Weak stifle/taking off hind shoes

Gnildron

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Hi everyone, looking for feedback on my horse, who has some issues.

He's a 9YO TB, I've had him since he was 5. He always moved skew, throwing his quarters to the right. Over the years, he began refusing jumps and later being very unhappy walking down hills. I kept him at a yard on a steep hill for the first four years, and while I did have some saddle fit issues and some concerns about his feet (he was shod on all four) I recently got the vet in who diagnosed him with atrophied muscles around his right stifle. She injected him with HA and at about the same time I moved him from the hilly hard to a flat yard with better footing—an ideal place for shoe removal, which my vet had recommended for his hind feet to encourage the feet to find their own balance and make the limb lighter for the stifle. Oh, and she xrayed the stifle and it showed nothing—although she could not rule out soft tissue pathologies.

Now, in the new yard, the shoes have been removed two weeks, and I'm worried. He's wearing the weak hind different to the other one, which I worry could destabilise the compromised stifle. He seems generally a bit unsettled and has lost some weight. There is some girthiness. Ulcers are obviously a concern, he's on ulcer prevention supplements but with all the changes I've made that may not be enough. My question is: should I perservere with barefoot behind? Does anyone have experience of taking off hind shoes on a horse with a weak stifle? I asked many farriers, they said it can go two ways with stifles - either they get better or worse when you remove the shoe. Generally, his stance looks better. But he's lost some weight since the move, which is normal I think, but obvoiusly also something that could be related to gut health.

On his foot wear, the outside of the compromised hind hoof is wearing faster than the inside, creating a bit of a 'turn in' (his conformation is upright and when he's been sore in the past and tense he tends to stand like a ballet dancer, so it's opposite to the old pattern, but that might not be good??). The farrier said he'd pop through today to just even out the toe so it's not uneven, but I also know there are people who say leave the feet to find their own balance as the horse might 'grow the foot he needs'.

On work, he's on a rehab programme from the stifle diagnosis, with the aim of strengthening him, so he's not jumping or doing anything hectic. Lots of walking and pole work, and straightness work.

If anyone has advice, thoughts, experiences to share about stifles and back shoes (and ulcers/moving/weightloss in relation to it), please do share? Happy to answer further questions. What would be the red flags while I adopt a 'wait and see' approach? It's so difficult to know what is related to what, with the move, the shoes, the new routine and care etc.
 
This may not be relevant but when my horse had a stifle injury (tear to medial meniscus) she had been unshod behind for a couple of months and the vet advised turn her away for a year and have hind shoes put back on for support as she was still shod in front. She came sound after 18 months of field rest.
 
I know you are in South Africa from your intro, so please pardon my ignorance of your situation. Are you able to get the stifle scanned at all? Even ultrasound might tell you something but I would want x rays as a minimum if he was mine.
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Dohhhh, just been told I missed that x ray already done, sorry.
 
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I know you are in South Africa from your intro, so please pardon my ignorance of your situation. Are you able to get the stifle scanned at all? Even ultrasound might tell you something but I would want x rays as a minimum if he was mine.
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the OP did say the stifle has been x-rayed which didn’t show anything, but i agree id want to ultrasound it!
 
the OP did say the stifle has been x-rayed which didn’t show anything, but i agree id want to ultrasound it!


Sorry I missed that, my brain must be scrambled. Yes, , I think i would want the soft tissue scanned now, too.

Turnout on a hill should really have strengthen it up, so something must be going on there.
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We are doing stifle rehab at the minute too. My vet suggested rehab before x-rays or scanning as she thinks our issue is also primarily muscle weakness and scans were unlikely to give us much information. My mare didn't have shoes on in the first place so I can't really help you there but the movement pattern in the hind end and the landing in the back feet is changing fairly quickly so I am seeing changes in the wear pattern also. In our case, the whole body movement is better so I am not particularly worried if one foot goes a bit wonk in the meantime.

ETA: If you haven't had a physio out as well, I would recommend it. We had a lot of lower back stiffness from compensatory movements and a massage/ adjustment to free up the lower back made a big difference. We also got a programme of stretches for the core and lower back and side tail pulls to "activate" the quadriceps before polework and walking. I really notice a difference when we do or don't do that prep beforehand.
 
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This may not be relevant but when my horse had a stifle injury (tear to medial meniscus) she had been unshod behind for a couple of months and the vet advised turn her away for a year and have hind shoes put back on for support as she was still shod in front. She came sound after 18 months of field rest.
Thanks for your reply! How did they diagnose the meniscus tear? Ultrasound/arthroscopy? My vet did say the next step was soft tissue scanning if I was up for it, but as all these things are never fully covered by insurance down here we usually start by trying something and seeing, then if things don't get better move to the next diagnostic step.
 
We are doing stifle rehab at the minute too. My vet suggested rehab before x-rays or scanning as she thinks our issue is also primarily muscle weakness and scans were unlikely to give us much information. My mare didn't have shoes on in the first place so I can't really help you there but the movement pattern in the hind end and the landing in the back feet is changing fairly quickly so I am seeing changes in the wear pattern also. In our case, the whole body movement is better so I am not particularly worried if one foot goes a bit wonk in the meantime.

