Experience with pastern joint infection?

[AusEventer]

What was the prognosis?

I found my yearling filly on 3 legs two days ago and had vet out. It was soon apparent we were in joint or tendon sheath territory (acute lameness, fever). There was only a slight amount of swelling, however her reaction when I touched her pastern indicated it was very, very sore.

Anyway, she had the pastern joint tapped for a fluid sample and it was definitely consistent with infection. She has now had two regional perfusions (one yesterday and one this morning) with broad spectrum antibiotics (as of course, this occurred late on a Friday, so we won’t have lab results for the culture til sometime Monday at best). She has not had bute since the first night in hospital and apparently is already looking sounder after one treatment, so fingers crossed things are going in the right direction. As she’s been a good patient, all procedures have been done standing and not required GA.

Has anyone else treated a joint infection like this and had a good outcome? Because we caught it early, I am hoping we have a better chance. I am aware though, that pasterns can be tricky. I am hoping she will recover to full soundness, but if an athletic career isn’t possible and she’s paddock sound, she will have a home here in my broodmare band.

It’s all been a stress out as I have not experienced a joint infection before. Am aware this is going to be an expensive treatment all up…

[CHT]

I had a horse with a severe joint infection, all from a tiny little nick on her pastern. She went from fine, to horrific in hours. We spent the money and had the surgery or whatever it is they do, but were warned she may never be competition sound. Unfortunately she developed gastric issues from the antibiotics and did not recover.

( This was not helped by the fact the clinic - on call vet thought I was being overly dramatic when I said she was not her normal self upon return, and I was too naïve to call a different clinic. By the time we got a vet out that took me seriously, and actually started treating her gastric issues it was too late.)

This is probably not a common problem, but please make sure to discuss with your vet the risks of the antibiotics your horse is on and how to limit their side effects. It sounds like your horse was not in as bad a way as mine, so hopefully the damage is less severe. Good luck and best wishes she recovers fantastically.

[AusEventer]

Thanks for sharing your experience. I will ask my vet. She is at an equine specialist clinic so I am hoping they will be monitoring gastric issues. I will ask, once she hopefully can come home, if there’s anything I should be doing re: gastric complications due to ABs.

[Bluey]

This was about 20 years ago.
Bought a horse far away, neighbor went to pick him up and, being closer to vet clinic than I was, kept him overnight.
Next morning vet exam we do on all new horses was at 10, went to get horse.
He was fine when fed, at this time was three legged, small puncture wound on ankle and suspected into tendon sheath, we never could find where he got it.
At the vet they were worried he was so lame, took x-rays and cultured from the puncture, all was ok, decided to keep him for observation and start antibiotics

Horse did develop a raging infection from a rare bacteria.
Lower leg was perfused on and off for six weeks, horse was in bad pain even with painkillers.
We went continuously to hand graze, but he was pretty lame and barely would walk.
Vets were continuously in consultation with TX A+M vets, tried everything sensible.
After six weeks he was put down, the infection was too severe.

Now today they can do wonders and every horse and every injury is different.
Your horse may do fine, keep fingers crossed.

[Janet]

I had a similar bad outcome with an infected hock joint. But that was 40 years ago and vet med has improved considerably snce then.

[NancyM]

Joint infections can go either way. Good luck!
I had one in a young filly out in the pasture. Vet said “blood borne” infection. Lots of antibiotics, and she had a broodmare career.
I had a mare caught up in a fence this past summer. I didn’t find it right away. Badly cut up on the pastern. Very deep. Lots of antibiotics, flushing and pain management. I don’t know if the joint was involved, if it wasn’t, it was pretty close. No vet service here for this sort of thing. She’s fine now, apparently sound. She’s only a pasture ornament at the best of times, but things are looking way better than I ever thought they would.

[Lusoluv]

I have 2 friends that have had pastern joint infections with their horses. 7 years ago: horse was 4 and he was treated with ABx and joint flushes, meds, etc. on and off for about 2 months. He’d had a mystery puncture in pastern area. He had good days and bad days, but the decision was to euthanize after continued pain and unresolved lameness. Last summer, another friend had a 20 year old WB who’s joint became infected after a scheduled maintenance steroidal joint injection. He was still very fit and in moderate dressage work. Mild lameness starting about 6 days after the injection, back and forth regarding treatment and on/off severe lameness. Finally took to university vet hospital and inability to get infection to resolve or reduce pain & lameness. Euthanized on the third day at the hospital. This was about 3-4 weeks after the original joint injection.

