew off the entire paw pad. Thereafter, the bandage was changed twice a day due to leakage of blood, pus, and extracellular fluid. Later the biting had mostly subsided but occasionally mild bleeding was observed. The wound did not show any signs of healing during this long period of time.

  Over the next 3 years veterinarians made multiple attempts to control the wound by various standard medical means, hoping healing would take place. Failing in getting the wound to heal, alternative treatment options were suggested by veterinarians and included: euthanizing the dog, amputation of the foot at the proximal joint, and a skin graft, even though a positive result of this option was slim to none. The owners decided against all these options and continued to administer conservative wound care by using ointments and changing bandages once or twice a day.

  In March of 2009 the dog’s owners visited our clinic seeking extracorporeal shockwave therapy (ESWT) as a “last resort” (Figure 1). Our goal was to attempt to restore the integrity of the blood vascular system in the metacarpal pad and leg using standard ESWT for wounds.

  The anatomy of canine paw pad is characterized by thin, pigmented, keratinized, hairless epidermis covering subcutaneous, collagenous, and adipose tissue that comprise the pads. These pads act as a cushion for the load-bearing limbs of the animal. The paw consists of the large, heart-shaped metacarpal pad (forelimb) or metatarsal pad (rear limb), and generally four load-bearing digital pads. A carpal pad is also found on the forelimb, which is used for additional traction when stopping or descending a slope (particularly in digitigrade species). Additional dewclaws were also present.

  Examination of the wound and palpation of the muscles of the lower limb:
     • the musculature of the mid portion of the limb was hard
     • the wound was soft to the touch
     • there was a rim of gray keratinized epidermis and white collagenous tissue
     • the wound was deep red in color and moist.

  The exposed musculature had minimal leakage of interstitial fluid.