Impar ligament advice

[Snapshot2016]

Morning, just to start with we have a lameness workout booked but I’m after abit of advice please, bit of background… 4 years ago my big horse went lame and after nerve blocking, X-rays and then an mri he was diagnosed with impar ligament damage in both fronts (more so in the right) at the time we were told there was no treatment and to remedial shoe with spider bars and then if that didn’t work de-nerving (which I would never do!) The shoes did the trick and he returned to full work. I eventually transitioned him to barefoot and we have been in fine form for 2 years. He is super sensitive in general and does not like hard ground.
In June he went lame in trot in his right fore, thought it could be an abcess, he had no heat or swelling and nothing ever came of it he has a couple of weeks field rest and then came right again… until yesterday when he was lame in trot again, no heat or swelling again so I’m baffled. As he’s not insured as too many exclusions an mri is out of the question. I’d put money on it being soft tissue but wasn’t sure where to go as far as rehab/treatment?
My question is are there any drugs for soft tissue damage in the foot? I have heard Tildren mentioned but wasn’t sure if this would be beneficial. Any advice greatly welcomed

 

[live2ride]

I'm in the middle of something very similar. My gelding went very lame on his right fore in May/June; he's had an on/off again niggle that always righted itself when I have taken him to vets for the past couple of years so that we couldn't diagnose the issue.

On the first visit, we nerve blocked the plantar nerve at the back of the foot; he was maybe mildly sounder, but not much. He was brought home for four weeks of rest - not box rest, just mooching in the field. I took him back to the vet with zero improvements; this time, he blocked fully sound to the coffin joint block. Unfortunately, an MRI is not feasible due to his being uninsurable, so we're theorising coffin joint cartilage issue or collateral ligament damage, as his x-rays are fine.

I brought him home for 6 more weeks of rest in a field; during this time, his physio also came every 5 days to apply a therapeutic ultrasound to the back of the hoof in the hopes it wouldn't harm him but could help heal. Having had zero improvements in the 1st 4 weeks, we had drastically improved soundness following the ultrasound sessions. At the end of the six weeks, whilst still not entirely sound, we were much less lame than before.

I have now just treated the coffin joint area with Stem Cells, which, in theory, can also help the area around the joint, so it should affect his coffin joint and collateral ligament.

Other options I was given were arthramid or alpha 2.

 

[live2ride]

A question: are you sure his balance is correct in his hooves?

I know mine has damaged his internal structures because he has a conformational fault in his leg, which encourages a lateral to medial landing. It is a constant battle to keep the flare under control. Unfortunately, at the start of the spring, his hoof growth got out of control despite a 6-week trim cycle and altered his hoof balance.

Since going lame, we switched to a four-week trim cycle as his hooves were still growing like mad and unable to self-trim, and now his hooves have quickly changed shape/balance for the better again.

 

[Snapshot2016]

A question: are you sure his balance is correct in his hooves?

I know mine has damaged his internal structures because he has a conformational fault in his leg, which encourages a lateral to medial landing. It is a constant battle to keep the flare under control. Unfortunately, at the start of the spring, his hoof growth got out of control despite a 6-week trim cycle and altered his hoof balance.

Since going lame, we switched to a four-week trim cycle as his hooves were still growing like mad and unable to self-trim, and now his hooves have quickly changed shape/balance for the better again.

I must admit I am clueless when it comes to feet, He has an EP who is quite knowledgeable and is seen every 5/6 weeks. She has not mentioned anything untoward. He does have abit of thrush at the moment but didn’t think that would be the cause. He’s due a trim in 2 weeks so will mention balance

 

[Snapshot2016]

I'm in the middle of something very similar. My gelding went very lame on his right fore in May/June; he's had an on/off again niggle that always righted itself when I have taken him to vets for the past couple of years so that we couldn't diagnose the issue.

On the first visit, we nerve blocked the plantar nerve at the back of the foot; he was maybe mildly sounder, but not much. He was brought home for four weeks of rest - not box rest, just mooching in the field. I took him back to the vet with zero improvements; this time, he blocked fully sound to the coffin joint block. Unfortunately, an MRI is not feasible due to his being uninsurable, so we're theorising coffin joint cartilage issue or collateral ligament damage, as his x-rays are fine.

I brought him home for 6 more weeks of rest in a field; during this time, his physio also came every 5 days to apply a therapeutic ultrasound to the back of the hoof in the hopes it wouldn't harm him but could help heal. Having had zero improvements in the 1st 4 weeks, we had drastically improved soundness following the ultrasound sessions. At the end of the six weeks, whilst still not entirely sound, we were much less lame than before.

I have now just treated the coffin joint area with Stem Cells, which, in theory, can also help the area around the joint, so it should affect his coffin joint and collateral ligament.

Other options I was given were arthramid or alpha 2.

Thanks that sounds similar to my boy. He did improve after a short rest but I’m just wondering if he needs something injecting to make him comfortable. Could I ask a rough price for stem cell?

 

[live2ride]

Thanks that sounds similar to my boy. He did improve after a short rest but I’m just wondering if he needs something injecting to make him comfortable. Could I ask a rough price for stem cell?

I may have made it worse than it needed to be initially by continuing to exercise him when he started to go lame, as he was already booked to have a review of his hinds and I wanted to find out once and for all what was happening in front. Previous experience: he’d feel off, I’d rest him whilst waiting to take him to vets, he’d be sound again by the time we got there.


He had horstem, and it was about £1200. I’ve had huge success with stem cells in his stifles before, so I felt it was worth the cost to try.

I was quoted £900 for alpha 2, which would give you 2 injections to play with, and was the 2nd choice my vet gave me. Stem cells being the gold standard, then alpha 2.