I think his pelvis really is not right. Those hocks certainly are straight, though.
FWIW, my problem horse had a few months when he turned 5 when he was super. Otherwise (I bought him at 4), he was a disaster behaviorally, and it was always one thing or another physically. He passed at age 9. His pre-purchase was also quite good. And his pedigree included a lot of well known horses including a successful sire line on both sides, close relatives in the Olympics, etc.
He is very wobbledy looking behind in the trot. I don’t know why though. He does look better when he gets moving more forward though but I don’t think the problem is a training issue or a young horse issue. And sometimes he starts looking a little lateral in the walk. I don’t think it is neuro though - I think it is pain. I just don’t know what is painful or doesn’t function correctly.
Apologies in advance for the fact that this is going to be a bit of a novel, but having spent the last four years dealing with PSD (while not knowing it was PSD until six months ago), I really don’t see PSD lameness there when I watch the video.
My horse was never really lame but he had been very consistently NQR the majority of the time I’ve owned him (bought him shortly before he turned three, he’ll be eight in May). For the most part, it manifested in a somewhat shorter step in his right hind, and we put it down to young horse weakness because he’s long everywhere except in his back and it always got worse after he had a growth spurt before it (mostly) went away again. I’ve spent most of the last fiveish years doing almost exclusively w/t work with him because we just couldn’t figure out what was wrong with his canter (worse to the left, he’d swap to the right lead in the back to guard the right hind, and he did buck me off a couple of times).
I moved him to my trainer’s barn last January and we set off on the (very) time-consuming journey of trying to get him stronger to see if that would make the canter issues go away. When we first moved in my trainer liked to describe him as a 2x4 because of how stiff he was through his entire body, so we spent a long time doing lateral work and intentionally overbending him to unlock him. Our performance vet looked at him after a couple of months and said to give him another ten to twelve weeks before we really dug in further, because she couldn’t tell if it was weakness or not either. Conformationally there’s nothing glaringly wrong with him aside from longer pasterns.
His canter got a lot better as he got stronger, but then it fell apart again, and we ended up nerve blocking and ultrasounding in July and confirmed PSD. He didn’t have a full tear, but there was edema in the hind right and compensatory strain in the hind left (plus signs of prior healed damage) so we were prescribed six weeks of stall rest aside from a daily 30-minute tack walk before reevaluating, which was going great until he spooked and nailed me in the ribs (and put me in the hospital) before I got on a few weeks in (after becoming increasingly more tense daily despite being on plenty of sedatives). Our vet didn’t love it, but my trainer and I agreed that, as long as he wasn’t being absurd, he needed to be turned out until I could ride again, for both our safety and his.
We actually went straight to trot work when he came back because we also did an internal stifle blister the weekend our vet cleared him. Strengthening had worked to a point, but our vet says he’s the first horse that she’s ever looked at and immediately thought he needed blistering, and she was right on that. We also took feet films that weekend and confirmed he was 4 degrees NPA in his hind right and just barely negative in the left. He was wedged (with full frog support) in October, which then resulted in a bunch of feeling weird at the trot as we added it back in. Trainer and I both agreed that he wasn’t lame because it always went away, he was just trying to move in the biomechanically incorrect way that he was used to and we took away his ability to do that when we wedged him so he had to relearn where all of his feet had to go. We’re still working through that at the canter, but he is ten thousand times better than he’s ever been and we’re actually making progress now. His front end, SI, and back soreness have pretty much entirely gone away since we wedged him and he doesn’t buck at all anymore except for once or twice when he’s been legitimately fresh.
All of that to say, I’ve been through the PSD thing, I know what it looks like, and in your case, I don’t think it looks like the main issue here. I’d definitely look into his SI and his back. It may be that there’s something actually wrong or it may be residual from the PSD situation, but either way, he sounds (and looks) like he needs to be given some pain relief there, and that would correspond to the bucking, etc. and to your statement that he’s historically gotten better in work (which to me indicates that he feels less of a need to guard the area when it’s stronger). We actually had my horse on muscle relaxants while he was on stall rest to help keep him calmer but also to help loosen up all of the tension that he was carrying through his back, so they may be worth a shot for you just from that perspective (and as a cheaper indicator of whether there really is something going on there).
