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Baffled by lameness

Palmar digital should block navicular bursa, distal sesamoidean, DDFT/DDFT sheath, digital cushion, Corium, palmar 1/3 of the sole, palmar coffin joint, palmar distal phalanx, and of course the skin.

It’s not super specific but it is generally the heel, yes.

Interestingly this horse was overdue for a trim from his usual 5 weeks by 2 weeks when he was done last. It was a scheduling problem too. I strongly suspect the shoes are what got us here but I can’t back that up.

Vet wants to see a wedge or an egg bar, believes that will fix the problem right away, by fixing the NPA.

On x ray sole depth was good:

LF sole depth 18.4mm
LF heel height 15.5mm
LF toe length 40mm
LF break over 21.6mm
LF medial heel 15.9mm
LF lateral heel 21.2mm

So there is a lateral imbalance, too much toe, too-long break over.

The RF is actually worse on the toe length and break over.

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That is tough with the conflicting opinions. I’ve dealt with some difficult to find lameness issues and particularly with the hoof, an MRI is the only way to get a more definitive diagnosis. So, if an MRI is an option, that is the way to get better answers and a better plan. And although the idea of a standing MRI is appealing, when I looked into it, the cost was very similar to a regular MRI, and I was advised that sometimes the standing MRI images aren’t as clear as the ones for which they are under general anesthesia, which can complicate finding something obscure, so I opted for the regular MRI at a university rather than a standing one, and it gave us the answers we needed to know to make a plan. Good luck!

Have you considered trying a Magnawave hoof box to see if there is any improvement or if it can help heal whatever is going on?

Good luck, I hope you find a solution soon.

Absent any change to the positive over the weekend after the farrier on Friday, I’d be inclined to pursue MRI. I would think coffin injections would help in navicular related soreness. Interesting that the right is objectively worse on length and breakover but the left is more compromised WRT horse’s soundness. The MRI would answer right away whether there is soft tissue in the hoof at play.

I don’t love wedges but sometimes they are a necessary evil if used temporarily. I would be careful about them in a horse with sore heels if the root cause is something soft tissue. Last big NPA project I had we used rim pads to lift the sole and short cycles to correct the toe.

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i went through something very similar but the horse didn’t block out in the feet. he was sore in his frogs to hoof testers but that seems to be a baseline for him. We have been correcting over time a negative palmar (the feet don’t always do what we want when we want, but we are finally out of negative territory after almost two years of working at it). It was not the NPA foot that he was off on. He improved with new shoeing jogging straight on the hard ground and then limped hard on a turn under saddle AFTER coffins were done.

turned out to be pedal osteitis in the foot that improved with the shoeing on straight away and a mild bone bruise in the fetlock that caused the soreness on the turn. Before the MRI I was convinced it was DDFT or collateral ligament. i was relieved it was a bone bruise. Bone bruises seem to hurt until they don’t so limited rest doesn’t improve it.

I hope you get answers and the prognosis is good.

I would opt for the MRI but that is due to my horse’s experience. He was barefoot and everyone agreed he had great feet. Until he was suddenly lame. Heel block made him substantially better. XRays showed less than textbook navicular bone. So when paired with lameness the thought was Navicular Syndrome. After some thought I opted for an MRI. There were some imbalances, inflammation, and edema, but the biggest issue appeared to be some fiber disruption in the DDFT near the coffin bone.

We did rest and rehab for the DDFT and he was shod with 2 degree pads to relieve strain on the tendon. He has been sound on this program for over a year following rehab. But if I hadnt had the MRI I would have ridden him sooner and possibly injured him further.

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We have PEMF and have been treating him daily with it.

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He is better today after the shoes were pulled yesterday. Still sore, but yesterday he was lame even on 2g of bute and today he is sound without the front shoe on a 1/2 dosage of naproxen. He was packed with ichthammol last night and again today per my specialist vet’s advice.

