I am thinking it might be this one after some searching. Please correct me if I am wrong @kaya842
Laser
Interesting. Iām currently getting cold laser therapy with an incredibly similar looking device as part of OT for my incredibly messed up hand, and I think itās part of whatās helping (not that much can; itās more a matter of trying to keep things from getting even worse.)
OP - I went through similar with my horse.
Two baseline ACTH were normal.
I knew something was wrong.
I found out about / asked for the TRH Stim test and the results were positive.
Our problems started last August - seriously bad - which I now know was because of the ACTH seasonal rise
High ACTH is immunosuppressant and catabolic.
Horse started on Pergolide.
I also went ārogueā after his hoof recovered - deciding to follow Rockley Farm protocol for self trimming hooves.
Leaving my horseās hooves alone trim-wise has been fascinating.
If you havenāt - you night want to read on RFās website and blog.
See how horses have become sound self trimming to what their hooves and bodies need.
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We are a year out and finally truly seeing some improvement.
I was frustrated by feeling plateaued in her progress and got a mentorship with a professional trimmer. We tweaked a few very minor aspects of her trim and both ultimately agreed to put her back in shoes with some big huge caveats there. I did not want her on a standard 4-8 week showing cycle as I think it is still too long for her, I did not want nails as I know she is sensitive to the pounding (has been ever since surgery #1), I did not want glue because of studies showing it can inhibit the contraction/ expansion of the hoof which she needs, I did not want casts over the shoes due to the same issue, I wanted frog/ caudal support. So that rules everything out right? Nope! Thanks to easy care she has shoes super glued to her hooves.
They are not overly costly and are easy enough to alter for her needs and for me to apply and remove. She is on her second 2-3 week cycle (supposed to be 2 but life happens and it was more like 2.5weeks) and after removing them to reset I could see she built some good sole depth that we had been missing. I hope she will only need these for a few months then go 100% bare for turnout and then boot for riding as needed but if she needs them longer itās NBD. It also gives me an option that is dressage legal should she ever be able to show again.
The other major change that seems to be largely beneficial is that I tore up the ground around their hay hut and put down several inches to a foot worth of sand. I cannot believe how hard the ground was (it came up in chunks like small boulders) itās no wonder they feel better on the sand. Both horses are standing more comfortably over all and both sets of hooves are improving. It was not cheap and it was not easy but it is SO worth it. They had a bodywork appointment just before we put the sand in and one again this week and the body worker couldnāt stop saying how much better they felt, how little there was to do, and how they felt like new horses since his last visit.
All that said, she is being put into light work (for real this time) as weather allows as we (body worker and I) think that may be the last piece now that her feet and body are feeling so much better.
Some photos of her trim and shoes. The shoes are not super pretty but man they help!
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Iāve looked at the Easy Care fingers before but ended up going with a glue on hoof boot. However, you may be the inspiration to try again. Great job!
Update on miss problem child. She was doing really well in the Versa Grip super glue shoes until about March when she wasnāt. Nothing changed as far as trim/ diet/ turnout/ etc but she started pulling the shoes and got sore and stayed sore.
I reached out to a new vet as the lameness specialist Iāve been using for years no longer does farm calls and she is the one who is unsteady in the trailer (which has not been resolved yet) so taking her to the clinic 1.5 hours away or to the vet hospital 2.5-3 hours away was out of the question. New vet wasnāt able to get her in until early May. We met and went over her background and as Iām going through it all new vet says āWell has she been tested for Cushings? Have you tried Osphos? Also, thereās a stem cell treatment that is showing promise in studies for issues similar to hers, what about that?ā And honestly I could have cried. These were all things Iāve brought up with the myriad of vets that have been involved and all of them dismissed all 3 of those things. They claimed she couldnāt have Cushings as a TB mare with such a thin coat and that Osphos and stem cells were a waste. I did get a cushings test last year after pressing for it and it came back WNL, this year the ACTH was elevated enough for us to start Prascend (I havenāt seen the new numbers - Iām curious if they match last years and the difference is really in the interpretation of the numbers).
We also decided to try the Osphos and stem cells which were done yesterday (5/17) She was put in a different shoeing set up, similar to what sheās been in before but with a few key differences (gluing to the wall only, not the sole, building the wedge with glue on the bottom of the shoe vs between the hoof and shoe, using a split heel shoe vs a solid heel, and covering the heels with a generous amount of DIM before casting). She is much more comfortable already.
We did a lateral of the hinds at her appointment yesterday and they are pretty NPA as well (but have good depth) so we will be wedging them as well. The hope is that she will be comfortable and move more and grow more foot between now and her reset in 6 weeks. We are doing follow up rads in 12 weeks. Iām really hopeful the Osphos and stem cells will give her some comfort and hopefully address whatever is happening internally that is keeping her from growing hoof.
Vet is supposed to be back in a few weeks for coggins and such for my other horse, and when she is I want to see what she thinks about a neck issue being the cause of the RF issues (we all believe the hinds are secondary to the fronts, as is all other soreness) as Iāve read a few stories of horses with neck injuries or arthritis having front hoof issues. Weāve already ruled out any issues with the venogram and there were no boney abnormalities when we started that could have been the initiator.
Edited for formatting and to add radiograph.
