Coffin Bone Infection - Possible Round 2

My life partner of a horse (the one in my avatar) was sound barefoot in boots and pads this spring until late June/ early July when she started to get touchy on the right front. I switched up her pads to something thicker which seemed to help for a while. Towards the end of July/ beginning of August she got worse so I took her in to a clinic for an emergency visit (a new to me clinic as the ones I normally use couldn’t fit her in). They did lateral views of all 4, used hoof testers and declared the only issue was thin soles and she needs shoes (along with several “it’s because she’s a thoroughbred” comments…).

Farrier comes out about a week later and we put flip flop pads on. Farrier notes an abscess on the medial side of the hoof is open and draining when applying the shoes. Two weeks go by without improvement, if anything she looks a bit more lame. Farrier comes out again to pull the shoe and see about floating the pad over the toe. When the shoe comes off, we see that the medial abscess is STILL draining (lots of nasty gunk) and there is now a second abscess on the lateral side. She also has some swelling in that same leg. We leave the shoe off, I wrap and pack the abscesses, do some PEMF on her RF and LH (as she is very sore bilaterally by now) and wrap all 4 with BOT. The next morning I rush her to our regular clinic for some more Xrays. Once we remove the hoof wrap at the clinic, we see 2 more abscesses have popped - one in each heel bulb (currently at 4 active spots in one hoof). The vet flushes those and digs a tract for the medial (which is going on 3-4 weeks now) and identifies two on the lateral side. Blood is drawn to test for inflammation markers to rule in/ out cellulitis which came back at 280 with 0-50 being normal. She had the radiographs looked over by the clinics surgeon who stated that they appeared normal. DX is to bute and give SMZs with stall rest and regular wrapping and packing of the hoof and 12 on 12 off of the leg with sweat wraps.

I was able to get a second opinion (roughly - they haven’t yet evaluated the horse, we go in for that Monday) who disagrees with the first surgeon and says there are significant changes and feathering of the bone between the radiographs from 2020 to the ones taken yesterday. They want me to bring her in for more imaging which we will do Monday.

To me, it appears we are headed down the same road we went down in 2016 when she suddenly became lame with an abscess that didn’t improve and was taken in to the second opinion vet above where they identified a bone infection in the coffin bone. She had surgery for debridement and a very long recovery time.

I am upset that vet 1 from early August brushed it off as thin soles and confused and worried that “history is repeating itself” with the same bizarre issue in the same foot. The surgeon at the second opinion clinic voiced a concern about that as well (will this be a continual thing? Why does it keep happening?). I appreciate any jingles, advice, commiseration. Radiographs below for those who are interested - should be current, 2020, side by side comparisons with the blue circles on the current xrays highlighting areas I am concerned about.

So barefoot and thin soles could have contributed to the pedal osteitis. But why all the abscesses and infection? Both @Peggy and I had neck horses who had propensity for concussion based foot problems. I think something like that could be a reason for “why always this foot?” I think the proprioceptive abnormality can be extremely mild to the point they look sound. Or perhaps it is a compensation posture versus a gait deficit.

I knew another TB who had BAD neck xrays but was sound for many years. Yet he always had front foot issues and shifting lamenesses and such and periodic abscesses that I don’t think you could really blame on “TB feet” all the time—he came off the track at 3 and had good farrier care.

Kind of out there, but just a thought to look at her neck.

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Such an interesting perspective I would have never thought of, thank you. Did treatment of the neck issues (assuming injections?) resolve or relieve the foot problems?

For me, it seemed to for a while. And then with changes to farrier care also he grew enough sole for 3 horses! But he also in a short period of time developed side bone. And then shortly before he died for unrelated reasons had navicular changes and DDFT damage in both fronts although the “good” foot was the more lame (maybe because we had done Tildren and stem cells etc for the “bad” one—which also looked worse on MRI and confirmed on dissection post mortem). I felt like his neck was very well maintained by this point. But with the right front he had an acute tendon injury in pasture, then after that healed, had pedal osteitis, and then it wound up with the worse of the now low DDFT and navicular surface remodeling. He was only 9 when he passed.

