I read much on these forums about horses with kissing spines. I thought this was an interesting article about a new and different way to treat the problem.
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Thank you for posting this. Just read it over my morning coffee.
My vet has a similar approach to Dr Newton. He is not really convinced either surgery have long term benefits. He believes that for many horses, the subsequent surgery is additional trauma/pain that makes it difficult for them to work correctly even post-healing because of pain memory.
Iām part of two very active FB groups (Pferde Mit Kissing Spine & Horses with Kissing Spines) and results of the surgery are all over the map. There are a lot of very sad stories. Part of the problem with KS is that unless it is severe it usually doesnāt present with a limp until a suspensory gets involved - which complicates the prognosis for return to sport.
One thing I have consistently seen is all of these symptomatic horses have really poor angles in their hooves behind. I really wonder why this is not more frequently observed with vetsā¦ and I also really wonder why I never see vets push for management changes like more T/O to help the horse. Many of the severe cases have PSD. Which came first? And why?
One of my TBs has KS. His are mild-to-moderate, 3 affected vertebrae with remodeling, no impingement. Not as bad as what was linked (those rads are severe clinically, IMHO). I did not do surgery, but I would be kidding myself if I told anyone the horse is completely asymptomatic. His KS was discovered āincidentallyā when we were x-raying his spine to make sure he had no fractures after a fall ā however, there were small symptoms here and there that made me realize that the KS was probably bothering him. Small things like moving away from the mounting block, not loving being brushed over his back, raising his head as the saddle was put on him ā all of these things I attributed to a possible poor saddle fit, but in hindsight I think were beginning symptoms of his back pain.
We treat with yearly mesotherapy - this is likely what Dr Newton meant by injections. The KS horse got a custom saddle. His saddle pads are all lined with sheepskin, which surprisingly he really seems to like. He is shod on all four as much as I would so prefer for him to be barefoot. I went through several farriers before I found one that worked for this horse. He is out 24/7. If you changed any part of this horseās management, I think you would see regression.
Just N=1 having dealt with it in my own personal (competition) horse, itās not a one-and-done treatment. These things will get worse as they get older, not better.
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Iāve seen the therapy Dr. Newton uses in person - there was an article about him in the Chronicle years ago. He uses very long needles with sarapin and a steroid, I believe.
Whatās PSD?
This is really interesting as Iām sorta diving into this world myself, with a horse with mild impingement. Other than long-lining to encourage the horse to lift his back and stretch those spinous processes (at least, not encourage them to kiss any more than they already do), what was the physical therapy? Did I miss it? Iād love to know more about works in the absence of a surgical candidate (since it seems hit-or-miss as to whether itās a long-term fix or not).
Alsoā¦
I am quickly become a believer that negative angles (especially in the back feet) were largely involved in the back pain my horse has been having. It was a pretty radical transformation when I changed farriers, took rads, and put wedges on. Iāll definitely be taking regular rads from now on to keep an eye on things. Weāre hoping to take follow-up pics soon to see if/how much improvement there has been, and if the wedges are ready to start coming down (any experiences/tips/ideas you might have are welcome!).
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Proximal suspensory desmitis.
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Thank you!
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This thread makes me feel vindicated. After years of what I was told were behavioral or training problems, even from my local vet, I finally hauled the mare to a big city vet almost four hours away and, sure enough, significant kissing spine in four places.
Like this article, the vet - who sees many, many horses as heās across the street from a racetrack -prefers a less invasive approach and only very rarely advocates surgery for KS. And heās a surgeon himselfā¦heās known for his skill with colic surgery.
He injected her problem areas with an anti-inflammatory. Heās also a chiro, which he does each visit, and we did a session of sonic wave with her. (I may have the name of that wrong). At home, Iāve not ridden her, but have used a combination of lungeing over railroad ties, slow and careful use of a Pessoa, turn out, and hand walking to encourage stretching and movement. I do a little Masterson stuff with her too, and when the circuit riding, slightly woo-woo chiro lady comes through, she works on the mare as well.
After almost three months, the vet believes sheās at least 70 percent improved. A dumb abscess has stalled our progress this week, but weāll stick with it. Some of her old behaviors have disappeared and thatās an indication that I may be able to try light riding soon. The vet said the process may take six to 18 months. Heās cautiously optimistic about her and pleased with how things are progressing.
