MRI for soft tissue injury in foot

Bernster

Bernster

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So, would you get Mri done if vet recommends it? Seems to me that it's an expensive diagnostic tool that is useful for showing exactly which area is affected, and how badly, but from what I've read it doesn't change the treatment significantly. Lots of people don't think its worth it. Already been nerve blocked to the navi/coffin area, a lameness work up and X-rays done.

I've got the vet coming this afternoon so would really appreciate some opinions as I do think he will say mri and although they are a good practice, they're not known for doing stuff on the cheap. Also not sure if insurance has accepted the claim, so that might alter the opinion (which also makes me wonder if it's really worth it).

I'm hoping to go bf and I'd rather ask nfu to cover those costs, which would be the same or less than the MRI, so they might be more open to saying yes if the whole cost is more limited.
 
There was something on RVC Equine's fb page the other day, they charge £995 for MRI of both front feet which is a good price. They'd be local to you and you can be referred even if you're not with the practice.
 
I had one in a couple of years ago, he blocked to the same area as yours, xrays were clear and MRI was discussed, he was only very slightly lame on a circle so we decided to treat it conservatively for 6 weeks.
I contacted the practice that would have done the MRI for advice as the horse was not mine and I had to advise the owner who was abroad and needed to make sure it was the right route and not wasting 6 weeks, they advised the same as my vet and said they would do so for their own clients, the recommendation was if after 6 weeks he was not sound then to have one done.
He had an easy few weeks on bute, then back to full work with no further issues so it was probably deep bruising rather than something more sinister, I think if the lameness has been going on longer without resolution it may be very useful to know what the most appropriate treatment is, friends had a horse that was rumbling on for a couple of months barely lame, he required tildren, box rest and a long rehab , he did have the MRI but it was more to confirm the diagnosis/ treatment plan and was paid by the insurance.
 
I had a MRI done on a horse last year, it didn't give a clear diagnosis and the treatment was the same whether we had it done or not. It is another tool in diagnosis and if your insurance covers it comfortably then have it done. I contacted my insurance company to confirm that they would pay etc before it was done.
 
Ok thanks everyone. It would be done at the Rvc criso so that's good to know. I think it hinges a lot on whether nfu will cover but even if it's covered I don't think its right to waste money if it's not going to be worth it. Will keep an open mid and have a good talk to vet about the pros and cons.

Interesting be positive as mine is the same type of case. Good to hear yours made a full recovery but in my heart I think it's more than that, don't know why, just a hunch.
 
Bernster said:
Ok thanks everyone. It would be done at the Rvc criso so that's good to know. I think it hinges a lot on whether nfu will cover but even if it's covered I don't think its right to waste money if it's not going to be worth it. Will keep an open mid and have a good talk to vet about the pros and cons.

Interesting be positive as mine is the same type of case. Good to hear yours made a full recovery but in my heart I think it's more than that, don't know why, just a hunch.
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I had a hunch the horse would not respond, he had been working pretty hard and was a chunky type that had never had good feet despite always being very carefully monitored, he previously belonged to my farrier who shod him every 5 weeks without fail, he also suspected there was something going on but he came sound, did plenty more work and in now in a hunting home going great guns, so don't expect the worst. I thought he would be crippled when the shoes came off for xrays but he was not too bad, we did go through remedial shoeing for two sets but went back to normal shoes, barefoot rehab was considered but due to the circumstances not the first option although if he had not responded that would probably be plan b.
 
be positive said:
I had a hunch the horse would not respond, he had been working pretty hard and was a chunky type that had never had good feet despite always being very carefully monitored, he previously belonged to my farrier who shod him every 5 weeks without fail, he also suspected there was something going on but he came sound, did plenty more work and in now in a hunting home going great guns, so don't expect the worst. I thought he would be crippled when the shoes came off for xrays but he was not too bad, we did go through remedial shoeing for two sets but went back to normal shoes, barefoot rehab was considered but due to the circumstances not the first option although if he had not responded that would probably be plan b.
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Ahh it's to difficult isn't it. Wish I had a crystal ball to know what to do for the best and how it will work out. I want to go the bf route with this one and give her some time and light work which I think will give her the best chance of coming right.

I'm hoping for answers this afternoon but from experience I suspect I'll just get more questions and tests.
 
paulineh said:
If you want to go down the BF route and your vet is in agreement and you are insured with the NFU I would look at the Rockley farm website. www.rockleyfarm.co.uk
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Thanks. Have been busy googling :-). Have seen the website and chatted to Nic at rockley. And I floated it to my vet last week so he knows I'm gonna mention it today. He's sent horses to rockley before and nfu have covered costs so I'm hopeful!
 
