Lameness/Bute - your thoughts please

Tiffany

Tiffany

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My mare went for a lameness assessment last week after being less than
1/10th lame. I'd had a full body scan carried out on her before going to vet and that showed her heel to be the problem. After nerve blocking her heel she went sound and freer moving. X-rays didn't show anything in either heel so, after the vet spoke to farrier it was decided to put bar shoes on front (she's not shod at all on back) and put her on bute for 3-4 weeks.

1st day 4 bute, 2nd 2 and since then 1. Problem is she is no different?

Any thoughts why it doesn't seem to be helping her?

Thanks
 
could she have done something to the soft tissue/ligaments? if she has then it wouldn't show up on x-rays, not sure how much would show up on a body scan though!

could it be an abcess or bruising? some horses react to the extreme with the simplest of things.
was she still lame on the bute when on 4 a day?
 
Maybe If she has been lame for a long time she expects to be sore even if she isn't? just an idea. Is she lame on hard and soft ground?
 
What was the scan? MRI should have shown you soft tissue injury very precisely and they don't MRI whole horses (do they??) so was it a thermograph, scintigraph or something else? It sounds like a bit of overkill to scan for a less than 1/10 lameness, but I guess that's why insurance premiums are getting unaffordable these days if your vet wanted that.

How long has she been unsound?
Was she shod in front before?
Are you sure that she does not have thrush in the central sulcus of her frog (black smelly gunge)?
 
Tiffany said:
My mare went for a lameness assessment last week after being less than
1/10th lame. I'd had a full body scan carried out on her before going to vet and that showed her heel to be the problem. After nerve blocking her heel she went sound and freer moving. X-rays didn't show anything in either heel so, after the vet spoke to farrier it was decided to put bar shoes on front (she's not shod at all on back) and put her on bute for 3-4 weeks.

1st day 4 bute, 2nd 2 and since then 1. Problem is she is no different?

Any thoughts why it doesn't seem to be helping her?

Thanks
Click to expand...

I would get the vet out again and see where you go from here.
 
As said above, an MRI will show up any soft tissue damage and its the only way to. It showed up my mares tear to her DDFT within her hoof. Sounds a little familiar to your situation. I would discuss with your vet.
 
Can I ask why you had the full body scan before going to your vet for a lameness investigation?

Was is scintigraphy (bone scan?)....

IME it is better to localise the lameness first - not always the easiest. If the pain has been localised to the heel area and xrays are normal, then a foot MRI is the next way to go.

DDFT injuries are being diagnosed increasing due to such good imaging from MRI but are by no means the only diagnosis. Remedial farriery is important but can take up to two to three shoeing for the benefits to show.

Good Luck
Imogen
 
have you had a disagnosis on what the lameness is caused by?

what do they think is in the heel that is causing pain?

bute is not a painkiller but an anti-inflammatory so it may not be having much of an effect if the area isn't swollen.
 
millitiger said:
bute is not a painkiller but an anti-inflammatory so it may not be having much of an effect if the area isn't swollen.
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This is not quite right. Phenylbutazone ("bute") is a non-steroidal anti-inflammatory drug (NSAID). There is a complex cascade of enzymes in which NSAIDs interfere and produce a pain-killing effect. So, Bute is a pain-killer too. Just like taking paracetamol for your headache. (also an NSAID)! :p

It should have a response in most cases of orthopedic pain - but not always.
 
Aaarrggghhh

Twice I've typed out a long reply responding to everyone who responded to my post and twice I've been advised I haven't been logged in - I was logged in :(

Off to bed now but I'll try again tomorrow.

Night :)
 
Hopefully I'll manage to stay logged in tonight?

Firstly a BIG apology, in my original post I missed out a vital word regards the scan. :o I should have said full body thermal image scan.

Riding High - with nothing showing on xrays it could be soft tissue damage?
I was away the first day so don't know if she responded to 4 bute. Having said that I would have thought 4, 2 and then 1 sachet a day should have got into her system?

Cas89 - Not much difference although I would say slightly more noticable in school.

CPTrayes - It was a thermal image body scan - didn't explain myself very well in OP and no there's no sign of thrush

Will post now incase I get booted out :D
 
3rd time lucky posting

Applecart14 - Spoke to vet again yesterday and she's now on 2 bute a day for a week.

