Vets can't figure out lameness - what to do next?

sammiero

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Hi everyone. My horse has been lame since the start of august and the veterinarians can't figure out why she is lame. The problem is in the left front leg, she clearly bobs her head up when left fore is put down and the head goes down when right fore is put down. This is only in trot, she is sound in walk.

The story is quite long and complicated but I'll try to take it from the beginning:
In early august she got new shoes and the same day I had a lesson. In that lesson my trainer pointed out she was lame. I didn't feel a severe lameness but I felt she was quite resistant to move forward so we ended the lesson. We thought it may be the shoeing but she was not warm or had a high pulse so we let her rest for a couple of days while waiting for the farrier. The farrier came and didn't find anything wrong with her hooves, so I had our home vet out. I lunged her for him on a soft ground and she was 0,5/5 lame. Then lunged on hard ground and she was 3/5 lame so very obvious. The vet didn't have time to do nerve block so we took her to the clinic where they have everything.

At the clinic we started of lunging and she was 1/5 lame on soft ground and 3/5 lame on hard ground when left fore was the inside leg and 1,5/5 lame when left fore was the outside leg. When trotted on a straight line on hard surface she is sound. The next thing we did was a flexion test. She was sound when flexing the right fore and sound flexing shoulder and upper limb on left fore, but 0,5/5 lame when flexing fetlock and lower limb on left fore. So we started doing nerve blocks. Nerve block in fetlock made no change, nerve blocks in hoof made no change. He then nerve blocked the whole foot from a little under the knee and she showed improvement, but she was not sound. Then he also nerve blocked the whole right foot from a litte under the knee and she came up sound on soft surface and almost sound on hard surface in the lunge. We then took x rays off both front feets from under the knee to the hoof and they were perfect. Then we also took ultrasound on both front feets from under the knee and down and they were also perfect. The vets discussed and recommended next move to be a MRI.

A MRI were booked and was going to take pictures from right under the knee down to the middle of the long pastern bone. The MRI results came back and shows absolutely nothing. By the MRI results were back it had been over a month since we first discovered the lameness and she had under this time only been standing in her stall and going out in a small paddock. I checked her in the lunge from time to time and could not see any improvement at all. The vet at the clinic pointed out she had a bit long toe and her heels were a bit low, but he didn't think that would make her that lame. Because of that we thought why not change the farrier and see if it helps. The new farrier comes and finds out she has a thick false sole on both front feet and some bad thrush. The back feet were also shod uneven. He cleaned up the hooves and gave me something to get rid of the thrush and told me to keep her feet dry and clean.

The day after the farrier gave her new shoes I thought why not see her in the lunge again. To my surprise she came up sound in the lunge og soft surface and was much better on the hard surface. The day after my home vet came for another reason and I asked if she could just see her in the lunge for a second. The vet said she was sound on soft surface and 1/5 on hard surface, so a big improvement. Called the clinic and told them the good news and we came to the agreement that I should start ride her again and in a month do a new checkup. I keep riding her and she gets better and better. I also lunge her once a week to see if she improves. And she does improve. 1 week after the home vet was there she is much better in the lunge on soft and hard surface, 2 weeks after she is even better and 3 weeks after she is completely sound on soft surface and 99% sound on hard surface. I was thrilled and start upping the training. It doesn't go so well. When I start to put her more together to do the harder stuff in dressage she is lame again. Sound when ridden on long reines but lame when I try to collect. I am devastated and don't know what to do now. In the videos I can't see any lameness if I only look at leg legs, they all have the same striding, but when you look at the horse she obviously bobs her head and look dead lame. The only thing I think I see is that she sometimes land toe first. And that's something I think I've seen since the beginning of the lameness. She also do not put left fore down as hard as right fore, it has a slightly lower sound when you listen to her walk on asphalt.

She's going back to the clinic next week, but the vets don't know what do to. So I feel like I have come up with all these theories for the vet to turn down after what fits or not. I don't think it is in the shoulder? But maybe heel pain? In the beginning before the new farrier came she had trouble walking a tight turn to the left and especially on hard surface. Now after getting new shoes I feel like she turns good both ways. And something tells me it's in the heels since it all started right after she got shoed and immediately got better after getting new shoes, but that doesn't add up with here not reacting to nerve block in the hooves?

If you made it this far I really appreciate it and I am so sorry it became this long. But we have done a lot so it's a lot of information :eek:
 

Xmas lucky

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Has she seen a physio my horse pulled a muscle in her back and caused her to be lame on both back legs. Vets couldn’t find anything it turned out she just pulled a few muscles in her back.
 

