Lameness work up result? Soft tissue?

[Jim bob]

I will take you all back to the start of this.

On the 2nd feb my horse came in quite lame on his right fore. ( we had been in light exercise and been brought back into work. been work for around 20 mins 3 times a week) I wasn't happy leaving him how he was so the vet came in a few days after, trotted him up and said he has either bruised it or a brewing abcess .
So box rest him for a week and dry poultice ( with him already have very thin soles) A week later, no sign or smell of an abcess. Farrier was due to come out in a few days time to reshoe and to discuss pads or bar shoes, for support. Then day before he was turned out with a home made boot and sadly came in without the home made boot on! The next day we decided pads and filling would be the best way to go with him. However a week later he still wasn't right. and still sore. My farrier said it might take him time to get used to them. Vet came down and watched him trot up and on he lunge again, he was sound on the soft and quite lame on the hard. Vet said if he is still the same in 2 weeks then to let him know as it will be nerve blocks and xrays. It ended up been another week or so afterwards.

So today the vet came down for a lameness exam and xrays if needed. He was trotted up and down a few times, still slightly lame on his right fore. He was sound on the soft when lunging, in trot and canter. And still slightly lame on the hard ground when trotting. We nerve blocked his foot, just the one area but both sides. and put him on the lunge again, on the hard ground. He seems better on his right fore but was now showing up lame on his left! Vet was now thinking possible lami and we would only know if xrays were done. Xrays were taking of his right fore which showed no changes, no rotation in the pedal bone, n issues with his coffin bone or his navi bone either or no signs or arthritis. Which is good I guess. Vet has said he is either foot sore or he has some sensitivity as he was positive for hoof testers near his toe.

There has been mention of an MRI been done of his pedal bone however my horse isn't insured for his feet The vet doesn't thing its ligament or tendon damage though.

The plan currently is to work him lightly, in the school only, reduce the dose of oral steroids he is on and report back to the vet in two weeks. Vet is going to speak to my farrier, regarding bar shoes, for support or vet has said I have the option of taking him barefoot as well. As he has such thin soles and he doesn't grow a lot of hoof. I asked.. basically how come when he was in racing and with previously owners they had no issues with him and now I have him everything has gone to mush. It could be , apparently, because he was in more work and therefore using his feet more. But as I said to the vet I cant work him if he is lame.

I am actually a little gutted. I almost wanted to find something as then I know what I am dealing with and know the limits. But all we really have it that its not bony and at the moment its down as been foot sore or sensitivity.

 

[twiggy2]

So the one foot was nerve blocked and nothing else?
If that is the case then a lameness work up was not carried out, the nerve blocks should have continued (in a set sequence) on both legs showing up lame, you are non the wiser as to where the lameness in the left fore was coming from if it was not nerve blocked out.
Bi lateral lameness is a pig to diagnose and one lameness can mask the other so a very comprehensive lameness work is needed.
I would query what the vet has done today but obviously I don't have the full picture.

 

[be positive]

Why is he on steroids?

 

[twiggy2]

Why is he on steroids?

I missed that, but yes why?

 

[Jim bob]

My vet thought the lameness was in the foot and showed that on the nerve blocks. Yes it was only the one leg as it has always been the one leg he was lame on . He is on steroids due to an immune disorder that he has.

 

[sheep]

If he's on steroids, could it be laminitis?

 

[stencilface]

Can you take some pics of his feet? They can often show up things to the HHO bf bods that sometimes a vet and farrier might not pick up.

 

[Jim bob]

The xrays showed that there was no rotation in the feet. I can do yeah.

 

[stencilface]

My boy had very much the same symptoms, I thought it was only lame on one foot, but a caudal block to the foot showed the lameness on the other one. He wasn't really lame on a soft surface, but was 3/10 lame on a circle on a hard surface. He was diagnosed with DDFT damage in both front feet, with one worse than the other. I let him 'rest' for months before a diagnosis as he was already barefoot and at first he had an abscess then I wasn't sure if a bit of lami, then bruising, but finally I caved and went for an MRI (insurance covered thankfully)

You can do an ultrasound for soft tissue injuries in the feet, its not as good as an MRI, but if you know where you want to look it can kind of work, its also a lot cheaper (especially if your horse is a dote like mine and doesn't even need sedating for that kind of stuff!)

 

[twiggy2]

My vet thought the lameness was in the foot and showed that on the nerve blocks. Yes it was only the one leg as it has always been the one leg he was lame on . He is on steroids due to an immune disorder that he has.

but on nerve blocking one leg an uknow lameness came to light i the other fore leg?
that should have been investigated too not just igored, the chances are there has been a bilateral lamenss all along

 

[ester]

So he is lame on both, and likely more lame on the 'lame' leg than he appears. It's a shame that vet didn't then block the other foot and see if that brought him sound.

