Finally! Vets diganosis on front lameness very confused

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pollypock1211

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Ok not sure if you have read my past posts but my horse has had multiple lameness issues since I bought him :( mainly being hind limb related. To summarise, he has OA in both his hocks (almost fused now), now (recently diagnosed) the start of OA in his stifles and he’s also got OCD in his stifles. As mentioned in previous posts he has had IM adequen injections and joint steroid injections on numerous occasions and he’s had the arthroscopy surgery on both his stifles and hocks.

We were competing very lightly in summer 2011 until he went lame on front which also sent his backend back to square one! He’s had more joint injections and improved very slightly behind (although still lame) but worse on front! Having used up all insurance I was advised by my vet to turn him away for a few months to see if he came right - he didn’t. I was then advised to retire him for good. I had his shoes taken off around 6 weeks ago and he’s got worse day by day. I decided to bite the bullet again and to have yet another full lameness investigation on front to see what was going off.

Here’s the conclusion - nerve blocks on front really exaggerated his lameness behind. He was very sensitive to the hoof testers on both insides of his hooves he has also worn down the insides of his hooves. He was very lame on the hard ground and on the rubble but sound in the sand arena. X-rays revealed that he has very thin soles, as well as them being very soft, and that he is almost walking on his pedal bone hence the reason he is lame. So the vet’s diagnosis is foot soreness! We have been given some Keratex with the hope it will strengthen his hoof wall he will improve in a few weeks/months time.

My concerns are the x-rays also showed up some mild changes to his navicuar bone but when I asked the vet if this was Navicular disease he said no, that it was quite normal and he would happily pass a horses vetting on the same changes :/ he also mentioned some side bone which was present but again it was not significant at this point!

Do people think this is normal?? and is it obvious that he’s going to develop navicular disease sooner rather than later or side bone or both??. It’s one of them scenarios yet AGAIN where its 'wait n see how he goes' well this is all we have been doing for the last 3 years and it seems no one can tell me what my horses future is going entail based on the medical evidence and there’s plenty of it :( very confused. We have no option but to trust these vets as professionals but I do question myself at times when all we seem to be doing is dangling on a string.
 
Poor you and your horse, it sounds like you've had a long and frustrating time together lameness wise.

The hock/stifle issues are arthritic, and as such there is no miracle cure, just pain management and possible fusing which can make the pain less severe.

The front feet however sound resolvable. Thin soles in a recently deshod horse is normal, and will correct itself in time. Temporary protection for them when he is walking over any uncomfortable surfaces would be a good idea, you don't want to add bruising/possible abscessing to the problems he's currently dealing with. Navicular in its early stages is reversible given the right barefoot care and in my experience sidebone will also settle down given correct balance and time.

So in your position, the key thing is to educate yourself what healthy equine feet look like, and make sure whoever is trimming him is doing a good job. Toe height needs to be kept in check, and medial lateral balance must be accurate to resolve the side bone issue.
 
pollypock1211 said:
We have no option but to trust these vets as professionals but I do question myself at times when all we seem to be doing is dangling on a string.
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O my word, you and your horse have been through the mill:eek:
When I read about all these joint problems on this formum, I do wonder which hurt caused which first and this poor horse will have been compensating for one original injury/degeneration. If only they could speak and tell us where it hurt in the first place:(

I would say you DO have a choice. I went against the advice of my vet and my farrier and they have been prooved wrong about my TB being able to cope with being barefoot.
If there ever was a case for sending a horse to Rockley Farm, this one needs to go. You cannot always just take a horses shoes off and it will heal it's self, especially when you begin with so many problems to start with.
You need to get very clued up about how to manage a barefoot rehab with existing problems because you are likely now to say that your horse cannot cope with being bare. If your field is very lush, and/or we have had frozen ground recently, it is not surprising your horse has got worse.
Please seek further advice from another professional in alternative remedies for all these problems, i.e. Nic Barker at Rockley, at least call her for a chat.
 