Gloi

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Is she now landing heel first?
Is all the thrush definitely gone, can you poke you hoofpick firmly in the cleft of frog without her flinching.
I'll get in here first and ask if you can post hoof pics from the side and of the sole ?
 

ycbm

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Have I misunderstood? If the horse was blocking to the foot why was the MRI of the top half of the cannon bone? "He then nerve blocked the whole foot from a little under the knee". Did you mean the whole leg?

Irrespective of the nerve blocks, since there was a marked improvement after farriery changes and you have seen a toe first landing then I would expect the vet to suggest MRI of the foot.

If the horse was mine I would remove the shoes and do a barefoot rehab.
.
 

Goldenstar

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She needs to have the vet check her for back pain and and SI pain .
I have seen PSD behind present as mild lameness in front but I would have expected the horse too lame behind when you blocked the front leg .
I think I would either get an MRI of the foot and pastern fetlock or go for a full work up before decided what to do next .
I think you are right to have addressed the shoes IME there’s no foot imperfection to small to cause issues in some horses .
If you asked me to guess I would say there’s soft tissue damage in the foot .
 

ycbm

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The problem is in the left front leg, she clearly bobs her head up when left fore is put down and the head goes down when right fore is put down.


GS's post has reminded me that I meant to ask if you were sure the horse is sound behind. An upward bob of the head instead of a downwards nod would normally make me suspicious of lameness on the diagonally opposite hind leg to the front leg that you think the horse is lame on.

I agree with GS that it could well be worth looking at the hind end too.
.
 

Lady Jane

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I'm confused - have you MRI'd the feet? It sounds like you did further up (didn't know you could do under standing sedation but maybe you had GA?). It certainly sounds like feet MRI is the next stage.
 

sammiero

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Sorry if I was unclear, it was a lot to write down. I'll try to answer the questions the best I can!

Has she seen a physio my horse pulled a muscle in her back and caused her to be lame on both back legs. Vets couldn’t find anything it turned out she just pulled a few muscles in her back.
Yes, she has been seen by a physio.

Is she now landing heel first?
Is all the thrush definitely gone, can you poke you hoofpick firmly in the cleft of frog without her flinching.
I'll get in here first and ask if you can post hoof pics from the side and of the sole ?
I think the thrush is gone. She does not flinch when I poke around under her hoof.
245649677_415592536625456_4589290214194465644_n.jpg
Here is from under her hoof. Don't have pictures from the side, sorry

Have I misunderstood? If the horse was blocking to the foot why was the MRI of the top half of the cannon bone? "He then nerve blocked the whole foot from a little under the knee". Did you mean the whole leg?

Irrespective of the nerve blocks, since there was a marked improvement after farriery changes and you have seen a toe first landing then I would expect the vet to suggest MRI of the foot.

If the horse was mine I would remove the shoes and do a barefoot rehab.
.
She was blocked in the coffin bone and low palmar without any improvement, therefore was the hoof ruled out as source for the lameness. The MRI was taken of marked area in picture:
245871901_4384507384978466_2922360283194914243_n.jpg
 

ycbm

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Sorry if I was unclear, it was a lot to write down. I'll try to answer the questions the best I can!


Yes, she has been seen by a physio.


I think the thrush is gone. She does not flinch when I poke around under her hoof.
View attachment 81239
Here is from under her hoof. Don't have pictures from the side, sorry


She was blocked in the coffin bone and low palmar without any improvement, therefore was the hoof ruled out as source for the lameness. The MRI was taken of marked area in picture:
View attachment 81243

Are you sure your x rays showed no lateral imbalance? I ask because the bar on the right of that photo looks as if it extends right up the frog and is thick and it doesn’t appear to be present on the left. Thick extended bars like that, in my experience, are "bracing" for a weak foot. But you have bracing on only one side, which says to me that foot is not balanced laterally.

It would be really interesting to see the x rays if you have them.
.
 

sammiero

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Are you sure your x rays showed no lateral imbalance? I ask because the bar on the right of that photo looks as if it extends right up the frog and is thick and it doesn’t appear to be present on the left. Thick extended bars like that, in my experience, are "bracing" for a weak foot. But you have bracing on only one side, which says to me that foot is not balanced laterally.

It would be really interesting to see the x rays if you have them.
.
Do not have the x rays unfortunately. But the x rays has been seen by 3 vets and no one has pointed out anything one the x rays. Everyone has said they look perfect. I attach some more photos of her hooves:
Left front:
245716809_461408735193535_8090722007299249692_n.jpg
245807763_4550639604972222_7964567112346531378_n.jpg
Right front:
246038421_879421766100929_3706945082105563252_n.jpg
Does it look unbalanced in these pictures, and compared to right hoof?
 

ycbm

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Yes I'm afraid so. Terribly contracted at the heel, hence the inverted V in the hair line at the back. Longer, though the photo is chopped, on the right than the left by the look of it. Very stacked, long high heel but also underrun. The great news about this is if you can take off the shoes and let the feet balance you've got a good chance the lameness will disappear in time.
.
 

