Horse has been lame for almost 8 months: next steps

[grandprixer]

Hi all. It’s been awhile since I’ve posted here but I could really use some thoughts about where to go with my boy. He’s a 2008 holstiener/TB gelding, I’ve evented him up to training level with plenty of room for more. This will be very long lol.

I’ve posted about him before, he’s mostly healthy but really been through the ringer lameness-wise (history is estimated, my timeline might be a little off):

Tldr at the end!

• 2017 torn collateral ligaments LF
  - stall rest for ~7 months, then ~5 months rehab
  - returned to full work, sound with no maintenance
• 2018 mild torn suspensory LF
  - over a year after the first injury
  - stall rest for ~4 months, then ~4 months rehab
  - returned to full work, sound with no maintenance
• 2019 diagnosed mild navicular in LF
  - mildly lame, resolved with wedges and osphos
  - returned to full work, sound with coffin injections
• 2020 diagnosed EPM
  - severe ataxia/neuro symptoms, sudden onset
  - responded very well to oriquin-10
  - returned to full work, sound with no additional maintenance
• 2022 navicular flared up
  - became mildly lame with no obvious reason, assumed to be navicular flared up
  - resolved with changing shoes and coffin injection
  - returned to full work, sound with no additional maintenance

Which brings us to last year:

• June 2023, 1/5 lame under saddle LF, very mild but definitely off
  - immediately stopped riding him and gave him a few weeks off

• July 2023, repeated coffin injection and did a full lameness exam
  - blocked 90% sound to his foot
  - flexed fine: could not elicit lameness

Then I had a major medical crisis and he was basically ignored until November. In late November I was able to get him in with the top sports vet in the area.

• November 2023, full lameness exam and X-rays
  - x- rays unchanged from early 2019
  - palmar angle neutral
  - 2/5 lame, improved with flat pads taped to feet
  - taping various wedges did not improve or worsen him
  - repeated osphos and navicular bursa injection
  - only improved 60-70% with blocking

Since then, he’s been steadily getting worse. He’s probably a 3/5 lame now: head bobbing at the walk, and obviously preferring to keep his weight off it. He still trots up for dinner with the rest of the horses, but I know him too well and it’s bothering him constantly.

TLDR: my boy has been lame LF since June 2023, progressively getting worse. I’ve spent over $5k in imaging, diagnostics, lameness exams, and injections. He definitely has mild

I don’t think it’s navicular: the x-rays are unchanged from before, it didn’t fully block to his foot, and raising his toe with a negative wedge doesn’t make him worse.

In addition, I’ve noticed in the past few weeks that his neck is extremely stiff - might be because I haven’t been riding, but it’s a definite change. Also, when the farrier does his feet, he seems uncomfortable holding that leg up for a long time and is reluctant to straighten it out again - but he’s fine to stand on that foot while the other gets trimmed.

I’ve been to all the vets within a 5 hour trailer ride, but I’m moving to Boston in July and I imagine the vets up there are much better equipped than here. So I want to get him looked at by the best vets up there before I make any permanent decisions.

In the meantime, how can I help him? I’ve tried bute but he would rather fight to the death than take it. I was debating previcoxx, but I’ve never used it before.

Any other suggestions to keep him comfortable until I can see a better vet?

[Libby2563]

I’m sorry your guy is struggling. I think to get a diagnosis you may need to go beyond X-rays to an MRI or CT. With what you’ve written I’d guess there’s a soft tissue injury in the LF foot and the remaining 30% that doesn’t block out is compensatory pain higher up. Compensation may also be making his neck stiff. The coffin joint injections may have provided temporary relief by reducing inflammation.

On the other hand he could have cervical arthritis that’s the root cause of both the LF lameness and the neck stiffness, so I would want good neck X-rays by a knowledgeable vet as well. I believe it is @IPEsq who had a horse whose repeated collateral ligament injuries were ultimately attributed to CA? (I’m sorry if I got details wrong but I think the basics are correct.)

I’m also reminded of my friend’s event horse who was on/off for much of last year. It was blamed on hard ground, thin soles, long toes, etc. The coffin joints were injected and that helped temporarily. So did pads and improved hoof balance. When it continued to be an issue she got a CT of both front feet and there is chronic enthesopathy where the DDFTs attach to the coffin bone. I really wonder how many horses whose lameness is blamed on arthritis or “bad feet” actually have something like that going on.

Can’t hurt to try Previcox/Equioxx but I don’t know if I’d feel comfortable waiting until July to do further vet work, especially with the recent changes of neck stiffness and difficulty standing for the farrier.

[IPEsq]

I think you are thinking of @Peggy’s horse? Mine with CA wound up having pretty awful changes to his DDFTs around the naviculars but he was only intermittently lame and the lame foot had never had a problem before (various other problems throughout his body, though). The other foot was actually worse but he was never lame on it after having Tildren regional limb perfusion years before due to mild pedal osteitis.