Poor horse - he has a multitude of problems. Having the shoes off will have done him no good at all - and keretex will not help a bit in this situation.

Get your farrier up, and get the shoes back on in front at least, asap.

If he were mine I'd turn him away until the summer with what ever medication was needed to support him, and then bring him in to see how he is.

But from the sounds of it his ridden days are over.
 
Having shoes of was a good move - but get some boots and pads to protect the feet.

Have a look at his diet...

Have a mooch on Uknhcp forum - lots of help there.
 
popularfurball said:
Having shoes of was a good move - but get some boots and pads to protect the feet.

Have a look at his diet...

Have a mooch on Uknhcp forum - lots of help there.
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Agree with this, your horse is crying out for comfy slippers ;) but you do need help with this, try contacting another professional if it's too much to think about right now.
Can't remember how old your boy is but mine was 18 when I had his shoes taken off. He would have been shod continuously since he was 4 years and had navicular, ring bone and spavins so I bought some Epic boots and pads in readiness for 'D' day and we transitioned him very slowly.
Good luck
 
amymay said:
How was having the shoes removed off the horse. He has thin soles, and therefore is compromising his pedal bone.

No wonder the horse is in so much pain.:confused:
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I wondered this too, amymay. :confused: OP has stated that he has got worse since his shoes have been off, indicating that he was in a better state WITH them.

If he has been to the vets before, would they not have initially identified that he has thin soles, or did your farrier not notice this issue??
I am no brainiac on this sort of thing, but IMO I would want shoes back on, or something on his feet to lift the soles off the ground a bit more and cushioning his pedal bones.
As difficult as a decision may be, you have to wonder what will actually be best for your horse, trying to help ease his pain with all of his issues, or to stop his pain altogether. Understandably, that is incredibly tough but in the end, you have to do what is best for your horse.
 
The uneven wear suggests that he needs to wear his feet this way to compensate for something elsewhere (injury or confirmation fault). He can't do this in shoes.

The thin soles need to be stimulated to thicken - shoes tend to encourage the sole to stretch in my experience. Also, if he is this lame standing - how likely is it he will find being shod comfortable?

Often with thin soles there are also frog problems (thrush, contracted heels) and shoes off will stimulate the frog as it is closer to the floor.

I would also have concerns around lgl or previosu bouta of lami or similar for a horse to be this uncomfy out f shoes.

My preference personally would be boots with pads, if a no go then glue on boots then glue on imprints then natural balance shoes... Though I might also be tempted by a second farrier opinion - I would be concerned the farrier hadn't notice thin soles etc

Any pictures of the feet? *nerd face*
 
amymay said:
How was having the shoes removed off the horse. He has thin soles, and therefore is compromising his pedal bone.

No wonder the horse is in so much pain.:confused:
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He has thin soles for one of three reasons, or two or all three:

- he has serious metabolic issues like insulin resistance which are preventing him from growing thick soles.

- he has a carbohydrate/sugar concentration in his diet which is too high for this particular horse and causes him to grow thin soles.

- shoes cause him to grow thin soles, as they do many horses.

Shoeing him may make things worse and worse. He is already lame in shoes so they aren't going to make him well. Removing them will provide the stimulation required to build a sole callous which he so badly needs. He won't build it in shoes and is currently a write-off in shoes, so what the point would be of putting them back on for a temporary pain respite before he is shot, I cannot see :(

De-shoeing him has exposed his real problems in the front feet. Getting his diet tuned (which may include a total removal of sugar from him diet, including grass) may allow him to be kept alive. Shoeing is not going to achieve this.

If he's that sore, bute is a better alternative for this horse than shoes.
 
pollypock1211 said:
My concerns are the x-rays also showed up some mild changes to his navicuar bone but when I asked the vet if this was Navicular disease he said no, that it was quite normal and he would happily pass a horses vetting on the same changes :/
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Changes to the navicular bone on x-rays bear very little correlation with unsoundness in the horse. You can x-ray 100 horses and around half of them will have navicular bone changes and be sound. I'm aware of a number of horses, including two I have owned, written off on the basis of changes to the navicular bone who are in full work after suitable rehab to sort out the actual cause of their foot lameness, soft tissue injury. Trust your vet on this one.
 
