Ideas please! Mild but persistent lameness

[Celtic Fringe]

The vet and farrier are booked AGAIN but just looking for some suggestions for possible causes of subtle left fore lameness.
Horse is an 11 year old 14.3 Irish Draught cross. Until April he was in work and competing in affiliated dressage at Prix St George with his professional rider but has been very slightly lame on and off since then.

No reaction with hoof testers but vet found remains of a bruise when he pared back sole in April - hoof was poulticed and pony had a couple of weeks off work - ground was softer then too. Was sound but then intermittently lame since.

• No swelling or heat anywhere in his limbs or hoof at any time since April.
• Very slightly lame in trot on the lunge, a little better when ridden but as rider picks him up and he lifts through his core unevenness is less obvious. Initially the vet didn't detect an obvious lameness so we had to explain that the pony usually moves very smoothly with quite a big stride and the choppy trot was not at all normal.
• Not totally sound after a week on Danilon
• Lameness work up in late May as still very slightly unlevel - no reaction on hoof tests, minimal reaction on flexion tests, hoof and fetlock nerve blocks inconclusive
• No abnormalities detected on x-rays
• Farrier has altered shoeing with more lateral and heal support. He has suggested pads but I'm concerned this will cover the problem not solve it.
• Was sound after coffin joint injections in June (hurrah we thought!)
• Saddle was refitted and chiropractor (also an equine vet) didn't detect any issues.

The daft thing has been galloping round on hard ground so now very slightly lame again and not improving. Still no reaction at all on hoof testers.
We have now padded his hoof and will keep him in over the next few days although I'm not sure now that the main problem is actually in his hoof.

We are stumped so any thoughts would be appreciated! Thank-you

 

[Zoeypxo]

Hi, what did you inject the coffin joint with? Is he insured? Id probably be thinking of MRI the hoof if expenses allow. If he is sound after coffin joint injections but x rays show nothing id be thinking maybe collateral ligaments or DDFT injury?

 

[Goldenstar]

I think I would mri the feet it’s a bit of a stab in the dark the other option is a bone scan to get a overall look at his bone health .
If I had to guess and it is a guess I would say you have a foot based soft tissue injury niggling on

 

[mariew]

Neck arthritis? Long shot but you never know.

 

[scats]

Another who would MRI the feet. It sounds like you might be dealing with a soft tissue injury.
Ive dealt with a DDFT injury and a collateral ligament injury and both presented similarly to as you describe.

 

[Fifty Bales of Hay]

Yes I would say MRI on both fronts sadly is your only way now to go. I had a 6yo that I thought had a bruise, but he was on off for a while. Various examinations and nerve blocks he was still slightly lame in front. MRI proved collateral ligament damage. He never fully recovered so was retired at 7yo and still now 7 years later he can be sound or slightly lame in the field.

 

[Sossigpoker]

You definitely need an MRI. Before my horse's DDFT properly tore , he had mild lameness on and off l8je this for about 18 months.

 

[Celtic Fringe]

Hi, what did you inject the coffin joint with? Is he insured? Id probably be thinking of MRI the hoof if expenses allow. If he is sound after coffin joint injections but x rays show nothing id be thinking maybe collateral ligaments or DDFT injury?

His coffin joints were injected with steroid (adcortyl) and hyaluronic acid. He isn't insured but I'm very fortunate to have savings and until now he has mostly only needed routine veterinary care so has not been expensive in that respect. We are also thinking that an MRI is the next step.

 

[Celtic Fringe]

Neck arthritis? Long shot but you never know.

Many thanks. This is also worth investigating although he doesn't seem stiff in his neck or poll and will happily do carrot stretches as well as acting like a giraffe to to eat the hedge round his field. However, he is very greedy and food generally takes priority over everything else!!

 

[Celtic Fringe]

Yes I would say MRI on both fronts sadly is your only way now to go. I had a 6yo that I thought had a bruise, but he was on off for a while. Various examinations and nerve blocks he was still slightly lame in front. MRI proved collateral ligament damage. He never fully recovered so was retired at 7yo and still now 7 years later he can be sound or slightly lame in the field.

Very sorry to hear about your horse. Our farrier is very keen to put pads on but I think this might mask the problem rather than solve it. In the meantime I think I'll ask the farrier to pull the shoes in readiness for an MRI.