I think you need MRI of that LF. Even if injections and Osphos have helped, you may have something more complicated going on and that is only sort of touching the symptoms. Would not hurt to evaluate the neck also, but sounds like he does have pathology in that foot and issues with hoof angles and quality. After my horse’s MRI, one of my vets said we should try stem cells (we had some banked), but it’s possible he would continue to have problems and might need neurectomy if not sound for retirement or very light work a year later. He passed the same day as that opinion due to unrelated severe colic, so I didn’t go down that rabbit hole. But at that time, I was also not sure I could put that horse through extended stall rest again at that point. So you definitely have my sympathies.

[grandprixer]

I don’t want to wait until July either but I’m in a bit of a sticky spot.

I’m a college senior, about to graduate with my mechanical engineering degree. So right now I’m dirt poor and eating ramen every night but I’m also negotiating an offer for a job that starts at a fairly nice salary for a first year graduate - especially since I’m going to be living at home.

I spent pretty much everything I have over the last year or so. I have a little over $2k left in savings but I don’t have insurance or anything for him and I just know he’ll colic and need surgery if I spend that on an MRI.

I’m really hoping to make it until July because that’s when I’ll be starting my new job and can theoretically spend a lot on a thorough exam at a top clinic in the new England area. I’m in a horse desert, so unfortunately while I do love our farm vet and local sports vet they’re extremely limited in how they can help.

Once I’m in Boston I’ll have so many more options for treatments/rehab centers

[grandprixer]

Thank you for the response.

I’d definitely like to get an MRI but it’s a 12+ hour haul from us and I don’t have a truck. I firmly believe there’s more going on than just navicular. Even if it’s not totally fixable, I won’t give up on him until I’m sure we know what’s going on.

It’s definitely devastating after he’s come back from so many significant injuries - but honestly, every single ride after the first collateral tear was a blessing. All I really need now is for him to be comfortably retired - I can get a new eventer when I start my fancy new job.

[Xanthoria]

@Libby2563

On the other hand he could have cervical arthritis that’s the root cause of both the LF lameness and the neck stiffness, so I would want good neck X-rays by a knowledgeable vet as well.

This, though a talented ultrasound tech found my horse’s CA. It may be easier that way if you have the right person?

[grandprixer]

If I could get decent x-rays of his neck, would any vet look at them without at exam first?

Like I’ve mentioned I’m in a bit of a horse desert. I don’t know that my local options would be able to give a truly knowledgeable opinion.

[Equestrianette]

Just here to say I would absolutely X-ray the whole neck. My horse had Lf lameness that ended up being secondary to arthritis in the neck and he’s only 5. He just got steroids to his neck and overall out of everything that was probably the cheapest part of his vet bills.

[Peggy]

@IPEsq

I think you are thinking of @Peggy’s horse?

Yes, that would be me. I was told by Mark Martinelli (lameness specialist with MRI instrument) that my horse’s collateral ligament issues were due to spinal narrowing in the vicinity of C6-C7. The way he explained it is that, while the horse was technically not neurological, the narrowing caused an occasional “packed of information” to be transmitted down the spinal column incorrectly, resulting in a temporary loss of proprioception, in turn causing him to put a foot down harder than usual. Over time, this caused damage to the soft tissue in his feet. Unfortunately, we only did the neck radiographs the second time he damaged the collateral ligaments: the first time I stupidly had them do scintigraphy of only what appeared to be the problem areas.

In the first go round, he told me that the CL injury was unlikely to recur and that these injuries were treatable with a good prognosis even if the treatment wasn’t started until some time after the original injury. That horse was retired in 2013 when he was 14 and I got tired of fighting all of the issues, including a digestive one.

His replacement turned out to have a horrible neck and recurring soft tissue injuries that I really feel were due to the neck. A number of horses from that particular breeding program had neck issues. They are no longer breeding and the youngest horses are well into their teens now in case anyone is concerned that they might have one. Also, not warmbloods. Anyway, that one got euthanized shortly after his seventh birthday.

Which brings us to the current horse (profile pic) where it wasn’t the neck, but the feet. A bit more than a year after I bought him, he got a quarter crack and then a check ligament injury. Healed check ligament and then fought quarter crack for a bit. Then he stepped on a rock at a show and did a combination of a bone bruise, collateral ligament, and DDFT (dx by MRI). Rehabbed that and got him going again. Then he re-injured it somehow. Cue months of rehab and on and off soundness, incredibly fancy shoeing jobs (was told that the horse would NEVER go in four flat shoes), and finally reached a point where I couldn’t even get him sound, let alone keep him sound. At that point he was 3+/ lame. So, I sent him back to his breeder (who said she’d always take him back), pulled his shoes, and let him live out. He was sound in the field within months. I gave him a total of six months and then we started him back painfully slowly. LSS, great footing, living out 24/7, meticulous care, and paying really close attention to the angles in his feet (he tends to way overgrow toe) seem to be the ticket. Goes in four flat shoes and jumps around in the meters.