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YES!! I agree with this 1000%. Negative plantar angles on my mare, and been battling them for 4 year now. For the past 3 Iāve had a fabulous farrier & vet team, and while weāve made progress, it wasnāt fast enough to avoid development of KS. I took full spinal films when I purchased, she was fine then. Had another taken about 2 1/2 years ago-ish, and then just 10 days ago we were back at vets and took another film and guess whatā¦ 
Funny your commentā¦ is exactly what my farrier asked me yesterday.
You are also right about the small things that in hindsightā¦
So right now I am developing a PT program for my mare, fingers crossed. Vet did steroid injections and Osphos (mare also has small navicular changes in one hoof). I ordered a ThinLine pad and a (knock off) Pessoa system.
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Four years?!? May I ask what you have been doing for them? We first discovered them in mine ~5 months ago. Sheās in wedges now, and trimmed with a shorter toe. I hope this doesnāt take us 4 years to straighten outā¦ so any suggestions you have, I am all ears!
A novel could be written about this and Iām sure others more knowledgeable than I will chime in, but be careful with the wedges. They will cosmetically align the angles better but may not actually encourage the foot to grow more healthily. In your position I would ask the vet/farrier how long they plan to use the wedges, what the next step would be, and how you/they will know when itās time to transition to that next step.
Hereās an excerpt from a useful podiatry website about wedges:
(https://www.equipodiatry.com/news/news-essays/the-negative-palmar-angle)
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Itās a very fair point. Our (me, vet, farrier) assumption going in was that they would be temporary for the reasons you cited. Iām hoping to do follow up rads soon to see if we can start easing her down back to flats. What other strategies are used to improve/correct negative angles in the hind feet? Without the wedges, all I had was ātrim the toe shorter, let the heel grow, and wait,ā but the horse was so uncomfortable.
First, wedges are a last resort. Some will disagree but I think the skill set required to apply wedges first and wean out of them successfully is something very few possess, or have the patience for. One thing I will say about what Iāve done, is taken a long approach. I wasnāt expecting this to be ācuredā in one shoeing or even 10.
Four years. Yes. I bought this mare late summer 2017. Did a thorough comprehensive PPE with full rads of her back, she is OTTB. Was barefoot at the time - had been in foal. Brought her home, put shoes on the front because I like to trail ride. Right from the start, she was weird about having her left hind picked up. When it came time to put hind shoes on? Forget it. In those first 6 mos, I am watching her left hind grow in this weird pattern, like it wanted to roll over on itself. I now know that is called bullnosing. Mentioned it to farrier, was blown off as ānothing wrongā. Meantime mare is not getting any easier to work on hinds. I take her to vet for films, sheās at a zero degree angle on the left hind and a -1 on the right! Farrier takes that as āsee I told you nothing is wrongā. I visit local farrier supply and start getting names and numbers of other farriers. Start researching via google, because Iād never heard of negative anything before. I get calls back from 3 farriers and ask them to do a āmeet and greetā because I want them to see the issue and talk with me face to face. I also want to see how they interact with my mare. I ended up hiring a young guy, he said to me āletās take her to Farriers Forumā (a monthly clinic put on by my vets office, where 2 cases are taken and multiple farriers/vets talk about and discuss). We took her there, got fresh rads, and he put her in something called Flip Flops. Basically what they do is float the heel, so there is no pressure on them, so they can grown down rather than under. She was in them for about 18 mos, and they did get us moving in the right direction. She was reshod every 4 weeks. This is crucial, you have got to catch things before they get too far in the wrong direction again. When we moved her out of the flip flops, into regular shoes with full pads, but flattened the heels of the shoe to somewhat mimic the āfloatā of the flip flops. Then she moved into a ānormalā shoe ( we didnāt flatten the ends), and rim pads. Throughout all of this, I kept up with regular vet visits for rads. Sometimes had farrier meet me there, so we could film before trim, after trim, and after shoe set back on. To this day, sheās on a 5 week cycle.
