Front Limb Lameness - possible causes?

redandblue

redandblue

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First some history; I have had ongoing issues surrounding front limb lameness (front left only) in my mare. She is 16 IDx and has mild arthritic changes to her coffin joint. However, her lameness came on overnight at the start of November following her spooking and breaking out of her paddock (through or over an electric bungy gate). One day she was sound the next not. She sustained a pulled muscle in her shoulder and it was initially thought that this was the cause - this was treated by both the vet followed by a series of physio sessions. The muscle strain resolved but still the lameness persisted. She was x-rayed to check for arthritic changes in the CJ and vet was hugely optimistic as there was barely anything to see, her pedal bone is where it should be and her foot balance is spot on. She wears natural balance shoes and her feet were balanced using the x-rays. After some field & box rest, the vets re-examined and decided to play a hunch that the lameness was in her foot all along (despite no obvious symptoms). After flexion tests her foot was nerve blocked and she trotted up sound for the first time at the beginning of January. Vet felt that it was too much of a coincidence given her known history in that coffin joint, and suggested injecting the joint with steroid and HA to give her the best chance. 10 days rest and she trotted up lame. (At her worst she has been 3/10ths lame). She is noticibly worse up hill, on hard surfaces and turning. So, vet is coming back out tomorrow (its been just short of 3 weeks since she was injected) to do further x-rays and scans and I am worried. This is a pointless post as without the results of the scans and x-rays its all speculation but I have wondered what else could be going on in the foot that would cause this persistent lameness - not being very well versed in the structure of the foot/hoof, I wondered if anyone else may be able to relate.
 
Not clear if she is getting box rest alternated with light work, or if you have the facility to turn her away for a prolonged period.
Lameness showing up more on hard surfaces, turning, and uphill is to be expected.
Did the NB shoes make any difference one way or the other, either in hand or ridden?
It is always frustrating to have limited knowledge and experience, and we have all been there. The best book on the subject of feet is Feet First by Braithwaite et al. There is a lot to take in on first read, but worth purchasing in my opinion.
The authors specialise in barefoot rehabilitation but most of the formation applies to all horses.
They have a re-hab facility at Rockley Farm and the site is packed with information.
www.rockleyfarm.blogspot.co.uk
 
Sorry! She was turned away for about 6 weeks and when that did nothing to help matters vet recommended box rest for 4 weeks - all that achieved was added stiffness! NB shoes have made no difference but were recommended by her previous owner/farrier so I have continued. Her feet are more tb than ID but heaps better since i have had her. My vet was hugely disappointed that the injections didn't work and suggested further xrays etc but hasn't said what he will be looking for - not totally sure he knows either. I know the foot is hugely complex (and that is about all I know!!) and I will definitely try to obtain a copy of the book you mentioned, had it not been for the nerve block I would have sworn it was higher up! I suppose I was hoping that at least one person may have had a similar comparible experience and offer some hope. My worst fear is that the xrays and ultrasound show nothing - with this leg being excluded from insurance - the thought of MRIs and Bone scans being the only logical step is hard to swallow. Thank you though for taking the time to respond - it is appreciated.
 
I don't know if this will help with anatomy and terminology: here is an X-ray of a foot, with some extra information.
http://www.rockleyfarm.blogspot.co.uk/2013/07/surprise-surprisenot-really.html
The article by Dick Vet School is interesting, but if you click on the www.dickvet.com in the blog you will see all the bones of the foot in diagram form.
The navicular is only one of the bones of the foot, the disease formerly known as navicular is now known as navicular syndrome. I am not suggesting your horse has this, just putting it in context with the blog.
 
Just an update really. Vet came and and x-rayed my mare. Absolutely no problems, coffin joint, pedal bone, navicular bone etc etc all good - surprisingly so considering she has a previous diagnosis of Coffin Joint arthritis! Her foot is nicely balanced and all looks ship-shape. He used the ultra-sound to check the soft tissue n that region and found nothing to suggest there was anything causing an issue (that he could see). So, by a process of elimination it would seem that it is a soft tissue injury - he didnt think it was the DDFT or the SDFT - most likely navicular bursa. Without an MRI we cant be certain (uninsured - see earlier post), but prognosis is guarded in so much as the vet could not say that it was 'X' and will come right in 'Y' amount of time. He also said that i could consider having the navicular bursa medicated or I could try a course of cartrofen but there is no guarantees that either approach will help. Paddock rest (stabled at night) for the next 3,6, 9 months - assuming she behaves herself and doesn't hamper her recovery :(
 
Hi redandblue, sorry you dont seem to have managed to get a solid diagnosis. I went through a similar experience with my mare and spent an awful lot of money trying to find out what was going on. We were left with a sort of diagnosis that it was a bruised bursa too. Nobody could tell me if or when we would see an improvement. We tried medicating the bursa but this didnt make any difference at all and can be a delicate area to inject so I'm not sure I would take the risk given my time again.

I thought i was going to be left with an unrideable young horse with no prospect of a job for her and vets couldnt really tell me any different. With lots and lots of patience, a strict farriery regime, good quality turn out and eventually sympathetic exercise, my mare is now sound (touch wood). It's taken a long time, and lots of set backs along the way, but please dont give up hope.

There are lots of things you can try, the most obvious being barefoot rehab. I chose not to do this with mine but the results speak for themselves.

I hope you get some more positive news and wish you lots of luck in her recovery.
 
Thank you PiggB - and I am glad yours in on the road to recovery. Do you mind if I ask how long it took from diagnosis to bringing your mare back in to work? It is hard being positive but then I remind myself that it could have been a whole lot worse.
 
My mare injured herself after escaping from her field at the start of July last year. She got a puncture wound to her coffin joint which became infected so had surgery to sort that. After she came home from the vets we just seemed to have problem after problem. She'd seem to be coming right then something else would go wrong. Eventually in September she got an MRI (by this point all the insurance money had run out and I had to scrape together money to pay for it myself) which diagnosed severe medial collateral ligament damage. It sounds similar to what your horse is showing. Vet said 3-4/10ths lame. She was obviously lame in trot on a small circle in the sand school, lame in trot on the straight on hard surfaces, looked ok in walk. She was given a very guarded prognosis for return to work. My vet had said probably only hacking in walk in straight lines at best. I decided to try barefoot rehab at home in the hope that I would at least be able to keep her field sound. She is doing really well and actually seems sound in trot now. Unfortunately winter has somewhat hampered our rehab but I'm hoping that when the lighter nights come I will be able to start walking her out again to help build up her muscles and strengthen her tendons and ligaments. I'd love to be able to ride her again but I'm just going to have to play things by ear and see how she continues to improve and how much work she can cope with. The vet is due for her jags in July so will get him out to have a look then and see what he thinks.

Tendons/Ligaments take 12-18months to heal to their full potential so it is a long road. I've put a few posts on here of what happened to my horse and the MRI etc and also a video of how she looked in October sort of time I think. If you want to know anything feel free to ask here or PM me.
 
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