DDFT injury

[Season’s Bleatings]

As some of you folks know already, our lovely big horse has been having some issues of late. As a bit of a timeline, just to give full context:
6th March he pulled a shoe; with hindsight we think this might have been the start of our issues. He was sound at the time but farrier did comment that he had probably done it with a fair bit of force.
After shoe went on, we had a lesson, hacked and went xc schooling.
16th March: I had a lesson and he was absolutely phenomenal.
18th March: Got on in the school and he didn’t feel quite right. Trotted up and def not sound.
22nd March: Went to see our lovely chiro vet who suggested to give him the benefit of the doubt at this stage - lameness was fairly minor and suggested resting initially.
I start to forget precise dates now but…
Approx 2wks after chiro vet, decided to go to main vet for work-up as still not quite right. Bit of swelling around fetlock but X-ray was clear. No nerve blocks at this stage, advised further rest and then see.
Minor improvement seen after two weeks so advised to continue rest and start to introduce turnout again.
A couple of days after that assessment he came in from field hopping lame - to the extent that we got out of hours vet to come out. OOH vet felt pain was coming from foot in this instance (turns out he was right!) and considered possibility of abscess as horse also had a small wound in his heel. More rest!!
A couple of weeks after THAT incident we were back to vet as still not right. Xrayed again and nerve blocks confirmed pain somewhere in foot. Vet advised steroid into coffin joint to see if that helped, another week off and to then start walk work for a week, evaluate after two.
Week two came, trotted up and still lame, more or less the same as on day 1. Vet advised next step MRI.
So after all that (approx 3 months from lameness to today) we had the MRI on Friday past and results came through yesterday. He has a tear to DDFT.
Options are
- Rest and wait to see what happens
- Rest, guided X-ray into affected area of steroid and HA
- Arthroscopy into affected area and PRP

Our vet felt quite strongly that the 3rd option would offer the best chance of him returning to soundness and a level of work; it would be carried out by a very experienced surgeon down at University College Dublin and he would likely spend a few days down there. I had a chat with our chiro vet last night (she’s wonderful) and her view was that proceeding with the surgery wouldn’t be the wrong choice for him and really it was as much an economic decision as anything. Her area of interest is rehab and she has a really good holistic, but science-based approach, and would support us through the rehab etc. She also discussed the reality of GA (she used to work at a surgical clinic in Newmarket) and yes there are risks but they are relatively small.

I suppose what I’m really asking is…
Have any of you folks had experience in managing this type of injury and if you did opt for the surgery, what were your experiences?

Part of me thinks: go for the surgery, we are insured etc and we always have the option of Dr Green if that does not go as planned. Success rate (returning/exceeding previous level of work) is apparently around 45%… and so much of the success leans on the quality of the post-op rehab.

He is such a special horse to us and I just want to do right by him - if all we do for the rest of his days is mooch about hacking, then so be it.

 

[Birker2020]

As some of you folks know already, our lovely big horse has been having some issues of late. As a bit of a timeline, just to give full context:
6th March he pulled a shoe; with hindsight we think this might have been the start of our issues. He was sound at the time but farrier did comment that he had probably done it with a fair bit of force.
After shoe went on, we had a lesson, hacked and went xc schooling.
16th March: I had a lesson and he was absolutely phenomenal.
18th March: Got on in the school and he didn’t feel quite right. Trotted up and def not sound.
22nd March: Went to see our lovely chiro vet who suggested to give him the benefit of the doubt at this stage - lameness was fairly minor and suggested resting initially.
I start to forget precise dates now but…
Approx 2wks after chiro vet, decided to go to main vet for work-up as still not quite right. Bit of swelling around fetlock but X-ray was clear. No nerve blocks at this stage, advised further rest and then see.
Minor improvement seen after two weeks so advised to continue rest and start to introduce turnout again.
A couple of days after that assessment he came in from field hopping lame - to the extent that we got out of hours vet to come out. OOH vet felt pain was coming from foot in this instance (turns out he was right!) and considered possibility of abscess as horse also had a small wound in his heel. More rest!!
A couple of weeks after THAT incident we were back to vet as still not right. Xrayed again and nerve blocks confirmed pain somewhere in foot. Vet advised steroid into coffin joint to see if that helped, another week off and to then start walk work for a week, evaluate after two.
Week two came, trotted up and still lame, more or less the same as on day 1. Vet advised next step MRI.
So after all that (approx 3 months from lameness to today) we had the MRI on Friday past and results came through yesterday. He has a tear to DDFT.
Options are
- Rest and wait to see what happens
- Rest, guided X-ray into affected area of steroid and HA
- Arthroscopy into affected area and PRP