[AusEventer]

Hmm, the number of bad outcomes is making me a bit nervous. Each scenario is so different.

It would seem the outcomes are likely to be worse the longer it takes to identify there is a joint infection.

I’m hoping like heck that as this filly was treated aggressively as soon as the severe lameness appeared, that she has a fighting chance. I know there’s no guarantees though.

Vet believes it is a blood borne infection as there’s no wound at all.

Have not heard anything from vet today, so hoping that no news is good news….(it’s now early afternoon here).

[Texarkana]

These things are really touch and go.

But, if you want words of encouragement, I had a horse survive the open fracture/coffin joint/tendon sheath/bone infection from h-e-l-l and go on to be perfectly sound for nearly 10 more years (she was already retired from riding when it happened).

Also, my current 2 year old filly had a septic joint infection at 3 weeks old (shoulder). Knock on wood, she’s fine with no lingering issues.

[AusEventer]

Thanks Texarkana.

Vet just rang. She had another standing IVRP this morning. Was observed to be slightly more lame than yesterday, but not catastrophically lame like Friday evening. Because of the crap timing, we may still be days away from lab results (if they manage to culture anything).

My nerves are shot. I’m sick at the moment too, which really doesn’t help.

The waiting (and not being able to do anything about it) is agonising.

[AusEventer]

Can I ask…with the really broken one, what sort of length of hospital stay did you have and what treatments did the horse undergo?

Because I’ve been sick through this whole ordeal, there’s a heap of questions I need to ask my vet that have only just come up in my mind.

We have done three IVRPs, and the plan is to do them til we either get lab cultures back this week (and change treatment if needed) she makes a big improvement in soundness and we stop, or if the filly suddenly goes very downhill - we euthanize.

I didn’t ask about metrics to measure healing. Should we have blood counts to go by? Do we just base it off level of soundness? How frequently do we do IVRPs and when do you stop? A friend with a similar kind of infection mentioned her horse was lame for months after, but only had 3 perfusions then went to systemic treatment…but did end up sound? I can afford treatment to a point - but like most people, don’t have an unlimited budget. I would spend more willingly if I knew the outcome would be good, but obviously I know horses don’t work like that and nothing is ever guaranteed.

So now I’m just totally confused, disillusioned and concerned. Not to mention absolutely wiped out with some stupid bug.

[Rnichols]

I dealt with a septic hock infection last year. Horse had a pretty gnarly wound on her right front, which was treated with oral antibiotics. A couple days after I noticed her left hock was triple the size. She was non weight bearing, off her feed and had a 103+ temperature. Luckily I noticed first thing in the morning and called the vet, who immediately checked her into her clinic. Vet tapped the joint and indeed it was infected. No idea why the hock got infected, I guess we were so focused on her RF giant wound that we must have missed a small cut on her hock?

I believe we had a week of 2X / day antibiotics infused directly into the joint and then was on IV antibiotics for quite a while. After 10 days are so I got to bring her home and switch to oral abx, cold hosing, dmso sweat wraps to continue to get the swelling down, etc etc. I’m not going to lie - I thought I would have to euthanize her. But she did make a full recovery and I ended up selling her to a teen recently and is going to do barrels with her. It wasn’t career ending or limiting.

When I first got my other mare 8 years ago, she stepped on a nail that knicked the tendon sheath. She also had to go into the clinic and get antibiotics perfused directly into the tendon sheath 2X a day for a week. Same mare also stepped on a screw years later that the vet was concerned about hitting the coffin bone and that was oral antibiotics for quite a while (which were SUCH a pain, I had to open 30 capsules 2X/day and extract the powder out). I still have her and we actively event - neither injury was career limiting.

Long story short, joint infections can be scary and if not caught early can absolutely be life threatening. I have a friend who lost her horse to one :(. It sounds like you caught it early though and hopefully throwing massive doses of antibiotics at it will eliminate the infection and your girl will be back to as good as new in no time.

[Texarkana]

@AusEventer

Can I ask…with the really broken one, what sort of length of hospital stay did you have and what treatments did the horse undergo?

Well, that was a calamity of errors that I wouldn’t necessarily emulate. Long story short, I wanted to euthanize her immediately, my vet I thought I was overreacting.