My mare was 4 tenths lame on a circle she was better after the first nerve block even better after the second and was sound by the time we nerve blocked the back of the knee, so I had x rays done of the foot and they scanned the leg, x rays showed changes in the coffin joint but no navicular, scan showed major tear to ddft in the pastern area just above the hoof at the back of the leg, the vet wanted to mri the foot to see if the tear had gone into the foot so I agreed because I had tried for some time to get the horse sound and just wanted to get to the bottom of it, there was no damage to the ddft in the foot but it did pick up a slight inflamation of the laminae, they also did an mri on the leg higher up to get a better look at the ddft tear and that just confirmed what they had already said after the scan but I got that mri done for free so thought she may as well have it done while she was there.

To be honest the xrays and the scan told us what was wrong so there was really no need for an mri but because this horse had had problems for a while and there was quite a bit going on I went for it, but I think I would only go ahead with an mri if xrays and scans drew a blank if I was in this situation again.

Did the xrays show anything going on in the foot?
 
Bernster said:
Thanks. Have been busy googling :-). Have seen the website and chatted to Nic at rockley. And I floated it to my vet last week so he knows I'm gonna mention it today. He's sent horses to rockley before and nfu have covered costs so I'm hopeful!
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Wonder if we share the same vet, he sent two to my knowledge mine and a friends. Friend's horse when he came back was 1/2 tenth lame when lunged on a tight circle on stony ground but she kept going and he continued to improve. She has since moved out of the area but horse is still going strong about 4 years later. Mine retired for shoulder injury but feet fine.

I had 4 or 5 months before MRI but this was before they installed the MRI at the RVC and then NFU would only cover half the cost so they were possibly more cautious about suggesting it back then (2009)
 
Bernster said:
Thanks. Have been busy googling :-). Have seen the website and chatted to Nic at rockley. And I floated it to my vet last week so he knows I'm gonna mention it today. He's sent horses to rockley before and nfu have covered costs so I'm hopeful!
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Glad to here this. I wished that I had known of Rockley before I spent all the Insurance money other wise my mare would have gone down there.
 
Thanks pb. Interesting to see you are a Herts. bod too.

Nothing showing on X-rays so it's soft tissue damage in that area. That's why I'm not sure what an Mri will do, other than I suppose to give more accurate info on where and how bad, but that may not change the treatment plan really.
 
My horse had to have an MRI last year which diagnosed a tear in her DDFT in the foot (hence not showing on x-rays) - according to the vet, the tear needed debriding or else the chances of her healing properly were less than 30% as the tendon tissues were misaligned and in a bit of a mess. Only an MRI would have told the vets this and he suggested that if treatment had just consisted of the usual rest etc, she wouldn't have come back sound. We're 8 months into our rehab and she's looking really good. I would say it was worth it in my case.
 
Bernster said:
Thanks pb. Interesting to see you are a Herts. bod too.

Nothing showing on X-rays so it's soft tissue damage in that area. That's why I'm not sure what an Mri will do, other than I suppose to give more accurate info on where and how bad, but that may not change the treatment plan really.
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I didnt know you are from Herts:) I used Rossdales Hertfordshire vets so she went to Newmarket to have it all done, my regular Herts vet is based at the hospital now so any problems I just ring him and take mine over to him I really rate him.

In your situation I think you will have to go for the mri as its the only thing that will pick up any soft tissue damage in the foot.
 
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My mare tore her DDFT in two places, I was offered an mri after all the usual lameness work ups, in the end she went to newmarket and was scoped and had it cleaned up for just a little bit more than the cost of an mri scan which in my opinion was money better spent because at least we had something done that would aid healing. Good luck with whatever you choose.
 
Yeah and that's been my concern ginegerarab, lots of money and we would still be into diagnostics, not actual treatment.

But, as expected, it's looking like mri if the insurance will cover it. But I did ask him why etc., and vet said it could change the treatment as there are a few options, although he also said time and light work is often what's needed, together with things like steroids or cartophen or Tilden. So I now wait another week or so for insurance to confirm. Knew there wouldn't be any clear answers today ��

Trotted up the same today, 1/10 on the right, no worse but no better. I know lots of people wouldn't be too bothered about 1/10 on the hard and usually I wouldnt but before the box rest it was worse than that so Im going to be conservative as there is something going on there.

