mystery hock swelling, walking on hind toes

[Lmabernathy]

Got a second opinion post 19
Update post 11, still swollen

Have a mare with both hocks swollen, left is a little worse than right. Sometimes walks fine on her own but if led quickly or asked to trot she walks on her toes in the back. Left heel is visibly picked up and right heel does not appear to make complete contact with the ground (a few centimeters off the ground while left heel is 2 inches off the ground)

Vet has her on rest and previcox but this is going on 2 weeks now with no improvement.

I think this happened when mare was in the round pen a few days by herself because of buddy sourness, not being able to be caught, and causing other horses to run with her. While in the round pen she would run the fence line. Then of course it rained over night and she had worked up about 4 inches of mud on 1 half of the round pen the next day. Didn’t do anything with her for a couple days and she walks fine at her own pace so noticed it about 2 days after the round pen episode.

Just got the mare in Feb. Just a poor horse keeping situation. This mare and another mare were kept in corral stalls under a carport for 6 months. This is why the mare is so buddy sour. This wasn’t a run in, in a field. Horses were literally kept under a carport at someones house. No turn out what so ever from what I understand.

Going to go the the vet for a recheck next week, but any ideas in the mean time? Hocks don’t feel squishy or even very noticeably hot, wondering if this damage was already there and I didn’t notice it because it is in both hocks and winter hair was covering it up. Thinking the round pen incident just inflamed it. With no improvement I am wondering if this is something I can even rehab? Feeling very bad for this mare because she was really nice under saddle. Just needed work on her ground manners.

[kdreger]

With stress from the move, stress from not having another horse, stress from a change in feed and her overworking herself I would be real worried she has tied up. Not sure if you are low in selenium or not.

[Lmabernathy]

Well, she is losing weight despite being rested for almost 2 weeks and uping her high fat grain (triple crown training). Don’t see her eating much hay (she has a free choice round bale in a paddock with 2 other low key mares since she can’t be left alone or even just share a fence line with other horses), she has been lying down more than usual.
Not sweating or breathing heavily. If brought out with a human she is just antsy on her feet, tight jawed, and looky in her eye, sometimes paws. If she is put in a separate area with no horse or human she paces the fence and calls out.

Did notice muscle spasms/quivering in her left stifle yesterday when farrier was out. We trotted her a few steps in a straight line to try to pinpoint why she doesn’t bear weight on the heel and ended up not trimming her because of her reluctance to bear weight.

When I got her she had poor muscle tone especially in the hind end. Started doing walk trot work with cavaletti to build muscle. Started a little bit of canter, less than 5 mins total canter time with walk breaks in between laps and changing directions. However, she never went sore during work. Noticed soreness after having time off

[Bluey]

I don’t know why you blame concrete for that?

Practically every horse barn decades ago in Europe had concreted stalls and horses lived in there, well bedded, for most of their lives, going out just to be ridden, although that several hours most days.

I never saw any problems from that kind of management that I didn’t see later here where stalls were basically bedding on dirt.

I think that your mare may have this problem now possibly more from repetitive type injury from walking herself silly when she was confined away from other horses when she was in poor physical shape to be doing that on top of it.

That of course is just a guess, your vets can help you sort better what is going on there.

Soreness after work may mean possibly arthritic changes somewhere.
First, try to get a good diagnosis, so you have something to work with.
Hopefully you can find a way to help her to get over this hump soon.

[findeight]

Sounds like you need a vet, run some blood tests. The muscle spasms concern me, I would not look for excuses to explain that. If she’s trying to tie up, you need to know and act accordingly.

Sometimes when you put one back to work that’s done nothing for some time and/or runs around like a idiot without proper warm up and cool down, they will tie up and that can shut the gut down and lead to colic (BTDT, good thing the vet ran the blood when he answered the colic call and we treated the correct problem).

Foget the concrete, worry about muscle spasms. Maybe look at her diet…upping the grain often is not the best way to go, there are other ways to add weight and horses really don’t even need grain unless in heavy work. Causes more problems then it helps. I’d get her off of it, feed alfalfa cubes, soaked or something like that. I’m sure our feed gurus can recommend something.

[Lmabernathy]

Not blaming concrete persay, just wondering if the swollen hocks were always there and I didn’t notice it because it was in both hocks and she had her winter coat, like maybe current issue doesn’t have anything to do with the hocks. Just worried about the mare and trying to figure out if there is something else I can do besides rest. Her not being able to be by herself makes feed changes hard because she is on bottom and if I takes her out of her little herd to eat she frets and still doesn’t eat.
high fat feed is what they recommend for tying up so that shouldn’t be making anything worse. Just worried about her long term use because she’s only 13. Vet is vet wait and see and I don’t mind that. Just don’t want the situation to get worse in the mean time

[Simkie]

I’m confused…You say her hocks are swollen, but then you say they’re not squishy. What are you seeing and calling “swelling” if it’s not squishyness?