 

[Annagain]

The problem with the MRI is that you have to fairly certain where the issue is to scan and I'm not sure you are? If the nerve blocks were inconclusive, the problem could be higher up? We spent months faffing about with my old share horse trying to pinpoint the problem. In the end we were totally stumped so went for the bone scan. Within hours we had our answer, he was treated and back working within a week. It turned out to be an arthritic elbow.

I'd be tempted to go for a bone scan of the front end. If that comes up with nothing, you pretty much know it's a soft tissue thing in the hoof and rest is really the only treatment for that.

 

[sbloom]

Step back and look at his musculature - we have got so used to seeing horses with mild topline issue, thoracic sling dysfunction etc, and these can be huge contributors to things like front coffin joint DJD, as well as hocks, suspensories, SI and KS. Not at all saying it's any of those, but once we learn to really LOOK, we can start seeing where issues are.

For starters, take a photo from both sides, stood square (does he easily stand square on the yard?), head and neck in neutral on level ground - and look at the two sides, do you see differences, is one side more uphill than the other? Is his shoulder well muscled, or can you see grooves across the shoulder blade and up to the intersection with the neck?

You may well need vet intervention, but likely there is compensatory movement patterns going on, and you'll need to fix those moving forwards whatever happens.

 

[Tracking_up]

I'm another that went down this path of subtle not quite rightness, with an initial Coffin joint arthritis diagnosis by xray and treatment as you've had. He wasn't right 5 weeks after the steroid/hyaluronic acid injection, had a further Arthramid injection (more expensive and longer lasting) but again lame within 3 weeks of that.

Hence we MRI'd both feet (they need both as a compare) , and this picked up chronic DDFT issues at the insertion/navicular area, healed but with lesions to the collateral navicular ligament. This can't be 'fixed', so we manage conservatively with pain relief/shoeing. We found Bar shoes didn't seem to do anything, and with this hard ground in the summer he is now in pads.....

at 17 he's still enjoying life

 

[Flowerofthefen]

Sorry havnt had tome to read through other posts but my now retired lad had a low grade lameness. Vet thought a subtle imbalance in hoof so farrier came and sorted. Horse had 6 weeks off and was totally fine after that. Hoping yours is as simple.

 

[Celtic Fringe]

The problem with the MRI is that you have to fairly certain where the issue is to scan and I'm not sure you are? If the nerve blocks were inconclusive, the problem could be higher up? We spent months faffing about with my old share horse trying to pinpoint the problem. In the end we were totally stumped so went for the bone scan. Within hours we had our answer, he was treated and back working within a week. It turned out to be an arthritic elbow.

I'd be tempted to go for a bone scan of the front end. If that comes up with nothing, you pretty much know it's a soft tissue thing in the hoof and rest is really the only treatment for that.

Many thanks. After some discussion at the yard this morning we will leave shoes on until the vet gets back from holiday in a few days and take it from there. I had my old cob bone scanned (in the days before MRI) with very interesting results and he did come back into work after treatment. In this case we have had x-rays already which show absolutely nothing amiss but I'm very open to all ideas at this stage including further x-rays and bone scanning

 

[Celtic Fringe]

Sorry havnt had tome to read through other posts but my now retired lad had a low grade lameness. Vet thought a subtle imbalance in hoof so farrier came and sorted. Horse had 6 weeks off and was totally fine after that. Hoping yours is as simple.

Many thanks. Our new farrier has re-shod and altered the foot balance but we could get him and our vet to look together. I have a suspicion that the problem is a little more complex but further changes in shoeing might also help.

 

[windand rain]

My pony had slight intermittent lameness when she had an annular ligament issues and torn manica scans revealed the issue nerve block going up the leg was good too. Had surgery and extensive boxes and came back sound for the next 20 years now gets a few days of slight lameness when the weather changes which is odd but then oddness is normal around here

 

[ester]

We had similar, it started intermittent in hindsight but was a bit more definite by the time it was worked up. Nothing going on coffin joint in X-ray but did improve with steroid injection for a similar period to yours.

pedal bones were flat on X-ray, as mri wouldn’t change what I did (shoes offafter the injection stopped working I didn’t bother (they were a bit less common place then)

I think I’d probably X-ray the neck before paying for the hoof Mri given uninsured.

