P3 Osteomyelitis

[Shelby720]

I had been struggling with a recurring hoof abscess in my 13yr old fox trotter for over a year. Multiple vet visits, X-Rays, farrier visits and FINALLY another set of X-Rays revealed P3 Osteomyelitis. I am just reaching out to see how many of you have dealt with this and how successful was treatment/what was your treatment.

Upon the discovery the vet cleaned out the abscess area (there is a tract that goes from the sole/toe area directly to the infected bone) very well and did a little “debridement “ of the area as best she could while big guy was sedated.

The vet gave me 2 options:

Treat this with long term oral antibiotics (30 days) along with antibiotics injected directly into the abscess tract, along with daily flushing/soaking/bandaging of the area to keep it clean. This option doesn’t have a high success rate, but is much less invasive and lowers risks of re-infection.

Second option is to do an in hospital surgery (farm surgery not an option with any local vets) with a 5 day hospital stay to remove the area of infected bone. Horse would then follow up with a month of antibiotics, daily bandage changes, and at least 6 month recovery/stall rest. Although more successful, This procedure would require a large area of hoof removed making the area susceptible to re-infection, with no guarantee of soundness, success after surgery.

For now I have opted to do just antibiotics and praying for a miracle. I am not sure if surgery will be an option for us due to a variety of reasons, aside from this guy has been through so much and I don’t intend to put him through any more.

For now the horse is happy, sound and most importantly comfortable while going through the antibiotic therapy. We are about 2 weeks in and the site “looks” good but there is still drainage from the tract, although it smells much better. I will not know how successful this is until antibiotics are stopped, and horse is eventually turned out without a protective boot/bandage.

What is everyone’s experience with this? Do you think we stand a chance to beat this without surgery?

[findeight]

Depends…if it’s a financial burden to go with the surgery, resection and supervised after care? Give it a shot. But you must be extra diligent in following the vets exact instructions and keep the area around that horse squeaky clean and making sure he gets the full dosage of antibiotics.

Are you using a dosing syringe or hiding the antibiotics in the feed? It’s vital he gets them, injection is usually the best way to do that. If it’s IM, your vet can show you how and leave them for you to inject. That’s how and why I learned to give an IM shot. Horse needed daily shot for two weeks and every other day for another 10 days. It was me or 20 farm calls…

[Shelby720]

Surgery would obviously be a financial burden as well as a mental, physical, emotional toll to take on the 6 month recovery with a foggy prognosis on it even working. Cold feet for the surgery option for sure.

These are oral antibiotics, but he is taking them willingly. I too was concerned he may eat around the antibiotics in feed or drop out bits onto the floor. I got creative and dissolve the dosage of antibiotics with water then mix them with instant (brown sugar) oatmeal. He comes running for this, and licks the bucket squeaky clean twice a day. I do stay present until every last bit is gone.

His hoof is double wrapped. Vet wrap with traditional duck tape boot. Then that boot is placed into a Davis soaking boot to keep dirt out completely. Turned out in small paddock and stalled for wet weather. The bandage is replaced once a day. Flushing/antibiotics done at this time. I have done a clean Trax treatment and a few diluted Lysol soaks per vet instructions. I only remove the bandage when he is standing on a bleach cleaned stall mat. If he accidentally gets his hoof away from me, I know setting it on this stall mat will not allow debris/bacteria to the hoof.

[Palm_Beach]

I’m sorry OP but I would try option 1 and if that did not work, put the horse down. Option 2 sounds like hell to me, with a good chance of the horse foundering and/ or having other complications. I am sorry you have to deal with this.

[Shelby720]

@Palm Beach

I’m sorry OP but I would try option 1 and if that did not work, put the horse down. Option 2 sounds like hell to me, with a good chance of the horse foundering and/ or having other complications. I am sorry you have to deal with this.

I appreciate the input. Honestly, this makes me feel better. I’ve worked my butt off to save this horse and spent a ton of money over this last year. I feel like at some point I have to draw the line, and it is relief to see that I am not the only one who would feel this way. This has been such a hard decision. I do everything I can to be a responsible horse owner, but that doesn’t mean I have limitless in resources.

[Palm_Beach]

@Shelby720

I appreciate the input. Honestly, this makes me feel better. I’ve worked my butt off to save this horse and spent a ton of money over this last year. I feel like at some point I have to draw the line, and it is relief to see that I am not the only one who would feel this way. This has been such a hard decision. I do everything I can to be a responsible horse owner, but that doesn’t mean I have limitless in resources.

((hugs))

[Texarkana]

I’m sorry you’re going through this, OP. Here’s my novel-of-a-story:

I went through a gnarly case of P3 osteomyelitis with my mare. I bought an older broodmare very cheaply from a farm dispersal in 2013. Thirty days later, she sustained an open P3 fracture in the pasture (on Christmas Eve, no less). I was living in an area with limited vet services at the time.