Our vet felt quite strongly that the 3rd option would offer the best chance of him returning to soundness and a level of work; it would be carried out by a very experienced surgeon down at University College Dublin and he would likely spend a few days down there. I had a chat with our chiro vet last night (she’s wonderful) and her view was that proceeding with the surgery wouldn’t be the wrong choice for him and really it was as much an economic decision as anything. Her area of interest is rehab and she has a really good holistic, but science-based approach, and would support us through the rehab etc. She also discussed the reality of GA (she used to work at a surgical clinic in Newmarket) and yes there are risks but they are relatively small.

I suppose what I’m really asking is…
Have any of you folks had experience in managing this type of injury and if you did opt for the surgery, what were your experiences?

Part of me thinks: go for the surgery, we are insured etc and we always have the option of Dr Green if that does not go as planned. Success rate (returning/exceeding previous level of work) is apparently around 45%… and so much of the success leans on the quality of the post-op rehab.

He is such a special horse to us and I just want to do right by him - if all we do for the rest of his days is mooch about hacking, then so be it.

Have no experience but watching with interest. I hope you find the right decision for you and your horse. Good luck.

 

[sbloom]

I'm sorry this link is in the wrong tone, it's not meant to blame at all, but I wanted a post rather than my typing, this is Celeste Leilani Lazari and her Balance in Movement Method (which is the perfect way to rehab the thoracic sling). I'm sorry it's not an answer to the three options, but worth considering in your thoughts:

https://www.facebook.com/wildmagicllc/posts/1851076268415808

 

[Season’s Bleatings]

I'm sorry this link is in the wrong tone, it's not meant to blame at all, but I wanted a post rather than my typing, this is Celeste Leilani Lazari and her Balance in Movement Method (which is the perfect way to rehab the thoracic sling). I'm sorry it's not an answer to the three options, but worth considering in your thoughts:

https://www.facebook.com/wildmagicllc/posts/1851076268415808

No no thank you so much for sharing that! Just as important to us as rehabbing the injury is making sure we give him the best opportunities to be the best he can be overall; it’s something we had been working on with our chiro vet as he is a big horse and quite weak behind – we’d been making good progress in that regard so I absolutely agree that a whole-body approach to rehab is likely to be instrumental in giving us a good outcome in the longer term. I will have a wee read of the link later on.

 

[quizzie]

I'm sorry this link is in the wrong tone, it's not meant to blame at all, but I wanted a post rather than my typing, this is Celeste Leilani Lazari and her Balance in Movement Method (which is the perfect way to rehab the thoracic sling). I'm sorry it's not an answer to the three options, but worth considering in your thoughts:

https://www.facebook.com/wildmagicllc/posts/1851076268415808

If I'm reading that link right, the implication is that she has never seen a DDFT injury in a pigeon toed horse?........as under development of the thoracic sling (in the absence of lower limb deformity) leads to a toe-out stance?

Does she differentiate between DDFT lesions within the hoof (above or below the navicular), those in the pastern/fetlock region, and those above the fetlock?

 

[sbloom]

If I'm reading that link right, the implication is that she has never seen a DDFT injury in a pigeon toed horse?........as under development of the thoracic sling (in the absence of lower limb deformity) leads to a toe-out stance?

Does she differentiate between DDFT lesions within the hoof (above or below the navicular), those in the pastern/fetlock region, and those above the fetlock?