The worst that can happen is you’re wrong and there’s something else at issue, but I was the one who asked for the hind feet films (said it was for my own peace of mind) and as soon as our vet looked at them, her comment was “You wanted these to see if he was negative, didn’t you?” If it’s not a problem from a financial perspective, I’d definitely investigate his back and SI. We took back and neck films the first time our vet looked at my horse and we didn’t find anything, but in my view, I have a good baseline for the future so it wasn’t a waste of money.
This does not sound like adequate rehab. Like you are starting rehab before the horse is healed. Rehab should be in the range of stall rest for a month, 6 weeks hand walking, 6 weeks walking under saddle. Then starting trot at 3 minutes adding on time every 5 days. The horse should be getting ultrasounds before starting any change. I personally will walk for a good 2 months. There’s no hurry.
I am not an expert, but any horse that I have rehabbed would have been dead ass lame if I had done 2 weeks of walking under saddle then started trotting. This horse , to me, looks like he’s not fully cooked. The rehab is not sufficient. Hind legs take a long, long time.
I hesitated on posting because maybe I am misinterpreting. If this is the case, then maybe the lameness is somewhere else.
I agree with you on taking it slower as far as the trot work, but there’s some evidence that full stall rest is not helpful for tendon/ligament injuries, because the fibers need some movement to heal correctly and without scarring. Therefore a lot of vets recommend handwalking from the beginning.
Yes, I understand this and agree. I am following this protocol on my current rehab. (I am actually frustrated at the lack of adequate turnout at my barn.) I have used turn out and think that more slow movement is best.
I was a little surprised at seeing 2 weeks walk under saddle and then start trot. I would substitute months for weeks. The second month could even be nice walk trail rides with adequate footing. Every rehab project that I have had or seen would have been unsound if I had trotted 2 weeks after getting on.
OP, how recent are these photos?
One thing I notice is just how different the angles are on these hind feet, and how the right one looks clubby.
When my gelding had PSD, the shoe recommended by Michigan State was thicker in the toe which I would think is exactly the opposite of this. My farrier custom makes my horse’s shoes to address his tendency toward PSD. Maybe something to look into. But I don’t like the looks of your horse’s feet at all.
OP, here is a link to a shoe similar to what my farrier makes my horse: https://www.euroforgesupplies.com/denoix-suspensory-shoe-thoroughbred-suspensorix-ps-hind/
Same concept but my farrier uses steel and the wide front is a little narrower than this.
Was this full, 24/7 turnout?
One thing I noticed that you did not ask for - his condition from the June 2023 show video, to the video you showed in your OP, is very different. But the lameness is there in the 2023 video, too. The loss of condition would be concerning for me as I am sure he is getting great care, notwithstanding.
Has a full neuro work up been done?
I don’t think that this toe dragging is laziness. Horses generally don’t enjoy dragging their toes.
I agree with others that other than the toe drag, I don’t see screaming PSD. PSD generally presents a pretty consistent lameness - the trot can look and feel lumpy like a tire is clumping along. In my experience I don’t see PSD having a lame step and then a non-lame step in the same session. Usually it’s fairly lame and gets gradually worse on circles and the longer the horse is moving at trot or canter. The asymmetry of his gait and loss of condition would have me start thinking about neurological diagnostics. Uneven steps behind can be something up high, but it also can be a neurological symptom.
Rubbing rails or not being able to clear them with their hind end can be anything soft tissue or even sometimes, sore hocks and stifles.
The pelvis could be worth checking out, but he does not move the way my horse with a broken pelvis moves. Firstly – my horse could not even walk or lift up the leg to get in the trailer. Every step was consistently lame - there was no vacillating between okay and not. For a long time, he was too unstable to even truck in. I don’t think he could have trotted if we tried. And the ROM in his leg started and stopped up high - it was a very distinct “swing out but not up” movement. But there are degrees to pelvic breaks and my horse’s was incredibly severe. Many horses compete with broken pelvic wing tip fractures, which are minor. If bad enough that it involves muscle/ligament attachment/tears, it can impact their future soundness.
Unless I missed it… did this horse have blocks done besides the initial nerve blocks that pointed towards PSD?
