How long can a heel abscess drain and stay sore?

[Pally]

So I get new horsie, get him settled, get him trimmed, the weather changes, and bam, he gets really lame. That is certainly following an abscess pattern, and sure enough, from day one of the lameness, there is what certainly appears to be a big blow out hole at the back of the frog.

I go with animalintex wraps, soaking in epsom salts, and leaving him on 24/7 turnout. There is a little drainage from the hole, but given how he seems to get no relief from it, I suspect a second pocket brewing.

Two days in he’s even more sore, not weighting the heel at all, so we bring him in to a stall. Give Bute (I know the principle that it stops the abscess from doing it’s thing, but not using the foot will slow it too. This was done on vet advice).

Not liking the picture I call the vet out for the next day, to rule out anything more tragic. Take x-rays and lateral view shows a gas pocket at the back of the foot. It’s not in a place where we can dig it out the sole. But also doesn’t show anything amiss in the bones (or what faint lines of the soft tissue can be seen). Phew right.

After this visit, I start getting a bit more drainage, but not a whole lot of improvement on soundness. Let the vet know so she comes back to recheck (1 week into whole thing, 4 days after her initial X-ray). OF course the goof walks out of his stall way better. Vet is happy, says if he was septic, the lameness and swelling up the leg would just get worse. Feel no need to re-X-ray. Stop the Bute, but have started on SMZs since there is definite drainage, it shouldn’t hurt. Left with the plan of wrap until after drainage stops, keep handwalking and get back to turnout in a few days when footing is dry. I think everyone just assumes he’s on the upswing…

But to me, it looks more like a plateau. Any improvements in lameness are miniscule. Drainage is still obvious but slowing. Until, I start some turnout gradually. With the increased movement comes a TON of fluid coming out. I get that’s why I want him moving, but I can’t quite wrap my head around where that much can be coming from. He is walking a bit better with the movement too…still I want …more better, lol, at this point (2 weeks).

Now I’m not sure if I just need to be more patient, or if this is beyond normal enough to get the vet again. I want to be somewhat proactive, but for the sake of my pocketbook, I would rather not have her out just to “check in” or take more X-rays “just to see”. On the other hand, I’m becoming a bit paranoid that this could have invaded the fun structures that live in the back of the foot. So I’m coming to the forums to survey horror stories. Er, I mean ease my mind.

So at the end of that long backstory (hey I had to put it in, or people are going to ask) my main questions are to those who have seen an abscess go awry [and I suppose to people who have seen the horrid looking ones turn out fine] . How long did the lameness last and what pattern did it take (ie. up and down, progressively better and worse)? How much drainage and for how long? For infections that invaded bone, did you see it right away on X-ray, or did that come later? For infections that invaded soft tissues, how did you diagnose? Etc, etc.

Thanks all - I used to be firmly in the “just an abscess” camp, but I’m starting to feel like a crazy person here.

[mychestnutvalentine]

Following this because I’m in the same situation as you. Good luck and I hope everything is on the upswing.

[JB]

My “abscess gone awry” ended up being a 1.25" pinky-sized stick rammed horizontally into the frog.

Has the vet done anything like sticking a sterile swab stick into the drainage hole to poke around?

[Against_All_Odds1]

Mine took over 6 weeks I think. I had a lengthy thread on it- let me dig it up

[Against_All_Odds1]

https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/340048-abscess-laminitis-bad-trim-new-video-update-12-7

[Groom_amp_Taxi]

My horse is abscess prone at times - it seems like he goes through spells when he will have multiple serial abscesses though it may actually be one abscess waxing and waning. In his case, there is never as much drainage as one might hope, but there is usually an exit hole, usually in a heel bulb - and sometimes the hole closes and then re-opens. There have been at least three instances of this type presentation over the time I have owned this horse (10+ years). The specific details escape me, but I can say that each of these three instances lingered off and on for 6-12 weeks.

I admit to being jealous of the folks whose abscess experience consists of 1) horse shows symptoms 2) owner soaks and poultices 3) abscess blows 4) horse is sound almost immediately and they continue on their merry way.

