For all those lameness experts

alsxx

alsxx

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I'm hoping some of you may be able to offer me any info relating to possible treatments, or any opinions at all on my mares palmer foot pain of the fore feet.

A brief outline, my mare has been lame now for coming up to a year - orginally it was the left hind, 2 months later 2nd opinion vet diagnosed lame in all 4 legs, which included palmer foot pain. She went for an MRI in Feb, this is the summary report of the feet (she did have an abscess at the time)

Right forefoot:
There is evidence of focal inflammation within both clefts of the frog either side of the midline. These are consistent with focal abscessation although can not differentiate between an abscess and the effects of deep paring of the foot.
The changes in the deeper structures of the foot reveal only mild changes involving the navicular bone, navicular bursa (bilateral distension), collateral sesamoidean ligaments, lateral collateral ligament of the distal interphalangeal joint, and distal interphalangeal joint (moderate distension – often secondary to other problems within the foot) which are of questionable clinical significance. There was no evidence of a tear to the deep digital flexor tendon.

Left forefoot:
There are similar, though milder, changes to the deep structures of the foot listed for the right forefoot.

I do have the full report at home, which goes into specifics if anyone is interested, the only real nugget of info is it mentions that in the LF there is moderate damage to the insertion of a ligament into I think the DIP joint, which could be an indication of early onset navicular, however nothing of interest relating to the RF.....but to cut a long story short, nothing has been done for my mare to 'help' her foot pain other than trying pads which made no difference (due to major arguments with insurers and vets), the MRI was done in Feb, and in April I made the decision to turn her away at grass for a year and took off her shoes (as I couldn't do anything else with her due to vet/insurer issues and as a result no more money left to afford to).

Now she is quite happy out in the field, and isn't noticably lame, however she often points the right fore, and I suspect if she was lunged on the hard she would be lame (she was reviewed in April before t/o and was still 2 10ths lame RF).

No vet (of the 5 that have been involved in her case!!!) have offered me any insight into what she actually has wrong with her/what is causing her lameness....as you can see the report above says of questionable clinical significance, yet SOMETHING is causing her pain. I'm just wondering if anyone can offer any words of advice/opinions....she's only 6 and I would quite like to be able to ride her once again (although I have faced up to the fact I probably wont be able to)!!!

Sorry its a bit of a blurted essay
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How frustrating for you. It sounds like an all too common case of loads of money spent on diagnostics but no progress on providing a treatment. Would I be right in thinking the vets have labelled this with the cover-all navicular syndrome?

My only suggestion would be to have her looked at by one of the really good specialist lameness farriers. They are few and far between and not cheap (what is with horses!) because you're paying for consultation time as well as treatment plus liaison with the vet for x-rays and MRI scan reports, and whilst there are never any guarantees I've seen them bring numerous cases classed as "fit only for a pasture pet" by the vet back to soundness. I can recommend one if you want to try that route?
 
My thoughts for what they're worth - I am not qualified in anyway, just from bitter experience...
The references they make to damage of the collateral ligament could cause lameness IMO. Jesper has some wear to his collateral ligaments and was lame because of this. His was a similar story with front and hind limb lameness over a course of time which eventually led to the list of ailments including suspensory ligaments, collateral ligaments, sacroilliac issues, low lying pedal bones and possible hock issues. It is likely the low lying pedal bones put extra stress on his collaterals causing the initial damage to his RF. He had previously as a youngster injured his LH suspensory, and when recovering from the RF injury it is likely he compensated putting more strain on his LH causing the suspensory to re-injure. Because of this he compensated again and probably caused the sacroilliac problems. Believe it or not he was never particularly lame, more pottery and lame when lunged on a hard circle.
Advice wise... I've always found Sue Dyson at New Market to be the leading expert on soft tissue within the foot, maybe worth a thought? With Jesper we tried steriod injections in to the coffin joint to relieve inflammation as well as shock wave therapy and nine months rest. He did return to work for a year but retired after the suspensory and sacroilliac problems. Sorry for not being much help but I think it is possible for the collateral ligament problems to be causing the slight lameness.
 