I’d be curious to do more block work - not cheap, but might give you an answer. Some blocks can be red herrings though. I’d want to see if he moves as lame with his stifle and SI blocked. His stifles in the video are not quite right - but sometimes when stifles look lame, it’s SI – and sometimes when SI looks lame, it’s actually the spine. If he doesn’t improve with blocking the hind end, I think you’re looking at something neurological.
ETA: I know you did not ask for this, but I went and watched every video of yours on your channel of this horse. Whatever he is dealing with, goes back to at least March 2022 in the FEH class. Even then, there is a gait abnormality and more than once he loses that white hind. This may be something he had when you bought him, but it took until now to get gradually worse.
He had a month of stall rest with hand walking. At the one month mark he was jogged again and with the lameness locator and that was the visit that said he was no longer lame. They said there was so much improvement that he didn’t need to be rescanned. Adding 2 weeks of riding at the walk, so he had 6 weeks of only walk work before we were to introduce small amounts of trot.
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This is not enough time to heal a suspensory. Nowhere near. This sounds like a big problem. Again, any horse that I have rehabbed would still not be sound for this amount of work. Maybe marginally sound on a lunge, but not sound for quick return to work. Frankly, I would not trust a vet who gave me the green light on this. Add in the recommendation to skip the ultrasound. This is not standard care. The horse maybe just needs more consistent time to heal.
It could be standard care for mild PSD which is just inflammation, with no tears or injury involvement. I agree with you that it would be closer to 6-9 months of stall rest and guarded return to work for an acute injury involving the suspensory. I’m not clear which it is in this case or how severe the PSD is. It kind of sounds like vet found an injury that was already healed on one leg, what about the other? OP, what did the fiber patterns on US look like?
Lots of questions to answer hopefully I can remember them all.
As for it being too short of a time to heal the suspensory I agree. When I started researching this condition people said bare minimum 6 months to a year. I was surprised to be back trotting so fast. And when I did start to trot I was expecting there to be a difference in his way of going but there wasn’t. No different with shoes, all the therapies, adequan, stall rest, etc. I definitely don’t mind giving it more time. I wouldn’t even mind tossing him out for a year to just sit in a pasture. He’s not one to really go crazy turned out. Sometimes he gets the zoomies but he definitely doesn’t when he doesn’t feel good.
I’m uploading a video of his Suspensory ultrasound to put here. It’s a screen recording on my phone and I flip through it kind of fast because at least on an iPhone you can pause and take your time to look. So for those who are really interested you can look and if you know how to read ultrasounds that’s even better.
For the rest of us I will include the language used in his discharge report that says what’s on the ultrasound.
“ Diagnostic Tests & Results:
Hoof Testers: No response on all feet
Lameness Exam: There was no lameness at a walk on hard ground. There was a mild, consistent (grade 3/5) right hindlimb lameness at a trot in a straight line. The right hindlimb lameness was exacerbated and a mild, intermittent (grade 1/5) left forelimb lameness became apparent when circling to the left. The Lameness Locator confirmed the presence of the mild, RH lameness.
Flexions: LF Lower: 0/3 LH Lower: 1/3
LH Upper: 1+/3 Diagnostic Analgesia:
RF Lower: 0/3 (no response)
RH Lower: 1/3 (mild response)
RH Upper: 2/3 (moderate response)
RH Low 4-point Nerve Block: mild improvement in right hindlimb lameness
RH Deep Branch of the Lateral Plantar Nerve Block: significant improvement in the right
hindlimb lameness. After this block a mild left hindlimb lameness became apparent.
Ultrasound: Ultrasound examination of both metatarsal regions was performed and revealed mild to moderate, bilateral proximal suspensory desmitis characterized by mild increase in size of both proximal suspensory ligaments, moderate proximal suspensory fiber pattern disruption of the left hind proximal suspensory ligament. There was also evidence of mild, chronic suspensory branch desmitis (medial and lateral LH, and medial RH).
Radiographs:
Left hind digit: The dorsal soft tissues are equal in thickness at the proximal and distal aspects of the hoof wall. The dorsal soft tissue thickness to plantar cortical length ratio is normal (0.28). The plantar angle is slightly positive. There is adequate sole depth at the toe. The remaining imaged osseous and soft tissue structures are unremarkable.
