Lameness with unknown cause

[neighsays]

Here we go… any and all suggestions appreciated

History:
My 13 y/o gelding was 2/5 lame front left in February, blocked out coffin joint and went sound, had coffin joint injected, put on remedial shoeing, came sound and returned to work, but was quickly lame again, diagnosed as SDFT tendon injury via ultrasound. Rehabbing, still lame, further ultrasound revealed suspensory branch injury (also had X-rays done in April with nothing that notable), kept rehabbing.

Bringing us to October, went 3-4/5 lame, worse on hard ground. X-rays revealed a slight change in fetlock from April, but nothing major. Nerve blocked out foot completely, only about 10-15% improvement. Started on equioxx, immense improvement (down to 1/5 lame), but now still stuck on that 0.5-1/5 lameness. Just started Pentosan injections because of the positive improvement with equioxx, waiting a few weeks to check results.

Also worth noting that horse has deep sulcus thrush (very wet climate and stuck on box rest) but not worse on any specific foot.
Vet suggested possibly either doing further nerve blocks/steroid injections, or going to MRI, not sure what to do at this point… I’ve attached the most recent X-rays. They say his navicular bone is ugly, but stable from prior X-rays.

 

[Glitter's fun]

Hi, welcome to the forum. Sorry you've had such a frustrating year with him. I don't have any useful suggestions but noticed you didn't get replies so this should put it up the list so people see it.

 

[Highmileagecob]

If you are seeing thrush, it is likely he is throwing his weight onto his toes to avoid heel discomfort. This will in time produce navicular changes and compromise the way the tendons support the leg. Then comes remedial shoeing, which holds the hoof in a rigid position and forces it to continue the un-natural growth direction....... Have a frank discussion with your vet and farrier and ask if six months without shoes, and light work, would help. Maybe take a look at Pete Ramey's Hoof Rehab pages and see if anything is relevant. First and foremost, the hoof needs to be strong with good heels and sole, and in good balance. Do not allow your farrier to trim the foot into balance too quickly. You must take six to twelve months to allow the tendons to keep pace with the changes, and consider using padded hoof boots for exercise. Treat the thrush as best you can. Will your horse stand with his feet in a soaking solution of Dettol? If not, wash off the mud, dry as best you can and use your treatment of choice - 1% iodine spray, zinc and castor oil cream, Stockholm tar etc.. Good luck, I hope you can make some headway with him.

 

[dorsetladette]

As above - I'd treat the thrush and have a conversation with the vet and farrier about alternatives as what is happening currently isn't working.

 

[PinkvSantaboots]

I would be inclined to get the shoes off and turn him away for a bit and deal with the thrush because that won't be helping matters.

 

[Tiddlypom]

Agree with others, the thrush alone can make a horse very sore indeed, so hit that hard and get on top of it.

 

[neighsays]

If you are seeing thrush, it is likely he is throwing his weight onto his toes to avoid heel discomfort. This will in time produce navicular changes and compromise the way the tendons support the leg. Then comes remedial shoeing, which holds the hoof in a rigid position and forces it to continue the un-natural growth direction....... Have a frank discussion with your vet and farrier and ask if six months without shoes, and light work, would help. Maybe take a look at Pete Ramey's Hoof Rehab pages and see if anything is relevant. First and foremost, the hoof needs to be strong with good heels and sole, and in good balance. Do not allow your farrier to trim the foot into balance too quickly. You must take six to twelve months to allow the tendons to keep pace with the changes, and consider using padded hoof boots for exercise. Treat the thrush as best you can. Will your horse stand with his feet in a soaking solution of Dettol? If not, wash off the mud, dry as best you can and use your treatment of choice - 1% iodine spray, zinc and castor oil cream, Stockholm tar etc.. Good luck, I hope you can make some headway with him.

I've been doing my best to treat the thrush (daily) for months now with my farrier's help, but being in pretty much no work combined with boxrest (aside from hand-walking), it's still quite severe. I muck out his box daily, but it's persistent. I've been using some of Pete Ramey's recommended methods, but no dice. My previous farrier kept the feet unbalanced, but he has been with the new farrier (who works with the vet directly) for at least 4-5 cycles now.

Both my vet and farrier are insistent that he needs to stay in the remedial shoeing to help support his heels, and didn't think it was the thrush causing the lameness because lameness is lateral and didn't respond to the heel/foot nerve block, but at this point I'm willing to try anything, just not sure if they would approve, and don't want to burn any bridges.

He's mostly sound on soft ground at trot, but when I've tried to bring him back to trotting in recent months, he's only sound for a few weeks then goes off again.

 

[Highmileagecob]

It's a tough call, and you must feel you are going round in circles. I have had good results with Stockholm tar for repeated thrush outbreaks in my oldie. Do you feel that the tendon injury has healed as much as it is going to?

 

[SEL]

I only got rid of thrush with one of mine when i removed linseed. I don't believe it was the linseed so much as her gut wasn't happy on it. Once I'd got her gut sorted a lot of niggles with skin and itchiness also sorted as well as her thrush.