One thing interesting is that ābeforeā this mare would stand very camped under. If you didnāt know, youād think she was sickle hocked. Fixing her angles has allowed her to now have a ānormalā stance. At one point last summer my farrier tried rockering her toes pretty hard. It was okay for about a cycle, then things went south. It just put her back on her heels too far and she crushed under again and when we took rads she was 2* negative. Ouch. More than that tho, is your hoof pastern alignment. Vet, farriers, and I have discussed this ad nauseum. There is no āsetā degree any horse should be. If your HPA is lined up, thatās the most important aspect. Keep that in mind. Finally, at our farrier appt in December, we decided that things were just not working, and we had exhausted the majority of options. He pulled out a 2* wedge pad, and thatās what she is in now. That said, I took her in for a vet appt on Jan 22 - she was at 4 weeks then - had farrier films done and she was running just barely negative. 4 weeks into her trim cycle, thatās decent for this horse. She had not been acting herself under saddle and was having a hard time holding her left canter lead, last thing I expected was to find KS. She can sometimes get sore in her lumbar area, and Iāve had it injected before. I figured she just needed it again.
I am sure I have skipped over some details and such, so any questions please feel free to ask! I am happy to share the what/why/how of this. Itās been a learning curve, thatās for sure.
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Lots of great info here, thank you! Luckily I do have my horse on a 4 week cycle while we try to correct things, and I have a great vet and farrier (though tough to get them out at the same time).
Interesting about the flip flop pads, I have not seen those before. Itās worth noting that my horseās wedges are not pads - they are trimmed to fit only under the shoe, so the heel is not compressed by anything other than the footing. I would think this would be better than wedges + full pads, which would compress the soft tissues of the heel even further, no?
Iāll have to mention the flip flops to my vet next week and see what he says. I canāt fully understand how those are different from traditional pads (with or without wedges), but maybe Iām missing something.
That seems like a recipe for frog prolapse? I would be interested to see photos. Hereās an excerpt from another site with a ton of good info on hooves and farriery:
(https://www.theequinedocumentalist.com/post/haemodynamic-mechanism-the-key-to-hoof-health)
Anecdotally, my LTLH/thin-sole horse has been in frog support pads for much of the last year and it led to huge improvements in his sole depth and the health of his previously underrun heels. He definitely had prolapsed frogs when wearing regular shoes.
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My first KS horse, and only one of two so take my experience with a grain of salt, had rads that looked remarkably like the ones in the article. Impingements, overriding, lesions, etc. The horse was violent for his relatively new owner, which was completely outside the norm for him. Their trainer wanted to push him through a ābootcampā of sorts; mind you, this was a finished and broke to death hunter who flunked out because he just wasnāt sitting back on his hocks and therefore just not brilliant enough. Back bothering him? Possibly. But he wasnāt a bad-minded or unruly horse.
Anyways, ownerās mom contacted me for my opinion and smartly thought the ābootcampā would make things worse; she said she thought he was in pain. I hauled the horse to my vet since I knew he would give us a straight-forward answer. Rads were bad and owners were advised that he probably shouldnāt jump again, certainly not without a major overhaul in his conditioning. Fast forward a few months, they asked if I would take him back since he canāt jump. I was getting ready to leave on a deployment, so I threw him out on a 3/4 acre paddock with a bit of an incline and told him Iād deal with him when get back in a year.
I got back and he was a completely different horse; fit, well muscled, round over his entire topline (he was an under-muscled, inverted mess when I got him back). I started riding him with the intent of keeping him round, and fit over his topline. I never had an issue with him, and in fact was able to re-sell with full disclosure to someone who has extensive experience with KS. He is now a 2ā6" equitation master at the local A circuit and happily totes around petite kids that have good/light seats. Heāll let them know if they agitate his back by sitting too hard.
We did nothing but allow him to get in shape naturally in his own way, and then maintain with proper conditioning.
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Here are two pics from last night. In terms of frog support, to me, these are no different than regular shoes. They may lift the heel off the ground an extra few centimeters, but there is still plenty of contact with most of our footing (whether itās in the pasture or in the arena).
Just to clear up, the wedge pads my horse is in, are rim pads, not full pads.
Iād be interested to see your horsesā hoof flat on the ground, if you could take other pics?
Flip flops, going to try to attach a link so you can see how they work. https://www.farrier-shop.com/flip-flop-pads If you look closely you will see they have a groove where half a shoe goes. Once applied you fill with packing. What happens is the entire hoof shares the weight load without the pressure on the back half of the hoof wall, so the heels arenāt under so much pressure.
Interesting! The website made it seem like they were all full pads. Iāll try to take a pic of mine flat on the ground tonight. Iāll definitely be asking my vet about these.
Flip flops ARE full pads. The pads my mare currently is in are rim pads, she is no longer in flip flops.