Izzwizz - Might have to be MRI scan if we can't get to the bottom of it being as xrays are clear
 
Imogen Burrows - It was the full body thermal image scan that highlighted the heel on right leg as being the problem area. It is the right leg that she's not quite level on and scanner wasn't aware of that (her choice).

Fortunately, I have a good farrier who's a registered remedial farrier so used to working with vets.

Out of interest, could you possibly explain the difference between straight and heart bar shoes, in terms of what they do?

Thanks
:)
 
Millitiger - She went sound when heel nerve blocked so heel seems to be the cause although vet is not sure why

Hopefully, we'll get to the bottom of it soon and get her back to 100%. It's such low level lameness I'm hoping that means it's nothing too serious?

Fingers crossed
:)
 
I do think you will get to the bottom of the problem if you can get an MRI scan done and if your like me you should be able to claim some of the cost through your Insurance. You will get to the bottom of the problem for sure if its soft tissue damage. My mare had egg bar shoes on to support her heel and still does at the moment. She will have them on for the next 2 shoeings then Farrier will look at putting some on with quarter clips, he says they will support her thereon. Shes had the egg bars on now for just under a year.
 
Tiffany said:
Imogen Burrows - It was the full body thermal image scan that highlighted the heel on right leg as being the problem area. It is the right leg that she's not quite level on and scanner wasn't aware of that (her choice).

Fortunately, I have a good farrier who's a registered remedial farrier so used to working with vets.

Out of interest, could you possibly explain the difference between straight and heart bar shoes, in terms of what they do?

Thanks
:)
Click to expand...

I've never been convinced about thermography there are too many variable for my liking and TBH I don't know why you'd advise it over other (and IMO better) imaging modalities, but there you go.

Still one thing in its favour it agrees with the block, which is optimisitic.
Blocking the heel is called the palmar digital nerve block. This not only take out the sensation to the heel, but a lot of other structures including the , pedal bone, coffin joint, navicular bursa, ddft, navicular suspensory and impar ligaments and many other soft tissue structures besides....
Not very specific huh? :confused:
My chosen path would be block the coffin joint and navicular bursa separately to rule in or out. FULL set of foot xrays (that's 7 in my book!) on each foot (to compare). Then if still a blank, MRI the foot. - or just jump to0 MRI depending on the insurer's requirements! ;)

Heart bars support the frog completely, straight bars don't. They are both there to provide extra support to the back of the foot, but I think heart bars were use far for frequently for laminitics prior to development of Imprint shoes!! TBH I don't really use heart bars much...but then I do use quite a lot of silicon pads and magic cushion stuffing for support with the straight bars....both a good when required and put on a well-balanced foot. I'm sure your farrier will have asked for the xrays already....most good remedial farriers will do a much better job with them.

Good luck
imogen
 
And on the "logged out" front . . . If you take too long on your reply and you get the main "logged out" screen when you go to post log back in on the main page that comes up, not the usual section in the top right hand corner. (Does that make sense?) Your post *should* appear as written on the thread and you should be directed back to the page, so long as you don't back up, refresh or similar. If you log back in using the section at the top of the page, like you do when you log on at the start of a session, you'll lose your post.

Or you can click on "leave me logged in" but I found that seemed to affect how the forum ran on my computer.

If the server drops you, either initially or as you're logging back in, unfortunately you're SOL but then the main log in page won't come up.

I'm trying to train myself to copy before I press reply, but that only works when I remember. ;)
 
OP your posts have a worrying similarity with my own horses lameness issue that has gone on since April this year.
I had 6 lameness workups done upto August when eventually he was reffered. The Lameness was slight & my Vet could not see it & virtually told me i was being a hypocondriac & to carry on as normal. I did this but the problem did not go away.

I really really wish i had pushed the issue as under an MRI it was found my horse has damaged his Impar Ligament (has severe inflamation) & he has adherment to the DDFT. He is now on 3 months box rest & was being remdially shod which made him worse, we have now taken his shoes off. He has a 50/50 chance of coming sound. Im devistated.:(

What im trying to say is if i was in your shoes i would be pushing to get an MRI & would not be riding.
 