She was only at the local, rural, one vet equine hospital a handful of days for a series of IVRLPs (3 I believe). Otherwise I did all of her care at home. She originally was on TMS (laughable), then IV gentamicin in combo something else I’m blanking on at the moment while also receiving the combo perfused to the joint. Then she was on enrofloxacin forever and a day… MONTHS. We did less lab work than we should have.

It was a long ordeal. It took about 3-4 months of intense management to get her to a point where we felt the infection was behind us, then another ~ 9 months of layup to be sure the injuries were healed.

[AusEventer]

Ok, wow! We are at a large regional equine hospital and although they are understanding of my budget (procedures all done standing as filly is cooperative) we are probably looking at a minimum of 5 IVRPs.

I haven’t had the full rundown of every drug she’s on and no idea of what the longer term treatment plan is until lab results are back. If the cultures are inconclusive, I really don’t know what we will be guided by. It appears lameness level isn’t always indicative of long term outcome.

(Obviously won’t be trying to keep her alive if she ends up back at ‘broken leg’ lame)

[AusEventer]

Thanks for sharing your success stories. Gives me some hope.

The puzzling thing about this case it that it appears to not be from a wound, just some kind of blood borne infection. Not knowing the how or why also means that it’s hard to know what type of infection it is likely to be. I’m freaking that it’s some resistant bacteria or weird non bacterial infection - although, the fact she had a positive response to initial treatment does suggest it’s not the case. I am not confident that lab results will shed any light on it - but, crossing everything….

[Texarkana]

@AusEventer

(Obviously won’t be trying to keep her alive if she ends up back at ‘broken leg’ lame)

Well, my horse’s leg WAS broken (her foot technically). With an open fracture no less, that my vet initially dismissed as “no big deal.” I have a background as a vet tech at a major university in a past life, so I disagreed with his “no big deal” diagnosis but was guilted into trying to treat her. When it (unsurprisingly) blew up with all the things infected, we threw the book at her and by sheer luck, she responded.

Compare that with my foal’s septic joint a couple years ago: she came in at dinner time dull and slightly lame, even though she had been fine all day up until that point. My vet (different vet) had her on antibiotics within the hour. When she looked no better come morning, I wasted no time getting her to the university hospital. They laughed at me (in the best of ways): “no one admits their foal this early in the course of infection.” And even that was touch and go despite super speedy intervention.

[AusEventer]

Who would have horses??

I understand your haste in getting a foal in quick!

This filly failed her IgG and had 2 bags of plasma. No health issues since, she’s now 16 months old.

Vet doubts current condition has anything to do with her rough start (Mum produced no milk initially). I do wonder…

[Texarkana]

@AusEventer

Who would have horses??

I understand your haste in getting a foal in quick!

This filly failed her IgG and had 2 bags of plasma. No health issues since, she’s now 16 months old.

Vet doubts current condition has anything to do with her rough start (Mum produced no milk initially). I do wonder…

My foal also had a low IgG and 2 units of plasma. She was actually born at the university hospital from a high risk pregnancy; the other reason I wasted no time bringing her right back.

But at 16 months, I wouldn’t think it would be related to that, either.

Many jingles!!!

[LuvMyTB]

I just went through something similar. Mare was truly broken-legged, non-weight-bearing lame; we were lucky to get her on a trailer to the clinic (she is a good egg). SAA was high, pastern/fetlock were huge. Ultrasound showed tendon damage but too much swelling to see anything else.

It took a month to get it under control. Even the $$$$ MRI couldn’t definitely say if the infection was systemic or localized to the joint. She was on heavy bute and 2 antibiotics (SMZs and Baytril) for a solid 30 days, with SAAs run every 5 days and a full CBC towards the end.

Honestly at the time, the treating vet did NOT want to put any needles into that joint and I was really frustrated-she did not want to further inflame anything. After 2-3 weeks, while the SAAs were still super high, she felt comfortable enough (horse was sound at the walk) to pull some fluid from a tendon sheath for analysis and inject the joint. In retrospect I’m glad she waited.

Outcome is still TBD. She is sound at the walk almost 4 months in but has a smorgasbord of soft tissue damage and bone bruising in that pastern. Just handwalking and stall rest right now.

[Bluey]

The problem with our horse was, the first cultures pointed to some type of bacteria and the antibiotic was appropriate for that, but missed another existing bacteria, a rare one not seen in horses but pigs, that the first antibiotic was missing.
Once the second cultures were read and antibiotic changed it was too late for our horse.
That was not all, but one more reason the infection did so much damage that horse could not get over it.