Mild, intermittent lameness - plan of action?

[Daniel_Jack]

I had routine physio and vet appointments scheduled today and I mentioned to the physio that I wanted to determine if we could identify any causes of my horse being slightly slower downhill (she's generally very laid back and steady but slightly more so downhill and on a very steep hill will tip toe down). After some lunging, trotting up, ultrasound and massage the following was found -

1. Broad stance on hind legs and horse not stepping through
2. 1 to 2/10th bilateral low grade lameness more evident on left hind.
3. Heat around the stifles post ultrasound suggesting this is more likely to be the source of any inflammation.
4. Subsequent front loading onto right fore but surprisingly no tightness or tension on shoulder or neck to suggest horse is bracing.
5. Uneven wear on hooves - wearing the outside edges of front feet and also squaring off toes of hind feet

Luckily the vet arrived just as the physio was finishing and we did another trot up and pincer test. No reaction to pincers so don't think it's that she is foot sore although can't fully rule out. Agreed re slight hind lamenss and front loading but said it was so mild and intermittent that nerve blocks would be pointless as it would still be too hard to diagnose. Generally didn't seemed overly concerned or pushing for any more investigation.

In terms of treatment, both recommended that the horse is shod again which I'm relucant to do unless it is necessary and we know it will help - her feet are fab and coming into winter her hacking will drastically reduce. Their argument is that it would a) address the footsore issues and b) would provide more support to the foot/help keep the foot balanced and prevent uneven wear. I've suggested that we try hoof boots instead which they seemed less keen on but agreed might be worth a shot but not as effective as shoes.

Vet suggests if this doesnt work we do a pain relief trial i.e. bute the horse and see if it helps. Both vet and physio were relucant to push for further investigation on the basis of how mild the issue is and the fact that the horse is used primarily for hacking and light schooling - instead to focus on strengthening the focus area (suspected to be stifles and possibly weak stifles and lack of quad strength).

My heads spinning now and I'm not sure what to do? Do I spend a couple of months trying the boots/strengthening exercises then move on to the pain trial? Or bite the bullet and just ask for xrays now? Physio and vet both think I'd be wasting my money and could spend a fortune to find no major issues. The horse does have poor forelimb conformation - a moderate above the knee turn on the front left limb and a mild above the knee turn on the front right limb - which could actually be contributing to this and could just be her way of going to compensate.

Would absolutely appreciate the thoughts of others!

 

[Floofball]

I’d try boots first if it’s so mild and the pros suspect it’s just a case of being footsore. The grass is flushing and she maybe sensitive atm?

 

[Lady Jane]

How old is the horse and what sort of work has he done? How long have you had him/her?

 

[doodle]

Squared off back toes to me means hock issues. Minto was only ever 2/10 lame before each arthritis diagnosis’s.

 

[Daniel_Jack]

How old is the horse and what sort of work has he done? How long have you had him/her?

Horse is 10. Has been passed about a lot before I bought her 2 1/2 years ago. Has done more this summer than ever before for variety of reasons unrelated to her (my pregnancy mostly) - she's ridden 5 days a week - mostly hacked on hilly roads in walk with one schooling or lunging session per week.

 

[Daniel_Jack]

Squared off back toes to me means hock issues. Minto was only ever 2/10 lame before each arthritis diagnosis’s.

Thats my concern - that and the slowing down when going downhill. Obviously boots will do nothing for this but I guess the pain relief trial might help identify if it could be arthritis.

Did you go down the nerve block route to diagnosis or straight to xrays based on the mild lameness?

 

[doodle]

I think we went straight to X-ray but I can’t really remember.