Right hind digit: The dorsal soft tissues are equal in thickness at the proximal and distal aspects of the hoof wall. The dorsal soft tissue thickness to plantar cortical length ratio is normal (0.29). The plantar angle is neutral. There is adequate sole depth at the toe. There is mild osteophytosis at the dorsoproximal aspect of the middle phalanx, mildly progressive from the referral exam. The remaining imaged osseous and soft tissue structures are unremarkable.
Conclusions:
Diagnosis: Bilateral hind proximal suspensory desmitis
Bilateral hind suspensory branch desmitis, mild, chronic
Treatment:
promote healing. Shockwave therapy provides analgesic effects and also promotes healing where soft tissues attach to the bone, like at the proximal suspensory region. We anticipate that Spankie may require 4-6 months of walk and trot exercise before being released to a gradual return to full work.”
Here is the follow up report from his 1 month check up on 12/1/23
“ Hoof Testers: No response on any limb.
Lameness Exam: There was no lameness at a walk on hard ground. There was a mild, right hind lameness observed in a straight line and when circling to the left (mild grade 3/5) that was moderately improved from his prior exam on subjective assessment. When circled at a trot in hand over hard ground, a mild forelimb lameness became apparent when circling either direction (grade 2 RF and LF).
Comparison Lameness Locator assessment revealed resolution of the RH pushoff lameness identified at his prior exam. On soft ground, the right hindlimb lameness was moderately improved and the bilateral forelimb lameness was not appreciated.
Diagnosis: Bilateral hind proximal suspensory desmitis (historic, improving) Bilateral hind suspensory branch desmitis (historic, chronic)
Housing & Exercise: Please continue to stall rest Spankie with controlled exercise twice a day. Please avoid large pasture turnout to decrease the chance of excessive activity or re-injury. Spankie should have ridden walking exercise once to twice daily, as possible, for 20 minutes. The time spent walking should increased by 5 minutes weekly. After the next 2 weeks of ridden walking exercise, you may introduce 3-5 minutes of trot into the middle of his walking exercise. The time spent trotting may increase by 3-5 minutes weekly for the following month. If at any point Spankie shows increased lameness or resistance to move forward, please reduce his exercise (time and / or intensity).
Diet: Spankie may continue his normal diet and ration.
Call If: You notice increased lameness or if you have any concerns about Spankie.
Additional Instructions: We discussed Spankie’s positive progress today and the plan to continue with his rehabilitation program. Cold hosing or back-on-track hock wraps may be used. Please continue to monitor Spankie’s progress as he progresses to increased work and let us know if you have any concerns. If you notice increased or worsened lameness at any time after introducing trot exercise, please reduce to walk only and schedule a recheck exam. We are hopeful that after a positive recheck exam again in 6 weeks (after 2 weeks ridden walk and 4 weeks ridden walk and trot) that we will repeat his ultrasound exam and may find Spankie ready to continue to increase ridden work and consider larger turnout.”
The past 2 days during our walks he has been naturally forward, ears pricked, minimal tension, and offered me trot. I went with him at his own slow pace and let him stop when he wanted to which was only 10-15 seconds. Yesterday he was feeling really good and in a positive way, workman like. We did some trotting and if he swished his tail or I felt tension I brought him back to walk until he was relaxed again. I sent this video to his vet and she said “ His trot looks good. Sounds like you are doing the right thing. As we talked about during the first visit, there will also be some behavioral / mental resistance issues to work through and it can be hard to completely separate those from pain. Going slow, but being persistent is important. We will make sure we check his back closely at his next visit. Until then… keep it up!”
I texted her previously that “just for my peace of mind I need have his back examined more thoroughly”
I don’t think his pain and acting out is behavioral or mental. I can see certain horse show venues where that might be an issue due to negative experiences and memories but he responds very well to confidence EQ. If I only have a sound and happy horse in certain conditions then he’s not sound imo. I don’t think a sound horse would suddenly be incredibly reactive when he gets emotional and insecure in a situation. I don’t think even natural tension in a sound horse would create the kind of reactivity he displays. He definitely acts like his back hurts and it’s not a saddle fit issue or ulcers.
I’m including video from his lameness exam in October and the one month follow up in December.
Lameness Exam Comparison
Thanks for taking the time to take an interest in us and help us and providing your experience and opinions. It really does take a village.