I think Peggy had to put her horse down at a young age after various injuries, but I’ll let her confirm.

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OP I’m sorry you and your horse are going through this! I have no advice but was intrigued by @IPEsq post. I also had a horse with neck issues and terrible front feet. Club foot, pedal osteitis and side bone.

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OP, sorry that you are going through this. It is so frustrating and heartbreaking.

I have had two neck horses, plus one non-neck horse with weird foot issues.

Star tripped a lot from the time he was started. We thought he was a klutz. When he was 9 (2008) he had a high suspensory injury; when he still wasn’t sound once the ultrasound showed the suspensory was healed, we went looking for something else and found collateral ligament damage in the foot. During that visit the vet noted that a history of abscesses that don’t present quite like a typical abscess is not unusual in horses that have collateral ligament damage. Rehabbed and all good for several years when it recurred several months after he broke his jaw. That time I had the whole horse scanned during the scintigraphy and we found the neck. There was transposition between parts of two vertebrae (C6 and 7?). Mark Martinelli said he wasn’t neurologic, but that a packet of information occasionally didn’t make it down the spinal column correctly, causing a transient loss of proprioception, resulting in him putting a foot down harder. Over time, that damaged the collateral ligaments. Twice. I never got him fully back in work after that. He was sound, but the stumbling was worse: it would get better after neck injections but then worsen.

The broken jaw? He broke it struggling to get free after getting it stuck on a chain used to keep him inside his stall. In retrospect I feel that he damaged his neck during the struggle to get free or during the prep or recovery from the jaw wiring surgery.

Skipper turned out to have a pretty horrible neck, even at a young age. While I think the neck was the driving force for some of his issues that recurred (high suspensory or check ligament damage, stifle damage) I think that his feet issues (pedal osteitis) were a separate issue. I have wondered if he could have compensated for one of the two things. Strangely he never stumbled. The vet said that the neck looked more like something traumatic had happened but at least one of his relatives had the same sort of thing and a number of his relatives had neck issues as well as lameness issues that young horses should not have. I had him euthanized shortly after his 7th birthday. At that point I think the neurologic issues were causing him to be a bit paranoid and overreactive, either because he felt vulnerable or because there was some sort of pain or tingling.

Current horse had a quarter crack, then a check ligament strain, and then a return of the quarter crack that culminated in a strange piece of tissue that emerged the sole of his foot. This was all LF. Everything seemed fine after that until his RF stepped on a rock at a show causing some combination of damage–DDFT, collateral ligament, bone bruise. Rehabbed fine and then it got re-injured. That time it didn’t rehab fine. Turned him out without shoes for six months, got his feet balanced better, figured out he had EMS which was probably exacerbating inflammation (in feet and elsewhere) and making it harder to heal soft tissue. Horse now in canter phase of rehab.

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Oh wow Peggy, that is quite a lot to go through as an owner. I’m glad to hear your current horse is on the road to recovery! I definitely will be mentioning the neck correlation to the hospital surgeons tomorrow and see what they think. I also have concerns that the coffin bone isn’t the only injury/ issue due to the severity of resistant swelling (no improvement from sweat wraps or since starting the antiobiotics).

Yuck, I’m sorry that sounds horrible. No real thoughts here. Hope she’s feeling better soon.

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My neck horse never stumbled. Except once when I tried riding him in SMB type boots up front. He stumbled several times and then got mad and threw a tantrum. I had usually done nothing or polos. Following tendon injury, vet suggested boots for rehab. Took off boots, got back on, and he was fine. I could longe or turn out no problem in boots but not ride. Otherwise he was quite sure-footed. He had a very thorough neuro workup. He had a slight gait deficit (intermittent lameness) that popped up just before we injected the neck the first time, but that went away never to return. Any other lameness he had up front was due to something in the lower limb. But he must have had pain from his neck because injections did help on a yearly then 6 month basis with his overall behavior. You could see effusion on the joints on ultrasound.