ImogenBurrows said:
I've never been convinced about thermography there are too many variable for my liking and TBH I don't know why you'd advise it over other (and IMO better) imaging modalities, but there you go.

Still one thing in its favour it agrees with the block, which is optimisitic.
Blocking the heel is called the palmar digital nerve block. This not only take out the sensation to the heel, but a lot of other structures including the , pedal bone, coffin joint, navicular bursa, ddft, navicular suspensory and impar ligaments and many other soft tissue structures besides....
Not very specific huh? :confused:
My chosen path would be block the coffin joint and navicular bursa separately to rule in or out. FULL set of foot xrays (that's 7 in my book!) on each foot (to compare). Then if still a blank, MRI the foot. - or just jump to0 MRI depending on the insurer's requirements! ;)


Heart bars support the frog completely, straight bars don't. They are both there to provide extra support to the back of the foot, but I think heart bars were use far for frequently for laminitics prior to development of Imprint shoes!! TBH I don't really use heart bars much...but then I do use quite a lot of silicon pads and magic cushion stuffing for support with the straight bars....both a good when required and put on a well-balanced foot. I'm sure your farrier will have asked for the xrays already....most good remedial farriers will do a much better job with them.

Good luck
imogen
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It was my idea to go down the thermal imaging route after reading good reports on here. The lameness is so slight I just wanted a started point. Vet said it would be a process of elimination so at least I had a starting point. Vet said even though the nerve blocked worked it still didn't identify the problem hence the x rays.

Farrier was there on the day and decided on heart bars after seeing x rays and discussing with vet.

I've been riding her in walk and tried her in trot on Sunday after being on bute a few days. I've owned her 8 years and I know it's slight but it's there and I'm worried riding her might be doing more harm.

TBH even if she comes sound on bute I'm not sure I'm happy just carrying on as if everything is ok because is bute not just masking the problem.

Don't get me wrong I'm not questioning my vet, I've known him for years and trust his judgement.

Thanks for your replies Imogen, I appreciate your comments :)
 
dressagecrazy said:
OP your posts have a worrying similarity with my own horses lameness issue that has gone on since April this year.
I had 6 lameness workups done upto August when eventually he was reffered. The Lameness was slight & my Vet could not see it & virtually told me i was being a hypocondriac & to carry on as normal. I did this but the problem did not go away.

I really really wish i had pushed the issue as under an MRI it was found my horse has damaged his Impar Ligament (has severe inflamation) & he has adherment to the DDFT. He is now on 3 months box rest & was being remdially shod which made him worse, we have now taken his shoes off. He has a 50/50 chance of coming sound. Im devistated.:(

What im trying to say is if i was in your shoes i would be pushing to get an MRI & would not be riding.
Click to expand...

Dressagecrazy thanks for your reply and I hope your boy makes a full recovery. You must be so worried about him.

With me, if I knew what the problem was with her at least I'd know what I was dealing with.

She didn't feel quite feel right at the start of July so I took her to vets but she was sound on the day when trotted up and after lunging and flexion tests so I just presumed she must have knocked herself. I've been riding her since without any problems and then about 3 weeks ago she just didn't feel right again. I went down the thermal image route because I didn't want the vet thinking I was paranoid.

I know some people might accept the level of lameness I'm talking about but, I can't. Vet has said an MRI might be the only way forward particularly, if she doesn't improve on bute.

If she does improve on bute and I carry on as normal could I be doing more damage? So many questions.
 
Tiffany said:
Dressagecrazy thanks for your reply and I hope your boy makes a full recovery. You must be so worried about him.

With me, if I knew what the problem was with her at least I'd know what I was dealing with.

She didn't feel quite feel right at the start of July so I took her to vets but she was sound on the day when trotted up and after lunging and flexion tests so I just presumed she must have knocked herself. I've been riding her since without any problems and then about 3 weeks ago she just didn't feel right again. I went down the thermal image route because I didn't want the vet thinking I was paranoid.
Click to expand...

:( makes me sad that you say this....we aren't all scary!! (Apparently I am though;))

I know some people might accept the level of lameness I'm talking about but, I can't. Vet has said an MRI might be the only way forward particularly, if she doesn't improve on bute.