 

[Annagain]

Many thanks. After some discussion at the yard this morning we will leave shoes on until the vet gets back from holiday in a few days and take it from there. I had my old cob bone scanned (in the days before MRI) with very interesting results and he did come back into work after treatment. In this case we have had x-rays already which show absolutely nothing amiss but I'm very open to all ideas at this stage including further x-rays and bone scanning

Have you x-rayed all the way up the leg? We got as far as the knee before we decided we were chasing shadows and a bone scan was best. We would probably never have got to the elbow without the bone scan as apparently, it's a very rare place for any issues that aren't trauma related so it would have been the last place we looked. Even with the bone scan they expected to find neck issues and were very surprised it was the elbow.

 

[Celtic Fringe]

Step back and look at his musculature - we have got so used to seeing horses with mild topline issue, thoracic sling dysfunction etc, and these can be huge contributors to things like front coffin joint DJD, as well as hocks, suspensories, SI and KS. Not at all saying it's any of those, but once we learn to really LOOK, we can start seeing where issues are.

For starters, take a photo from both sides, stood square (does he easily stand square on the yard?), head and neck in neutral on level ground - and look at the two sides, do you see differences, is one side more uphill than the other? Is his shoulder well muscled, or can you see grooves across the shoulder blade and up to the intersection with the neck?

You may well need vet intervention, but likely there is compensatory movement patterns going on, and you'll need to fix those moving forwards whatever happens.

Many thanks. Will try to upload a pic! He was fit and fairly well muscled before we had to decrease his work due to the lameness with a good topline and very obvious engagement of his core muscles when working.. Saddle templates are symmetrical and he halts square when loose schooled, lunged or worked in-hand. However, he is a cob with large hooves and short pasterns and so not a 'classic' shape for dressage although he has been brought on very carefully and we try to vary his work as much as possible (hacking, ridden and in-hand schooling and sometimes a water treadmill) and he mostly lives out. He is on a yard which is really cautious about any lameness or imbalance - initially we had to persuade the vet that he wasn't 100% right as the lameness is mostly quite subtle. I suspect that once we have a conclusive diagnosis then we may need to think about what changes might be needed once he is (hopefully) back in work.

 

[sbloom]

If you can get pics from both sides, full confo shots, one of his chest and front legs, one along his back and one of his back legs with tail knotted, then we could all have a stab, and they're great to take every month or three, to look at progress.

 

[Celtic Fringe]

If you can get pics from both sides, full confo shots, one of his chest and front legs, one along his back and one of his back legs with tail knotted, then we could all have a stab, and they're great to take every month or three, to look at progress.

I'll need to take some new pics to get all these views but here are a couple of 'informal' ones from April when he was fairly fit and slim! He is significantly fatter and much less fit now!

 

[Zoeypxo]

OP, did you ever find out the problem?

 

[Celtic Fringe]

His hooves, pastern and fetlock joints were MRI scanned in early September and this showed up several possible issues but we think were two main problems which were causing the lameness. These were fluid in both coffin joints and inflammation of the right fore collateral ligament on the coffin joint (although he was presenting as lame on the left fore). The MRI also highlighted a possible issue with the deep digital flexor tendon in the left fore but an ultrasound scan showed a small 'bump' on the tendon sheath but it is totally intact so this might be an old injury.

He has been in a small paddock at night when everything is quiet and boring and in during the day. When he was out during the day he was galloping round telling everyone he needed food and attention - he is a terrifically greedy cob! As recommended by the vet I've also been walking him in-hand for 15-20 minutes along the road which is smooth and flat. The farrier has also been trimming his feet every 4 weeks to maintain really good foot balance.

He had Arthramid injections in both fronts last week so we are carrying on with the small paddock turnout and in-hand walking for another 10 days and then our vet will re-assess.

He is roughed off at the moment so is a hairy, fat, feral cob! Once he is given the all clear we will start some in-hand work in the school to build his top-line again and then slowly introduce some ridden work. Our saddler, chiropractor (also a vet) and clippers are all on standby - though it will be several weeks before we need them all.

As soon as I can work out how to post them I'll add some pictures!