Poor you - with reference to the thin soles - how much work/exercise does he get in the sand arena.

A racing stables where I worked had a problem with thin soles which stemmed from the sand that was used on the track - sharp sand - the sort with angular sides will literally sand the soles away just like sandpaper.
 
cptrayes said:
He has thin soles for one of three reasons, or two or all three:

- he has serious metabolic issues like insulin resistance which are preventing him from growing thick soles.

- he has a carbohydrate/sugar concentration in his diet which is too high for this particular horse and causes him to grow thin soles.

- shoes cause him to grow thin soles, as they do many horses.
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Sorry, I didn't realise you have been present at the vet consultations.


If he's that sore, bute is a better alternative for this horse than shoes.
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Speechless.
 
I won't get in to the whole barefoot/shoes debate as each to their own, and no one approach fits all horses.
What I will say is I think you need to take a long hard look at this horse. I've had one with a similar list of problems. Started with hind suspensory, then thin soles, collateral ligament damage, sacroilliac... after that came suspected front suspensory, hock and possibly kissing spines (this was over a 6/7yr period to give perspective). He retired to hacking following the collateral ligament damage, and retired completely after the SI. We finally lost the battle to what was assumed to be a ruptured DDFT and he was pts.
Our vets viewpoint was that each time you treated a problem you were generating a new one. He was compensating for each weakness putting excess pressure on other areas. It was a mixture of bad luck (hind suspensory) and poor confirmation that kicked things off for us but once you have more than two or three issues it's difficult to get back on top of it.
From the limited information (and not being your vet) I think you have to make some careful decisions. Your horse sounds quite unhappy and I think you need to find a way to manage that both short term and long term.
 
amymay said:
Sorry, I didn't realise you have been present at the vet consultations.
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There are really only three reasons for thin soles Amymay. I don't know which has affected this horse but he wasn't born with them.


amymay said:
Speechless.
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Likewise, I am speechless that your idea of helping a horse who has compromised feet is to suspend his bodyweight from what are probably compromised laminae (they go with thin soles) instead of letting him stand on his foot bones via his frogs.

Your suggested approach risks masking the pain short term with shoes only to cause catastrophic failure with pedal bone rotation or total sole collapse later. My approach is to mask the pain short term with drugs and use the time bought to change the things that need changing to allow him to grow thicker soles.

The horse is unsound in shoes and yet you would put them back on. It makes no sense to me.

Perhaps if you had the experience I have had of taking on a horse in shoes who was about to be put to sleep because his feet were so soft they could be bent with your fingers, with soles on xray 3.5mm thick, and seeing him turn into a barefoot hunter and national breed show winner, you might be a little more open to the idea.
 
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cptrayes said:
Perhaps if you had the experience I have had of taking on a horse in shoes who was about to be put to sleep because his feet were so soft they could be bent with your fingers, with soles on xray 3.5mm thick, and seeing him turn into a barefoot hunter and national breed show winner, you might be a little more open to the idea.
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Yes, experience is definitely required to have an opinion on such cases. Great news about the National Breed Show Winner for him :)
 
sadly but realistically the prognosis is not good. OA in hocks and stifles OCD in stifles, front problems incl thin soles, navi changes and side bone. so yes keep the horses barefoot, put on a sugar free diet, soak hay, no grass, in a box? not much of a life, and not much of a future. but each to their own! i would suggest a serious chat with the vet concerned re treatment, prognosis, best scenario situation.
 
ofcourseyoucan said:
sadly but realistically the prognosis is not good. OA in hocks and stifles OCD in stifles, front problems incl thin soles, navi changes and side bone. so yes keep the horses barefoot, put on a sugar free diet, soak hay, no grass, in a box? not much of a life, and not much of a future. but each to their own! i would suggest a serious chat with the vet concerned re treatment, prognosis, best scenario situation.
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I do agree with this. If the horse was mine with that many problems, I would probably have it put to sleep :o.
 