The fact she can’t put her heels on the ground is alarming and hocks sure wouldn’t be my first thought. She needs a full lameness work up, including a neuro exam.

[IPEsq]

[QUOTE=Simkie;8131835]
I’m confused…You say her hocks are swollen, but then you say they’re not squishy. What are you seeing and calling “swelling” if it’s not squishyness?

The fact she can’t put her heels on the ground is alarming and hocks sure wouldn’t be my first thought. She needs a full lameness work up, including a neuro exam.[/QUOTE]

Ditto!

[Eventer13]

Yes, I’d be very concerned if my horse wasn’t bearing weight on their heel. And I would not think the hocks were the primary cause.

[HealingHeart]

Round pen and mud wasn’t the best choice. Have you ever played sand volleyball, but never played. It is hell to get out of that deep sand… Mud and running around doesn’t seem like the the perfect situation…she is muscle, perhaps joint sore…it will take time… Hand walks and cold water on the areas of concerns… Massages even better

[Lmabernathy]

Ok so went back to the vet he ran a Cbc panel and everything came back normal. He prescribed 7 days of smz tabs and dex injections everyother day for 2 weeks.

Initially I did see some improvement. She’s up more not laying around anymore. Swelling stated going down although it had gotten really bad, swelling around the entire hock front back and sides, worse on the outside and back and even showing puffiness in the gaskins. Been on dex 11 days now and still has significant swelling on both outside hocks. Looks like a small water balloon under the skin. Not mushy but not hard, think of a n avacodo feel. Left is still worse than right. Still walks on toes. Occasionally twists dramatically on her hind toes when she walks. Twisting motion comes and goes. Any ideas? This is so weird, she’s been lame for about 6 weeks and swollen for 4-5 weeks now. Has also lost a significant amount of weight, despite 24/7 access to hay and increased feed. Feed is high fat with flax and increased omega 3s on top of everything else.

[Ghazzu]

I think it might be time to seek a second opinion.

[MoonlightsMom]

Have you had any Xrays or ultrasound done?

[Lmabernathy]

Well my second opinion vet is fairly pessimistic. For instance last time I took a horse in for a lameness evaluation he blocked him said he had navicular and white line disease and he needed to be put down if he continued to be as lame as he was when he saw him. Horse actually looked better than what he normally looked like. Told me to keep him barefoot and see if he could be pasture sound on previcox. Did previcox for 6 months no improvement. Treated for white line (which was in the outside of his foot) was then able to nail a shoe on just to see what happens. Wore plain ol reg shoes for 3 weeks and finally started going sound. Evidently he just had significant bruising or tenderness. Didn’t react to hoof testers but since the shoes have been on he’s been sound for 6 months now, touch wood. Not on any meds or supplements either. The white line prevented me from being able to put shoes on sooner because it affected the area where the nail would go, so shoes just kept coming off.

Don’t have a lot of choices for large animal vets without a lot of driving time and this poor mare has a hard time stepping up into the trailer in her condition. Just looking for possibilities I can research in the mean time

[Lmabernathy]

Have not done xrays or ultrasound, first vet doesn’t really feel that this is an injury. I’m not really sure if I’m following this correctly but he said he doesn’t think the hock joint is affected. That the fluid is a pocket outside of the joint. He never gave me an actual diagnosis but I was under the impression that he thought it was some kind of infection. Although, the blood test came back normal so I might be reading into this something completely different than what he intended.

[Simkie]

I don’t quite understand why you’re not more concerned about this. A horse unable to bear weight on the heels with two huge hocks would be an emergency in my barn. The fact she’s so unstable she can’t even step into a trailer for a ride to the vet is alarming.

Get the vet out. Get a second opinion. Get radiographs. You may need to tap the joint to check for infection in the joint. Or you may need to ultrasound to check for significant tendon damage.

Perhaps I am misinterpreting what you are posting, but it sounds like this poor horse is in a terrible amount of pain and at considerable risk of supporting limb laminitis due to being unable to bear weight on the hinds.

[Lmabernathy]

I am concerned about her that is why I am wondering if anyone has ever had a horse with similar symptoms. The horse is under vet care. She can get in the trailer (just not as easily as a normal horse and I worry about her balance in my 4 horse open stock trailer), she can move, she even tries to trot away and will rollback because she doesn’t want to be caught especially now that she is getting shots every other day. She will bear weight in the hind end while standing still.

