Intermittent, mystery hoof lameness - is this soft tissue? - help

[EventerGoneJumper]

I have a wonderful 9 year old 1.30m/1.40m jumper, he just had 3 weeks of showing a month ago.

We got home from the show, and he got his normal 5 days off and went back to work feeling great for 2 weeks. Since he wasn’t jumping, we let his feet grow out onto a 5 week cycle (he normally is done every 28-30 days religiously) and he came up a little wonky on the LF but worked right out of it within 60 seconds. Had the farrier come out same day and do his feet, jogged him for the farrier and he looked amazing again. Went back to work for 3 days, popped some cavaletti, felt great and came out the next day dead lame on the LF for his ride. Farrier was out later that afternoon, and jogged him - super sound and amazing 10 hours after being dead lame. Vet came out the next day, jogged great on soft and hard ground, looked good on flexions, decided it had been 14 months since his coffins were injected so went ahead with some coffin injections and did X-rays to check hoof balance (x rays came back clean).

Did the 5 days of stall rest/hand walks post coffin injections, came out sound for 3 days of walk/trot, on the 4th day he was a little wonky for the first few steps but then was fine and continued trotting for 5 minutes to see if it got better or worse and he stayed sound. The next day (yesterday), comes out and is dead lame on the LF again.

This big guy is 17.3hh/18hh and is a diva. Any little thing upsets him and makes him ouchy, he’s not stoic at all. His front feet have a history of being hard to manage … he wears custom size steel baby heart bars, is incredibly sensitive to moisture (has a history of abscesses, zombie foot infections, dermatitis on the leg that makes him lame) and has impression material with copper sulphates under a wedge pad year-round. He gets balance X-rays every 6 months atleast to make sure the angles are good.

I’m a bit baffled by the on and off intermittent lameness and the severity. One day he’s great, 10 hours later he is abcess lame, the next morning he’s fine again. Any ideas?? I have the farrier coming out today, and have already put in another call to his vet.

[hoopoe]

since the feet are known to be problematic and you have a program of care and maintenance, I would start questioning issues further up the leg into the shoulder neck and back. I would also stop any kind of Bute etc so you can really show off potential discomforts.

[weixiao]

Maybe see if the farrier will try resetting the shoes in case maybe there is something bugging him with the pads intermittently or see if there is something abscess-y brewing under there that the X-ray missed? With intermittent lameness I’d also suggest making sure (if you haven’t already) you try and get good video of him jogging on the off days so if the vet turns up on a sound day they have at least a little something to point them in a direction.

Did you x-ray anything other than the feet? Any heat or swelling anywhere? Is there any difference on a straight line versus a circle in one direction or the other?

[EventerGoneJumper]

@weixiao @hoopoe The big guy never gets bute (even at shows, I’m too scared of masking anything)… he hasn’t had any bute since this weird lameness has started.

His legs are perfect, clean and tight, no swelling and no heat. His legs are furrier than normal right now somehow so I can’t tell if there is dermatitis underneath the hair, so I’ll be clipping the legs today before the farrier comes to check for that.

On the day the vet came out (June 29), he was sound. He lunged in circle on soft ground, good both directions. Jogged sound straight line soft ground, jogged sound straight line hard ground. Flexed all joints on hard ground, and didn’t flex positive to anything other than slight coffins.

We didn’t X-ray anything other than feet, and I wanted to ultrasound the last time the vet was out but vet was sure it was just his coffins needing a touch up since he was perfectly sound during his exam.

When we did the coffin injections, the LF did “geyser” with fluid. We are on Day 10 after coffin injection.

[flyingchange]

I would get him to your nearest referral center asap to make sure you aren’t dealing with an infection in that coffin joint. And if so, to start him on IV abx as well as get the joint flushed, etc.

This is a situation when a bone scan may also provide some help - if you have something going on further up the leg (eg, fractured scapula).

[Posting_Trot]

You’ve gotten some excellent suggestions from other posters, but I just want to throw one other possibility out there. Intermittent lameness can be a symptom of lyme disease. It’s worth discussing with your vet, and it can be diagnosed via a relatively simple blood test.

Good luck.

[EventerGoneJumper]

Update:

Big guy has stayed lame for 24 hours finally. We started by having our farrier watch him go under saddle. He was significantly lame (3/5) tracking both directions, but felt worse when tracking to the right. Lameness was pretty much the same on straight lines and through the turns. Farrier said it looks RF to him, it felt LF to me under saddle.

We got off and pulled both shoes. After removing the impression material, we hoof tested him. He is reactive to hoof testing, on the inside heels of both front feet (and a little reactive on the RF outside heel area as well, but not LF outside heel).

Farrier says no abscess, We decide to pull the impression material, widen the wedge pad for more space and do magic cushion underneath.

