Ongoing niggly lameness- WWYD?

[kirstie]

Hi, sorry for the very long post. My horse has had a niggling lameness and I'm just not sure what my next step should be. I have had her for coming up 7 years and apart from one severe abcess over 4 years ago she's never had a lame step. 17h 11yr old trakehner. Slow to develop dressage horse just coming really good.

She first went lame on 30th October, left fore, about 2/10 after reportedly hoolying around in the field. Got vet out after 2 weeks when she was still not right after 2 weeks box rest. She had slight swelling of the left fetlock on the inside. Slight positive reaction to flexion test on that leg. Slightly lame on circle on soft and concrete both ways but not consistent. Worse going slightly uphill in straight line that downhill on concrete. No more than 1/10 lame inconsistently- so some strides sound. She was not lame enough to nerve block. He said he thought it was soft tissue strain in the fetlock joint, just needs time and rest- rest her until she comes sound and then gradually bring her back into work in a controlled way. Rested for 2-3 weeks, came sound. Started walking in hand. Few explosions on the yard (despite sedalin) and probably too much obsessive trotting up and she then went not quite right again in the beginning of December.

Decided to completely box rest her while I was on holiday over xmas, so she had about 3.5 weeks complete box rest. Trotted up on Jan 3rd completely sound. Gradually started walking her in hand and built it up, started riding and built the walk up over about 2.5 weeks until she bucked me off. She just exploded despite sedalin and draw reins, I had no hope. Still sound.

I cannot risk falling off badly, I broke my back 4 years ago from being bronced off a youngster. It's not a risk I'm willing to take again. Decided to let her explode in the arena and go from there.

Started free schooling, gently lunging and riding gently for short periods. She was in work for 5 weeks in total (inc the walking) no problem (apart from falling off) and was sound.

Against my better judgement I decided to turn her back out into the field. Turned out on 8th Feb and 9th Feb for 3 hrs each day. No major explosions, though it is muddy around the gate. 9th Feb PM trotted up lame. Vet booked for 13th Feb.

Rested from 9th-12th and trotted up on 12th Feb much better. Vet cancelled.

15th Feb pretty much sound. 18th Feb sound. 9th-18th Feb box rested totally. 19th Feb, 5 min walk, progressed to 15 mins by 22nd and then I went on holiday. She went on the walker most days I was away for approx 20-30 mins a day.

Got back on 1st March and she was not right when trotted up, vet booked. Box rested until 5th March when Vet came up. Less than 1/10 lame every 5-6 strides uphill concrete. Downhill sound. Circle soft sound. Circle hard sound. Told to bring back into full work as not lame ever so slightly unlevel and nothing really to see. Vet thought still soft tissue issue niggling on though pretty much better.

Has been free schooled every day since, walk, trot and canter. Some explosions but generally calm- just a chance for her to kick her heels up if she needs to. Ridden most days or put on the walker for 30 mins, so exercised 2x a day.

Started gradual trot under saddle on 12th March and building up very slowly.

Not right last night, a more consistent lameness. Probably 2/10 lame. Probably lame enough to nerve block. Trotted up this morning better, probably 1/10 ish every stride. Not lame enough to nerve block and see a difference.

My gut is saying 2 different things. I know with this type of injury the free schooling will not be helping. She is genuinely not safe to ride or lead out without it though. Even sedated. She is big and explosive at the best of times. I could possible walk rehab her via a lunge line in walk in the arena though.

I've tried to phone my vet and see what he thinks but no answer so will try again.

I'm just interested to see what other people would do in my situation.

Properly rest and try again in a controlled way? Ask for X-rays and poss MRI? Or something else? I'm tearing my hair out!

Sorry for the absolute essay- thanks so much if you've got this far!!

 

[ILuvCowparsely]

no help here but my horse has been on off lame since 2013

 

[mega spoilt ponies]

Sounds a bit 'naviculary' to me, esp the fact that she is not sound uphill (more pressure on heels)

I would go for mri, but thats based purely on personal experience with similar symptoms

 

[JillA]

I have a big horse who was 1/10th lame in front, retired from eventing and not resolved after three years in the field or on light work, suspected DJD after starting hard work too young (he is a big coarse boned WB). Two months on turmeric + micronized linseed+ pepper and he is sound. Worth trying if you suspect it is an inflammatory condition and you have nowhere other than retirement to go.

