Be sure to say hi if you see my big Irish baystard!!!
Do you think that because he has the desmitis from the proximal down to the branch that this is actually DSLD??
This and the bilateral nature should raise the question to the vet - also the hind leg conformation, which may be a result of DSLD. In the early pictures you posted, his fetlocks looked dropped.
Here is an informative article: https://madbarn.com/degenerative-suspensory-ligament-desmitis-in-horses/
What might also be going on is “just” arthritic changes in fetlocks (or other related joints) and not actual DSLD.
I’m not a vet so just passing on what I know from my mare who I retired due to suspensory branch issues bilateral in the hind legs. She is a pasture puff with fancy back shoes. I dont know how sound she is as she rarely does more than walk, but doesnt seem in pain, in spite of the drop in the fetlocks/straightened back legs. Original presentation was just a NQR sense under saddle. Not clear then WHERE the NQR was coming from. Its been maybe 6 years or so; I never did further tests, but I dont think hers is DSLD and it really wouldn’t make a difference her care. Always have said that if she shows real discomfort, I would euthanize.
I feel for you and the struggle to get answers. It makes me unsure (at my advancing age) about getting another horse after my current rideable 22 yr old is done. It seems like more and more I hear about and see people who are having nothing but weird problems, freak accidents, etc.
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I got his discharge papers in my email today so I will share that here as an update and a resource for future search purposes.
Presenting complaint: Recheck (with possible lower back issues)
History: Spankie, a 5-year old Irish Sport horse gelding used for eventing, presented for a recheck lameness examination. At his first appointment with the TAMU-LAH Equine Orthopedic Surgery service on 10/27/23, Spankie was diagnosed with bilateral hind proximal suspensory desmitis and bilateral hind suspensory branch desmitis. A grade 1/5 left forelimb lameness was also observed but not treated. At that time, he received bilateral hind suspensory periligamentous injections of platelet rich plasma and shockwave therapy. He was also administered Adequan and sent home with 7 doses. At a recheck exam on 12/1/23, Spankie showed moderate improvement in his right hind lameness. He also had bilateral grade 2/5 forelimb lameness that was appreciated while trotting both directions in a circle on hard ground. He was discharged with instructions to continue controlled exercise. Since this time, the owner has reported no improvement since his first visit in October. She walks him under saddle everyday for 40 minutes with 15 minutes of trotting, and she has observed stiffness, attempts to buck, and unwillingness to train. He is currently turned out in a small paddock, and his diet is unchanged.
Physical Examination: T: 99.3*F Pulse: 32 bpm Resp: 12 brpm
On presentation, Spankie was bright and alert. On thoracic auscultation, clear bronchovesicular sounds were present bilaterally, and a regular, strong cardiac sinus rhythm was auscultated. Mucus membranes were pink and moist with a CRT<2sec. Normal borborygmi was present in all abdominal quadrants. Digital pulses were within normal limits on all limbs. On musculoskeletal exam, there was mild bilateral coffin joint effusion in the forelimbs. There was mild bilateral effusion of the medial femorotibial joints, and both hind flexor tendon sheaths had minimal effusion present. There was no sensitivity to palpation of either hind suspensory ligament. Dorsal spinous process and epaxial musculature palpation were unremarkable with no signs of discomfort and appropriate spinal range of motion in lateral and dorsoventral flexion, extension, pelvic tucking, and sternal lifting.
Diagnostic Tests & Results:
Hoof Testers: Negative on all limbs
Lameness Evaluation: There was no lameness appreciated at the walk or trot on hard ground in a straight line. A mild, inconsistent, right hind limb lameness (grade 2/5) was observed when trotting on hard ground in a right circle, and a left front (grade 2/5) lameness was present while trotting in a left circle on hard ground. Spankie was sound on soft ground.(*I encourage anyone to watch his lameness exam from this visit that was posted previously and see if you think he’s sound on soft ground because he doesn’t look sound to me at all) These findings were confirmed with the use of the Lameness Locator objective lameness assessment system.
Flexion Exam: LF Lower: 1/3 (mild) LH Lower: 0/3
LH Upper: 1/3
RF Lower: 0/3 (no response) RH Lower: 0/3
RH Upper: 1/3
Diagnostic Analgesia: After performing an palmar digital nerve block of the left front, there was an 80-90% improvement.
Radiographs: Radiographs for the left fore foot were acquired on January 12, 2024. 8 images were acquired. Undated referral images are available for comparison (PACS date February 22, 2023).
RADIOGRAPHIC FINDINGS: A metal opaque shoe is now affixed to the sole of the left fore foot with 6 nails. The P3 solar margin is mildly irregularly marginated (lateral>medial). There is minimal dorsal osteophytosis of the distal interphalangeal joint. The solar angle remains positive, the sole depth is normal and there is minimal mediolateral imbalance (medial side distal to the lateral). There is minimal enthesopathy at the level of the insertion of the collateral ligament attachments on the navicular bone and mid-dorsal P2.
CONCLUSIONS
- Minimal left front distal interphalangeal joint osteoarthritis.
