Avascular necrosis of the pedal bone

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smja

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Hi all,

Apologies for the essay, but the the horse in question is very dear to us and I need some advice, please.

Horse is 19 years old, has been sound all his life. Presented in autumn 2014 with intermittent lameness, then soon after a seemingly mild abscess. Abscess encapsulated and wouldn't drain with poultices/antibiotics, so ended up opening hole in hoof wall and scraping out dead tissue. Healed really well, hole grew down nicely, horse came sound.

Then was brought in from field hopping lame, same foot. Farrier summoned immediately, horse much better as soon as he opened abscess up. Poulticing and 2 weeks of antibiotics then reassessed by vet. X-rays "look like a mouse has been eating at his pedal bone". Horse usually has size 3 or 4 nails, but for this there's no reaction to a size 7 nail up the hole.

Vet diagnosis is avascular necrosis, and he recommends surgery. We're getting another opinion (fully supported by our vet who hasn't seen one like this very often!), but I was wondering if any of you have any experience of this kind of thing?

Many thanks in advance :)
 
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No experience at all. Only in humans, when avascular necrosis of a bone occurs following the interruption of the bone's blood supply. Usually caused by a fracture, but I suppose infection could erode a blood vessel. Has any treatment been suggested?
 
Treatment - vet now suggesting surgery to excise the dead tissue. The x rays don't show any kind of fracture - could an impact/bruise cause this sort of thing?

The horse is mainly a hacker these days (doesn't particularly enjoy schooling/competing), was in v. light work before all this happened, I can't remember him having any kind of accident/injury. Unless he's done something in the field?
 
An impact to cause that much damage would have to be substantial. Probably more likely to be an infection, a tiny puncture can admit bugs into a bone, leaving virtually no sign.
 
Afraid I've had no experience with avascular necrosis in humans, only dogs where sometimes the femoral head (ball of the hip joint) can get the blood supply cut off. It needn't necessarily be a wound/injury that's done it, but sometimes a compression of the blood vessels - so maybe conformational in certain cases, but that doesn't fit in with your lad making it to 19 without a problem... If he had a history of laminitis that could explain it, but again, he doesn't!

Has he had a venogram done? (where contrast is injected into the veins supplying the hoof, so it shows up where blood is getting to in the hoof). Other than referral/MRI (which I suppose would be the best way of definitively diagnosing, but is £££ if not insured) it's the only diagnostic thing I can think of... Might be worth asking about - it doesn't seem to be commonly done (I've only ever seen it in a few baaaad laminitis cases) but might help with diagnosis.

Let us know how you get on; I'd be very interested to find out some more! :)

ETA. I'd assume an infection would result in an osteomyelitis, not avascular necrosis, but if they're going in to remove the affected bits of bone I would hope they're sending them off to the labs (+ giving him some serious antibiotics!)
 
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He's as tough as old boots, has no lameness history (apart from two bog standard abscesses, easily sorted with a poultice). Unfortunately, he isn't insured :(

Farrier is experienced in remedial work, and works closely with our vet on many horses with foot problems...both farrier and vet want a specialist opinion on him because it's "fairly unusual", apparently.

X-rays have gone off for second opinion, will let you know once they've been looked at! Will also ask about the venogram/MRI options.
 
Not specific experience but can recommend Phil Cramp, the guy who sorted my then yearling colt from a nail injury that penetrated right up to the navicular. Poor lad was on youngstock livery and some twit who lived there (non-horse person) pulled the nail out and told them that he had a sore foot, so stood with a hole in it for 24 hours+ so had rampant infection by the time we got him to the vets and a not fantastic prognosis as a result.
He and Caroline headed up the team at Oaklands vets who also saved Monet's Garden.
They've since branched out on their own - http://www.hambleton-equine.co.uk/
Phil Cramp also works out of Rainbow Equine at Malton until their own hospital is built. (and he does articles for H&H)
 
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