Thank you, that’s all very informative. In the lameness exam (Oct) I see lameness at the walk. It’s pretty obviously both hinds at trot. The ROM in the December video is inconsistently better at times. He looks more comfortable in some spots, more lame in others.
After watching the video of both exams, I don’t wonder if it’s time for a neuro exam at a big hospital. There were several times in the transitions and turns his proprioception seemed off.
The latest information provided indicates the horse has suspensory branch desmitis (described as chronic) in addition to the proximal problem which seems to be improving. In both of these, the presentation is bilateral.
I have experience with one horse who has branch desmitis in both hind legs. Her fetlocks have dropped some and legs are much straighter than when diagnosed maybe 6 years ago. Vet told me at the time that her prognosis for full soundness was not great; given the bilateral presentation it could be degenerative. She was 16ish at the time.
Based on the pics of your horse’s back legs, it appears there is some fetlock drop - angle of the white area right hind different that hoof angle; dark leg looks the same.
I hate to be a downer on this one, but even with the improving situation up higher, I think full improvement might be unlikely - the conformation and chronic nature of the branch situation work against him. I retired my mare after diagnosis with back support shoes; she is pasture sound but I rarely see her do more than walk…
He’s already been going to the big hospital so I will definitely inquire about neuro at his appointment. What neuro thing do you think of with him? Sometimes he crosses his front feet. Randomly like in the cross ties and in my halt transitions when he’s having trouble and taking small steps to halt. Then there’s whatever happened the other week when he just exploded out of nowhere and didn’t seem to remember it after because he just went on like normal and nothing happened. He doesn’t sweat as much as he should. He stands weird. He does a weird thing in the cross ties where he licks his lips and chews his lips until he’s a frothy rabid mess. Just thinking of anything random that might mean something. I wish there was a Dr. House for horses 
He is only 5 too which is sad. And quite pathetic. And bad luck for both of us. That’s one thing the (different) vet from February remarked on at that lameness exam was that he had “conformational dropped fetlocks” but insisted that it wasn’t anything bad and definitely wasn’t the reason for his behavior. 
Well, the way he is standing is a pain stance. It can be from any number of things. I see it from horses with back pain, SI pain, NPA and/or sole pain/hoof pain, ESPA/DSLD, suspensory pain, etc. It is a symptom of pain, not a symptom of one specific disease.
What I see specifically that makes me think a neuro evaluation might be warranted is the abnormality and asymmetry of his gaits. Sometimes asymmetry is injury related, so it is not always a sign of a neurological disorder by itself.
Stepping back to look at the big picture here –
You have a young horse with various NQRness that wasn’t immediately defineable. This young horse has PSD as diagnosed by ultrasound. The months of time off in the summer for resection did not make this better. This young horse has a video record from the time he was 3 to now - and the asymmetry is present at his earliest riding video I could find. Is it possible it’s a field injury that predates his riding career? Maybe. But there are other pieces that don’t fit: this young horse has always had issues cantering. He loses his step and/or slips out at the trot in every video you’ve given. He is tight in his back and won’t use his hind end. He can’t keep rails up. He’s lost condition between June and now. Despite therapeutic intervention he has not improved. In the vet exam videos, he does not seem to have a clear idea of where his hind end is when asked to turn on his haunches, circle tightly, and back up. He drags his feet and/or trips over them. At the walk and trot, his stride length and ROM are inconsistent and impacted by his head height and/or what he is being asked to do in hand. His hind end lameness travels and when blocked or put on a tight circle, there is a traveling front end lameness. You’ve shared that he crosses his front legs together, including in transitions while being ridden. He has demonstrated unhappiness in ridden work with crowhops and tail swishing. I would say all of these symptoms paint a picture of a horse who is honest but can’t make his body cooperate with what his rider is asking – and that can be neurological.
I don’t want to be right in this; the more you share, the more I wonder if someone with experience with ESPA/DSLD should look at him. The traveling forelimb lameness, presence of fiber pattern disruption and chronic PSD on US in an especially young horse (5), over-straight hocks, the pain posture, and the difficulty in being circled are symptoms that overlap with this disease.
He might need a wedge behind the way he is standing and with flatter plantar angles.
I agree also that it’s worse news for future performance that he shows chronic branch desmitis as well as a 5yo.
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