 

[neighsays]

It's a tough call, and you must feel you are going round in circles. I have had good results with Stockholm tar for repeated thrush outbreaks in my oldie. Do you feel that the tendon injury has healed as much as it is going to?

The vet and are both thinking that the tendon issues are a result of something else as they have been pretty mild. She seems to think it's joint related because of his reaction to the blocks, but it could very well be the thrush contributing. At this point I'm leaning towards the MRI just because it would give a more definitive answer. But I'm nervous about the process of doing that under anesthesia and the additional stress it might put on his system (not even considering the financial aspect, insurance won't cover it I don't think).

 

[MissMay]

Is it an option to remove shoes and put him out till spring.

That might help clear the thrush and as its a mild lameness could come right.

You have done most things so I'd ne inclined to go the old proven which was a year at grass

 

[Highmileagecob]

Agree that no shoes, bring the feet into balance over six to twelve months, and a forage based diet, as basic as he will cope with may help. Any option of a small turn out pen instead of box rest, or is he likely to be silly? Have you tested for Cushings?

 

[neighsays]

Agree that no shoes, bring the feet into balance over six to twelve months, and a forage based diet, as basic as he will cope with may help. Any option of a small turn out pen instead of box rest, or is he likely to be silly? Have you tested for Cushings?

He's been on a forage based diet since February. He's an easy keeper and is still in good shape even while being out of work. He's very likely to be silly in turnout (gave himself a hematoma on the same leg last time we tried), and my stable doesn't really have permanent turn out pens for each horse (other than one for a herd), instead the horses are turned out in batches, and rotate throughout the day. (they aren't allowed out at night), so turning him away for a few months really isn't an option, and the paddock are almost always muddy with the amount of rain we get here in the fall/winter

 

[neighsays]

I haven't tested for Cushings, but I can bring it up when they pull blood to check his kidneys for the equioxx

 

[IrishMilo]

What are you using to treat the thrush? Apple cider vinegar and Sudocrem to keep the foot dry has always worked very well for me. Both are anti fungal.

This is one of those situations when you have to be really able to advocate for what you believe is best. I was in the vets a couple of months ago with my Thoroughbred, and one of the things that I've struggled consistently with is his feet (shock). He'd never been lame to my eye but he's had chronically under-run heels and long toes, and always very trippy.

When we X rayed his feet we could see some mild navicular and paper thin soles. I knew before going in that the vet would say pads and corrective shoeing would be the answer, and I told him straight up that I didn't want to go down that route as it's a plaster fix rather than addressing the root cause. He was really receptive and supported my suggestion of 6 months without shoes/in boots. My train of thought is if you always do what you've always done you're always going to get the same result!

We've written off riding for 6 - 12 months and have turned him away. I've had a lot of flack for doing it, mainly from people with no hoof knowledge and can't understand why I wouldn't just stick shoes back on to relieve his short term discomfort...

But he is miles from when we took them off (i.e. literally unable to move and hopping lame) and is now trotting around the field

 

[ester]

Was the suspensory April?/ where are we time wise on rehabbing that?

I can’t see how keeping shoes on this horse seems to be helping any tbh.

 

[neighsays]

What are you using to treat the thrush? Apple cider vinegar and Sudocrem to keep the foot dry has always worked very well for me. Both are anti fungal.

This is one of those situations when you have to be really able to advocate for what you believe is best. I was in the vets a couple of months ago with my Thoroughbred, and one of the things that I've struggled consistently with is his feet (shock). He'd never been lame to my eye but he's had chronically under-run heels and long toes, and always very trippy.

When we X rayed his feet we could see some mild navicular and paper thin soles. I knew before going in that the vet would say pads and corrective shoeing would be the answer, and I told him straight up that I didn't want to go down that route as it's a plaster fix rather than addressing the root cause. He was really receptive and supported my suggestion of 6 months without shoes/in boots. My train of thought is if you always do what you've always done you're always going to get the same result!

We've written off riding for 6 - 12 months and have turned him away. I've had a lot of flack for doing it, mainly from people with no hoof knowledge and can't understand why I wouldn't just stick shoes back on to relieve his short term discomfort...

But he is miles from when we took them off (i.e. literally unable to move and hopping lame) and is now trotting around the field

Thanks for your reply. I've been using zinc oxide mainly, but have tried apple cider vinegar and similar products, treating daily if not twice daily. I don't know much about feet/hoof health, so I agreed to put him on the remedial shoeing back in February (thrush was not present at the time). The vet says that he needs the pads to help push up his heel to reduce the stress being placed on his tendons (they were too low before)

Even if I could convince the vet/farrier to let him go barefoot, I am unable to turn him out for very long (I would most likely need to sedate for turnout), and I'm not sure if there would be as much benefit at that point.

Also worth mentioning that the vet said he has a bit of heat around the coronet band, which she thought indicated coffin joint.

