Baffled by lameness

[soloudinhere]

I am completely baffled by my current lameness situation and I’m hoping maybe others have some useful info.

Two weeks ago, my horse trotted up slightly lame at the beginning of a lesson. Nothing to suspect that he would be lame, we ended the session and checked the shoe thinking he had a small bruise. It was clearly left front.

He did have a shoe that was pretty tight on the frog. It had been put on five days before this incident. We had the farrier reset it that day.

Next day no change. Had the vet watch him jog and hoof test him. He reacted very slight positive in the heels of both fronts, but the vet felt that it was the horse responding to the pressure in general and that we did not have a problem in the foot. The vet felt he was sound on the jog, but I felt he was still very slightly off from normal.

We have the horse bute and scratched him from a show that we were supposed to go to that weekend (now 10 days ago). I packed the feet that whole weekend and jogged him every day and he was sound.

That Monday, tacked him up, and he was lamer than ever under saddle. Trainer felt it might be saddle fit and claimed his back was spasming but I don’t think I am fully confident in that. Changing saddles made no difference and continues to not make a difference.

Called my specialist vet and made an appointment for last Friday. Horse continued to be lame under saddle all week consistently. Gave him bute until Wednesday so he would be unmedicated for the appointment.

Vet diagnosed mild heel pain and hoof balance x rays show slight negative palmar angles. She graded him 1/5 lame on that left front and 0/5 lame on the left from after palmar digital block.

Based on the positive results of the block, injected the coffin joints in both fronts since the block on the left seemed to indicate some discomfort on the right.

Did the required stall rest, hand walking - today was the first day going for a trot. On manicured, good footing, he was possibly as lame as he has been this entire time. I would grade him 3/5 at a minimum and it’s very clearly still left front.

2g of bute does resolve the situation. Farrier is coming Friday to see what can be done about the shoes.

I’m baffled. Soft tissue should have shown SOME change after 2 weeks of stall rest. Anything in the foot should show pretty significant improvement after the injections if only from the steroid effects. This is getting worse, so I gave him more bute today and decided to bute/ice/rest because at this point I have to treat something. Jogging today he is about 2/5 lame and took a very significant ouchy step turning left.

I can only think of DDFT. Is there something else I could be missing?

The entire time there has been no swelling, heat, anything anywhere in the leg. Today I could maybe have made a case for some slight swelling at the ankle but there’s no heat, no pulse in the feet that I can detect. Maybe some heat in the coronary band but it’s so slight and I could be trying to feel something at this point; the vet detected no such thing on Friday.

I’m stuck with where to go next at this point. Whatever this horse needs he will get but I’m baffled.

[Posting_Trot]

It might be worthwhile to post some photos of the hooves. Given the information you’ve provided (shoe tight to the frog and negative palmar angle), it certainly seems possible that at least some of the problem is related to how the horse is trimmed/shod.

It sounds like a frustrating situation, for sure.

[Simkie]

My swag vote is one of those persnickety pieces of soft tissue that’s within the hoof capsule. They can be a real bear to heal. Diagnosis is an MRI of the foot. Thankfully those are becoming more available and can be done standing.

Can you get some video of him looking very lame to show the vet, since he wasn’t that bad last time she saw him?

[Marla_100]

Agree w/ Posting_Trot- I’d address the negative palmar angle. Poor angles and improper balance can eventually make them sore. I’d start there. Another farrier’s opinion maybe?
Yes, post hoof photos for more ideas.

[punchy]

I haven’t found rest or bute to be particularly helpful once heel pain settles in. Sounds like you need to get the angles fixed, which is going to take some time. Pads may help in the interim with heel pain. I’d stop trying to squeeze any more riding in at this point.

[trubandloki]

@Simkie

My swag vote is one of those persnickety pieces of soft tissue that’s within the hoof capsule. They can be a real bear to heal.

This is my thought too.

[EverElite]

Depending on how long those angles have been negative, the horse may have some all-over body soreness contributing to the lameness.

When standing around in the crossties, does he park his feet his feet under his belly? Horses often compensate their posture to relieve NPA discomfort. Poor posture over time creates soreness, and the cycle continues. Would highly recommend you work in conjunction with a bodyworker and chiropractor until you get the feet sorted out.

[No1]

Navicular bursitis. Easily injectable. Shoeing changes will also help.

MRI is the gold standard in foot imaging, if you continue to have hoof related lameness.

[mlb722]

You can have soft tissue injuries with no heat or swelling. My horse had a core lesion in her SDFT high behind the knee with zero heat and swelling. High suspensories can have no heat or swelling. I’d rule out soft tissue in the lower leg before assuming the foot.

[No1]

It blocked with a PD, so definitely in the foot. Which doesn’t preclude it being soft tissue, of course. But, the only way to determine that with any certainty is an MRI.

[mlb722]

Sorry I missed that! Best of luck, just went through a difficult diagnosis as well.

[soloudinhere]

Just want to clarify the only reason we were riding him was because he was only lame under saddle for part of this, so it was for comparison purposes. He hasn’t trotted for more than two minutes since the day he came up lame the first time.