Thanks for everyones replies its really very helpful.

I did have front shoes back on last week as requested by my vet - I got a new (recommended) farrier to do the job as i felt a fresh pair of eyes would be usuful. He has shod him as he would a horse with Navicular - with pads and full frog support. I observed him for a few days in the field and then rode him (again as advised by my vet) for 10 mins on a lose rein down the lane and back again. He feels fine plodding along in walk but in trot he is still lame and going down hill he has a very shuffled gait and feels uneasy - so overall hes not that much better with the support shoes.

I discussed this with my vet yesterday who has told me i would have seen an improvement if he was foot sore with the shoes on. He now feels that the navicular is playing a big part in his lameness :( He is wanting to start Trildren treatment which is a drug administred via drip! i dont know what to do for the best - my horse as been through so many tests as it is how do i know when to call it a day. I wish the vets would tell me but it seems they are wanting to do everything they can to help him but its as though he still has a future when its pretty obvious to me he has not! :( :( :(
 
I have a navicular horse and the first time I tried barefoot I couldn,t get him right, so I followed my vet,s advice and he was shod in eggbars, which to start with made him sound but after six months he went down hill and his feet fell to bits!
So I am now really trying with barefoot again I have the help of a good trimmer which is a great help, he is on a proper barefoot diet and most importantly I am making sure he is comfortable so atm this means he is turned out in boots and pads while the ground is so hard, I will do this until his feet can cope!
 
I'm a bit surprised that your vet is discussing "navicular disease" - how is he defining that? It's pretty much accepted now that what we used to call a disease and judge by pitting in the bone etc is really a syndrome meaning "heel pain" and can have many contributing factors. As above, studies comparing radiographs and case histories have pretty much proven it's not as simple as looking at an x-ray and extrapolating from the state of the bone.

Anyway, in this case, there seems to be a whole lot going on. The problem is horses are "systems" and once they fall out of stasis it can be very hard to get them right again if there are too many points of weakness. In your horse's case what might help one part of him might very well stress another part more than it can take.

By all means, look at the alternatives - including pain control - but don't beat yourself up for considering his quality of life. Imagine what it must be like to have four sore legs you can never, ever rest. :(

Tildren may very well help him. Be aware it's not a cure though, it merely moderates the arthritic process and bone loss. It's very likely the effects will be short lived in a horse with his history.

I mean this in the best possible way, but keep in mind that vets are scientists. They are hard wired to keep doing "stuff" so long as there is "stuff" to do which might, possibly help even in the short term. It's their mandate to treat so long as you are keen to do so. And while some are great at giving realistic situational advice, that is not really their job. There job is to give you all the options and let you pick which ones you want to gamble on. I am NOT slagging off vets - they are some of my favourite people - but only the owner can act as the horse's advocate and with a full picture of the situation. Even money has to be considered - there is no point in doing expensive management once if you can't keep doing it or if it means you can't give the horse whatever else he needs. This is a very tough call but the fact remains, you can only do what you can do.

Best of luck. It's a tough situation to be in. :(
 
Tildren will at best buy you a bit of time.
This is a horrible situation to be in and OP I feel for you so much, the vets will treat and treat ( and bill and bill) you know your horse best and you must assess his quality of life and take decisions accordingly these multiple issue horses are heartbreaking.
 
How do shoes help and protect thin soles? All they do (in my understanding) is numb and slightly lift the hoof off the ground they do not stop larger stones pressing on the sole they just stop the horse feeling it.

Op I agree with everything cptrayes has said. These issues are so often dietary in origin. The navicular bone damage will probably be from consistent toe first landing. Second also considering Rockley farm or at least contacting Nic Barker for advice.

Thin soles need protection and or keeping off any stoney and uncomfortable surfaces as bruising is a risk. Again shoes do not protect soles from this.