Did you lunge him on the hard?

Have you observed how his feet land, that can be quite telling.

you say yourself he has thin soles so it doesn't sound like his feet are that happy and the steroids might be contributing to that and generating a low grade lami situation (lami but no changes on xray).

What is his diet

Is he possibly PPID or EMS

If he were mine, and depending on the above answers I would be looking to get his shoes off but arming myself with some good transition boots that will allow for padding to keep him comfortable

The thing with MRI is that it can tell you what is wrong but I'm not always sure it influences the treatment. I could take a guess what would have shown up on my lad once we had had a good look at his landing.

 

[mightymammoth]

Is this your horse that has L V?

 

[TeamChaser]

Bit similar to my boy. I went for MRI in the end as nerve blocks and x rays (hocks, back and feet) inconclusive and at that point was a case of, we've come this far ..... My horse has had performance issues, suddenly stopping team chasing having never had single stop, so needed to get to bottom of it to decide whether he can compete again. Facing into bill in excess of £3k and just hoping insurance will cover some

Anyway, turns out he has oedema in pedal bone, we hope just due to concussion injury rather than anything more sinister. Only apparent on MRI scan. He's had Osphos to help strengthen bone as it heals and some new alternative to steroid injection from Newmarket. After 4 wks of walking for 20 mins, he's going in right direction and gradually introducing trot on soft surface and building up. Drugs were bloody expensive - around £900!

Controlled exercise on soft surface seems to be the approach so what you're doing probably sensible. Best of luck, hope he's on mend soon

 

[Jim bob]

but on nerve blocking one leg an uknow lameness came to light i the other fore leg?
that should have been investigated too not just igored, the chances are there has been a bilateral lamenss all along

When we first trotted him up. He was lame on only the one fore and not both. ( like 6 weeks ago) he could have been compensating and now sore on that leg.

 

[Jim bob]

Did you lunge him on the hard?

Have you observed how his feet land, that can be quite telling.

you say yourself he has thin soles so it doesn't sound like his feet are that happy and the steroids might be contributing to that and generating a low grade lami situation (lami but no changes on xray).

What is his diet

Is he possibly PPID or EMS

If he were mine, and depending on the above answers I would be looking to get his shoes off but arming myself with some good transition boots that will allow for padding to keep him comfortable

.

Yes we lunged him on the soft and the hard surface, was sound on the soft and lame on the hard. Diet is low sugar and starch, alfa a , fibre beet and micronized linseed. He is only 9 and a tb. blood tests earlier on ruled them out.

Is this your horse that has L V?

Yes he has LV

Bit similar to my boy. I went for MRI in the end as nerve blocks and x rays (hocks, back and feet) inconclusive and at that point was a case of, we've come this far ..... My horse has had performance issues, suddenly stopping team chasing having never had single stop, so needed to get to bottom of it to decide whether he can compete again. Facing into bill in excess of £3k and just hoping insurance will cover some

Anyway, turns out he has oedema in pedal bone, we hope just due to concussion injury rather than anything more sinister. Only apparent on MRI scan. He's had Osphos to help strengthen bone as it heals and some new alternative to steroid injection from Newmarket. After 4 wks of walking for 20 mins, he's going in right direction and gradually introducing trot on soft surface and building up. Drugs were bloody expensive - around £900!

Controlled exercise on soft surface seems to be the approach so what you're doing probably sensible. Best of luck, hope he's on mend soon

Thank you. I am thinking thought if it was low grade lami or that's what the vet thought then he wouldn't suggest lightly working him would he?

 

[TeamChaser]

Thank you. I am thinking thought if it was low grade lami or that's what the vet thought then he wouldn't suggest lightly working him would he?[/QUOTE]


Wouldn't have thought so. Whereas bone injury, controlled exercise will actually help healing and to strengthen re growth apparently ... think that's how vet explained it to me?! We're reviewing Lockie each month so giving him plenty of time. Needing to be bit patient and the month of 20 mins walking bored the arse off both of us but hoping it'll be right course of action to get him right

He was pretty much sound when trotted up but 3-4/10th lame when lunged on hard surface

 

[Michen]

Just because there is no damage to the navicular bone on X-ray doesn't mean it's not "navicular". What did the vet say about his hoof balance. T had no navicular bone damage on x Ray the issues showed on MRI.