My horse is the same :-( months of lameness and into thousands spent on diagnostics. I am going for MRI on Tuesday as i can't watch him hobble anymore. Its been narrowed down to the heel as he is sound as a pound with a palmar digital nerve block. They were at one point going to do a neurectomy as they thought it was down to his ringbone. Further nerve blocks at my request ruled this out so we were back to square one.
I can sympathise with your frustration when no-one will help you and you don'tknow what to do next.
 
No funnily enough she hasn't been labelled with anything.....I dont think they actually know tbh!!

The big problem is the two main vets that have been involved in her case completely disagree with each other. One reckons she should have her coffin joint and NB medicated with MORE steroids (this is the vet that medicated both her hocks, her front fetlocks and her tendon sheath.....the other vet doesn't think she even has/had arthritis in these joints, although the sheath is a confirmed problem)....

I like the idea of a specialist farrier, but the only issue there is which vet do I get them to speak to? I don't necessarily trust 'my vet' (the second opinion vet) but the other vet wouldn't want to know either....How much do they generally cost/what do they actually do that is different to a normal farrier? She was correctively shod in Nov in conjuntion with my vet and x-rays.

For all the money that has been spent on her in the last year (must be around £15k by now) I swear she has actually got worse than when it all started. And I don't know what is wrong with her let alone what to do about it!!!
 
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Believe it or not he was never particularly lame, more pottery and lame when lunged on a hard circle.

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That sums up Ellie pretty well tbh....

I had the option of going sending her to a specialist centre and if I had chosen it would have been Sue Dyson, sadly at the time I opted for her to stay where she was, hindsight is such a wonderful thing....if only I could turn back the clock
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She had her lameness worked up at the RVC by Roger Smith, who was the one that referred for the MRI.

Its such a joke that they get to use all their fancy tools and equipment but cant actually tell you what is the problem
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I just typed a whole long reply and lost the lot! Grrrrrr. Anyways....

You obviously already have the MRI scan report but the farrier would need to see that latest set of x-rays (you could always involve a.n.other vet to do an upto date set, via the farrier).

It sounds rather like the vets have given up so they may actually be quite open to listening to a lameness farriers recommendations. No disrepect to vets in general but in my experience I have found that many do rely on doing what they've always done, just because it is what they've always done, rather than go with the opinion of a specialiast farrier who has all sorts of products and leading-edge techniques at their disposal .

Cost wise it's a case of how long is a piece of string. I would expect to pay by the hour for consultation (£50-75), plus treatment. I have seen "pasture pets" walk into the forge lame and walk out again sound after just careful rebalancing of the feet and correct placing of a set of early breakover shoes at £75, graduated pads and shoes put on to allow soft tissue injuries the right conditions to heal at £120, right up to the application of Equine Digital Support Systems (EDSS) which are serious bits of kit with all sorts of bolt-on goodies, rails and supports which can be adjusted as necessary to place the internal structures in the correct position (again to allow nature to do her thang) at £250 a pair! Then it's a case of allowing time for the chosen remedy to work, which could mean several repeat shoeings and making sure that whatever caused the issue in the first place, especially if it is foot balance related, isn't allowed to recur. Until your horse as been seen there is no way of knowing what expense you are looking at, but if you do go for a consultation you always have the option of saying "sorry, too much money, thanks and I'll go back to plan A - pasture pet" if you consider the treatment plan to be spending good money after bad. I hope that helps.
 
I'm no expert, but I've dealt with more than my fair share of foot problems.

I'm sure that there will be some success stories, but IMO, even though the vets are understanding foot problems better they still don't have any truly, proven successful treatments. New things are being developed, clever shoeing or going barefoot sometimes helps for varying lengths of time, then there are the shockwave, IRAP, etc, that have a less than 50% success rate. But overall the outcome IME is pretty grim.