 

[neighsays]

Was the suspensory April?/ where are we time wise on rehabbing that?

I can’t see how keeping shoes on this horse seems to be helping any tbh.

At last scan it looked good, not 100%, but good enough that she thought it wouldn't be causing him lameness.

 

[neighsays]

I could ask about pulling shoes and putting on boots to keep moisture out, but being able to turn him away for months is not realistic for our situation.

At this point, is it wrong of me to just bite the bullet and go for the MRI? I just want to know what's going on and have a real treatment plan instead of failed hypotheses

 

[ester]

Boots keep moisture in not out, they tend to get a bit sweaty, though necessary if they need the extra protection.

The mri might help you know exactly from a soft tissue point of view but what are the treatment options going forwards/ are they going to change dependent on MRI results.

For the thrush my go to is red horse sole cleanse then packing with their hoof stuff.

The reason I was asking about the suspensory was mostly whether we still had to be considering that re. Still box resting/limited turnout.

 

[ester]

Fwiw my then 19yo had the same start as yours, blocked to coffin joint, injected, remedially shod, seemed sound, started trot work on 2nd shoeing cycle and went lame.

Didn’t mri -less accessible then- as it wasn’t going to change treatment plan, injected again, took shoes off, v slow rehab, sound on it for the next 10 years (PTS at that point for other reasons)

Do you have any photos of the hooves as well as the X-rays, they might be helpful atm I’m a bit stuck on horse has to be off box rest at some point and what is that helping currently with his various pathologies

 

[neighsays]

Knowing how he gets when he's turned out, because he would only be able to go out for a few hours a day maximum I feel like he might do even more damage to himself and that's why I'm hesitant. (We're currently in the Netherlands, so we have veeeery limited turnout and too much rain)

 

[neighsays]

Fwiw my then 19yo had the same start as yours, blocked to coffin joint, injected, remedially shod, seemed sound, started trot work on 2nd shoeing cycle and went lame.

Didn’t mri -less accessible then- as it wasn’t going to change treatment plan, injected again, took shoes off, v slow rehab, sound on it for the next 10 years (PTS at that point for other reasons)

Do you have any photos of the hooves as well as the X-rays, they might be helpful atm I’m a bit stuck on horse has to be off box rest at some point and what is that helping currently with his various pathologies

I put the xays at the top of the thread, here's a photo of hoof shape, and I can try to get a better photo of frog/thrush when I'm there later. The first time back in February he did block to the coffin joint, but the most recent time a few weeks ago there was minimal/improvement, which is why she then thought fetlock.

Vet wants him on box rest not to heal anything currently, but to keep him from doing more damage.

 

[ester]

Ah it makes sense that your turnout situation might be quite different to ours then. Looks like he has pads/wedge pads in that photo?

 

[neighsays]

Yep, he's got a pad with the frog area cut out so I can reach it, and then a sort of putty/silicone/cushion material in his front hooves under the pad

 

[ester]

It’s usually DIM - dental
Impression material.

Is he on shavings/similar- just thinking/pondering here that with the frog cut out + shoes you could be getting no frog stimulation at all which is likely to make it more atrophied/contracted which then isn’t helping the heels but if he’s bedded on something conformable that would mean that wasn’t the case

 

[neighsays]

He's on straw. I try my hardest to keep it clean but he keeps a messy stable, and his box is outdoors (with roof), so rain sometimes gets in.

 

[neighsays]

It’s usually DIM - dental
Impression material.

Is he on shavings/similar- just thinking/pondering here that with the frog cut out + shoes you could be getting no frog stimulation at all which is likely to make it more atrophied/contracted which then isn’t helping the heels but if he’s bedded on something conformable that would mean that wasn’t the case

Here are the photos of his frog. Looking closer at it now, the foot he’s lame on is definitely worse. Do you think he’d respond to a nerve block if we redid it? (Now that whatever was causing the severe lameness seems better with the equioxx)

Out of curiosity, how long did it take your horse to recover?

 

[PinkvSantaboots]

Swan antibac is good for thrush you can buy it online.

If you have an mri it's done by standing sedation they don't us an anesthetic for that so it's a simple procedure.

Thing is the pads often cause frog issues because the frog gets no stimulation and is covered by the pad so allows bacteria to grow.

I still would get those shoes off and consider a barefoot rehab with boots and pads, it's your horse at the end of the day and the vet and farrier work for you.

Most remedial shoes work for a while and then they don't so it's just masking the issue and not curing it.

One of my horses had navicular changes and soft tissue damage vet wanted him in remedial shoes after doing research I decided to just take them off and let him have field rest, after 3 months he was sound and has been fine since that was 5 years ago his 19 now and his been barefoot since.

 

[Zoeypxo]

I had a similar situation to yours and i turned out for 9 months and took the shoes off.
I think your going to struggle to improve his feet without him getting any turnout. Is there any track systems/surface turnouts in your area?