I suspect the reason he is worse on the left than on the right is because he has a significantly worse medial-lateral imbalance on the left, and the place he is sore is on the inside heel, which is more than 5mm lower than the outside.

I would have expected coffin injections to show some improvement just due to the betamethasone for soft tissue as well, but he was worse. It should have brought down inflammation, which is why the second vet suspected something mechanical and immediately removed the shoes. That seems to have been the right decision, though of course the medication can help, he is on significantly less than. he was yesterday and is still sounder today.

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I had a horse with a similar lameness in one foot (RF, I believe). It was June/July, she blew an abscess out her coronary band, and then was never 100% sound in that foot (mild lameness, maybe 1-1.5/5, but was significantly worse when turning) for a few weeks. Like your case, there was no obvious heat or swelling and I was worried we were going to be looking at an MRI for something wrong in her foot. However, a heel block made her 100% sound and rads showed NPA on that foot (other foot was fine). We put a wedge on that foot (and a pour-in pad on that foot, if I remember correctly) and she walked away from the farrier sound. In her case, I think it was just a combination of good grass/warm weather/good nutrition caused her foot to grow quickly (even though she was on a 5 week shoeing cycle) and it exacerbated her pre-existing high/low foot conformation to let that toe just get out in front of her.

I continued to use the same farrier but had my vet markup the foot rads with how she wanted the foot done and he was more than happy to follow her directions. The plan was to only use a wedge for 1-2 cycles to encourage heel growth and then transition back to a regular shoe. Unfortunately, she had to be euthanized (for an unrelated reason) before we could complete that transition but had zero lameness issues after putting a wedge on.

I have had a similar case to @mep0726 , but bars sufficed to bring him sound (no wedges). In the interim he was sound most of the time but had probably 2 episodes presenting like the op’s current situation that ended up being very slow brewing small deep abscesses that burst out the heel.

This sounds like DDFT to me. I’m in the camp that would do an MRI next. Are you near me OP? SEPA/NJ? I have a farrier you might consider consulting with if you are.

I am in northwestern Connecticut.

Oh sorry. I thought you were local to me… so scratch that idea.

I suspect that putting on an egg bar and pad would fix the issue RIGHT NOW, but might not allow the hoof to grow properly. I’ve had horses with egg bars that just crushed the heel more (I think that farrier had not idea wtf he was doing). I think how they are set, and keeping them on, is really important if you decide to go that direction.

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My horse’s MRI was done at Fairfield Equine (I am in SE CT. ) I also have an excellent and well regarded farrier if you are looking.

The farrier was out and put a 3 degree leather wedge on with a natural balance shoe (open heel, not a bar shoe)

We jogged the horse when he was done and felt he was worse than before. After some thought, we removed the wedge and reset, the horse was better though still not sound.

Today, he was better but still not sound. He’s on a half dose of naproxen at the moment. He does almost immediately get better after trotting a few steps especially right out of the stall.

Vet doesn’t want to see him unless he’s still lame after a week in shoes. I am stressing severely that it’s already been 3 weeks and we are just wasting time.

Is he on stall rest or does he get turnout? I was wondering if he is turned out is there improvement after moving around some or is it the same.

I hope your horse improves with the shoes on. It is so frustrating to know what to do in these situations.

This sounds so much like the DDFT strain my horse had. Very on/off. Never as bad as you’d expect for that injury and sometimes even seemed sound for a little while. Messing around with shoes and injections etc. changed it some but never solved it. And then I got an MRI— and that was the answer.

How long/what was the protocol you followed for that DDFT strain?

This was many years ago. 8 months of stall rest. The horse went back to full work after that and a slow rehab back. I believe now there are some other adjunct therapies you can try (stem cells!?) but the main therapy is still rest. This happened to my horse around age 10. He went back to work and lived more than a decade before other issues caused his retirement and later his euthanasia. The DDFT strain did heal with just the rest.