But there were several signs that his good quality feet did not handle concussion well. And while he was a very light, smooth mover, I just could not figure out any other reason for him to have had so many issues due to loading type stresses.

The other horse I mentioned was quite clumsy well before he became clearly neurologic. He had the transposition at c6-7 on one side and the other side had a piece totally missing. By the time he was neurologic, he had arthritis at all other joints from c3-4 to T1.

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I don’t believe there is a connection between bad feet and cervical arthritis. I do firmly – after living it myself – think that very bad trim jobs can hasten the arrival and symptoms of CA. (Side note: a prominent symptom of CA is often forelimb lameness)

On COTH alone, we have a lot of people who are unfortunately dealing with CA in their horses… and when they post full body pictures, the horses are always the same in their feet. Long toe, underrun heel, horribly NPA.

I went through this with my first OTTB. I’ll spare the saga – but I saw firsthand how a bad trim could make him suddenly so much worse - including abscesses, which he never got in all those riding years I had with him. I put him to sleep and not a day goes by where I wish I knew then what I knew now – looking at pictures of him taken a few months before his death, I can see how badly his trim job deteriorated in the last two months of his life, and sometimes it makes me wonder if I had a better farrier or if I knew what a good trim job looked like then, if he would still be around today. He gave me 15 beautifully healthy years and taught so many people how to event - and he never a single issue until his last few months.

All that to say, OP, that if you think the CA or neck issues are worth investigating, don’t forget to seriously look at the angles and shape of the feet. We trust farriers to be good at their job, but the older I get, the more and more I realize that many – including those in my area – are the direct cause of several unsoundness issues and soft-tissue injuries in their own clients.

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Oh Beowolf, yes all of that! With this horse, at this point, it’s a chicken vs egg situation. After her surgery 6 years ago we have STRUGGLED every day since with terribly thin soles, extremely underrun feet and low heels. Even with over a year of “remedial” shoeing there has been very little change. I got fed up in April with paying so much for that farrier and not seeing any progress (we were doing Eponas, DIM, glue to make edges, casting tape every 6 weeks) so I took over myself and saw what I thought was good progress until she became lame. Photo below of her progression from when I took over in April to late June/ early July. I didn’t know much (anything) about hoof alignment/ balance or other health besides thrush and abscesses but can’t fully remember what her hooves looked like prior to the surgery. I do know she was sound in regular steel shoes for several years before the surgery and isn’t / hasn’t been sound without pads since.

Wanted to add that should we go down the surgery route again tomorrow/ this week I will be refusing the hospital plate and going with hoof boots as the hospital plate was awful last time and really wrecked her feet for a while.

I agree with your last statement Beowolf about Farrier’s causing unknown harm. It is quite shocking how many poorly trimmed horses I see around where the owners sing the farriers praises. This is why I had been doing my own trimming and even tried casting on shoes before breaking down and calling out a farrier (couldn’t get the casted shoes to stay on longer than a few days, Im sure it was operator error but still frustrating).

That’s some good progress. I’d like to see more heel growth but considering where she was before that’s pretty impressive.
If she’s still struggling with some growth after this, I really recommend the easyshoes with equilox glue. They seem to cause the soles to grow tremendously and the heel bulb to open up.

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This is what drives me absolutely crazy, and why I have no tolerance for lousy farriers/trimmers. You made GREAT progress, and your wording makes it sound like you had little to no experience in trimming?

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I’m getting so mad about how few people hve access to good farriers!!! Why is it so hard!!!

Wow. That is incredible progress – that first picture is borderline hoof sabotage and is exactly what I mean when I say so many farriers truly have no idea how to trim… and sadly, many owners don’t recognize a pathologically unhealthy trim until they experience it themselves (btdt!). Your horse doesn’t have thin soles because she’s a TB. She has thin soles because the farrier allowed her toe to get incredibly long and her heels collapsed and ran forward as the hoof capsule stretched beyond what is natural or comfortable for the horse.