 

[Jim bob]

Just because there is no damage to the navicular bone on X-ray doesn't mean it's not "navicular". What did the vet say about his hoof balance. T had no navicular bone damage on x Ray the issues showed on MRI.

Vet didn't mention his hoof balance. Ahh okay. My horse isn't insured for his fore feet.

 

[Andalucian]

Been there, done that with my first horse.

Bi-lateral lameness in front feet is no accident, nor is it arthritis. Foot balance and contraction (under run possibly also) are the causes. Go barefoot with someone skilled in this approach, it's the only way to fix it.

I didn't with my first horse . I did with my second

 

[twiggy2]

Been there, done that with my first horse.

Bi-lateral lameness in front feet is no accident, nor is it arthritis. Foot balance and contraction (under run possibly also) are the causes. Go barefoot with someone skilled in this approach, it's the only way to fix it.

I didn't with my first horse . I did with my second

one at work is bilaterally lame, she has arthritic knees and and damaged suspensories i both legs.
you cannot diagnose OPs horse via here but it does sound like more investigation is needed

 

[ycbm]

When we first trotted him up. He was lame on only the one fore and not both. ( like 6 weeks ago) he could have been compensating and now sore on that leg.

If he was more lame on one than the other, but lame on both, it would have appeared that he was lame in one leg only.

How does your vet explain his belief that your horse does not have tendon or ligament problems inside the foot?

 

[Jim bob]

The vet, at least before the xrays believed it was still firmly in the foot and the blocks proved that.

 

[ycbm]

The vet, at least before the xrays believed it was still firmly in the foot and the blocks proved that.

Yes, and most long term foot lameness is caused by damage to the deep digital flexor tendon, the collateral ligaments, the impar ligament or more than one of those, all inside the foot.

I don't understand how your vet is ruling that out without an MRI, or is that not what you/he meant?

 

[Jim bob]

I think he is going by the horse he has infront of him and how he has got better with rest but not completely sound, hence today. Maybe because he knows what I am like however he has mentioned mri-ing the pedal bone.

 

[ycbm]

I think he is going by the horse he has infront of him and how he has got better with rest but not completely sound, hence today. Maybe because he knows what I am like however he has mentioned mri-ing the pedal bone.

Jim bob, ,that's what tendon and ligament injuries do. Get better with rest and then worse again if they aren't fixed. Foot tendon and ligament injuries, though, don't resolve unless you sort out whatever is wrong with the balance of the foot or strength of the foot or the landing of the foot that allowed the injury to happen in the first place.

Does your horse land heel first, flat, or toe first when walked on a hard flat surface? Does he land one side of the foot before the other?

I am totally baffled that your vet thinks he can rule out tendon and ligament injuries inside the foot from x rays and looking at the horse. Is it possible he's explaining himself badly and you have misunderstood him? Numerically, it would be far more likely than any disease of the pedal bone (though that's not impossible).

 

[Goldenstar]

This sort of thing is a complete pain .
If the horse where mine I would be thinking about perhaps a period of box rest followed by a bf approach to getting the horse moving only because it's what I did in similar circumstances and it worked.
The thing I would right now is order some of the forage plus performance balancer that's the thing that speeded up J 's foot growth .
I would also be getting some video of the horse walking and trotting and slowing it down to watch his foot falls if he's landing toe first then that's what you have to sort first and the only way I know to do that is to remove the shoes and gently get the horse moving .
But I would still be worrying about LGL if it's been missed it won't be the first or last time .

 

[be positive]

I would also still be thinking it was LGL on your previous thread it definitely sounded as if it was
http://www.horseandhound.co.uk/forums/showthread.php?724495-steroid-induced-laminitis

Just because there is no rotation showing on xrays does not rule out laminitis and would also explain why he is bilaterally lame with one foot more effected than the other, I would be very careful about exercising him and would want to stop the steroids completely.

From reading through some of your other threads this horse has complex issues which could be all linked, the cribbing, has he been scoped? if he also has ulcers it could be causing further stress and contributing to laminitis induced by the steroids. I am not sure your vet is getting to the bottom of things and it sounds as if he is grasping at straws, now may be the time to get a second opinion.

 

[Pinkvboots]

I would also still be thinking it was LGL on your previous thread it definitely sounded as if it was
http://www.horseandhound.co.uk/forums/showthread.php?724495-steroid-induced-laminitis

Just because there is no rotation showing on xrays does not rule out laminitis and would also explain why he is bilaterally lame with one foot more effected than the other, I would be very careful about exercising him and would want to stop the steroids completely.