Why not ask on the thread for both questions, I have absolutely no idea on the second? I would guess that she's looking at the hoof region. I have to say that in my experience TS dysfunction isn't always associated with toe-out, despite the comment ref the elbows, probably more often corresponds with base-narrow which seems to be very common.

 

[abbijay]

Alfie, horse in my avatar did his DDFT in 2019, although due to his size we couldn't MRI to establish the extent of the issue and had to take a more "old fashioned" approach to treatment.
At the time Alfie was 16 and had already had major surgery age 12 for an infected pastern joint (different leg) so I felt we had already ridden on borrowed time for 3 years. We initially box rested and he started to become stressed by it. We persisted for 12 weeks but then he developed right dorsal colitis and ended up on ICU and banned from eating hay/haylage for the forseeable future. He still hadn't come sound. By this point I was tearing my hair out with stress. We made a judgement call that this wasn't working and we had to do something different so we made the decision to permenantly retire him and turned him away - literally chucked out in a herd and left to it, accepting low grade lameness for quite some time while we waited.
It took almost 9 months of turn out for him to get to the stage where I would call him and he'd happily canter over again. I have been able to get back on him occasionally - he is officially retired but we both get a little buzz from getting back on board. I probably could have rehabbed him differently but he is worth more to me than I can explain so having him as a happy, hairy, hippo always stuffing his face with grass with his friends was more important than trying to bring him back to a competitive career for me.

 

[kathantoinette]

I had one with a DDFT tear. He was approx 13 when it occured. I turned him away for a year (no surgery) - I think 9 months might have done it but I went for a full 12 months. I didn't do any box rest and in the winter he was out during the day and in at nighttime.
I brought him back into work by the book and took my time with him. He came back 100% sound - I didn't re-xray.
I hacked and did some dressage on him and he stayed sound but unfortunately got lymphoma and I had to have him PTS about 16 months after I brought him back into work.
Who knows if he could have gone on to harder work - I was happy hacking him and doing my dressage. He was such a lovely horse.
Good luck with whatever you decide.

 

[PinkvSantaboots]

My experience isn't great I'm afraid my warmblood mare injured her ddft in the pastern area when she was 13, I tried 3 times to bring her back into work after long Bix rest periods and field rest but she would just not stand up to a low level of work so I retired her.

We believe it was an old injury possibly done before I bought her as she had extensive scar tissue, due to this there wasn't really any procedures that would benefit apart from steroids which I wouldn't have done as she had cushings and ems.

I think in your situation I would try and have the treatment as it sounds like the best option for a return to work.

 

[Alibear]

I'm so sorry Sheep. You know your horse best, whichever route you chose will be the right one. Fingers firmly crossed for you.

 

[HelenBack]

My horse was recently diagnosed with a ddft tear too. In his case the vet said that the nature of the injury meant that surgery wouldn't really be helpful but she seemed to think that in those cases where surgery is an option it does stand a good chance of improving the outcome for them. I think given that you're insured and your vet seems to think it's a good option I'd be tempted to give it a go. My understanding with tendon injuries is that things like surgery don't shorten the recovery time and just increase the chances of it being a successful recovery in the end so I guess you will be doing all the rest stuff afterwards anyway, and you probably have nothing to lose other than the hopefully very small risk of the surgery.

Mine is currently about half way through box rest but on reflection I wish I'd just turned him away really and let time do its thing. There's no pressure for him to come back to ridden work anyway as I've decided I'd rather retire him and keep him here, and if he does get sound enough to be ridden then it will be whenever he's ready and time is not an issue. He does actually tolerate the box rest well but understandably can be a bit of a prat when I take him out for his hand walks and I'm not convinced it's the best thing for them anyway.

I think you just have to weigh up the options and pick the one that you think is going to give you the best chance of a positive outcome for your horse, whatever positive outcome might mean to you. Then stick with it, do your best and try not to have any regrets or wish you'd done things differently.