If you have tried the treatment options financially available to you and the horse is still toe pointing and not totally sound, I think you are right to think realistically you won't be able to ride her. Foot problems are sadly often still not fixable. Maybe if you can afford to keep her as a pet if she is comfortable, things will have advanced in a few years and some real solutions might be available.
 
Flame....we haven't tried any treatment options as I was left with my back up against a wall due to vet/insurer issues...I have recently got them to pay out for the diagnosis for the feet by going through the ombudsman - they owed me £3k. But I have no insurance money left (well there is a bit but after everything I don't think they will pay any more out on her) so couldn't really afford anything fancy anyway.

All she has had was the foot balance addressed, and then she was tried with pads which made no difference what so ever, hence why I had the shoes taken off in the end.

She's perfectly happy as she is, she whizzes around the field and people say that she doesn't even look lame, but I suspect she probably is still, as she toe points. But she has a home for life anyhow, I've had her since a foal, its just so gutting that as a 5 year old she goes lame when I have been so so careful with her all her life. Horses seem to be so fragile.
 
If anyone is interested, extracts from full MRI report:

clinical history - analgesia of right fore DIP joint partially positve (30%); analgesia of right fore navicular bursa partially positive (70%)

Right fore MRI findings:

- mild modelling of the distal border of the navicular bone
- mild patchy decreased T1 signal in the medulla of the nav bone
- mild patchy STIR signal in the medulla of the nav bone
- moderate distension of the DIP joint
- moderate distension of the navicular bursa
- collateral sesamoidean ligaments are mildy thickened
- lateral collateral ligament of the DIP joint is moderately swollen and has heterogenous T1 and T2* signal intensity

Left fore MRI findings:

- mild to moderate modelling of the distal border of the nav bone
- mild patchy decreased T1 signal i nthe medulla of the nav bone especially distally
- mild STIR signal in the medulla of the nav bone
- mild focal STIR signal in the distal phalanx at the site of insertion of the distal sesamoidean impar ligament (DSIL)
- mild new bone formation/irregularity of the bone surface of the distal phalanx at the site of insertion of the DSIL
- moderate distension of the distal interphalangeal joint
- mild to moderate distension of the nav bursa

The interpretation of findings says: 'there is evidence of mild navicular bone damage and moderate distension of the navicular bursa in both feet, but changes considered mild and may be result of physiological stress rather than indicating degenerative disease. However there is some evidence of damage to the insertion of the DSIL onto the distal phalanx in the left fore, which may suggest early navicular disease.

The distension of the navicular bursa is more than they would expect as a secondary change, and suggest possibility of synovitis/bursitis.....this finding is considered likely to be significant in terms of lamenes, however it is noted tha the RF navicular bursa has been injected recently (nerve block done week before), which would result in distension.

The damage to the lateral collateral ligament of the DIP joint is mild, and therefore difficult to be sure how significant it is in terms of lameness.'

So, reading that it suggests its the navicular bursa and poss collateral ligament, yet upon speaking with both vets they were very dismissive of the findings saying that most horses if MRI'd would have similar findings, as her changes are considered mild.
 
She has never had lami.

However in Jan she had an abscess LF in the white line (not associated with any nail holes), 2 weeks later she was assessed by my vet and was sound, she then went for a week at the RVC where her RF lameness got progressively worse, and then just before the MRI a week later she went hopping lame, which was an abscess in the RF which was deep in the foot by the cleft of the frog (I've never seen one so deep in the foot before), and we think it had been there for a couple of weeks at least which was the ause of the lameness.

If you read OP the summary report I have copied and pasted it mentions this second abscess - at the time they put her lameness down to this, but she's still lame, as I say she's fine in the field, but in April when she was reviewed she was still lame on a circle on the hard (about 2/10ths).