 

[be positive]

1/10th lame is enough to block and see a difference, I had one done that was even less than 1/10 th you could barely see anything but when blocked you could see he moved more comfortably in general, if you are going to get the vet out keep doing as much as you can to show her at her worst, I think it has been going on too long without a diagnosis, total box rest may not be helping, if it was a minor soft tissue injury it should not keep reoccurring.
If you are going to MRI you need to know where the problem is as it only does a tiny area, so worth blocking, xraying and if it is above the foot scanning before sending her in, or send her somewhere for a full assessment so they can do the lot.

 

[Pinkvboots]

I agree 1/10th lame is enough to do nerve blocks and after all this time I would want them done, it sounds like its soft tissue and its repairing itself then going again I had a mare that had exactly the same, I would get it sorted as there is a lot they can do for soft tissue but not if it has scar tissue in the area this then llimits treatment.

 

[glenruby]

Depends, some will say 1/10 is not enough but after this time I would be blocking regardless as if you can see it on the straight and on the lunge both reins and there is a positive flexion test then it is blockable IMO. I would say though, if there was a swelling to the inside of the inside of the fetlock you probably are talking about soft tissue injury and suspensory branch would be high on my list. Id be starting with a Palmar digital block and then going for a medial only abaxial sesamoid to start with. May need to rest for unto 24hrs and then start more localised blocks. I would be looking for radiographs and/or ultrasound once nerve blocks have isolated the region.
However, personally I would be sending her into the vet clinic to get the work up done in one session (as much as is possible) as it has been dragged out enough (not necessarily anyones fault).

 

[kirstie]

Thanks for the replies.

 

[kirstie]

Oops, silly phone.

I have booked for the vet to come on Thursday- I agree that although there may be not much to see on the face of it, a nerve block may still make a difference. Last time he saw her she was less than 1/10 lame every 5 strides or so.

He pretty much ruled out navicular due to the symptoms she has been displaying.

This evening I went up there and trotted her up straight from her box. She was sound- I couldn't believe it. I then gently free schooled for 10 mins and then trotted up on the concrete again. It was like a different horse was trotting- noticeably lame. Something definitely not right and I have something to show the vet now.

I just hope whatever it is is fixable. I adore this horse- she's my horse of a life time and I've waited so long for her to physically and mentally mature. She is very high maintenance and would not do well living out retired and is certainly not a happy hacker. Everything crossed.

 

[kirstie]

Depends, some will say 1/10 is not enough but after this time I would be blocking regardless as if you can see it on the straight and on the lunge both reins and there is a positive flexion test then it is blockable IMO. I would say though, if there was a swelling to the inside of the inside of the fetlock you probably are talking about soft tissue injury and suspensory branch would be high on my list. Id be starting with a Palmar digital block and then going for a medial only abaxial sesamoid to start with. May need to rest for unto 24hrs and then start more localised blocks. I would be looking for radiographs and/or ultrasound once nerve blocks have isolated the region.
However, personally I would be sending her into the vet clinic to get the work up done in one session (as much as is possible) as it has been dragged out enough (not necessarily anyones fault).

Thanks for this, very interesting. The slight positve flexion was in November. 2 weeks ago there was no difference after flexion and less than 1/10 every 5 strides or so. There has been no swelling since December.

I'm definitely going to get this investigated now. Will have him up on Thursday and probably look to get her to the RVC, AHT or Rossdales.

I'm grateful for the opinions- just confirmation in my head that it really does need to be looked into.

 

[cellie]

I have a big horse who was 1/10th lame in front, retired from eventing and not resolved after three years in the field or on light work, suspected DJD after starting hard work too young (he is a big coarse boned WB). Two months on turmeric + micronized linseed+ pepper and he is sound. Worth trying if you suspect it is an inflammatory condition and you have nowhere other than retirement to go.

sorry to hijack post but I have similar lameness issues and diagnosis is navicular . I've had X-rays. Mines only showing lameness ridden . He's had osphos but I've bought turmeric to try but unsure how much to use and quantity of pepper ? He has linseed anyway in his feed .