Can steroids (specifically Kenalog) cause hoof bruising?

[jcc813]

The saga of trying to get husband’s horse back to 100% continues…

I know sometimes steroids can cause laminitis, but anyone experience other hoof issues following injections?

We had hocks injected in early March. After the rest period, he didn’t appear much better. First day back under saddle, he felt tight in LH. Next day husband found a small, sharp rock that was embedded in the LH frog. There was a little blood when he pulled it out so we assumed that was the issue.

When farrier came 5 weeks post injection, he found bruising on all 4 feet around frog and toes and heel of LH + a small abscess on RH. The appointment before this his feet were perfect. He had primarily been on indoor turnout and only ridden lightly a couple times so the bruising seemed odd.

When he was injected 6 months prior, 3 weeks after the farrier found some separation at the toe and the voids were full of “black gunk” and bruising in the medial toe and abscess in the lateral toe, extending thru the lateral quarter.

Kenalog was used both times and farrier seems to think the feet issues are related, but I haven’t been able to find much info on a correlation. Other vets we’ve worked with seem to favor using betavet but current vet prefers kenalog for certain uses.

During this time horse has been on doxy for Lyme and we recently switched to minocycline. We also started gastroguard a week ago b/c we suspected ulcers (based on vet checking acupuncture points and other behavioral observations).

The week after shoeing and a few days after starting the new meds, he was looking really good on lunge line. But then over the last few days is starting to look stiff and uncomfortable again though not lame per se.

Vet is returning this week and we are considering whether his RF coffin needs to be reinjected as we also did that 6 months ago but not with the latest hock injections. But I’m debating whether I should ask him to use a different drug.

Really at a loss as to what this guy needs…over the last year we’ve done

RF coffin - Renovo, injections + Noltrex
RH - lower hock injections + Noltrex | upper and lower injections
LH - lower hock injections | upper and lower injections
Round of Zycosan in Dec
Daily firocoxib

Farrier also suggested trying Polyglycan but I didn’t want to throw another med into the mix until we see how he does w/ the GG and mino.

[NaturallyHappy]

How old is this horse?

[Simkie]

Laminitis can cause bruising, and steroids can cause laminitis. I’d be pretty hesitant to use any steroid at all in this guy going forward with that change in his feet. Maybe it was just a weird coincidence, but risky if not.

[cayuse]

I also think the bruising could be related to the steroids and like Simkie said, bruising can be caused by laminitis. Before my pony had full blown lami, he had bruising.

[NaturallyHappy]

I agree w @Simkie and @cayuse. I would be very hesitant to use steroids ……

[jcc813]

Hm, well that’s concerning that the vet didn’t seem concerned when I told him about the bruising and what I heard about laminitis.

I did just talk to another farrier who said laminitis from steroids is rare in TBs—more common in quarter horses and WBs. She seemed to think it might be more related to the doxy…

He’s 9 yo.

We did run an ACTH and insulin test last year and both were normal. He’s also fed only senior grain and his pasture is mostly dirt and some scrubby stuff.

He’s had previous injections w betavet and not had issues so I wonder if it is related, maybe it’s specifically the kenalog?

If it was laminitis, shouldn’t we expect his condition to worsen/see obvious lameness?

[jcc813]

Ok I just found this online…

At his shoeing he did take a funny stance like he needed to pee but when they put him in his stall he didn’t do anything. Initially they were thinking this was sign of ulcers bc he had reacted to acupuncture points for that.

We have been checking for heat and pulses and neither has been detected so maybe (hopefully) it was just a more mild case? What does one do if this happens? Ugh…this is like horse issue no. 55 I’ve had to research….

[Simkie]

Laminitis doesn’t always progress. Sometimes they get some inflammation, and it resolves. But you see evidence it happened with the next trim.

From my own experiences with steroid joint injections (in my own body) once I started having systemic effects, they just got worse with every injection. It’s super sucky.

I really wouldn’t go with steroid again here. Next time might be more serious.

[jcc813]

Ugghh. I feel awful that we might’ve caused him more pain.

If it’s not a serious case does it just resolve on its own with time?

What are alternatives if steroids are not an option?

[Simkie]

@jcc813

What are alternatives if steroids are not an option?