Imo this will take time and care to help him but with the right, experienced support improvements are very possible. x
 
TarrSteps said:
I'm a bit surprised that your vet is discussing "navicular disease" - how is he defining that? It's pretty much accepted now that what we used to call a disease and judge by pitting in the bone etc is really a syndrome meaning "heel pain" and can have many contributing factors. As above, studies comparing radiographs and case histories have pretty much proven it's not as simple as looking at an x-ray and extrapolating from the state of the bone.

Anyway, in this case, there seems to be a whole lot going on. The problem is horses are "systems" and once they fall out of stasis it can be very hard to get them right again if there are too many points of weakness. In your horse's case what might help one part of him might very well stress another part more than it can take.

By all means, look at the alternatives - including pain control - but don't beat yourself up for considering his quality of life. Imagine what it must be like to have four sore legs you can never, ever rest. :(

Tildren may very well help him. Be aware it's not a cure though, it merely moderates the arthritic process and bone loss. It's very likely the effects will be short lived in a horse with his history.

I mean this in the best possible way, but keep in mind that vets are scientists. They are hard wired to keep doing "stuff" so long as there is "stuff" to do which might, possibly help even in the short term. It's their mandate to treat so long as you are keen to do so. And while some are great at giving realistic situational advice, that is not really their job. There job is to give you all the options and let you pick which ones you want to gamble on. I am NOT slagging off vets - they are some of my favourite people - but only the owner can act as the horse's advocate and with a full picture of the situation. Even money has to be considered - there is no point in doing expensive management once if you can't keep doing it or if it means you can't give the horse whatever else he needs. This is a very tough call but the fact remains, you can only do what you can do.

Best of luck. It's a tough situation to be in. :(
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Thank u :) my vets diganosis is based on the x-ray results, his past medical history, symptoms of his lameness and the nerve blocks previously performed. I do, however, think he has rushed into the diganosis as the insurance are pressing him for the report and this worrys me so much! My vet has gone from the diganosis of foot soreness to a 5 minute phone call with me and then stating that the navicular changes are playing a big part in his lameness despite me asking numerous times over the navicular changes in the first place :/

I just feel i am totally unable to make a decision :( it has kept me up endless nights, i really dont know what to do for the best for him and at the moment i am thinking more along the lines of PTS but at the same time i feel so guilty as he doesnt seem to be in any obvious pain. Ideally i want the vets to tell me what to do as a professional after all is that why i am paying them ?? i dont know
 
amandap said:
How do shoes help and protect thin soles? All they do (in my understanding) is numb and slightly lift the hoof off the ground they do not stop larger stones pressing on the sole they just stop the horse feeling it.

Op I agree with everything cptrayes has said. These issues are so often dietary in origin. The navicular bone damage will probably be from consistent toe first landing. Second also considering Rockley farm or at least contacting Nic Barker for advice.

Thin soles need protection and or keeping off any stoney and uncomfortable surfaces as bruising is a risk. Again shoes do not protect soles from this.

Imo this will take time and care to help him but with the right, experienced support improvements are very possible. x
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I agree with this, my navicular boy has very thin soles,which is why has boots and pads when needed, he is fine in these!
I also feel that now his diet is correct that his soles will start to toughen up, it won,t be a quick fix for him, but my trimmer is optimistic for him to come right in time , I would really look in to barefoot for yours!
I was also thinking about pts .
 
pollypock1211 said:
Thank u :) my vets diganosis is based on the x-ray results, his past medical history, symptoms of his lameness and the nerve blocks previously performed. I do, however, think he has rushed into the diganosis as the insurance are pressing him for the report and this worrys me so much! My vet has gone from the diganosis of foot soreness to a 5 minute phone call with me and then stating that the navicular changes are playing a big part in his lameness despite me asking numerous times over the navicular changes in the first place :/

I just feel i am totally unable to make a decision :( it has kept me up endless nights, i really dont know what to do for the best for him and at the moment i am thinking more along the lines of PTS but at the same time i feel so guilty as he doesnt seem to be in any obvious pain. Ideally i want the vets to tell me what to do as a professional after all is that why i am paying them ?? i dont know
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Unfortunatly it will be you that has to decide and I feel it's a desision you take alone, i do Take time Think though then think it though again I think insurance sometimes confuses things even further I have been here not that long ago and wish you well.
 