If she does improve on bute and I carry on as normal could I be doing more damage? So many questions.
Click to expand...

Ooooo, you shouldn't go down the route of "accepting" that degree of lameness until you know what it is IMO....there's a differenc in accepting it and not knowing about it! ;)

Sadly though, my opinion is the answer to a salient question - could you hurt her buy continuing to work on bute - is yes. Of course you could. My husband insisted on continuing to run on hs strained ankle until his achilles tendon went bang about 4 miles from home.:eek:
If you don't what the underlying cause of the lameness is, then it could be aggravated by exercise. Sometimes I even have to get horses worked a bit to make the problem more consistent in order to find out the cause - I can't say I'm ever 100% happy about this, but until my patients can tell me where is hurts, or I become Dr Doolittle, it is necessary ocassionally.:p

Personally if you can go for the MRI, do.

BTW, you didn't mention if any of the more specific blocks had been done? Coffin jt/navicular bursa....they don't just rule out the obvious conditions....the navicular on especially often blocks the end of the DDFT and impar....useful here.

Imogen
 
ImogenBurrows said:
:( makes me sad that you say this....we aren't all scary!! (Apparently I am though;))



Ooooo, you shouldn't go down the route of "accepting" that degree of lameness until you know what it is IMO....there's a differenc in accepting it and not knowing about it! ;)

Sadly though, my opinion is the answer to a salient question - could you hurt her buy continuing to work on bute - is yes. Of course you could. My husband insisted on continuing to run on hs strained ankle until his achilles tendon went bang about 4 miles from home.:eek:
If you don't what the underlying cause of the lameness is, then it could be aggravated by exercise. Sometimes I even have to get horses worked a bit to make the problem more consistent in order to find out the cause - I can't say I'm ever 100% happy about this, but until my patients can tell me where is hurts, or I become Dr Doolittle, it is necessary ocassionally.:p

Personally if you can go for the MRI, do.

BTW, you didn't mention if any of the more specific blocks had been done? Coffin jt/navicular bursa....they don't just rule out the obvious conditions....the navicular on especially often blocks the end of the DDFT and impar....useful here.

Imogen
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Don't disagree with anything you have said Imogen although I do feel uncomfortable questioning the vet. I think he believes it can't be anything too serious or she would really be lame.

He's a little reluctant to go down MRI route at this stage and no she didn't have specific nerve blocks although x rays were navicular, pedal and something else (sorry can't remember).

I'm going to ask about MRI scan

Thanks
:)
 
Tiffany said:
Don't disagree with anything you have said Imogen although I do feel uncomfortable questioning the vet. I think he believes it can't be anything too serious or she would really be lame.
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Do you not pay us (vets) a LOT of money to work for your horse??? You have right to ask what you want... Don't be shy about asking your vets about stuff you don't understand or are not totally happy with. You should be able to walk away from the consult being able to re-explain the situation to your mates...if you can't because you didn't understand fully, you're not daft- we didn't do our job very well....:(

He's a little reluctant to go down MRI route at this stage
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Why????

and no she didn't have specific nerve blocks although x rays were navicular, pedal and something else (sorry can't remember).
Click to expand...

A diagnosis can't be made without further work and mild lameness is just as relevant as really big lameness.....I'd advise you get some proper investigation done....more blocks for best info...full set of xrays to support and THEN MRI. Some insurers won't pay for MRI unless you've gone through the rest first.

If your vet fobs off further blocking either the horse isn't lame enough (work until it shows up a bit more!) or they aren't happy doing it...then ask to go somewhere where they are. It'd ok to say - "I'm not happy to pop a needle in the navicular bursa" in my book, lots of people aren't. But it's not cool to not offer because you can't do it. It may be that they don't think it's necessary, but if you don't block the coffin joint (easy to do!) and the MRI shows coffin joint arthritis, you've wasted a load of time and money when a simple block would have worked....

I'm going to ask about MRI scan

Thanks
:)
Click to expand...

Thank about the best order....best not to just request an isolated test, but a more detailed evaluation.....
Good luck.
Imogen
 
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