Thx for your input everyone, I feel better about the mri as an option

Ps still does trouble me that vets recommendation differs depending on the insurance route. If she really needs it she'll get it, whether it's covered or not, but def seems to affect the advice being given.
 
MRI is amazing for finding things that other 'normal' diagnostics such as x-ray and ultrasound can miss.

They may miss them because of what they are (eg. bone bruises can only be seen by MRI), where they are (eg. ultrasound cannot pass through the hoof wall) or something else (eg. to see a small fracture, the x-rays need to be lined up with the fracture; if the angle is wrong it can be missed). Having said that, 'normal' diagnostics can give you a full answer in many cases.

The question is, in cases where you and your vet don't have a clear answer, what do you do?

One option is to try rest and painkillers and see what happens. Or you could make a guess as to what the problem is and treat for a specific issue (eg. by therapeutic shoeing). MRI is also an option at this stage.

The disadvantage of MRI is, as we are all aware, that it is expensive (although insurance will usually pay for it). The advantage is that, once your vet has determined the location of the lameness by nerve blocking, MRI has a better than 90% chance of finding the exact issue(s) allowing specific, targeted treatment for the injury or disease that has been identified.

Applying the correct treatment to an identified problem gives the best possible chance of a good outcome.

As to the question of whether MRI affects the treatment, that very much depends on what you were planning to do before the MRI, and what the MRI finds. Even if the news is bad and the problem is career-ending, better to know about it now than after 12, 18, 24 or more months of trying this and that with no success.

My opinion is that lameness is not a time when "ignorance is bliss". It's more a case of "information is power".
 
Thanks Dan B that's a thoughtful post and some good points. Ive been thinking about this, and from the vet perspective, the mri ofc makes sense but they realise that if not insured a lot of people can't afford it even though it would be helpful. so they treat without but they won't be as well informed. Makes sense.
 
Thanks, Bernster.

If you go with the option of treating without a diagnosis, it's a bit of a gamble. You absolutely could get lucky, the horse comes sound quickly with a minimal bill and everyone is, of course, happy. Much of the time a vet will give this option a chnace initially as it makes sense and works in a proportion of cases.

There comes a point, however, when proceeding without a diagnosis is actually going to cost more in the long run. At this point it is better to go for more advanced diagnostics (even though they are more expensive) to stop the haemorrhage of money on 'trial treatments'.

The insurance companies recognise that in complex lameness cases there comes a point where it is more cost-effective to pay to get an answer than it is to continue shooting in the dark for months and months. They pay for MRI because their records show that it saves them money in the long run.

The difficult question to answer is knowing when, for a particular case, is the right time to say "We need an answer". That's where your vet is best placed to provide advice specific to that exact situation.
 
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Having been through this, I would have an MRI again if insured.

The rare cases where surgery is helpful would not be likely without an MRI to indicate it's needed. The operation would be expensive but you would need the MRI to justify it.

The various types of soft tissue damage which is much more likely don't have an expensive treatment option that I could claim so the MRI won't get in the way of this.


The thing is with foot issues is that diagnostics have moved on however treatment options have not. With current remedial farriery and drug therapies, you're still down to about 22% for DDFT and 10% for collateral ligament returning to full work to give a couple of examples from the study below. I'm not convinced we've move on from the days where horse was just turned away for 6 months to see if it came right.

http://onlinelibrary.wiley.com/doi/10.1111/j.2042-3306.2010.00081.x/abstract

Drugs like Catrophen and Adequan are prescribed on the basis that 'they can't do any harm and insurance will pay' but there is no real evidence that they help and even so will not break the bank insurance wise.

So you are back to rest, gentle exercise and helping the horse develop a stronger foot.

I'm not with NFU anymore but £500 used to be the most you can claim for alternative treatment, remedial farriery and things like rehab livery (comes under alternative husbandry in their words) . My current insurer has the same cap so seems quite a common approach. So even taking £1000 out for an MRI isn't going get in the way of this.
 
Thanks Criso. The vet did explain why the mri is helpful and it did make sense to me. That report makes sobering reading though :-(. But I do feel I'm right to assume it will be light work for a while yet (with transition to bf hopefully in there at the right point).nfu are now at 1k for alt husbandry.
 
Think of it as rehab work which sounds more like you've on your way somewhere than light work.

And take photos of her feet. I used to do it without shoes just before shoes went back on and just newly shod so I was always comparing the same point in the cycle. Vet and farrier were sure things were improving but an objective document told the opposite story. Hopefully yours will document improvement.
 
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