With hooves it is often a very long process. You aren’t just fixing the feet. You are remodeling the entire body, which has been gradually adjusting and accommodating to postural changes to compensate for the pain of their feet. There’s a lot of soft tissue and muscle that will be unlearning the compensation, and that takes a long time and can be a painful process in of itself. Many horses with feet that bad (in the first picture) are bilaterally lame to the point where they can almost look sound, and they will often stand posturally under themselves in a pain stance that can be unmistakable once you learn to recognize it. It will also come – sometimes – with difficulty keeping muscle tone, topline or weight.

I would go with the second vet. I am not a vet either but I do see the feathering and changes they referred to. A horse that had a trim job like your first picture, there’s no way there wasn’t remodeling going on under the surface.

I would ask vet#2 for farrier suggestions. I imagine all the soundness issues you are dealing with are hoof related. Healthy feet shouldn’t – and rarely do – get abscesses. Repeated abscesses and infections in the hoof are, IMHO, a symptom of a pathologically unhealthy hoof.

See if you can find any old pictures pre-surgery, sometimes that can help you on your hoof journey. If you are considering continuing to learn how to trim, ABC Hoof Care on FB may be worth investigating. Many owners there that have gone through the exact same journey as you, with lots of helpful advice and know-how.

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I am not an expert at all but I second this… I remember my chiro once showing me that soreness in certain acupuncture pressure points in the neck correspond to front feet problems. I think it’s just a chicken/egg question…

Sorry you’re dealing with this!!! But great job on that trim!

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There are some points in the brachocephalicus muscle (the one that can be over-muscled in an upside down neck) that can correlate to front foot pain. Of course, many acupuncture points can also be hot if there is local pain. But it would make sense to brace the underside of the neck in an effort to avoid loading a front foot normally. Just so happens that some of these points are nearish C5 where the spine becomes more palpable. But there are a couple up high near the throatlatch as well.

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It’s been a long, long day. More radiographs confirmed my initial findings / concerns - yes there is bone infection resulting in bone loss. They identified inflammation in the tendons in the LF as well (brain is fried and don’t remember which tendons but “both” is what comes to mind). This infection is much worse/ more aggressive than our last go round meaning two surgical sites instead of one (one medial and one lateral) and antibiotic provisions which weren’t necessary last time.

We did ultimately decide to go with surgery for debridement and full treatment with profusions over the course of 7-10 days. We will know more during and after surgery according to both surgeons - they will be able to see how much bone is infected and if any bone has died that we couldn’t identify on rads. There are several concerns but neither surgeon had much to say other than she is clearly a unique case which complicates everything. Concerns about support limb laminitis, that we may fail to thicken her soles and that as such the cycle will perpetuate, and concerns that the RF hoof or rest of the leg may not hold up during rehab.

We are going all in as above with the surgery and antibiotics and have already put her in “Ultimates” shoes (will have to find an example of them later) which they have used with success on other horses to grow soles (predominately laminitis/ founder cases). Hopefully surgery goes well and we can get down to business with rehab. Currently looking to see what I can do to support her during rehab (alternative therapies, nutrition, physical therapy exercises).

Interestingly, her venogram was mostly normal save one small spot where the previous surgery was. The vets say she presents like a sinker but isn’t according to rads and they have no idea why she is struggling so much to grow sole. We believe the thin soles are a symptom of something else we can’t yet identify but also the cause of the infections/ abscesses spiraling out of control.

I would guess that you’re just not far enough along in the rehab yet. You’re doing a great job with the trimming, but maybe she hasn’t grown enough hoof with a new tighter connection yet. You just don’t get decent sole until you get more concavity, and you don’t get the concavity until the stronger white line connection has grown down far enough that it starts to be able to hold the suspension of the coffin bone in the hoof at the new angle. This happens when the new growth gets to about half way down the toe wall. Are you at that stage yet?

Judging by the timing (April to now) you’re probably right at the 5 month mark where you will have about half a hoof’s worth of new growth. Obviously you won’t see miracles overnight, but I think you’ve only just reached the point where you will start to see the positive effects on the sole/concavity etc. Hang in there. I think expecting much change to the sole before this point would be really optimistic. It just takes time.

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