Fortunately I have not experienced an abscess turning septic although the last one did cause swelling all the way up the leg in the last 36 hours before it blew, and I got to experience the joy of doing antibiotics for a week at Christmas time.

[hunterprincez]

I have had waaayy too much experience with abscesses lately in my guy. The last one got to brewing right before Christmas and blew out the cornet band. He had had 2 other abscesses in the same foot that came out the sole about 6 weeks and 4 weeks before the big one. It was so gross the vet did not want any nails in that foot for a few months to let everything calm down. She felt like the abscess was just close enough to where the nails were going that it would re-irritate the area and cause more inflammation and pain every time he got re-shod. It seemed like every time we would get him comfortable and put a shoe back on he would go lame again the next day. He has been in a glue on for two shoeings on that foot and knock on wood he seems very happy and sound. I will definitely have anxiety when we get to the point of nailing a shoe back on that foot. I had to do a lot of soaking and wrapping. Good thing I work in the veterinary field and get vet-wrap and elastikon at cost!

[JBD]

You might try a clean trax soak and keeping it bandaged. I’ve had abscesses that lasted until my vet did a mini-resection that exposed the track.

[Pally]

@JB

My “abscess gone awry” ended up being a 1.25" pinky-sized stick rammed horizontally into the frog.

Has the vet done anything like sticking a sterile swab stick into the drainage hole to poke around?

Ah…ew. No, she did not…we had him lightly sedated for the X-ray which also allowed her to squeeze it and trim some flap - putting a stick in would have required a knock-out punch. But surely something like that would have shown on the rads, I mean even if wood isn’t exactly radio opaque, right? RIGHT? Dear lord. :eek:

AgainstAllOdds and Groom&Taxi, I’m relieved to hear you had “just abscesses” that weren’t quick and easy. But if this goes for 6-12 weeks I might really cry.

Hunterprincez - totally get the anxiety you’re having about the shoes. Luckily my guy is barefoot - my anxiety is going to be about recurrences when the turnout conditions aren’t ideal (and isn’t that 50% of the year around here…99% of March, sigh).

I’ve been keeping it bandaged all the time [yay diapers. Even though I’m certainly of the demographic to be buying them, I feel weird…like the clerks are judging me for getting the cheapest ones :lol: But they’ve been a godsend]. I haven’t tried the Cleantrax…I used it in the past on a horse I groomed that had WL disease, but I don’t know if my employers “muled” it into Canada or just ordered it here. Anyone know offhand of Canadian availability?

Thanks everyone for sharing. I felt like he was looking good today so here’s hoping tomorrow is even better.

[ArabDiva]

I’ve been dealing with a stubborn heel bulb abscess this winter. It took a week to blow and the leg was swollen to the point where I was worried about it being something more serious. It blew a 1" hole at the coronet band at the back of the heel and took another week for the swelling to go completely down, and she was limping for that entire time too. Then it’s gotten ouchy again anytime the ground re-freezes. (We’ve been in a frequent freeze-thaw rollercoaster cycle for the past 6+ weeks.) But I would be sore too if I had a foot problem and then stood on basically the equivalent of concrete all day. I think the heel/frog area is just a lot more sensitive and takes longer to recover than abscesses closer to the wall or toe.

I totally get the driving yourself crazy with worry that it could be something else, could have gone into the bone, etc…

best wishes for continued recovery.

[JB]

@Pally

Ah…ew. No, she did not…we had him lightly sedated for the X-ray which also allowed her to squeeze it and trim some flap - putting a stick in would have required a knock-out punch. But surely something like that would have shown on the rads, I mean even if wood isn’t exactly radio opaque, right? RIGHT? Dear lord. :eek:

That’s the crazy thing - we DID xray things when she evaluated him on about Day 4 (she was already there for shots, I figured what’s a little more money to have her check things out. Would it have shown up if we’d done some different angles? Maybe?