I live in So Cal so lots of sports vet and equine hospital options, which helps immensely.

In the case of the OP’s situation, I’d be tempted to try previcox and let the horse be a horse until July, unless the neck stiffness gets worse or he appears not to be safe to handle. If nothing else, it would be interesting to see if the discomfort with the farrier is helped by pre-dosing with some sort of NSAID. My guess is that it’s neck or hoof angles or some combination.

[Weezer]

I agree that if Previcox keeps him sufficiently comfortable, you should combine that with time off. It wouldn’t hurt to do some massage work on his neck if you can.

When I was in college, my horse remained mildly lame and unridden for over a year because I couldn’t afford diagnostics. Once my financial situation improved, I was able to address it and life went on - no big deal for the horse.

[TWH_Girl]

Can you swing the generic equioxx (firocoxib) until you move? That seems a simply and relatively cheap option to help his comfort until then. You could get it from your vet or some of the online pharmacies have it for good prices.
I’ve always used Valley Vet and they give you an additional discount for authorship.
That’s a lot going on. Hugs that he can feel better.

[IPEsq]

Your local vet could send the images to an equine radiologist.

[IPEsq]

Also keep in mind that front limb lameness can cause a lot of neck soreness because the neck stiffens and lifts up to try to alleviate weight on the foot. So I don’t think there is a need to panic about neck pathology necessarily but it is relatively easy to look if you have anyone with a good field ultrasound or xray machine.

[kaya842]

I too am part of the hoof and neck issue club. I haven’t done an MRI on my horse (she’s 19 now) mostly due to the following rhetorical question: What would an MRI change in regards to treatment? In my case, pony is already out of work and I’m not up to do lengthy stall rest + she was already getting stem cell treatment along with other therapies so nothing would have changed with MRI findings. I do think my horse’s hoof issue is similar to Peggy’s horse where it actually started in the neck (my horse would sit back when tied when she was young so I imagine she damaged her neck doing that). I do think it can be a chick or the egg cycle with front hooves and the neck, though.

I think daily Equioxx and time off is a reasonable course of action until you are in a spot to pursue further diagnostics. IIWM, I’d start with the neck since you’ve done lots of imaging on the hoof/ leg already. Reading other threads, neck injections seem to be a 50/50 shot at making an improvement (vs hocks where it seems like it’s helpful 95%+ of the time). No personal experience there as I haven’t injected my horse’s neck yet. She’s vastly improved in the past 3 months with a new farrier and shoe set up.

[atr]

LF hoof and neck club here too. I know my old man has cervical arthritis, he’s had it for many years. He’s chronically mildly unsound on his LF for no really apparent reason.

When it first cropped up we chased it around and I’d get him apparently sound, start riding him, and he would completely wig out under saddle, leading me to believe he still hurt. As he was 19 at the time and had other stuff going on I decided to just call it quits and retire him. I haven’t MRI’d it. He’s now 23 and we haven’t pursued anything other than really good trimming and pain management when needed. I look at him bebopping merrily around in the pasture sometimes and its quite tempting to try hopping on him again. Then I remember quite how high off the ground 17.2 can buck and decide to leave him be.

I’d put him on firocoxib and leave him be on the back burner while you finish up your college stuff, then deal with it, if I were you.

[theresak]

When you can, I’d get a look further up the leg. My horse’s chronic problem leg where everything injury and issue seemed to be in the hoof for many years ended up with a very arthritic knee. We always focused on the foot and stopped when blocking the foot got us close to sound. I wish I had kept going up the leg until we got 100% sound or was to high to block because we might have been able to find and treat the knee earlier and given him more relief for a longer time.

[Lunabear1988]

I had a horse that was a Wobbler and his front feet were a catastrophe. I always wondered if there is a connection as he was only 5 and barely started. Although his hoof care before I got him wasn’t great either.

OP I think time off and some equioxx is a solid plan. I wouldn’t give equioxx and then keep working your horse though unless you know what’s going on.
Best wishes!!

[clburnham11]

Don’t mean to hijack, but I’m curious about what anyone knows about cervical arthritis and holding up the front feet for picking/farrier? My horse has been a bit nqr seemingly localized to the SI region, but is finicky about holding up the rf. My vet said she thought neck x rays weren’t necessary but I may push.

[Libby2563]

@IPEsq

I think you are thinking of @Peggy’s horse?

Shoot, I’m sorry I mixed that up!

I think the interplay between neck and other issues is very interesting/frustrating, and something about which we will learn more as vet diagnostics advance.

OP, with your constraints I see why rest and firocoxib would be a good option. I hope you come back to update us when he’s feeling better or when you get more info!

[fivestrideline]

Not who you asked but a painful SI can cause them to do that because picking up a front makes them shift weight back to the hind. Also if they’re protecting the SI they’ll dump weight on the front, which can make everything sore.

I wouldn’t immediately jump to neck unless you’ve treated the SI/back already. But that’s just me