Long term box rest with guarded prognosis

[Starry123]

Hi all,

My horse was diagnosed with a significant tear in her DDFT in her foot about 2 weeks ago. The tear runs from the insertion of the DDFT onto the pedal bone up to mid proximal phalanx and covers 50% of the DDFT lateral lobe. The vet has suggested 6 months box rest with controlled exercise and graduated heal shoes however, the prognosis is guarded and through reading, injuries in this region of the foot are really challenging to heal. Unfortunately surgical debridement isn’t really an option due to the location of the tear and likewise at this stage, injections aren’t going to do a lot. She’s been on box rest for 2 weeks so far and has been an absolute angel. I’m under no illusion that rest and rehabilitation is really important for these types of injuries however, I’m really struggling with the idea of box rest for such a long period when the prognosis isn’t great. I don’t feel it’s fair to put my horse through that when she has lived out for 15 years of her life. While ultimately I want to heal the injury, there is still a horse attached to that injury and I need to consider her mental well-being as well.

I’ve heard of people turning away for 1-2 years and at the end of the day, I’m in absolutely no rush to return her to work. Despite the significance of the tear, she’s only noticeably lame in trot. However, at this time of year with the fields as muddy and slippy as they are is this even a sensible option? While I’d be happier she was out, the last thing I want is her hobbling around.

My final concern is that the tear was only able to be diagnosed with MRI due to location and the vet has confirmed that she would need another MRI to understand how the injury is healing. If I do decide to go down box rest and controlled exercise, how am I going to know when is safe to increase exercise etc?

What would you do in this situation? I have very little previous experience with these injuries and I am learning as I go.

 

[ycbm]

Personally I would turn her away for the winter and start a barefoot rehab in 6 months time and the last thing I would do is box rest for a guarded prognosis or go anywhere near remedial shoeing.

You can learn a lot about these types of injury here. Many of these horses had very poor prognosis and were still lame after medication and remedial shoeing.

Rockleyfarm.blogspot.com

 

[paddy555]

I would turn away for up to a year and if the field is slippery I would try and adjust the turn out even if she was alone and in a smaller area to try and make it safer. I'm sure she would have a better quality of life even hobbling. No way would I box rest for 6 months. That is no life for a horse. Possibly bring her in at night if that makes her happy. How I made turn out work would depend on the character of the horse. If another horse kept her quiet and happy or if alone she wasn't chased around.

I would as above try a barefoot rehab. Basically if she comes sound then great, if she hobbles but is not in a lot of pain and happy I would keep her as a pet and if all fails then that would be it.

 

[McGrools]

I’m another who wouldn’t box rest for a long period of time. I would turn away and see where you are next summer.

 

[HelenBack]

This sounds quite similar to my horse's injury. Yours is possibly a bit more severe from what you have described but it's in exactly the same place and I was given a guarded prognosis too. My horse was also only around 2/10 lame in trot. I was advised around three months of box rest followed by small pen turnout gradually increasing to a paddock. My physio actually advised against the box rest and said that she would turn away. Her reasons made sense from a healing point of view but I'd already started the box rest by then and decided to continue with it for personal reasons. I really don't think I would have agreed to six months though. Three months was doable but hard on both my horse and me, six months would have finished us both off I think.

As my horse is a bit older and already has some other issues I set my stall out from the start that I was going to retire him and my only aim was for him to be happy in the field. My local vet said not to give up hope on riding him again but the MRI vet said retirement was a realistic aim. I didn't plan to MRI again but did end up doing so for other reasons and there has been some healing but some of the injury remains so retirement was the right aim for us.

I think in hindsight if I were going through this again I wouldn't do the box rest, and I definitely wouldn't agree to six months. It aged him quite a lot and I became quite worried about the overall impact on him. He bounced back once he was out again thankfully but I wouldn't want him to have to go through that again. I was lucky that it was in the summer but I think if you can find a way to turn your horse out with minimalised risk of hoolying about then that's what I would do in your situation. I think probably you will have to keep an open mind about whether to try to return her to work or not but I would be inclined to give it at least a year before you even consider it and then see where you're up to then. If you do want to try riding her again then I think your options will either be to MRI to see if it's safe to do so or try it but be prepared for the lameness to return. I think there's quite a big risk that she could look sound enough but the injury still be present.

I'm on the fence about the remedial shoeing. My horse was already barefoot when he had his injury. The vet suggested wedged shoes in the short term but I refused because my horse already has upright feet and I didn't think they would help. If your horse has long low heels then I might be tempted to consider the 3D pads in the short term to help alleviate the tension on the DDFT. Long term though if the hoof confirmation is poor then I'd want it sorting and I do agree that often a barefoot rehab gives better results. The main thing I'd want is a really good and open minded farrier to discuss all the different options with and decide what's best for your particular horse.

 

[Starry123]

Thanks for such a thorough reply! I’ve spoken to my vet again today and explained that I didn’t think box rest was fair which he understood. I’m going to start looking at options for turning away instead. I think realistically my goal is just to have her happy and comfortable and if I ever got to ride her again that would just be a bonus.

 

[tda]

Although it's costly, a properly built and maintained track system with a settled herd would be ideal

 

[Zoeypxo]

Mine had a simular injury although lame in walk and 6/10ths lame in trot. I tried remedial shoes and injections and it didn't work.
So against vet advice i took the shoes off and turned away for the winter, she took 7 months to come sound and ive lightly hacked since then ,( June 2023) , i am only now doing a small amount of schooling on grass and adding a bit more trot and short canters to our hacks. At the moment all is well, barefoot but booted for hacking . Still unsure about a surfaced arena but im ok with not schooling or jumping again.

