Misterious lameness

[tina1976]

First of all, I’m not looking for a treatment option or veterinary advice. I’m just trying to understand what may have happened.

I own a mare who was diagnosed with arthritis, from time to time she was lame. As per my vet advice, we were taking a conservative approach : light work, equinox, rest when needed.
Then a vet came to the barn, one who’s expert on lameness. She took several x-rays, and advised a change in shoeing, joint injection and a slow program to introduce her to work.
For a while this regime seemed to work (the whole recovering program was about three months) but in the last sessions the mare started showing lameness again. And it was much worse than it had been before.

So I called the usual vet (since the other was a thousand miles away), he did the nerve blocks and found that lameness this time was related to the extensor tendon, and advised a change in shoeing, again.

We changed the shoeing, but so far there has been no improvement. The mare is very lame, noticeable even at the walk.

She’s not working, just out in the paddock (she just walks there) and some walking on hand in the best days.

None of both vets can give me an explanation.

Have you ever heard or experienced anything like that???

[lenapesadie]

Welcome to COTH! Sounds like you are doing your best to diagnose and treat your mare. I’m sorry she’s still ouchy. I don’t have any relative experiences to share other than it can be difficult sometimes to get the farrier and the vet on the same page.

[Simkie]

Very lame at the walk with no apparent cause is often the result of a hoof abscess. Has that been considered? If you’re somewhere with winter, this is a common time of year for abscessing, as the deep freeze settles in and the ground becomes rock hard, causing bruising, which can easily turn into a painful abscess.

[JB]

I wouldn’t expect a damaged extensor tendon to produce the lameness you describe, since that’s not a weight-bearing tendon. I’m curious how the vet decided that the improvement was related to the ET

Where is the original arthritis location? What joint was injected?

All of this could be easily explained if it’s symptoms that are being chased, not the root problem

[Abbie.S]

@JB

I wouldn’t expect a damaged extensor tendon to produce the lameness you describe, since that’s not a weight-bearing tendon. I’m curious how the vet decided that the improvement was related to the ET

That was my first thought, too.

It honestly sounds to me like the extensor tendon was an incidental find and the real cause has yet to be determined.

[tina1976]

She isn’t very lame at the walk. But you can notice it, if you pay attention, she places her left foot with care. Very noticeable at the trot.

[tina1976]

The case is, she was a little lame before. Hardly noticeable most days. After the first change in shoeing, joint injection and the following routine, she seemed to improve for two months and a half. Then she started showing lameness again and this time it was much worse. Following that, after the nerve blocks, we changed the shoeing again, and put her on active rest (paddock and hand walk). And the lameness is worsening, not improving in any way.

What would you do??

[Simkie]

It sounds like this horse needs a full lameness workup at a referral center, if you’d really like to get to the bottom of this.

Ultrasound is generally used to diagnose soft tissue injury like you describe. You don’t mention any ultrasound here–was one done?

[Abbie.S]

What would I do? I would probably, as Simkie said, get a more comprehensive evaluation done.

I guess I am having a hard time understanding your timeline and what you’ve found out already. You have a horse diagnosed with “arthritis”. Arthritis in what joint? How was it diagnosed? What imaging was done to confirm the arthritis? Why was the shoeing change advised as a treatment for the arthritis?

Injections don’t work for all horses. It’s entirely possible that the issue IS the arthritis and it is too advanced to be helped long term by injections/injections just aren’t going to work with this horse. It’s also entirely possible the lameness has zilch to do with the arthritis.

I’m wiling to wager a guess that, since you say the mare was “a little lame before” and now “much worse”, the true root cause has not been identified yet but was exacerbated by a return to work. I’d be getting a more thorough set of diagnostics done.

[Posting_Trot]

This may not be what you’re looking for, but my take would be the following.

Horse was lame, had good days and bad days. Probably the “good” days meant that the pain was controlled enough that the horse could work through it, while the bad days meant that the pain was more intense.

The shoeing changes advocated by the fly-in specialist probably shifted how the weight was born in the legs and feet. So parts of the legs and feet that weren’t sore were being asked to do most of the load-bearing and flexion. Because they weren’t sore at the outset, the horse went “sound” for a while.

But, probably the new way of going with the new shoeing loaded areas that couldn’t take the persistent use. That created even more soreness but in different areas.

Maybe that is what happened, but of course, it doesn’t get you to a diagnosis of the problem.

Good luck in sorting everything out.

[IPEsq]

Where is the arthritis? What joint was injected? What were the shoeing recommendations and why?

A horse can basically cut its extensor tendon in half (which sometimes happens!) and be ok. You are dealing with something else most likely, and lameness at the walk is not a good thing. First guess would be something having to do with the feet, given the shoeing changes, and possibly an abscess. You can block the foot to confirm it is something in the foot.

Other than an abscess, things that come to mind that could indicate lameness at the walk in the front would be a serious foot issue, such as bad bruise that hasn’t abscessed–yet?, farrier problem like a hot nail or really bad trim, coffin bone fracture, severe pedal osteitis, collateral ligament injury, severe navicular syndrome…

If the lameness is not in the foot, then you go up the leg from there. It is possible a shoeing change could cause a different problem than what it was meant to address. But arthritis in the knees can also show up at the walk.

What you risk in not getting a diagnosis is if this is something that needs strict rest (such as fracture, collateral ligament injury) or immediate attention by your vet and/or farrier, continuing to move this horse around could really have a negative impact on the prognosis. While movement is good generally for arthritis, there is a very controlled approach to movement for a soft tissue problem, and then if you have an infection or fracture, that will need other intervention.

[BoyleHeightsKid]

What was injected?? The coffin bone, fetlock, knee?? If there was a change in shoeing, I think we need pictures of the feet.