Stubborn hoof abscess (potentially)

[Mopa25]

3 weeks ago now my horse came in hopping lame. I called my vet out straight away who prescribed bute & box rest with a view to follow up after a week with nerve blocks and x rays. Well, by the Saturday he would not weight bear at all so I called the vet back out and she x rayed (no nerve blocks due his CPL and the skin being too thick to get the needles in) - the X Rays were all clear so we started treating as a potential abscess even though there were no signs of one or any gas tracts on the x rays, the vet had a dig and found nothing, we just thought it was a sneaky one. I turned him back out and poulticed & hot tubbed all that week, still with bute and also antibiotics (ive since read very conflicting things about using both when it comes to abscesses!). Still nothing. But did have a couple of days where he walked ever so slightly better and even trotted to me twice. Last week I had the farrier out to see if he could do a better dig around to find it, again, nothing but he also was convinced an abscess and told me to carry out hot tubbing/poulticing. We're now just starting week 4 of this and he's back to non weight bearing!! I stopped the bute as it wasnt doing anything anyway and his poo's looked a bit off so was worried it was doing more harm than good. I just want to know if there's anything else i can do? Has the bute and antibiotics delayed things coming to a head?
TBH the thought of it being an abscess has kept me going as I did say if we couldn't work out what was causing his lameness, I'd PTS. but now im wondering how long i continue for? he is okay in himself. still eating/drinking etc; Just hate seeing him so uncomfortable.

 

[Pearlsacarolsinger]

I would ask for a Cushings test. Whe my mare gad a abscess that rumbled on she tested positive and it resolved when she was on Prascend

 

[Mopa25]

I would ask for a Cushings test. Whe my mare gad a abscess that rumbled on she tested positive and it resolved when she was on Prascend

That's not a bad idea tbf. My other horse has Cushings but has never shown any clinical signs (was diagnosed before I got her after a bout of lami) so might be worth checking. How long did it take to resolve once you started the Prascend?

 

[SEL]

I'm going to flag @SpotsandBays who has been dealing with the abscess from hell for months. Her horse did have to go to hospital for further investigations as the x-ray wasn't good enough to identify if there was a foreign body in the foot.

 

[Mopa25]

I'm going to flag @SpotsandBays who has been dealing with the abscess from hell for months. Her horse did have to go to hospital for further investigations as the x-ray wasn't good enough to identify if there was a foreign body in the foot.

This is what worries me. Ive already been told hospital/MRI will be well over £1000+ (ive already spent that just in the first week) and I dont have any confidence in the insurance paying out so Im a bit stuck in that regard.

 

[ihatework]

It’s sounds like one of those tricky situations.

Yes it could still be an abscess for sure, I had one a few years ago that I was convinced was an abscess (vet was less convinced!) and did turn out to be one. Annoyingly there was nowhere to be found to dig it and it ended up coming out of the coronet and completely beggering up the foot.

That said it could be something else completely unrelated. Given nothing obvious on X-ray it would be a soft tissue injury most likely. In that case if you want an answer it’s MRI time or you manage it symptomatically.

I suppose it’s about how lame the horse is and how unhappy. I’d be inclined to discuss pain management options with your vet for short term management, see if any access materialises and if not then you need to make a longer term call

 

[Sanversera]

Sounds very much like my heavy weight cob last winter. Vet thought it was a soft tissue injury. After about six weeks he became sounder but not totally. Turned out it was a deep seated abcess. It did come out but took an age. Its the second one like this he'd had.

 

[Pearlsacarolsinger]

That's not a bad idea tbf. My other horse has Cushings but has never shown any clinical signs (was diagnosed before I got her after a bout of lami) so might be worth checking. How long did it take to resolve once you started the Prascend?

I can't quite remember, sorry but I know it was a short enough time to be sure that it was Prascend that made the difference. The vet had put her on bute prior to that but she was still.in pain.

 

[SpotsandBays]

Ugh so I’ve been through similar recently although an odd presentation… buckle up - it’s a long one!

My 20yo gelding presented with a bump on his coronet band and intermittent lameness initially. It looked like it was about to burst so I left it alone but nothing seemed to be happening. Farrier came and didn’t dig as couldn’t see anything on the foot (other than the coronet bump) that looked suspicious.