ETA - it was actually 9 months turned away since the injury started but 7 months barefoot.
Farrier and vet now compliment how good her feet look!

 

[pistolpete]

Please don’t lock your horse up in the stable if not horrendously lane try and find a better way. There’s plenty of good advice already given. I don’t understand why vets say this

 

[marmalade76]

Six months box rest would be a no for me. If she's comfortable enough, turn her away.

 

[LadyGascoyne]

I’ve just done a long stint of box rest with one of mine, for a suspected DDFT tear (not confirmed by MRI).

We started with taking shoes off and booting with supportive pads (June) and turned her out 24/7 but she just wouldn’t rest properly and played with the other horses too much. We then did the winter (October to March) on a small pen with access to her stable. We turned out as soon as the ground was soft enough, and she has started to come back into work this summer albeit walking only and in straight lines.

Definitely look at your horse’s hoof angles as a starting point. The biggest difference for us was taking the pressure off the tendon when her feet started changing shape. She went from fairly limpy to striding out nicely in about 3 months once the angle had changed. Proper trimming and managing foot balance has been game changing.

 

[PinkvSantaboots]

My mare had a very similar injury some years ago now and we did 3 lots of long box rest and each time she just went lame again, I really wish I hadn't done it but just followed vets advice and wasn't as clued up then.

I would pull the shoes and turn away.

 

[abbijay]

I haven't read all the replies but I will tell you what I did when Alfie did his DDFT...
We couldn't MRI as he is too big so all diagnosis was done the "old fashioned" way.
I ended up doing 10 weeks box rest by which point my angel of a horse was pee'd off, bursting out of his box when I opened the door and then developed an allergy to bute that necessitated a stay in ICU for a week! The vet wanted to put remedial shoes on and continue with box rest for another 8 weeks. When your horse is so big it's already in m2m shoes the cost of m2m remedial shoes and the work involved would have been a huge long term commitment and my farrier basically said getting them back out of remedial farriery is another huge challenge.
I was done at this point! It was breaking me seeing my poor horse going through mental torture and not getting and better. I read and researched a lot and talked it through with my farrier. We decided to pull shoes and turn away (helpfully at my farrier's house). He remained notably lame for quite some time and didn't join in much playing with his field mates. 6 months later he came trotting up the field looking like a different horse.
I have never brought him properly back into work but I have ridden him on maybe 6 occasions since (over the last 4 years). He had already had a "career ending" diagnosis 4 years previously and I just couldn't risk him breaking down again - he is worth more to me as a best friend than anything and I couldn't risk his happiness. I am not convinced he is fully sound these days, there is an occasional stumble on a tight turn but he is field kept so only does tight turns of his own choosing. If there is an underlying issue I can't believe any rehab work wouldn't have exacerbated this.
If I had my time again I would have turned him away sooner. He didn't deserve to go through all the agony and pain he did, despite my best efforts and following the professional's advice (vet).

 

[IrishMilo]

It depends what you are looking to achieve. And as you've said if you don't ride her again that's fine, in your shoes I'd turn her away barefoot.

I think it's rarely as simple as saying 'Just chuck them out' or 'Just do the 6 months box stint' because there are so many different factors to consider - how important the overall success rate is, your future plans with the horse, how they would cope being out 24/7 or in 24/7, etc.

If you have a horse who is likely to hooley around all the time AND you wanted to ride at the end of it then I'd do the box rest. If you have a relatively quiet type and you don't much care to ride again, then yes I'd turn away.

I wouldn't box rest anything for 6 months. 3 months would be an absolute maximum on the provision that I would be getting it out the stable multiple times a day for short walks, grazing, stimulation etc. and only if the horse was content in the box. If I had a complete stress head who box walked and called the yard down each time a horse came and went it would be turned away regardless of my personal goals or quite possibly, put to sleep.

 

[doodle]

Not the same injury but my horse is on week 7 weeks of 12 weeks box rest for a fractured pedal bone. Vet said it simply will not heal with him in the field. Initially he was awful and turned into a sweating super stressed box runner. Gave up after 5 days and made several stable size pens in his field. This worked and he had 3-4 hours out a day and in the rest when he had comoany. Then another horse became injured so now he has company he is fine. He still throws the toys a bit in the morning but he is bored and being annoying rather than stressed. The other horse has 3 more weeks so potentially then he will be alone again. Pens are wet now so if need be he will get a smaller area of the field for the final 2 weeks. If he had to have 6 months I don't think I could do it to him.

On the other hand, my old horse loved his stable and when he did his SDFT he had 4 months box rest. Started walking in hand and then was turned out after 8months and he was ok with it.

The vet has assured me that he will make a full recovery so I am willing to do the 3 months. I think if prognosis is guarded and you are comfortable with retirement then I would not be doing 6months.

 

[Sossigpoker]

My horse had this , I box rested fot 12 weeks and then started rehab.
Against all odds he became sound again and we had a lovely summer of hacking witn some lessons. But then he sadly tore it even further and i had no choice but to let him go.
I wouldn’t box rest for 6 months as that wouldn't be fair mentally on the horse IMO.
I'd be inclined to box rest for a shorter period and then see if he's field sound enough to be turned away.

 

[Maryann]

Mine has a similiar injury and I have been advised by the vet hospital to have him on restricted - can move about but not hooley - turnout for a year and then look at starting rehab after another scan. He doesn't look lame and is young.