Advice...... hind lameness, odd diagnosis?

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dunkley

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A friend of mine brought her horse in to lunge it. When it started in the arena it was a little 'stuffy' in walk, so she asked it to trot on, to loosen it up. It was then apparent that it was seriously unsound behind, but had done absolutely nothing to cause injury. No sign of lameness up to that moment. She stopped immediately, and the horse was not wanting to bear any real weight on it. There was no discernible heat or swelling, but as we watched, the leg literally blew up in front of us, from halfway down the cannon bone, through to the fetlock and coronary band, and very hot inside the leg, just above the fetlock joint.We very slowly walked him back to his box, where he stood quite happily, but resting his foot at the toe, non weightbearing. Touching it was very 'ouchy, ouchy'. She rang her vet, who (over the telephone) diagnosed a foot problem - "pus in the foot". The vet did come out, did not see horse walked out at all, and straightaway removed the shoe, and started cutting away at any black lines on the sole. (Personally, I thought it was more like 'hacking'). Nothing came out. Vet is of the opinion that there is an infection in the hoof, which has suddenly become unbearable, hence the sudden onset lameness. Prescribed hot poultice 2x day, and box rest. If horse is still lame and nothing has come out of the foot, vet will come back and "have another dig" in a "few days". I have tentatively suggested to my friend that she should not wait for more than 2/3 days with the horse in this state, and if he is still non weightbearing, hot and swollen, and nothing has come out, he really should be seeing vet again, sooner. (I think a different vet, but that's just MHO) I have to be careful, as she is very loyal to this vet, but I wouldn't have him touch a horse of mine :( Also, no antibiotics whatsoever, as vet says they would be detrimental to evacuating the pus, and could just prolong the issue. I'm sorry it all seems very 'woolly' but I am concerned for the horse, and just wonder if anyone else has experienced similar visible swelling and heat, so quickly. Also, am I being unfair to the vet, or would you also be concerned at the diagnosis?
 
I have never had a leg come up like that from an abscess in the foot, it sounds as if it is either a nasty infection in the leg, even a small scrape can set this off, which should have antibiotics immediately, a strain to a ligament or tendon or worse.

I would not leave it, if I did feel it was in the foot my farrier would be called out, but either way if still not weight bearing, I assume it is on bute, it needs a vet in the morning, otherwise it is the weekend and you may not get the vet of choice.
 
Antibiotics are not correct for pus in the foot.

But neither is sudden onset swelling. Sudden onset lameness can happen, and did to me in the middle of a sponsored ride once and it was very peculiar! Horse fine one moment and hopping the next, and pus came out a day later.

But I've never heard of swelling appearing in front of your eyes like that, and it sounds like something far more serious to me like cellulitis/lymphangitis. That would also cause pain in touching the leg/skin, which is definitely NOT symptomatic of pus in the foot.

Cellulitis/lymphangitis which has caused severe lameness needs antibiotics immediately or it can go very dangerous. If the horse still has pain on touching the swollen leg, then I strongly suggest that you call another vet and try and get them to come out tonight.

If you see water leaking through the skin definitely get a vet on emergency callout.

Even if it is pus in the foot and nothing else, being non weight bearing on one leg can cause the other to break down, so the horse needs to be got more comfortable quickly.
 
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I have never seen anything like it. it was literally five minutes from being no swelling or heat, to the horse not wanting to weight bear, and the swelling coming from halfway down the cannon bone to the coronary band. The CB was swelling out away from the hoof. Both hind legs are bandaged, as per vet's advice, I'm not sure he is even on bute.
 
That sounds very odd. Are you sure there isn't a hairline fracture? I'd be getting an x-ray at the very least given the way it came on. :(
 
I just think the vet had decided it was pus in the foot before he even saw it, and made no attempt to look outside that particular 'box'. I can't believe he didn't even see it out of the stable. I shall see it again tomorrow. I would love the vet to be right, but...... :(
I made sure she didn't do the bandages too tight, in case there is further swelling, but it's a fine line between too tight, and useless. At least the other hind leg is properly supported.
 
Did your friend make the vet aware of just how quickly the leg swelled up? Might be worth reminding the vet of it, in case they didn't hear, and asking direct whether they have ever seen a foot abscess cause swelling in the space of only a few minutes?

Other than that, where did the swelling start? Just wondering if that might be significant. In other words, did it start immediately above the hoof, and work its way UP the cannon bone. Or did it start further up the cannon bone, and work its way DOWN the leg. Although I have no experience of this, I just wonder if it might give you more of a clue as to where the problem really lies.

My trimmer (and my own few experiences) have been that a foot abscess causes swelling which starts just above the hoof initially, and becomes more prononounced further up the leg as time goes on.

Whereas, if the blood supply to/from the foot is compromised, the leg can start to swell below the knee initially (for example, in laminitis some swelling where you would look for the digital pulse just below the knee can be an early indicator of laminitis). Not suggesting it's laminitis, but just explaining my line of thought.

I'm guessing that if there's a problem higher up the leg, the swelling will start close to that point.

Hope you get to the bottom of what's going on.

Sarah
 
The swelling started high, and ballooned downwards. The vet was told very clearly just how quickly the swelling and heat developed. He was adamant that there was an infection that had tracked round the hoof, then the pressure/pain became too much to bear, and it travelled up the leg. I asked why there had been no other sign of lameness/heat while it was 'brewing' and he was pretty non committal, basically saying it happens like that sometimes. He cut and scraped away at every little black mark on the sole he could, and even though horse flinched a little bit at times when the vet used the 'prodder', it was not as violently as he objected to his leg being handled. If he was in that much pain, I would have expected him to at least try and pull his foot away, but he only really got stressed when the vet manhandled his leg up higher to get a grip on it.
 
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