ETA: If you haven't had a physio out as well, I would recommend it. We had a lot of lower back stiffness from compensatory movements and a massage/ adjustment to free up the lower back made a big difference. We also got a programme of stretches for the core and lower back and side tail pulls to "activate" the quadriceps before polework and walking. I really notice a difference when we do or don't do that prep beforehand.
My physio came out two days after the back shoes came off, he was so sour she struggled to get a good treatment going (he has a cow kick when uncomfortable). I have a red light photizo and do a lot of bodywork on him and it does seem to improve things, also walk in hand over poles and other loosening/strengthening groundwork. I do think getting a handle on the muscles in his hind end is key, so thank you for reaffirming that. I've done tail pulls, but never before riding so I will try that!!! Any other exercises, do share!
 
Thanks for your reply! How did they diagnose the meniscus tear? Ultrasound/arthroscopy? My vet did say the next step was soft tissue scanning if I was up for it, but as all these things are never fully covered by insurance down here we usually start by trying something and seeing, then if things don't get better move to the next diagnostic step.
not the person who commented by my mare had a medial meniscus tear, which was diagnosed via ultrasound - if you’re interested pm me and i can find the invoices for the price! vet did say he could do the arthroscopy but we both agreed it was pointless in my scenario as rehab and treatment was the same regardless of the outcome of it
 
Thanks for your reply! How did they diagnose the meniscus tear? Ultrasound/arthroscopy? My vet did say the next step was soft tissue scanning if I was up for it, but as all these things are never fully covered by insurance down here we usually start by trying something and seeing, then if things don't get better move to the next diagnostic step.

A friend's horse's meniscus tear was diagnosed by ultrasound but it depends where the tear is whether they can see it, I think.
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Sorry I missed that, my brain must be scrambled. Yes, , I think i would want the soft tissue scanned now, too.

Turnout on a hill should really have strengthen it up, so something must be going on there.
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Yeah, it's kind of weird because you'd think he'd get strong on a hill. But I think it was just too steep - hardly any flat ground. Since moving to the flat his whole posture has changed and he's let himself 'down'. Back muscles are soft, not bunched. That said, the stifle was only symptomatic - we didn't find any pathology on xray. It could be that there is something else that resulted in a movement pattern that atrophied the stifle/hip muscle area on the right. Hoping time on the flat will help clear the picture a bit... side note, I had his feet xrayed a few years back, his back feet were near negative and that could also have been an issue traveling up the hind end I guess? We tried to get that under control with farriery but I'm not sure how successfully. Also xrayed his back for kissing spine, that was clean as a whistle but no wonder because of the camped under/tucked pelvis way he was standing...
 
This may not be relevant but when my horse had a stifle injury (tear to medial meniscus) she had been unshod behind for a couple of months and the vet advised turn her away for a year and have hind shoes put back on for support as she was still shod in front. She came sound after 18 months of field rest.
How severe was the injury? What were the symptoms? Lameness score, if you know? My horse was never unsound enough to not ride, although he was likely masking pain in his movement patterns (but it took people years to see and confirm what I was feeling...).
 
My physio came out two days after the back shoes came off, he was so sour she struggled to get a good treatment going (he has a cow kick when uncomfortable). I have a red light photizo and do a lot of bodywork on him and it does seem to improve things, also walk in hand over poles and other loosening/strengthening groundwork. I do think getting a handle on the muscles in his hind end is key, so thank you for reaffirming that. I've done tail pulls, but never before riding so I will try that!!! Any other exercises, do share!
Tail pulls to the side have been the most obviously helpful. With the leg being worked stepped slightly forward, square and slightly behind for targeting it fully, do a couple and build up as my mare did find it difficult to start with. Belly lifts and butt tucks for the core and back, but these also difficult if they have never done them and puts you in quite a vulnerable position if your horse might kick. I am also not a physio so pinch of salt, obviously.

Our work plan sounds similar to yours. Lots of in hand poles and slow hill work. We are working our way up to in hand lateral stuff for adduction/abduction so if you are focusing on straight-line work at the minute that might not be appropriate for right now.
 
Did you get hind feet x-rayed?

My little pony's way of going suddenly made a lot of sense when we got the x-rays, but she needs shoes to keep her comfortable because she slams down the outside of her hind feet. Bone structure means that will never change but at least making her comfortable meant the issues higher up went away.
 
Did you get hind feet x-rayed?

My little pony's way of going suddenly made a lot of sense when we got the x-rays, but she needs shoes to keep her comfortable because she slams down the outside of her hind feet. Bone structure means that will never change but at least making her comfortable meant the issues higher up went away.
I have had side on xrays done a couple of years ago but not head on. Which angle were your xrays that gave you the insight?
 
I have had side on xrays done a couple of years ago but not head on. Which angle were your xrays that gave you the insight?
here you go. Basically the bones look straight but the hoof most definitely isn't. Not saying yours will be as odd as this (you'd see it in the feet) but hoof problems can lead to body problems & vice versa. If "normal" stifle strengthening isn't working then sometimes you have to go looking somewhere else
 

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Yikes! So what did this problem make your horse do? Short stride on that hind? Skew movement? Hopping behind?
Nope! She just felt a bit "off" after a minor fall in the field so went to the vets for a work up. They had covid restrictions in place and ignored my "be pragmatic " instructions by spending a fortune on x-rays and scans. A full set of hoof x rays showed quirky bones all round.

Her hind shoes have lateral extensions on now and she hammers them to razor fine in 6 weeks. By putting them on its stopped that pressure on her frog and been hugely beneficial to her way of going. All round she's a much happier pony - always assumed to be a grumpy mare. She isn't when she isn't sore.

I'm now a bit evangelical about hoof x rays!
 
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