 

[milliepops]

I think given that you're insured and your vet seems to think it's a good option I'd be tempted to give it a go. My understanding with tendon injuries is that things like surgery don't shorten the recovery time and just increase the chances of it being a successful recovery in the end so I guess you will be doing all the rest stuff afterwards anyway, and you probably have nothing to lose other than the hopefully very small risk of the surgery.
[...]

I think you just have to weigh up the options and pick the one that you think is going to give you the best chance of a positive outcome for your horse, whatever positive outcome might mean to you. Then stick with it, do your best and try not to have any regrets or wish you'd done things differently.

I haven't any experience of ddft injuries, only sdft. but I agree with this. though having had an MRI and then surgery on top, if you decide to go for it just make sure you get an estimate first and are happy with it, my mare had MRI and then surgery after a bit of a work up (stifle issue but assume similar £) and it pushed me quite a lot over the top of my insurance funds.

 

[Season’s Bleatings]

Thanks so much everyone for your insights and experiences, it is really valuable. I’m so gutted for our big lad, he’s the sweetest, funniest eejit and just a lovely soul, would be lost without him!

 

[BBP]

I’ll ask my sister for details when I’m home. Her horse had two separate surgeries on ddft, one in each hind leg. About 12 years ago if I had to guess. Our biggest issues were how we managed the recovery and rehab in the situation we were in, he went on to develop EMS and mild laminitis due to being inactive for too long, so would change that. BUT, those injuries and issues have not stopped him having a fantastic life. He is now in his 20s and a fit and well as he has ever been all things considered. He is a fantastic trec horse. In fact out of a group of him in his 20s, bbp at 17, plus an 11yo and a 2yo he is currently the soundest one and only one in full work right now. It’s his arthritis and feet that need the most management.

I’ll try to find out a bit more for you.

 

[muddy_grey]

My mare had ddft surgery 5 years ago. Hers was above the pastern. She had a mild swelling for 6 months before going lame. The surgery revealed an adhesion had ruptured. The damage was to the edge of the tendon so they basically shaved the side off. Prognosis was poor 50/50 chance of being sound. 6 weeks total box rest, then with walking building up to an hour. Introduced trotting and was trotting for 20 minutes before being turned out un a small pen (this was just before 6 month mark). Was in full work within a year and has been sound since. She has a fat leg as they cut the annular ligament to access it, but it is just cosmetic. She was back competing sj, but is currently in light work due to me having a baby. Hope this gives you some hope

 

[Season’s Bleatings]

Thanks so much BBP and muddy_grey, it’s good to hear your direct experiences of similar types of thing. I think we will probably go the surgery route- on MP’s advice I’ve asked them for a detailed estimate so we can just make sure we are in a position to proceed etc.

 

[Elf On A Shelf]

Regardless of surgery or not it is the rehab that is the most important thing. We have had horses go on to race again after ddft injuries - some round the fetlock, others in the hoof and everywhere in between. Some have had surgery, others haven't. Some have come fully sound, others have come servicably sound (ie. They have a mechanical lameness that will never leave them, the BHA vets have seen them and know how they should trot up every day at the races and do indeed always check on them before and after races) all have carried on to do things after racing if they are not still in it.

Time is going to be your best friend. I would scrap the next 12 months and just stick to the rehab plan you are given. Somethings heal quicker, some slower. Age isn't always a barrier for this.

Whichever route you go down I wish you the best of luck and hope the outcome is what you want in the long term.

 

[Season’s Bleatings]

Thanks so much Elf - that is really important and I think mentally we are there, as in we know it’s going to be a long slog to get the best result.
We’re really lucky to have access to a clinician (not our primary care vet) who practiced as a vet, trained as a chiro and really specialises in rehabbing horses and working with them as individuals to maximise their ability / recovery. She knows our vet well, and also knows the surgeon well so I feel like she’s the final piece of the puzzle.
He’s a very special big horse and we really want to do what’s right for him and what allows him to make the best recovery he can.