Goldenstar

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Sometimes thrush is just something environmental, but thrush is sometimes the first thing you see when you about to see some serious trouble if this where my horse that’s something I would be very worried about .
If she where mine I would be giving her a shoeing break and I would be getting her suspensories branches ultra sound scanned .
You need to get someone really good to trim her feet .
 

sammiero

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Yes I'm afraid so. Terribly contracted at the heel, hence the inverted V in the hair line at the back. Longer, though the photo is chopped, on the right than the left by the look of it. Very stacked, long high heel but also underrun. The great news about this is if you can take off the shoes and let the feet balance you've got a good chance the lameness will disappear in time.
.
Do you know of any good articles about this? Interested in learning more!
 

Equi

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Yeah I dont like that shoe - either the farriers not doing a great job or your horse is making the shoe that way. As others have said I would take them off (knowing it’s going to probably take a very long time to get the hooves right) as the shoe may be masking the actual issue.
 

sammiero

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Yeah I dont like that shoe - either the farriers not doing a great job or your horse is making the shoe that way. As others have said I would take them off (knowing it’s going to probably take a very long time to get the hooves right) as the shoe may be masking the actual issue.
Out of curiosity, what do you not like with the shoe? Just changed farrier after 5 years with the last. The new one is hopefully trying to fix this. He said when shoeing her for the first time that the hooves weren't the prettiest, but reluctant to go any deeper into it
 

ester

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It is hard to judge a farrier on a job they've only just started sometimes, something that comes up often is that if you don't know what they had to start with it's not always fair to declare it not a good job.
I do note that she has quite a lot of bar material there which is often compensatory. Given what you've done so far I think I'd be reluctant to spend more on diagnostics unless you had such a time limit on your insurance that taking shoes off and chucking the horse out for the winter wasn't viable either. There's definitely plenty of hoof improvement to be done, so although it didn't block to the hoof it does of course have repercussions higher up too. Especially as the nerve blocks indicate she is struggling with both fronts.
 

sammiero

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I see most of you are saying it is best to take of her shoes and turn her out for the winter. Unfortunately I don't think that is an option here where I live. But either way it must be possible to fix with shoes? She was really lame but when the new farrier came she got better and better and eventually became sound in the lunge. She is only lame when I try to do collected work, not lame when riding on loose reins or when being lunged on hard or soft surface. With that much improvement after just 1 shoeing I feel like it does not take a long time before she is completely sound again?
 

sammiero

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Thanks for all replies, I really appreciate it. I have now 3 things I want to ask the vets to take a closer look at: Her hooves, back and right hind leg.

The “only lame when I try to do collected work” suggests neck/ back to me. There are definitely front foot problems, but this could be a result of or causing other issues higher up. I’m not sure only addressing the feet will do it.
I have clean neck x rays of her. Thinking about taking some back x rays of her at the clinic, and if those are good I guess we can rule out back problems?
 

angel7

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Are these pictures from the new farriers shoes or the old ones?
I agree with others as above, needs shoes off to allow the heels to relax and wear down the excess height. The frogs need stimulation to function better and change the terrible hairline at the heels.
If horse only going from field to stable to arena you should be able to cope without shoes and look at some boots if its stony.
 

McGrools

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The “only lame when I try to do collected work” suggests neck/ back to me. There are definitely front foot problems, but this could be a result of or causing other issues higher up. I’m not sure only addressing the feet will do it.


I have a mare who is bridle lame in collected work but fine on a loose rein.turns out she has arthritic changes in the facet joints of her spine. Hard to spot on xray. Our vets just had some new powerful xray equipment literally on the day she was in the clinic and it was picked up. She had some steroid injections in her back to keep her comfy and now just hacks and does fun rides. I no longer school her. Xx
 

sammiero

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Are these pictures from the new farriers shoes or the old ones?
I agree with others as above, needs shoes off to allow the heels to relax and wear down the excess height. The frogs need stimulation to function better and change the terrible hairline at the heels.
If horse only going from field to stable to arena you should be able to cope without shoes and look at some boots if its stony.
From the new farrier. They are much better now with the new farrier so you can imagine how bad they were before. Really long toe and low heel.
"terrible hairline at the heels.": You mean the crack that almost goes up to the hairline. How du you fix that? I guess it just needs time to grow until there is no longer a crack?
 
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