You could use hyaluronic acid or any of the biologics.

[NaturallyHappy]

I have seen 3 laminitic horses w no reaction to hoof testers and no pulses…diagnosed w radiographs and mild rotation. All 3 recovered well w appropriate care.

[Amberley]

That’s AI I wouldn’t put too much stock in it, it’s mostly junk answers.

[OzarksRider]

I don’t think this AI generated information is junk. It includes links to the sources, so you can evaluate whether the source is likely to be reliable. But the biggest reason I think this information is correct is because I have a horse prone to laminitis, and he has shown every one of these signs. A very mild attack can present as blood stains in the hoof wall at a trim. Of course that could be caused by stone bruising, but if it’s present in multiple feet it’s a strong indication of a previous laminitic event. Other things you might notice at a trim are a stretched white line or a more prominent ridge starting to show below the coronet band. These are all strong indications of a previous laminitis attack that is now resolving, even if the horse never appeared lame.

One other sign I look for is increased ouchy steps on gravel. My horse normally travels over gravel like a tank in his hoof boots, so if I notice him taking too many ouchy steps, especially in spring and early summer, my laminitis radar is flashing red even if I don’t see any other signs and he doesn’t have any digital pulses.

[jcc813]

When you see signs of a mild attack, are there any specific actions you take or you just wait it out?

How does one confirm it’s laminitis for sure?

[Simkie]

You might treat with nsaids or other meds like pentoxy. You might pull the horse off grass or start soaking hay or pull grain. You might start icing the feet or bed on something different (like sand) or boot the horse. You might radiograph the feet to see if there’s any rotation. I think you could even do a venogram, but not sure that’s really a typical step outside of referral centers and pretty severe cases.

It really just depends on what’s triggered it, and how bad it is.

It’s not terribly uncommon for some bruising or redness to show up in the white line with a trim and the maybe the owner remembers that oh yeah he was a little footy a few weeks ago. If the horse is better, there’s often nothing that needs to be done, although reviewing what exactly was going on and making note is a good idea. Moved to grass? Different feed? Rides on hard ground? Tick fever? Or, like here, steroids? Avoiding those things in the future if possible is probably good.

If the farrier finds something that looks laminitic, and the horse is still sore, then that probably needs some attention from the vet and perhaps some management changes to get the feet happy again.

If this horse isn’t foot sore now, then you’re probably fine. You could have the vet out for rads if you’re concerned. But avoiding steroids for him going forward is probably best.

[Amberley]

@OzarksRider

I don’t think this AI generated information is junk.

It might get a few things right but it’s mostly junk and often wildly incorrect. It pops up on every google search now and quite frankly no educated person capable of doing even basic research for themselves should be using it for anything. Concerning that so many people liked your post to be honest.

[jcc813]

It might get a few things right but it’s mostly junk and often wildly incorrect. It pops up on every google search now and quite frankly no educated person capable of doing even basic research for themselves should be using it for anything. Concerning that so many people liked your post to be honest.

So, in the interest of helping educate, can you point out what is not accurate?

All the AI is doing is aggregating information published on multiple websites–the same thing a person could do manually (the “basic research” you reference) but a lot slower. It’s not just writing stuff from thin air.

Sometimes, yes, the source might need more scrutiny, but as @OzarksRider said, you can see the links next to each piece of information and evaluate if the source is reliable.

[IPEsq]

Have you just done baseline insulin or have you done a sugar challenge test? Kenalog is triamcinolone which we know now causes the worst insulin spikes of any of the steroids commonly used. One of my vets won’t use it at all anymore for joint injections even on horses with no known problems with steroids.

[cayuse]

I’d probably have the vet come out and do some baseline x-rays in case he has another flare up, that way you have something to compare to. And check to see if he is metabolic, I know you said he’s youngish, but if he’s not registered he may be a bit older than you think. Be really careful assessing him for lameness, if he did have a episode of lami and it was mild but bilateral, he may look fairyl sound but still be sore, it can be hard to pinpoint lameness if they are sore on both fronts.

[jcc813]

I don’t think they did the sugar test–at least they didn’t mention anything to me about that. We just fasted.

The results were for ACTH Endogenous, Insulin and Glucose.