My plan was to euthanize her. My vet, who had been practicing for many years but had little experience with these types of catastrophic injuries, made me feel -->this<-- big for wanting to put her down and basically guilted me into trying a conservative approach. Seeing as how I had just purchased the mare for almost no money, I was adamant that I was not going through the hassle/cost of driving her several hours away to another time zone for surgery + hospitalization. I had worked for a major university vet hospital in my youth and saw the outcome with similar injuries to be unsuccessful more often than not.

We started with IM Excede and sterile bandaging over a corrective shoe. I told my vet that wouldn’t work. Spoiler alert-- it didn’t work. Two weeks later she had purulent discharge coming out of every part of her hoof. Radiographs showed a considerable portion of her P3 had already been lost to infection. At which point my vet went, “aw shucks, I guess I was wrong and we need to euthanize her.” But I was emotionally invested by that point and said, “no, you don’t get to give up that easily… what other options do we have?”

We did a series of intravenous regional limb perfusions with gentamicin (and I think something else), then continued with IV gentamicin and oral enrofloxacin after the IVRLP. We kept up the oral enrofloxacin for MONTHS-- the open crack/tract in her hoof closed with new sole in early March, but I don’t think we stopped the enrofloxacin until nearly May. Meanwhile, she was getting sterile bandage changes 1x-2x a day while the tract was open. She also wore a thick-soled Soft Ride or Easyboot RX over her shoe to keep the bandage clean and dry. She was originally on stall rest only; when the infection became established, I began hand-walking her because movement, while bad for the healing bone, has been shown to help clear infection. Because of the bone loss from the infection, she was on stall confinement with only hand-walking and limited turnout in a small “medical paddock” for a year; I think it was February 2015 when I finally returned her to unsupervised 24/7 turnout.

Nearly six years later, the mare is happy and sound, living barefoot in the pasture as if nothing ever happened. This mare has become a beloved pet and while I’m grateful she is with me today, I’m not sure I’d do it again. We got very, very lucky that our approach worked. Sometimes I wonder if we were successful because we didn’t go the surgery route and be exposed to the more resistant bacteria that pervades busy hospitals. But in the long run, I certainly didn’t save any money as compared to a surgical approach. If I could go back in time, I would have just taken her for surgery in the first place, or insisted on euthanasia despite my vet’s protests.

[Shelby720]

@Texarkana

Nearly six years later, the mare is happy and sound, living barefoot in the pasture as if nothing ever happened.

This is amazing. I am sure this was a long and exhausting journey but you guys did it. This gives me hope that persistence may work for us. Your case sounds more complicated with the fracture, and a larger infection. Gratefully, my guys infection is very localized in an isolated area of the tip of the coffin bone. Your story gives me hope that if you beat this, perhaps we can too.

[Texarkana]

@Shelby720 It’s certainly doable, but I don’t want to give you false hope, either. But you’re right in the sense that we were dealing with a complicated fracture on top of widespread osteomyelitis.

Also, this mare is not a riding horse, never was a riding horse, so when I say she is “sound,” she is sound for loafing around the pasture with her friends. I’m not sure if she’d hold up to riding; I definitely don’t think she’d hold up to riding barefoot.

I certainly would be more proactive than me and my vet were. Trying to treat it conservatively only led to more complications, which my horse luckily overcame.

[Saskatoonian]

Oh boy, sorry you’re going through this. Add my name to the column Palm Beach started. Went through this with my guy and did the surgical route. Managed to get through rehab without infection returning and was transitioning him to turnout when he was playing loose in the indoor, reared and came down, and was 3 legged. He’d broken that coffin bone. Rehabbed THAT. Prognosis still good. A year into unsuccessful rehab, I turned him out in a field to give him a year (carefully transitioned, obviously). Bottom line: he’s never been sound again. He was lovely to rehab - so good on stall rest - but even so, it was hard on him on so many levels as well as extremely expensive. If it happened again, I wouldn’t do the surgery.

Good luck, whatever you decide.

[stryder]

I have a good story:
My 20+ yo mare had recurring abscesses. After a few cycles of treat, drain, reshoe, lame, drain, treat … We got a set of images that showed pedal osteomyelitis. I was heart-broken. Mare won’t tolerate stall rest, and frankly doesn’t haul particularly well.

Vet is an equine podiatrist. He showed me pics of his wife’s mare, who had a similar diagnosis. Vet had done surgery, and a few months later, wife’s mare was sound. No stall rest. Said he’d done an equine fellowship in Kentucky, had done many of these surgeries on broodmares, who went back out to their pastures when they woke up.

So we operated in January, which is wet and miserable in the PNW. It was a bloody mess. Put on a glue-on shoe and hospital plate. Every 3 days, then 4, then 5, the plate was removed so hoof could be treated and repacked.
She has a small turnout attached to her stall. We tightened the paddock up a bit to keep her out of the deeper mud.

We were working her in hand in 2-3 months, and lightly riding a month or so after that. I can’t remember the specifics, but it took a while to graduate out of the hospital plate. Then she had a hard blue plastic piece under her shoe, then a full leather pad, and finally back to her regular leather v pad.

She is completely sound. The surgery was under $1K.

Good luck.