Commentary: Its time for veterinarians to stop mutilating cats feet

Shutterstock.comI applaud the American Association of Feline Practitioners and the fact that it has (finally) taken an appropriate stand against the mutilation of cats through toe amputation. I am saddened that any compassionate veterinarian would object. It is worth remembering that we are one of the only developed nations on the earth that still allows it.

Amputating the last phalanx (P3) of the toes of cats was once considered a “commodity” procedure, commonly performed by well-intentioned veterinarians. As time has passed and our understanding of feline pain, biomechanics and quality of life has evolved, we now recognize many downsides to this procedure and truly no upside.

For the purpose of this commentary, let's consider three distinct perspectives on the issue of feline toe amputation:

• The clinical bioethical perspective

• The pain perspective

• The biomechanics perspective.

Clinical bioethical perspective

Cats are sentient beings with moral agency who, it has been recently argued, should be approached with the same consideration as nonverbal children.1-5 It behooves us to consider them within the context of the foundational principles of clinical bioethics.

The four cornerstone principles of clinical bioethics have been described as respect for autonomy, nonmaleficence, beneficence and justice.6 Let's look at each of these in turn as we examine the clinical bioethics of feline toe amputation.

Respect for autonomy means we must consider cats' preferences. If cats could be given a choice between being subjected to multiple toe amputations and maintaining intact feet, one can easily make the case that cats would prefer intact toes and feet, avoiding the pain and disfigurement associated with multiple toe amputation.

Nonmaleficence means “do no harm” or “avoid harm.” The question then becomes, does amputating all of a cat's front toes (P3s) cause harm? Amputation is painful, potentially for the rest of the cat's life. It also forever alters the way a cat walks, prevents natural (scratching) behavior, and forever prevents the cat from being able to defend itself by fighting or climbing to escape a threat. Clearly toe amputation causes harm.

Beneficence means to act in a being's best interest. Can we truly argue that amputating all of any cat's third phalanges of the front toes is ever in that cat's best interest? It appears that the answer to this question is a self-evident “no.”

Justice is the fourth cornerstone principle of clinical bioethics. Translating this for application in veterinary medicine focuses on fairness. The relevant question to ask is if amputating the third phalanx of each of a cat's front toes could ever constitute fairness to the cat within the context of its life and lifestyle. Considering all of the compromise that toe amputation creates, as a formally trained clinical bioethicist, I respectfully submit this does not reflect fairness.

Pain perspective

Multiple studies have demonstrated that most cats receive woefully inadequate pain prevention and management for procedures like spays and neuters-procedures far less traumatic than multiple toe amputations. The pain literature clearly demonstrates that acute pain poorly managed at the time of the trauma often leads to permanent pain states. This means ongoing, self-sustaining, chronic maladaptive pain that constitutes lifelong torture.7,8

The few studies that have evaluated either the presence of leftover bone fragments or regrowth of sharp bone spurs after toe amputation demonstrate that an embarrassingly large number of cats suffer from this extra bony tissue.9 These sharp shards perpetually poke at the underside of the skin at the end of each toe stump, making every step like walking on needles or nails.

Finally, we know from pain physiology that when we sever a nerve, there is a high risk of creating self-perpetuating neuropathic pain. Humans most commonly develop neuropathic pain as a result of conditions such as amputation, direct nerve trauma, shingles and diabetes. People who develop neuropathic pain can describe how it feels, so we know the unremitting torture they endure each and every day-tingling, burning, electric-like pulsed pain, pins and needles. We also know that once chronic maladaptive neuropathic pain is in place, these people report ongoing challenges relieving pain.10-12

We know from pain and neurology research that companion animals are “wired” precisely as we are. When nerves are cut-as they are in feline toe amputation-the probability that the cat will develop neuropathic pain is exquisitely high. These cats can go on to develop many different aberrant behaviors. These may include:

• reluctance to walk on certain surfaces

• reluctance to jump onto or off furniture, window ledges and so on

• overgrooming of feet or legs.