She has never suffered with abscesses before or since, and one vet's opinion is that it could be as a result of all the steroid injections she had, but he also said it could be as a result of where her feet were re-balanced in November, or even where she was on box rest for so long.
 
That's interesting. Sorry for missing it in the OP, I get a bit overwhelmed by MRI reports.
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I've got a pony who's almost sound 95% of the time since an attack of laminitis coupled with a massive abscess on the inside heel of his RF 20 months ago. He's never been right on the RF since, it only shows up on tight turns on hard ground, uneven ground or roads with a drastic camber. His foot balance is good and x-rays suggest he has good feet. The vets have no idea why he's still unsound. ETA He nerve blocks sound in the RF hoof but not around the navicular area.

I was talking to someone else the other day with a pony with the same problem. They had it MRI'd and still don't understand what's wrong. Very frustrating. Anyone an expert on abscesses and what lasting damage they can cause?
 
Thats interesing Flame, the lameness your's has sounds very similar to Ellie. My vet did mention that an abscess can affect the status quo of a foot and could take a while to settle? Not very helpful.....seriously though it was huge, when it was dug out it must have been a good inch deep in the foot.
 
Interesting to hear about the abcesses. They are of course natures way of getting rid of necrotic tissue within the foot and indicate soft tissue damage.

I know of a horse which had appalling foot balance which caused tremendous damage within the foot resulting in lameness. Once the foot balance was corrected the farrier advised the owner to expect repeated abcesses whilst the internal structures healed and he was right - they went on for two years! Because she'd been warned what to expect she "kept the faith" and stuck with the treatment program (graduated pads, Magic Cushion and graduated early breakover ((NB)) shoes) and the horse is now sound, happy and enjoying a full working life despite having been written off as a top level dressage horse at the age of 9.
 
Have to say sounds very similar to Jesper's MRI report in that there is mild damage and inflammation to both collateral ligaments, however Liphook were of the opinion this was enough to be causing Jesper the low grade lameness he was experiencing. I would have loved to have got a second opinion from Sue Dyson for him but due to his other problems it wasn't worthwhile. His MRI showed very mild arthritic changes to all structures within the coffin joint but this was seen as a secondary issue. Apparently on MRI his collaterals look a little moth eaten around the insertion points.
He was only retired this February and since then has put on lots of condition and when the vet came for a general check up last month he was sound on the lunge and for flexion tests for the first time ever. I don't intend to bring him back in to work but the vets have suggested it might be worth considering next spring and certainly if he didn't have a whole host of other problems I'd have no doubts about doing it.
What I'm trying to say is it's amazing what a year or two in the field will do for young horses with soft tissue damage, don't write her off yet if she's only lame on a circle on hard ground. Like Flame says a lot is still not known about soft tissue damage in the foot. Having lost Sammy to collateral ligament damage I'm very aware of how far diagnosis techniques and treatments have improved in six years but I'm also aware of how far they still have to go.
I do hope in a years time all your worrying will have been for nothing but it's so lovely to hear she has a home for life - rather like Jesper!
 
I do hope you are right Marchtime, and maybe in a couple of years I find I have a sound Ellie again! She owes me nothing, she's the sweetest thing and trusts me with her life and I love her to bits, it would just be nice as we had such a short time doing things and she loves being busy.

Its exactly a year today she first went lame, we had a cuddle in the field
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But this is a picture of her in happier times:

Elliepic2.jpg
 
She is stunning and looks to have lovely paces, it's always so heart breaking. We lost Sammy to a ruptured collateral ligament when he was 8yrs old, it was devastating. Then when Jesper was diagnosed I felt like my world was falling apart. He did come sound though after nine months rest and had it not been for his previous suspensory damage I maintain he would be back in work now, we were just unlucky.
I'll keep everything crossed for you, give her this winter and see how she is come spring, she's only young.
 
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