 

[Henry02]

Can she be kept in work as she is to see if you can make the lameness “.worse” for a better diagnosis

 

[Daniel_Jack]

Can she be kept in work as she is to see if you can make the lameness “.worse” for a better diagnosis

Thats what I've been advised to do - keep working her and in fact work her harder to encourage her to use her hinds more/strengthen them so lots of hill work, pole work etc. I think this has been grumbling for a while but has just become more noticable to me with more work - since I bought her I've always had a niggle that something wasn't 100% right but both vet and physio have not previously found issues other than sore feet. I don't think she'll get worse just doing more work as I don't think this is a new issue. Tempted just to bite the bullet, ask for a referal to the vet hospital for xrays and pay a few hundred pounds for peace of mind if nothing else - it's going to cost a couple of hundred for 2 pairs of hoof boots anyway!

 

[Henry02]

Ok well to me it would depend on a couple of bits. If my livery is mega bucks, I’d have her off to hospital ASAP, and I wouldn’t be wasting time faffing around.

if a more basic affordable livery I’d be tempted with a set of shoes and a few weeks worth of the strengthening work

 

[PinkvSantaboots]

I think that lameness is enough to nerve block and investigate.

 

[PinkvSantaboots]

And if the horse is insured don't waste time get to the bottom of it now

 

[Daniel_Jack]

Livery is cheap. It's more the uncertainty that will bother me! Think I might phone the vet tomorrow and discuss referal and just suck up the cost if it does turn out to be nothing!

 

[Daniel_Jack]

And if the horse is insured don't waste time get to the bottom of it now

Horse is insured thankfully.

 

[Sossigpoker]

Sounds a bit like mine. He was wide behind too. Struggling to go downhill. First went stifle lame. This initially responded to treatment (mild stifle OCD). But two weeks later went downhill again and very clever vet thought to x-ray his neck. He turned out to be quite a bad case of wobbler and was PTS 2 weeks later.

I would want the stifles x-rayed as a minium as if there is any joint abnormality, working will make it worse.

 

[Daniel_Jack]

Sounds a bit like mine. He was wide behind too. Struggling to go downhill. First went stifle lame. This initially responded to treatment (mild stifle OCD). But two weeks later went downhill again and very clever vet thought to x-ray his neck. He turned out to be quite a bad case of wobbler and was PTS 2 weeks later.

I would want the stifles x-rayed as a minium as if there is any joint abnormality, working will make it worse.

Very sorry to hear about your horse ?.

Was this a sudden onset of lameness? Or a gradually worsening issue?

Both vet and physio claimed that current workload is unlikely to cause issues/make things worse but I'm not so sure given we don't know what the issue is!

 

[SEL]

If the horse is insured then your vet records will show the problem started from this visit - I've been caught out by this before and now don't wait around!

Problems with left hind and overloading right fore has caused some quite serious damage to that right navicular in one of mine. I'm kicking myself for not insisting the "very mild it's barely there" lameness wasn't investigated 2 years ago.

 

[asmp]

Another one here who had a niggling suspicion something wasn’t right - over the years thought it was bruised soles, touch of laminitis etc. At the last trip to the vets where she struggled to see any lameness, I asked to have his front hooves x-rayed and it turned out he had huge calcified side bones. Explains a lot. Now in hoof boots and seems happier.

 

[Daniel_Jack]

If the horse is insured then your vet records will show the problem started from this visit - I've been caught out by this before and now don't wait around!

Problems with left hind and overloading right fore has caused some quite serious damage to that right navicular in one of mine. I'm kicking myself for not insisting the "very mild it's barely there" lameness wasn't investigated 2 years ago.

Really good point although this will depend on whether or not the vet logs it as the appointment was actually just for a flu jabs but because of the physios findings I raised this.

Think I'm just going to push for further investigation and be relieved (but skint) if there is nothing there.

 

[ihatework]

What was the horses response to flexion? And trot on small circle hard/soft?

 

[Daniel_Jack]

What was the horses response to flexion? And trot on small circle hard/soft?

It wasn't done although she was lunged on soft surface which showed the slight hind and possibly forelimb lameness. Probably needs to happen before referral.

 

[ihatework]

It wasn't done although she was lunged on soft surface which showed the slight hind and possibly forelimb lameness. Probably needs to happen before referral.