Called the vet as the lameness was getting worse and said to give it everything I’ve got for two weeks so I was poulticing twice daily, hot tubbing etc for 2 weeks - nothing. We’d also started him on Bute which initially didn’t do much.

Vets came out again and blocked, xrayed, ultrasounded and stabbed it with a needle. Xray showed a sort of shadow and mentioned sidebone but didn’t think that was causing the issue. Scan showed what they believed to be multiple tracks and little pockets within said bump but nothing came out when trying to draw with a needle. Vets were a bit stumped but mentioned MRI and opening it up. He’s not insured and at 20 I was NOT keen on having him put under a GA unless I had to so we started antibiotics and less frequent poulticing/tubbing as the foot was getting a bit gross from all of the moisture. (I still had him turned out at this point with a boot on). They mentioned the possibility of PTS if we couldn’t get on top of it.

Rescanned 10 days later as no improvement to his comfort levels and no visible changes. Surgeon did the scan and thought there was something in there. Gave me the option of scan and surgery or PTS. Kept him in and got him booked into horspital the following week for a CT (cheaper than MRI) with the plan that they would open it up…

By the time he’d got to hospital he’d been on antibiotics for over 2 weeks and literally the day before I took him he seemed to be more comfortable. CT scan confirmed no foreign body and because the lameness had improved they decided not to open it up yet (tricky location which no one was keen to open). Scans however did show the sidebone more clearly, inflammation around that area and also inflammation of the lateral collateral ligament. They do believe there was an abscess initially however at that point they think the antibiotics had helped to clear it. I’m still not exactly sure what the cause is, whether it was the side bone, an injury or just a combo of everything.

Sent him home with 2 more weeks of antibiotics and strict box rest with no active walking. He has continued to improve and whilst we’ve still got a funny bump it’s much smaller, less angry looking, and he’s much more comfortable. We finished the antibiotics, had two more weeks of strict box rest and have just over a week ago started to turn him out for a few hours a day in a small pen.

It’s been a long road and we’re still on it but that’s where we are now. I know others would have opted for PTS but he was dragging me around the yard to pull at grass even when he was at his worst in terms of lameness so I just couldn’t imagine it being his time yet. The thought of surgery under GA was terrifying and also very risky from what they were saying, just due to the location but I just had to give him that shot because other than this has a very well horse if you know what I mean.

Sorry for the brain dump, it’s been a long couple of months

 

[Birker2020]

I had the same with Lari, my non ridden boy. Vet thought it was an abscess same as you despite no tracts on foot xray. Possible remodelling issues on coffin joint (DIJ) were seen on xray but vet was not convinced this was the cause of the foot pointing, she did speculate soft tissue injury in the foot but MRI cost is a no no.

He also displayed on/off lameness. Worse on tight circle on one rein. Treated for abscess twice, if not three times but to no avail. Hooves got very overgrown (was being trimmed 3-4 weekly at retirement) but then when i brought him him home went two months on recommendation of new farrier so he came and trimmed on my request. He found two bruises on one foot and a deep seated bruise on the problematic foot. He's on a 4 -5 week trimming cycle now. They've already overgrown again and are splitting and we're only in week 4!

Has been on 2 bute/30 paracetamol which is now down to one bute and no paracetamol. Anything under one bute and he starts to point his toe again and look 'footy'. You can see it when he's been stood in one spot for a while and walks on.

I'm getting his coffin joints medicated in the next few weeks and he's having fronts on Friday. He's been much better since it's rained which to me points to coffin joint/bruised foot.

Did your farrier not find any evidence of bruising in the foot? The ground has been so hard through April/May.

And were there any signs of changes on your horses xrays, coffin joint or navicular? Did the vet suggest it might be a soft tissue injury? It's a bummer about the nerve block. I can't believe a CPL horse can't be nerve blocked but freely admit I don't know much about CPL.

If you're worried about giving bute (I personally don't and never have) then ask your vet about giving him paracetamol. Go with someone else shopping and you can buy 4 packs between you in each shop. We did that and went in six shops down one High Street!

I wouldn't rule out its an abscess but I'd start looking at other possibilities now.

N.B All the vet practices by us give bute with abscesses although paracetamol is becoming more popular. You can leave an animal in pain I guess is the reasoning.

Good luck.