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Well we had a nice run where she was super comfortable and even getting back to consistent work and staying sound, but she came up quite lame roughly 2 weeks ago now. Same leg, of course. We had the vet out today but I wasnāt able to meet the vet myself since sheās at a boarding barn and not at home anymore. I havenāt seen the rads myself nor spoken with the vet yet but did speak with my BO who was there. BO was shocked at the rads and said her coffin bone looks like a circular saw blade because itās so jagged around the edges. That has been the key identifier the last 2 times she had bone infections. Iām trying not to get too down until I see the rads myself/ get them to surgeons to confirm but of course we would be going into the weekend with plenty of time to worry. The vet was apparently shocked she had been sound at all (for any length of time) based on the state of her coffin bone. This is a new vet since we moved to a boarding barn.
If she does have another bone infection, this will be it. Sheās 20 now and clearly there is something larger at play that the best vets (all of the vets really) in my area cannot figure out despite the collective best efforts. Life can be a real b!tch. I realized just the other day that Iāve now lived more of my life with this horse than without. Ugh.
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Iām so sorry and hope you get answers to guide next steps.
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Get sent over the rads this morning. This is a new vet with the move to the boarding barn in May so itās her first run with this horse and these issues. Iāve sent the rads off to Mizzou for a second opinion with the surgeons who have done our 2 surgeries, pending a response there. This vet said she does not see an abscess (attributed the gas pockets to the pour ins) or anything overly concerning. She noted long toes and that she would her palmar angle to be higher (at 4 degrees I am thrilled so thereās that). Horse is due for reset a week from today (5 week cycle). Farriers (I have a team of two and love them) believe the gas pockets look like abscesses. Iāve asked if they can make it out prior to our next appointment to pull the shoe and see whatās what, pending response from them too. Good news is she appears to have decent sole depth and good angles for her. SAA test was done Friday and came back at 10 which is partly why this vet is ruling no abscess/ infection. She recommended adding Tylenol to the bute and see if that helps as she agrees the bute isnāt doing much/ enough. She talked about doing Osphos, coffin injections, and supplements all of which weāve tried at one time or another without enough improvement to say āyes X definitely helpedā.
So.
Currently we donāt have a diagnosis, pending second opinion from surgeons, and pending farrier response on when they could come and pull the shoe. If there is no issue to diagnose (saying hypothetically this is just the natural progression and there is no condition or acute issue to treat/ fix), we donāt have a ton of options to increase soundness as a pasture ornament. I am leaning towards believing she isnāt sound enough to be pasture sound - she will move around with the herd but is head bobbing even on bute and I believe her trotting or cantering to be with the herd is more anxiety driven (as in she is worried about being left behind as the weak link). She has gotten more flighty when injured as sheās aged, it seems to make her fairly stressed. We know itās not mechanical as she improves with a nerve block. Neither vet nor I believe sheās a candidate for a neurectomy due to the infection history, and I donāt want to put her through even that surgery.
New rads attached. Blue is gas pockets attributed to pads, red is only area of question per this vet. No idea what the artifact is on the right side of the hoof. Horse is in direct glue ons so there is no glue on the hoof wall. Iām also not sure why it wasnāt retaken but wasnāt there.
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Oh man, Iām so sorry. Those are really ugly rads. The amount of peripheral bone loss is enormous. She definitely has a very long toe, but with her age and that amount of bone loss Iād be hesitant to try and āfixā itā¦
Jingling that you find a simple abscess and it easily resolves.
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Big fat jingles for you and Saphira, Iām so sorry. 
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Jingles!!!
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Given her very long toe it looks like it will take a year of very frequent trims to allow her hooves to grow out and Iām not sure what is going on with the holes in her coffin bone. Sending positive thoughts for good news or at least some reasonable treatment options.
Farriers come tomorrow AM at 10 so we will get the shoe off then and hopefully have a better idea of whatās going on. The surgeons that I sent the X-rays to for consult are out of office this week and next, so Iāve sent the rads to another clinic for consult and hopefully Iāll hear back from them tomorrow as well.
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Farriers pulled pad and shoe and hoof tested all around with the only reaction in the heel. No reaction over the odd looking spots in the rads. They watched her move and we chatted and they surmised that the glue may have created a pressure point over time on her heels. We ended up putting her in a wall attached glue on (Hantons) with a rim wedge pad (shoe also supposedly had 2 degrees but all 3 of us we dubious to that fact). She is due for a fuel reset on 8/26 so we decided to see how she likes the rim pad + wall glue (vs direct/ sole glue) and if it offers any improvement. If she isnāt improved, we are going to try an eggbar with the rim pad.
The lameness specialist also called back for a second opinion consult and wasnāt overly concerned on the rads. He agreed with the farriersā assessment and we discussed doing a coffin joint injection, which he recommended Noltrex for. I didnāt have a chance to call around today to see who else offers it/ pricing, as his clinic is haul in only and is about an hour and a half away but that seems to be on the list of possible treatment as well. We did steroids in April so am not ready to do them again at only 4 months / if they will wear off that quickly.
She was ādiagnosedā with caudal pain back in 2019, at which point we did a rim wedge pad and 30 days of Equioxx which cleared up the issue. I donāt remember her being this lame that time, though she seems better than I was expecting after a few days away from the barn. Sheās still very spirited, galloping back to the herd even with her BFF waiting at the gate for her.
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Fingers crossed that the wall attached gue-ons work, with rim wedge. I have gone a rim wedge on a horse before for caudal heel pain, with good results. Not uncommon for the glue ons to have some pressure points over the heels, that seems to be one of the detractors to that set up.
It has been a few years since I stood in for a coffin joint injection but if I remember the last one I pad for was $350.
It is good she is volunteering to gallop back to her buddies. Fingers crossed for continued good progress forward. I remember her feet when you first posted them - itās been a long journey for you both.
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