The problem with bilateral lameness is the horse often doesn't look incredibly sore. I've seen horses blocked that look okay-ish normally but are hopping lame on the non-blocked foot. :(

I think my point was "navicular" isn't necessarily one, easily treated thing. A horse can have dicey looking x-rays and be serviceably sound. Another can have great x-rays and be dead lame. The problem is if he does have changes in that joint - as he has in other joints - then it it likely to cause him a problem even if it is not the thing that's causing a problem right now. Yes, a barefoot rehab program might help his feet - there are many stunning success stories. BUT he has to be well enough elsewhere to withstand the not always easy process and it will not help his other problems, plus those problems will stress his front feet more as they take up the slack.

Is your goal to get the horse riding sound? For what job? This is very different than just making him comfortable.

Unfortunately, as said above, your vet cannot tell you what to do. That is not their job (although some are willing to try) and in fact they are often dissuaded from giving their opinion either officially, or by being burned in the past. Their job is to treat the horse. Your job is to care for him, which includes what treatment to pursue. I know this sounds harsh but vets can't see the future either and I think it can be unfair to lay that burden on them - after all, they don't have to pay for it or look after the horse for the next x number of years.

I'm sorry, I know I'm not making this easier. But I do see horses suffer because owners are expecting vets to make the ultimate decision and I think it's useful to know that legally and morally it's not their decision to make.

I am NOT saying you should put the horse to sleep. I don't know the horse and I'm not you. But I do know that people are quick to pass moral judgements and make people feel guilty for doing what they know in their hearts is right and I think it never hurts to get both sides.
 
Why don't you ask them the questions you need answered? Is he likely to have a good quality of life afterwards? Is it going to be severely compromising his welfare to keep him going for long enough to have a chance to make him comfortable? I am perfectly happy to tell people when their horse us clearly saying he has had enough. They generally seem to appreciate it. However you are in the difficult position of having pursued it for so long that there is always the thought of holding out just airless but longer for a result. Your vets probably haven't given you "the talk" as you initially wanted to try to treat his ailments. Maybe it's time to ask their frank opinion. And make a plan as to where to draw the line.
 
Thank you and i do not disagree with any off the comments being said. I have asked my vet before about my horses quality of life and previously he made me feel very guilty by even considering the pts route which is why i have avoided the subject since.

He told me as a retired field ornament my horse still has lots of quality of life as his pain can be managed by bute and steroid injections. (this was before the Navicular diganosis) He also told me that although my horse is just 9yrs old he has the bones of a 30yr old horse but then again there are plenty of happy 30 year old horses out there!

I dont know what my goals are with my horse or what i am trying to acheive with him i initially bought him as a showjumper we had high hopes for him and he was doing very well. I suppose i would like him riding sound just to be a light hacker. He is field sound atm. I think its the unknown pain thats bothering me - god i wish they could talk. I have just booked in for a Thermal Imaging session for next week despite my vet advising me not to do it (false readings and all that). will be very interesting to see what it comes back with.
 
So sorry to hear you're in such a difficult position, I know exactly how you feel having been there. I had a super little mare who I owned from 2 years old and backed and brought on myself. At 7 years old she damaged her coffin bone collateral ligament and from then on seemed prone to muscle, tendon and ligament issues. She was retired at the age of 9, then developed laminitis from lack of work and I had her put to sleep last November at the age of 11 when it became obvious that the only way to keep her sound was to keep her permanently off grass and away from her friends which was no life.

It was the hardest decision I ever made as I'd tried so hard to fix her, done everything the vets said and spent a fortune of my own money (insurance refused to pay out, saying the conditions were linked and therefore excluded) but in the end she went so peacefully and though I miss her like crazy I know it was the right decision as she was suffering and her life wasn't worth living.
 
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