Is she sound, no. Is she flailing around, labored breathing, sweating, temp, high pulse, no. She gets up and down without assistance. She’s eating and drinking well. She doesn’t pin her ears, she doesn’t mope about. She is bright eyed, on her feet, and interested in what is going on around her. I don’t know, my vet didn’t act like this was the worst thing he has even seen so I am not in a complete panic, but I am trying to research what might be going on. That’s why I’m posting about it. In the past Coth has been a very valuable source of information.

The reason I am not more concerned about the weight loss is because when I broke my elbow I lost 70lbs. Easiest diet I have ever been on lol. The body uses a lot of energy to heal, that part I can understand. That’s why I have been increasing her calorie in take. I am trying to get the mare better. I’m not turning her out to pasture and waiting on nature to take its course.

She is getting better, just not at the speed I would like to see. The swelling is more localized now. My vet did mention draining and testing the fluid off her hock. I guess that will be our next step after the dex is completed. He wanted to see how the dex and smz would work first.

Her willingness to pivot on her hind end and the occasional twisting walk perplexes me. The walking on the toes doesn’t seem to mechanically fit up with hock soreness to me. Can anybody relate this to a human for me? I am just trying to understand what is happening to her, that way I know if the vet and I are treating her aggressively enough or if I should ask for a different route. I do trust my vet. He has been my vet for the last 12 years and has seen dozens of horses in my care. I like him so much because he is willing to listen to me and will try things I would like to try, my experience with other vets is you do what they say and there are no other options. He is also very practical when it comes to a financial stand point. He does try to spend money where its most needed, most vets will have you spend money hand over fist.

[Simkie]

No one can tell you what’s happening with her except a vet with some imaging equipment. We can make swags, and I think those guesses are all pretty grim and likely costly with long rehabs and unsure outcomes (especially with treatment starting so late in the game.)

My expected standard of care for a horse in this condition would have been, in this order:

Lameness exam to pin point problem area.
Imaging as appropriate. Radiograph and/or ultrasound.
Course of treatment appropriate for problem. If outcome with treatment is not expected to be positive, or treatment is too costly, then euthanasia.

If I had a vet tell me to put her on a week of SMZs and some dex, I would find another vet, as that is so far way from the standard of care I’d expect it’s not even in the same country. Even if the cause IS some sort of infection–say in the joint or the tendon sheath–a week of SMZs wouldn’t even begin to treat the problem. Far more aggressive management and treatment would be needed.

I’d recommend advocating for this horse here to get to the bottom of this problem, or putting her down. This has been going on for a MONTH by your account. That’s at least three weeks too long without answers.

[Lmabernathy]

Ok went to a new vet today! Did x-rays, both came back clean. No signs of any arthritis or any other bone damage/injury.

Drained and tested fluid in the hock. It’s just clear fluid. Testing only showed white blood cells at 500, vet wouldn’t even call the fluid inflammatory at that percentage.

Gave a steroid shot in the swelled area. This vet also said the swelling is not in the joint but in the tendon sheath. She thinks the area is basically swollen from being a bruised type injury from banging her hocks into something. I am suposed to call back on Mon and let her know if we have any signs of improvement by then.

I still don’t understand why the horse wrings her hocks, only wants to pivot in a turn, and walks on her toes if her hocks are basically just bruised? I would think those movements would put more pressure on her hocks instead of relieving it. I hope the vets are right, because that would mean she should get better now. The symptoms just don’t make a lot of sense to me. Can anyone relate this to a human injury for me, so I can understand the mechanics of it?

[Simkie]

Did the new vet do a lameness exam to confirm the only issue is in the hocks?

Did the new vet perform a neuro exam?

Did the new vet ultrasound anything?

What did the new vet actually inject? The hock joint? The tendon sheath?

What did the new vet say when you asked her why the horse was wringing her hocks and only wants to pivot?

No, I wouldn’t expect this degree of lameness with “bruising,” either. I’d want the vet to ultrasound the hind limbs to see what exactly is going on with the tendons, and I would also want the horse evaluated neurologically, as EPM can cause some really bizarre locomotion. If EPM, treatment can be costly and less likely to return the horse to “normal” the longer you wait.

The horse is moving funny because she’s in pain. Without more information and imaging, it’s impossible to relate this to anything. It’s like saying “my knee hurts and is swollen. What’s wrong?” Well, it could be a muscle injury, or a tendon injury, or a cartilage tear, or perhaps even something in your HIP, because pain sometimes refers that direction. You’d be told to go to a doc to be evaluated and there’s a good chance you’d go in for an MRI to determine what’s actually going on.