We cleaned, she pared away some of the back of the frog where there were 2 oozing holes, felt abx were warranted, and I packed and wrapped for another 10-ish days. 2 weeks from the day he came cantering in on 3 legs (and I was SURE it was a suspensory because the whole leg was swollen, but found no heat or discomfort on palpation, and 3 days later he was all but sound), I was dutifully cleaning things up again, happy that the pus had finally stopped several days prior.

A few cuss worse flew as I saw pus AGAIN, which required a bit more thorough cleaning, and there the stick was, poking its mean little head out of the back of his foot. Vet came the next day to check it out, squirted some barium in there and did a set of xrays which showed the stick had hit nothing of real importance. She removed more frog so there would be more air getting to the tract, and after a couple weeks wrapped and in an Easy Boot Rx, he was good to go.

Here’s the album if you want to peek

[Angela_Freda]

No soaking in hot water/Epsom salts?
If you can’t soak you can make a salt poultice with hot water in a diaper and ‘soak’ the hoof that way.
ETA the cheap diapers that don’t breathe are the best for this… keep buyin’ those cheapies!

[Angela_Freda]

I have a stupid question, having not dealt with many abcesses in hooves…

When I get an abcess, from say a splinter… I often will use Hydrogen peroxide to open it up [it kills epithelial cells] and help the gunk clear out.
Why don’t people use HP on hoof abcesses to do that?

[2DogsFarm]

My Abcess Horror Story was 10yrs ago, so my Timeline is a bit fuzzy now.
A bruised heel - bruised tissue on radiographs - turned into a subsolar abcess that ended with horse sloughing half his sole - vet said it looked like a resection - & took 8mos of twice daily soaking/cleaning/wrapping.
I saw inner hoof structures only a vet student should see.
When the sole regrew we went through 3mos of glue-on shoes, then keg shoes for another couple months & finally back to barefoot.

I was pretty certain horse was Done with any use & would decorate my pastures but that was fine as I’d had him close to 20yrs & he’d earned it.
Surprisingly (to me) he returned to full use.
He got so used to the care routine I’d feed him his grain in the aisle, unhaltered & untied (my private barn) & he’d stand with his foot in the bucket & eat while I worked on that foot.

Hope you don’t need to spend as much time with your guy,
Abcesses are The Worst!

[Scribbler]

@Angela Freda

I have a stupid question, having not dealt with many abcesses in hooves…

When I get an abcess, from say a splinter… I often will use Hydrogen peroxide to open it up [it kills epithelial cells] and help the gunk clear out.
Why don’t people use HP on hoof abcesses to do that?

Because the abscess is inside the hoof, in the thin area of soft tissue between the hoof wall or sole, and the coffin bone. When it starts to brew there is no tract to the outside. If you soak and wrap in poultice, you can soften the heel or frog enough that the abscess blows out through the frog area. Otherwise it can travel up the hoof and blow out the coronary band. Some vets like to cut a hole in the sole of the hoof to let the abscess out, but then you have long period healing that hole up, so I prefer to soak and let it burst out the frog bars or heel.

What this means is that you can’t really treat the abscess topically. You can’t get in there. Once the abscess has blown a hole, it is already draining and healing. Also, the hole may or may not be close to the actual site of the abscess (in the case of a coronary hole, a long ways away from the site).

That’s why it’s so painful, because it is trapped in there inside the hard hoof, between the wall and the bone.

And also while we call them abscesses, the fluid that comes out is black gunk (maybe looks gunky after it hits the gooey animallintex pad!) but it isn’t typical pus. So I’m not entirely sure how much of the problem is the infection per se, and how much is fluid buildup in response to the problem.

You can clean out the flaps and gaps in the heel build after the abscess blows, but you probably dont’ want to be squirting anything the damages cells into the inside of the hoof, which I think would cause problems and not necessarily address the seat of the problem.

And because the blood flow to the hooves is not great, systemic oral antibiotics are not generally used.