I’d get pictures of the feet but another vet pulled his shoes today to hoof test him as she felt strongly the shoes were part of the issue, so it’s not really representative of the situation. I do have the hoof x rays I can potentially post which were taken with the shoes on.

The vet today pulled the shoes and felt he was positive on the testers left inside heel, and the angles were way not good. Suggested packing both fronts with animalintex and giving it some time with the shoes removed. She did not feel it was DDFT or suspensory. Farrier coming Friday to fix the overlong toe.

[soloudinhere]

No. He stands and walks normally - head bobbing lame when ridden and now when jogged.

[Marla_100]

Same farrier coming Friday to fix long toes or a new one? I’d be shopping around for a better farrier that can look at a hoof and see dysfunction and imbalance. This problem doesn’t happen overnight but instead happens over several months or years of improper trim before shoes.
It shouldn’t take a vet to point out problems to a competent farrier.
Vent over.

[soloudinhere]

Interestingly, this farrier doesn’t shoe this horse year round. In Florida he is shod by someone else - so this round was the first he’d had done since coming back from Florida first week of April.

He was fine before this trim and had never had an issue in 3 years being done by this pair of farriers, one at home and another in Florida. So if it had been building for months - it was started by someone else.

The person who shoes him in Florida regularly shoes very challenging cases and some of the most valuable race and performance horses in the world, so I would trust his second opinion, but yes, the same farrier who shod him last is coming Friday. I am not sure exactly how we got here but I do not recall thinking there was anything atypical about his shoes until this issue cropped up.

[Marla_100]

I’ve had a discussion with an excellent farrier here and my question about another supposedly excellent farrier’s trim style went something like this:
“How do you explain the obvious difference in trim styles, angles, toe length, between how you trim and the other farrier?”
His answer made sense, he said. “He trims (shoes) for performance and I trim for hoof health.”
In other words, because the other farrier did a lot of expensive race horses, his style of long toes and low heels helped with speed, in their opinion. It did make sense as I’ve thought about this over the years.
Sadly, most horse owners don’t notice the difference until it’s late in the game and dysfunction
causes lameness and damage to internal hoof structures and the damage can move up the leg to other structures.

[beowulf]

Got a video?

If I am following (and I am sorry you and your horse are dealing with this), the palmar blocks resolved at least some of the lameness, and that was the reason for the coffin joint injection on both fronts. But the coffin joint injections have done nothing to resolve lameness.

I wouldn’t discount soft tissue improving after 2 weeks of stall rest if it’s aggravated or even injured and it’s something in the lower leg.

NPA is a PITA to resolve and doesn’t always do so swiftly. They don’t happen overnight, and by the time you see NPA visually on rads those structures have been straining for weeks or months at a time. I usually see a slightly better improvement in way of going for the TBs fresh off the track after the 2nd cycle trim, but it takes weeks for those tight muscles and sore tendons to feel better.

Occam’s razor would be that this is a hoof issue: the tight shoe putting pressure on the frog, the sore heels, and NPA – could be that addressing this all with the farrier will solve the issue in a cycle or three.

If there was only a slight improvement after blocks and injections, my next step would be suspecting collateral ligament strain or navicular burstitis.

You mentioned hoof balance x-rays – have you done navicular-geared shots (removal of shoes)?

I hope you can get some answers ASAP and an easy, uncomplicated road to recovery.

[sorrelfilly721]

@Simkie

My swag vote is one of those persnickety pieces of soft tissue that’s within the hoof capsule. They can be a real bear to heal. Diagnosis is an MRI of the foot. Thankfully those are becoming more available and can be done standing.

I second this. I had a mare with a mystery lameness similar to this. No heat, no swelling, but lame. Ended up being a torn impar ligament inside the hoof.

[soloudinhere]

There was significant improvement with the PD block, though I would not say he was totally 100% sound, he was significantly better like 95%.

I do not like the angle on the feet on the x ray but now I am trying to figure out how we got here because I have total faith in my farrier and have never, ever had an issue - and I really thought that the one who did him in Florida is competent.

I’m confused on how to address it. The horse currently does not have shoes on. The diagnosing vet doesn’t want to see him unless he’s still lame a week after having wedges put on. The second vet cautioned against making any shoeing changes or farrier changes. I don’t know what to do

[beowulf]

Man, I feel for you there. I wouldn’t know what to do either re: two trusted conflicting opinions.

My memory of the range of the palmar block is fuzzy - that’s the heel block, right? That block introduces analgesia to the entire hoof (toe, navicular, heel) and distal ranges of some soft tissue like proximal suspensory?

Were any flexions done, or no since it was assumed possibly hoof/heel related?

Look at me - asking more questions than offering answers. In your shoes, I’m stumped too.

Why does the vet want wedges - to fix NPA? Was the sole depth decent in these rads?

Don’t beat yourself up about how you got here. This type of thing creeps up on us because hoof change is so gradual and can be influenced by trim cycles; can take a cycle or two to really suddenly take a turn for the worse. I’m dealing with NPA in one of mine while the rest of the horses done by this farrier look great. Things were fine and then we had to go a few weeks longer because of some scheduling issues and it seemed like overnight the horse got bullnosed and sore. Still a few cycles out from where we want to be, too.