Abscess or trauma? Hoof mystery

[Mareish]

One of my horses has a mysterious hoof injury that appeared 10 days ago. Photos here in chronological order (how it first appeared to present after yesterday’s ride covered in silver spray, plus rads). Vets and farrier do not think it is an abscess but we don’t have a great alternative theory either, and we’re struggling with next steps without knowing exactly what it is.

Two days prior to the injury, his LF fetlock and pastern was puffy and very hot. He was actually off and sensitive to hoof testers on his RF, not LF - we believe now from compensating. We were cold hosing and wrapping the LF and packing his RF hoof. The night prior, I tucked him in with standing wraps on – there were no cuts or injuries. On his walk out to turnout in the morning, the groom suddenly saw a lot of blood coming from his coronary band on his LF. Presumably, he would have seen an injury while removing standing wraps immediately prior to walking him out to his paddock. There was no blood in the shavings and no obvious disruptions to his stall (from kicking, casting, etc).

At that point he was quite lame on the LF – not surprising given what it looked like. The RF has not been an issue since. He got progressively sounder over the next few days and is currently sound. I have ridden him very lightly a few times over the past few days per vet instructions and he stayed sound. However, the wound still occasionally drains a clear smelly liquid and also occasionally bleeds, including after riding yesterday. His fetlock also remains a bit filled on the LF but is no longer hot and goes down with movement. The wound is very sensitive to the touch, and we have been trying to manage the granulation tissue using topicals including topical dex. He has been on antibiotics for 10 days.

Given that it is not healing how my vet would have expected, we did rads today and there is a tract that can be seen but my vet isn’t sure what it is (could be tunnel, could be dirt, can’t rule out foreign body like wood?). Rads are included in the photo folder above. My vet is currently recommending keeping it dry, silver spray, turnout, no riding, and no more wrapping, and just continuing to monitor. She is also going to discuss shoeing changes for more support with the farrier.

Questions: have you seen an abscess that looks like this before? Any recommendations for treatment? Or would you suspect a foreign body and opt for an MRI?

My personal theory is abscess but two vets and a farrier all think that it is not looking and behaving like one and are inclined to think trauma (spontaneously while in a stall overnight?). I would like to avoid an MRI if I can, and he is sound, but very interested in everyone’s thoughts!

[Scribbler]

I would suspect a foreign body like a tiny stick or straw jammed up there. Astabdard hoof abscess that burst would close up sooner.

[IPEsq]

Agree maybe foreign body. That’s more blood than I’d expect from an abscess.

[Mareish]

Does anyone have experience with foreign bodies working their way out on their own? My vet is not urgently pushing an MRI at this point and comfortable waiting to see if it starts healing and/or if something can work its way out…? Any input would be helpful!

[MsM]

Did he suggest flushing it?

[hybriseris]

Personally I would be uncomfortable with a “wait and see” approach if other visual diagnostics are possible in your situation. If there’s a foreign body, gravity isn’t really on your side with the tract going downwards in to the hoof. Something may work its way out, or it may cause further issues. The bleeding and smelly fluid feels to me like his body is trying to expel something, though of course it could simply be a self-cleansing process. If you have the option and ability to get a more comprehensive image of the hoof through MRI - or even more ideally, CT - I think it would certainly give you a better idea of what you’re working with.

[PamnReba]

I would try to numb it up and then see if you can dig anything out - or at least flush the hell out of it like @MsM suggested. Looks like a foreign body to me, and I wouldn’t wait for it to try and work its way out.

[Alex_and_Bodie_s_Mom]

I agree, hoof injuries are not ‘wait and see’ things. Too much can go wrong.

That said - Alex bursts abscesses through the coronet band all the time. Currently growing out the last one, from 6 months ago. But they are not as extensive as what I see in your photos. When he does, his symptoms are exactly what you describe - heat in the hoof and leg, swelling in the fetlock and lower leg, noticeable lameness (almost 3-legged lame). No matter how I pack it, it invariably goes up, not down.

I would definitely want more diagnostics, now. If there’s a foreign body, it may not work itself out. It might even continue to fester, and start involving bone structure. I don’t think I would ride this horse right now until I knew exactly what we were dealing with. If it’s still painful and draining, something is going on.

[lenapesadie]

My horse has blown a couple abscesses through his coronet but nit the magnitude of your pictures. Just dime size flaps with a hole behind it.

[Mareish]

Thanks for all the opinions! To be clear, the vet is monitoring it nearly everyday – we’re not doing benign neglect with this

The vet flushed it previously (before the rads that still show … something … in the tract/tunnel). It is now healing well where it was previously draining/bleeding, though, so she does not want to reopen. We are focusing now on getting the part towards the heel which has not oozed but is a higher motion area to try to close up. If it does not heal, we will move forward with the MRI – currently scheduled 2+ weeks from now, as soon as we could get in.

Leave it to my horse puncture (??) himself in a clean stall overnight while in standing wraps!