These cats must walk on their painful feet!

Biomechanical perspective

Finally, we must consider how feline toe amputation forever alters the biomechanics of the patient.

When a cat is subjected to toe amputation, in addition to having the last bony phalanx removed, all of the surrounding tendons and ligaments that attach to that bone are severed. This changes the architecture of the feet, thus changing the biomechanics of how the feet work. Because approximately 60 percent of the cat's body weight is carried on the front feet, altered biomechanics changes the way the entire body moves. If we superimpose chronic maladaptive neuropathic pain in the feet onto altered front foot biomechanics, we amplify the downstream implications of the cat moving in an abnormal fashion. The altered biomechanics can significantly interfere with the cat's ability to exhibit normal cat behaviors.

We also know that the vast majority of cats 10 years of age and older suffer from degenerative osteoarthritis (OA) in at least one joint.13,14 The majority of cats who develop OA in later life have it occur in their equivalent of the human lower back-where the spine and pelvis come together. When the biomechanics of movement are altered, so are the forces generated throughout the body's joints-in particular the joints of the spine.

The repetition of ergonomically unsound movements over time creates microtraumas to these joints, which can contribute to the development and progression of OA. Then, OA contributes to ongoing chronic maladaptive pain in these cats. As both a board-certified specialist in rehabilitation and a pain expert, I find this completely preventable, endless cycle of altered biomechanics and chronic maladaptive pain to be a call to action.

Conclusion

The bottom line is that amputating the last phalanx of the toes of cats violates those cats on many levels-bioethically; from an acute pain perspective; from a neuropathic pain perspective; from a biomechanical, movement and lifestyle perspective; and from an OA and chronic maladaptive pain perspective. It is time for this arcane and barbaric mutilation procedure to be removed from the veterinary surgical lexicon.

References

1. Andrews K. Beyond anthropomorphism: Attributing psychological properties to animals. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

2. Copp D. Animals, fundamental moral standing, and speciesism. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

3. Downing R. They do not deserve to hurt: Closing the gap between what we know and what we do for companion animal acute pain. MS thesis, Union Graduate College, Schenectady, New York, 2016.

4. Nussbaum M. The capabilities approach and animal entitlements. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

5. Low P. Cambridge declaration of consciousness, ed. Panskepp J, Reiss D, Edelman D, et al. Francis Crick Memorial Conference on Consciousness in Human and non-Human Animals, Cambridge, UK, July 2012.

6. Beauchamp TL, Childress JF. Principles of biomedical ethics, 7th ed. New York: Oxford University Press, 2012.

7. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: A maladaptive response of the nervous system to damage. Annu Rev Neurosci 2009;32:1-32.

8. Dahl JB, Kehlet H. Preventive analgesia. Curr Opin Anaesthesiol 2011;24:331-338.

9. Martell-Moran NK, Solano M, Townsend HGG. Pain and adverse behavior in declawed cats. J Fel Med Surg May 1, 2017; epub ahead of print.

10. Sandkuhler J. Spinal cord plasticity and pain. In: McMahon SB, Koltzenburg M, eds. Wall and Melzack's textbook of pain, 5th ed. (e-book). London: Elsevier, 2006.

11. Woolf CJ, Salter MW. Plasticity and pain: Role of the dorsal horn. In: McMahon SB, Koltzenburg M, eds. Wall and Melzack's textbook of pain, 5th ed. (e-book). London: Elsevier, 2006.

12. Woolf, CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004;140:441-451.

13. Kerwin SC. Osteoarthritis in cats. Top Companion Anim Med 2010;25(4):218-223.

14. Lascelles BDX. Feline degenerative joint disease. Vet Surg 2010;39:2-13.

Dr. Robin Downing, who holds a master's degree in clinical bioethics, is a diplomate of the Academy of Integrative Pain Management, a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, a certified veterinary pain practitioner, a certified canine rehabilitation practitioner, and hospital director at the Downing Center for Animal Pain Management in Windsor, Colorado.