From reading through some of your other threads this horse has complex issues which could be all linked, the cribbing, has he been scoped? if he also has ulcers it could be causing further stress and contributing to laminitis induced by the steroids. I am not sure your vet is getting to the bottom of things and it sounds as if he is grasping at straws, now may be the time to get a second opinion.

I agree with this I would stop the steroids first and manage him like a laminitic and then see if he looks any better, I too think if it were me I would get a different vet out maybe one that has a recommendation, I don't think working any horse that is even slightly lame is a good idea especially as the vet really has no idea what's causing it this would worry me.

 

[ester]

I agree with this I would stop the steroids first and manage him like a laminitic and then see if he looks any better, I too think if it were me I would get a different vet out maybe one that has a recommendation, I don't think working any horse that is even slightly lame is a good idea especially as the vet really has no idea what's causing it this would worry me.

And when you know he is actually a lot lamer than he looks because he is lame on both sides.

the concept that a vet can find a lameness in the hoof and not mention it's balance is :eek3: to me.

If he were mine he would be coming off the alfalfa and going onto a plain straw chaff, I would stop the steroids as much as possible feed on hay/stop grass and take his shoes off and replace with a good pair of boots and someone experienced with tricky rehabs.

Or I would decide that he had too many things going on and call it a day for him.

 

[Jim bob]

Jim bob, ,that's what tendon and ligament injuries do. Get better with rest and then worse again if they aren't fixed. Foot tendon and ligament injuries, though, don't resolve unless you sort out whatever is wrong with the balance of the foot or strength of the foot or the landing of the foot that allowed the injury to happen in the first place.

Does your horse land heel first, flat, or toe first when walked on a hard flat surface? Does he land one side of the foot before the other?

I am totally baffled that your vet thinks he can rule out tendon and ligament injuries inside the foot from x rays and looking at the horse. Is it possible he's explaining himself badly and you have misunderstood him? Numerically, it would be far more likely than any disease of the pedal bone (though that's not impossible).

he has always landed toe first,generally. I don't hind he has ruled it out but just he doesn't think it is atm. My vet has mentioned mri-ing he pedal bone.

This sort of thing is a complete pain .
If the horse where mine I would be thinking about perhaps a period of box rest followed by a bf approach to getting the horse moving only because it's what I did in similar circumstances and it worked.
The thing I would right now is order some of the forage plus performance balancer that's the thing that speeded up J 's foot growth .
I would also be getting some video of the horse walking and trotting and slowing it down to watch his foot falls if he's landing toe first then that's what you have to sort first and the only way I know to do that is to remove the shoes and gently get the horse moving .
But I would still be worrying about LGL if it's been missed it won't be the first or last time .

LGL? He spent time on box rest recently and also had 9 months off in the field last year.

I would also still be thinking it was LGL on your previous thread it definitely sounded as if it was
http://www.horseandhound.co.uk/forums/showthread.php?724495-steroid-induced-laminitis

Just because there is no rotation showing on xrays does not rule out laminitis and would also explain why he is bilaterally lame with one foot more effected than the other, I would be very careful about exercising him and would want to stop the steroids completely.

From reading through some of your other threads this horse has complex issues which could be all linked, the cribbing, has he been scoped? if he also has ulcers it could be causing further stress and contributing to laminitis induced by the steroids. I am not sure your vet is getting to the bottom of things and it sounds as if he is grasping at straws, now may be the time to get a second opinion.

That's what my vet said just because there is no rotation doesn't mean it's not lami and this was the reason he didn't want him on steroids in the first place. But was overruled. He I on steroids for a skin issue.
He has been scoped and there was no ulcers but he does have IBD. We have reduced the steroids at the moment too.

I agree with this I would stop the steroids first and manage him like a laminitic and then see if he looks any better, I too think if it were me I would get a different vet out maybe one that has a recommendation, I don't think working any horse that is even slightly lame is a good idea especially as the vet really has no idea what's causing it this would worry me.

I called my vets only recently as I thought he had lamo. We stopped the steroids and he was on box rest for the weekend the vet then came put and told me he didn't have lami.

And when you know he is actually a lot lamer than he looks because he is lame on both sides.

the concept that a vet can find a lameness in the hoof and not mention it's balance is :eek3: to me.

If he were mine he would be coming off the alfalfa and going onto a plain straw chaff, I would stop the steroids as much as possible feed on hay/stop grass and take his shoes off and replace with a good pair of boots and someone experienced with tricky rehabs.

Or I would decide that he had too many things going on and call it a day for him.

Right now I won't be calling it a day with him though I appreciate your opinion he is a very poor doer and is already on high fibre diet I am quite happy to try the barefoot route though.