[Angela_Freda]

@Scribbler

Because the abscess is inside the hoof, in the thin area of soft tissue between the hoof wall or sole, and the coffin bone. When it starts to brew there is no tract to the outside. If you soak and wrap in poultice, you can soften the heel or frog enough that the abscess blows out through the frog area. Otherwise it can travel up the hoof and blow out the coronary band. Some vets like to cut a hole in the sole of the hoof to let the abscess out, but then you have long period healing that hole up, so I prefer to soak and let it burst out the frog bars or heel.

What this means is that you can’t really treat the abscess topically. You can’t get in there. Once the abscess has blown a hole, it is already draining and healing. Also, the hole may or may not be close to the actual site of the abscess (in the case of a coronary hole, a long ways away from the site).

I understand some may not have a tract with an external opening… but then neither do the one’s I have had with a splinter in them… but the HP, because it kills epithelial cells, takes off the outer layers of skin [epithelial] revealing the tract usually.
That was more my question… why HP would not do that to hoof sole.

@Scribbler

That’s why it’s so painful, because it is trapped in there inside the hard hoof, between the wall and the bone.

And also while we call them abscesses, the fluid that comes out is black gunk (maybe looks gunky after it hits the gooey animallintex pad!) but it isn’t typical pus. So I’m not entirely sure how much of the problem is the infection per se, and how much is fluid buildup in response to the problem.

Well that’s what an abcess is though, right? A build up of fluid [serum] and then pus, in the bodies attempt to expel something, whether a large something like a splinter, or smaller something like bacteria…
And I don’t think I have ever seen black pus from a hoof…yikes!
What is an abscess and what causes it?

An abscess is a collection of pus. Pus is a thick fluid that usually contains white blood cells, dead tissue and germs (bacteria). The pus may be yellow or green and may have a bad smell. The usual cause of an abscess is an infection with bacteria. Certain bacteria are more likely to be ‘pus-forming’ as they make chemicals (toxins) that can damage the body’s tissues. These include Staphylococcus aureus and Streptococcus pyogenes. The infection causes the immune system to set off white blood cells and chemicals to fight the bacteria. In this ‘battle’ some tissue dies. A cavity forms and fills with pus. The cavity becomes bigger if the infection continues and the pus can’t get out.

OP I found this interesting article:
http://www.thehorse.com/articles/268…sses-in-horses

And also remembered a rescue I follow on Facebook has a Clyde with recurring abscesses… and iirc in his case she used maggots to help clean the area out. Really interesting!

[Heinz_57]

My longest one kept my horse lame even at a walk for 12 WEEKS. Farrier accidentally opened it up during a routine trim in late fall, horse was sound prior to that, no indication of a problem brewing. Dead lame afterwards.

[Groom_amp_Taxi]

Heinz57, we had one instance where we encouraged the vet to dig in the sole to open an abscess. He really didn’t find anything dramatic - like gushing pus - and I think that was the one that kept on for about three months. Since then, I have been a firm advocate of letting an abscess find it’s own way out rather than vet or farrier helping it along. Of course, that did happen with horse’s “pancake” foot. He has worn a pad on it since and has even managed to abscess under the pad.

[Scribbler]

@Angela Freda

I understand some may not have a tract with an external opening… but then neither do the one’s I have had with a splinter in them… but the HP, because it kills epithelial cells, takes off the outer layers of skin [epithelial] revealing the tract usually.
That was more my question… why HP would not do that to hoof sole.

Because the hoof soie is far too tough to be eaten away by hydrogen peroxide.

HP can be used topically to treat thrush, which is an infection of the surface of the hoof. You can also use solutions of chlorine bleach or anything else that disinfects. These certainly don’t dissolve the surface of the sole or frog! They are keratin, not skin cells.

[Angela_Freda]

@Scribbler

Because the hoof soie is far too tough to be eaten away by hydrogen peroxide.

HP can be used topically to treat thrush, which is an infection of the surface of the hoof. You can also use solutions of chlorine bleach or anything else that disinfects. These certainly don’t dissolve the surface of the sole or frog! They are keratin, not skin cells.

re bold, those solutions do not destroy epithelial cells either though, do they?
And how is Keratin different from skin cells?
I thought Thrush was fungal?