 

[BBP]

Had a chat with my sister. Her horses surgeries were both ddft in fetlock. She said she had no regrets at all about the surgeries, but would have changed the rehab. Thinks he spent too long on box rest and then didn’t have a rehab plan other than build up hand walking duration and then ridden duration. We didn’t have the experience or experienced support at that time to understand the real importance of training the horses posture and straightness. So that is the aspect she would change as we think he went downhill into being an ‘old man’ really fast. Once we found excellent instructor, osteopath and trimmer, the horse really turned a corner and looks and works better in his 20s than he ever did.

I’ll admit that the last couple of injured horses (both ruptured their superficial digital flexor tendons above the hock) have done small pen rest rather than box rest and then gradually increasing paddock size until they were both on track systems (so most playing done on straight lines).

 

[Season’s Bleatings]

Had a chat with my sister. Her horses surgeries were both ddft in fetlock. She said she had no regrets at all about the surgeries, but would have changed the rehab. Thinks he spent too long on box rest and then didn’t have a rehab plan other than build up hand walking duration and then ridden duration. We didn’t have the experience or experienced support at that time to understand the real importance of training the horses posture and straightness. So that is the aspect she would change as we think he went downhill into being an ‘old man’ really fast. Once we found excellent instructor, osteopath and trimmer, the horse really turned a corner and looks and works better in his 20s than he ever did.

I’ll admit that the last couple of injured horses (both ruptured their superficial digital flexor tendons above the hock) have done small pen rest rather than box rest and then gradually increasing paddock size until they were both on track systems (so most playing done on straight lines).

Thank you so much BBP, that is so helpful. I think we are in a good place rehab-wise with the support of the chiro vet, she is really rehab focused and really proactive in keeping up to date on the latest best practice.
The thought of surgery still terrifies me but I think it’s our best option for the big lad.

 

[Cherryblossom]

Thank you so much BBP, that is so helpful. I think we are in a good place rehab-wise with the support of the chiro vet, she is really rehab focused and really proactive in keeping up to date on the latest best practice.
The thought of surgery still terrifies me but I think it’s our best option for the big lad.

I don’t have any experience with that particular injury, but I suspect we use the same chiro vet (ESS) and she’s previously referred my mare to the UCD team. I would have every confidence in both these vets, and if they’re both in agreement about your horse, then I wouldn’t think twice about going for surgery.

 

[Michen]

Oh no Sheep I'm really sorry to read this! Poor you.. had really hoped it would be something really minor.

Good luck with whatever you do, FWIW when I thought Bog needed surgery I did decide I would go ahead as wanted the best shot at a useful life

I spoke to a few vet practices to reassure myself on their GA recovery procedures.

 

[Season’s Bleatings]

I don’t have any experience with that particular injury, but I suspect we use the same chiro vet (ESS) and she’s previously referred my mare to the UCD team. I would have every confidence in both these vets, and if they’re both in agreement about your horse, then I wouldn’t think twice about going for surgery.

Yes that’s her! She is fantastic, isn’t she? Such a lovely lady and so willing to share her knowledge.

 

[Season’s Bleatings]

Oh no Sheep I'm really sorry to read this! Poor you.. had really hoped it would be something really minor.

Good luck with whatever you do, FWIW when I thought Bog needed surgery I did decide I would go ahead as wanted the best shot at a useful life

I spoke to a few vet practices to reassure myself on their GA recovery procedures.

Aw thank you.. flippin horses eh..! it’s reassuring to have the perspectives from others who have faced similar decisions and good to know that my gut feeling about what to do next aligns with what others would do, if that makes sense.

 

[Michen]

Aw thank you.. flippin horses eh..! it’s reassuring to have the perspectives from others who have faced similar decisions and good to know that my gut feeling about what to do next aligns with what others would do, if that makes sense.

It sent me into utter turmoil at the time but in reality the risks of surgery are pretty low. I would ask the Q's of the practice he may go to in order to put your mind at rest. Good luck whatever you decide xx

 

[Season’s Bleatings]

It sent me into utter turmoil at the time but in reality the risks of surgery are pretty low. I would ask the Q's of the practice he may go to in order to put your mind at rest. Good luck whatever you decide xx

Thank you so much!xx