We jog him on the lunge line after making the shoe adjustments and significantly better an hour later. Sound on soft ground tracking left on the circle. About a 1/5 on soft ground tracking right on soft ground circle (farrier says RF, I see LF). It’s very hot today, and farrier saw enough improvement in 60-90min to believe this is a pressure related issue with both heels, didn’t want to keep trotting him or try hard ground today - give him 2ish days and re-jog then.

Any other ideas on what this could be? I’m worried about soft tissue injuries at this point. Still waiting to get an appt with my vet to start with ultrasound…

[EventerGoneJumper]

[EventerGoneJumper]

Pics shows where he was hoof testing reactive ^^

[flyingchange]

There are so many things that this could be. Collateral ligament rutpure or sprain. Joint infection. Caudal heel pain (aka “navicular”). Your farrier isn’t doing him any favors … Get him to a qualified veterinary lameness specialist asap.

[EventerGoneJumper]

We have a call in for his regular performance vet (who manages all of his performance/lameness problems over the last 4 years - he is the vet who just did the coffin injections) … he is ISELP certified. We just haven’t gotten an appt since the lameness really started yesterday (Saturday) afternoon.

[NotAmused]

I am not even remotely close to an expert, in anything. But I also have a big horse, not stoic, and had some minor on off lameness in front that couldn’t really be pin pointed and would come and go with no discernable pattern. Eventually decided to pull shoes, and give her some Dr Green time and it’s been a massive positive change. She’s in full work, 8 months later and her hooves are so different in shape and function. I had shoes on all 4 for 4 years…again no expert! But for such a big boy, to have such owchy feet needing serious shoeing and sore heels (and again I am not trying to make an armchair diagnosis based on pics but he has such big hooves and what looks like a really contracted causal heel area) can he have some time barefoot? If there’s nothing else serious going on that gets diagnosed it might be worth a try. I used to scroll old forums every night trying to figure out how to help, and something as simple as pulling shoes ended up really helping. Took a few weeks for her to be comfortable but it’s been really really positive long term. Hope your guy finds a good solution and it works out!

[Bluey]

If there is some kind of injury that can heal with turnout, that could be why horse heal, not necessarily going barefoot.
Cause and effect, if there is no clear diagnosis, makes it hard to say how things fare later and why.
Just turning out also can be lost time if something needed addressing, why pursuing a diagnosis is best.

[IPEsq]

I had this sort of thing happen, and it took an MRI to diagnose. Even blocks were not that helpful. And actually we did both feet and the more sound one at the time looked worse on MRI.

[EventerGoneJumper]

@IPEsq Yes, I have a feeling it might come down to that. As a 5 year old, he went from 17hh to 18hh he is now in like 4 months and he starting moving wonky and we sent him for an MRI then. MRI then showed a bunch of mild this and mild that in both front feet, so we chalked it up growing pains and and gave him 6 months off to grow into himself. Obviously, he’s fully grown now but I do remember how MRI’s can pinpoint every little thing and sometimes cloud a diagnosis. My vet is lameness specialist and a genius with an ultrasound, so I’m hoping he will get back to as soon as Monday rolls around and see the big guy this week.

What happened with your horse? Was it presenting similar to this?

[DMK]

One of the (oh so many) things that may be related to intermittent lameness is collateral ligament strain or other issues. Obvs there are a million things that can happen in the foot, so this is by no means diagnostic, but that “it looks to be one side and feels like the other” rings a bell when it’s medial collateral ligament.

But I’m inclined to think it’s more related to the heels, mostly because it’s almost always the heels and you should never look for a zebras when there’s a horse standing in front of you. But the collateral ligament is the more likely zebra in my experience

[IPEsq]

He never was abscess lame but he had intermittent lameness for a while. MRI showed that the DDFT was in bad shape near the navicular bones. Unfortunately, I lost him to colic the day the MRI results came back but the prognosis wasn’t great. My vet also dissected his feet post mortem and found adhesions and cartilage erosion as well.

[IPEsq]

Also adding this was a big horse too (though I don’t think he reached 18h…I quit measuring at 6yo)…I got him as a young looking 4 and he kept growing through his 8yo year. The lameness showed up at 9. And he never made it very far in sport despite having a lot of athleticism and some very successful close relatives because it was always something physical going on, mostly in the axial skeleton. His full, older brother is a hand shorter.

[sheltoneb]

Intermittent lameness can. E caused by suspensory issues.

[Peggy]

My intermittent front lameness horse with DDFT strain (and other supposedly minor things) based on MRI was ultimately fixed by turning him out sans shoes for six months and then a meticulous return to work in excellent footing while still living out 24/7 (and shod). Still lives out, still in excellent footing, now shod in Eponas. And I drive a lot to keep him in that situation. But he went from a horse we could first not keep sound while showing 3’ and under (roughly three years of being more out of work to in work) to one that we could not get sound (tried for 9 months) to one that is sound and doing the 1-1.05-m jumpers.