Id be inclined to refer then, because it’s very sloppy for the vet not to have flexed while he was there. On mildly lame horse it can really help pinpoint the areas to investigate first. If you can afford, send to a good orthopaedic vet

 

[mariew]

Really good point although this will depend on whether or not the vet logs it as the appointment was actually just for a flu jabs but because of the physios findings I raised this.

I have had vets log a random issue not even asked about on reports before and been surprised to find it excluded on insurance, so I would assume the vet would have reported it unless you ask and know for sure.

 

[Daniel_Jack]

Think I'll put her on the bute to see if there is any improvement and book in another appointment with vet for next week aiming for referral.

 

[ycbm]

Horse is insured thankfully.

I am stunned at your vet's approach given that the horse is insured and your clock is now ticking to get this investigated within 12 months before it gets worse. (It's not relevant whether the vet has noted it, it would be fraud not to give the right date of when you first asked for it to be investigated). The fact no flexing was done and the problem dismissed would make me change vet.

I would get her off to a vet hospital for a full workup to find out what the issues are. Squaring toes and trouble walking downhill are classics of hock issues and the horse is a good age for it.

You shouldn't do a bute trial before next week's appointment, it will affect the diagnosis.
.

 

[Daniel_Jack]

I am stunned at your vet's approach given that the horse is insured and your clock is now ticking to get this investigated within 12 months before it gets worse. (It's not relevant whether the vet has noted it, it would be fraud not to give the right date of when you first asked for it to be investigated). The fact no flexing was done and the problem dismissed would make me change vet.

I would get her off to a vet hospital for a full workup to find out what the issues are. Squaring toes and trouble walking downhill are classics of hock issues and the horse is a good age for it.

You shouldn't do a bute trial before next week's appointment, it will affect the diagnosis.
.

I'm undecided as to whether to get vets back out again for a better lameness assessment (I did kind of spring this on the vet yesterday and she was already running late and had 3 others to see at the yard) or just see if they will refer to the vet hospital.

 

[Pearlsacarolsinger]

I would suspect hock arthritis and think that this is an explanation for her reluctance in the school. I would use this as a good reason to stop the sharer and concentrate on hacking as much as possible while continuing to work her, there is no need to subject her to working on a soft surface, which is obviously uncomfortable for her.

I would be inclined to find a new vet, this one doesn't sound to be much use, tbh but then a referral for a full work-up to a specialist would be my preferred way forward.

ETA, if the vet was unprepared for the problem, that does put a different light on the skimped examination.

 

[Daniel_Jack]

I would suspect hock arthritis and think that this is an explanation for her reluctance in the school. I would use this as a good reason to stop the sharer and concentrate on hacking as much as possible while continuing to work her, there is no need to subject her to working on a soft surface, which is obviously uncomfortable for her.

I would be inclined to find a new vet, this one doesn't sound to be much use, tbh but then a referral for a full work-up to a specialist would be my preferred way forward.

ETA, if the vet was unprepared for the problem, that does put a different light on the skimped examination.

She's not overly reluctant in the school when I ride her and her way of going has improved but definitely don't want to do more damage if there is an issue.

Vet was definitely un prepared so giving her the benefit of the doubt as this vet practice is well regarded. They don't have in-house facilities so would alway refer to the vet hospital. It's just whether or not they would refer without further in house investigations.

Going to call them today.

 

[Sossigpoker]

Very sorry to hear about your horse ?.

Was this a sudden onset of lameness? Or a gradually worsening issue?

Both vet and physio claimed that current workload is unlikely to cause issues/make things worse but I'm not so sure given we don't know what the issue is!

I don't think mine was right to start with but it became more apparent as he was worked more and had a growth spurt.

I really would advice against just working the stifles without having an x-ray to see if there's joint damage.

 

[Sossigpoker]

And I agree, you need a better vet. This one seems to be out of his/her depth.