- Minimal left front navicular collateral ligament insertional enthesopathy
- Minimal left front collateral ligament (distal interphalangeal joint) origin enthesopathy
- Mild P3 solar margin remodeling/resorption may be secondary to pedal osteitis or remodeling associated with exercise.
Ultrasound:
RIGHT PLANTAR METATARSUS
The proximal suspensory ligament remains moderately enlarged with an associated mild to moderately shortened fiber pattern. There is similar focal bone irregularity at the plantarolateral aspect of metatarsal III. The medial suspensory branch has similar mild heterogenous echogenicity and mildly irregular fiber pattern with similar mild bone irregularity at the insertion onto the proximal sesamoid bone.
LEFT PLANTAR METATARSUS
The proximal suspensory ligament remains similarly moderately enlarged with fiber irregularity. The lateral and medial suspensory branches have similar mild heterogenous echogenicity, mild shortened fiber pattern, and the same mild bone irregularity at the insertion on the respective proximal sesamoid bones.
Conclusions:
- Similar bilateral mild to moderate proximal suspensory desmopathy (left worse than right).
- Similar bilateral mild chronic suspensory branch irregularity.
- Similar right hind mild chronic medial suspensory branch irregularity.
Diagnosis: Historic bilateral hind proximal suspensory desmitis - moderately improved Historic bilateral hind suspensory branch desmitis - improved
Mild, left front foot pain - open etiology
Treatment: Spankie was sedated with 250mg xylazine during his ultrasound exam.
Instructions to Owner
Medications: After discussion regarding further treatment options at this time, you
elected to proceed with an NSAID treatment trial. We discussed the pros/cons of firocoxib (once daily administration, possibly less risk gastric ulceration development, maintained therapeutic levels, less potent / less strong anti inflammatory for most horses) vs bute (twice daily administration, possibly more risk for gastric ulceration development, more potent / more strong anti inflammatory for most horses), and you elected to being with firocoxib. If you do not see improvement in Spankie’s willingness to work on this medication, you may consider switching to bute as prescribed below. Do not administer both at the time sime. If you notice any signs of decreased appetite, colic, or loose manure, please discontinue the anti inflammatory medication and call.
Firocoxib (227 mg tablets): Administer 3/4 tab (170 mg) by mouth once on the first day of administration. Thereafter, administer 1/4 tab (57 mg) by mouth once daily for 2 weeks. If significant improvement is seen, you may continue this medication for an additional 2 weeks, or 1 month total. If no significant improvement is seen, discontinue this medication and consider a bute trial, as described below.
Phenylbutazone: Give 1 scoop (1 gram) by mouth or on feed twice daily for up to 2 weeks.
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Housing & Exercise: Please continue to turn Spankie out in a small paddock with controlled exercise. Avoid large pasture turnout to decrease the chance of excessive activity or re-injury. Spankie should have ridden walking exercise daily, as possible. You should continue with walking 40 minutes and 15 minutes of trotting. His level of exercise should not be increased before his next recheck exam and until his response to the anti inflammatory trial is assessed.
If Spankie continues to show resistance to move forward, bucking, rearing, or has any increase in lameness, please reduce the duration and intensity of his exercise and schedule a recheck exam.
Diet: Spankie may continue his normal diet and ration.
Call If: Spankie becomes inappetent, develops diarrhea, shows signs of colic, you
notice increased lameness or if you have any other concerns.
Additional Instructions: At today’s exam, we were pleased to see Spankie’s baseline lameness has continued to improve. He is sound on a straight line (confirmed with the Lameness Locator) and on soft ground. He still has a mild RH lameness when circling to the right and LF lameness when circling to the left on hard ground. Today, we localized his LF lameness to his digit with near resolution after a PD nerve block. Radiographs revealed minimal abnormalities. We discussed that this lameness may improve with shoeing, or that there could be a source of pain originating in the soft tissues, since we are unable to evaluate these on radiographs or by ultrasound of the foot. We discussed that while mild, this source of discomfort may contribute to his unwillingness to work and poor behavior under saddle. I offered a coffin joint injection with antiinflammatories to reduce discomfort in this region. We also discussed an anti inflammatory trial (bute or firocoxib) to assess for discomfort as a contributor to his poor behavior / exercise avoidance while under saddle. You declined the coffin joint injection and elected to proceed with an anti inflammatory trial as described above.
We are very pleased with the improvement in his hind limb lameness since his diagnosis in late October. As we have discussed, we are hopeful that as his lameness continues to improve, so will his rearing, bucking, and reluctance to work. If these behaviors continue as his lameness improves and resolves, we will have to continue with a process of elimination and trial and error to determine if there are other contributing factors. The anti inflammatory trial may help to answer some of these questions.
That’s it! At our appointment tomorrow at Brazos Valley if he ends up not having castration adhesions I will discuss with Dr. Warnock about proceeding with the left front coffin joint injection. I can’t really say at this time if the previcox is helping because we haven’t been able to ride because of this wicked winter storm. It’s super cold. I’m not feeling well. I worked 4 nights in a row. With this appointment tomorrow he won’t be ridden either. I did forward all his records, X-rays, ultrasounds, and the YouTube videos of his lameness exam to review. To whoever previously said that previcox won’t address the hoof pain and I should get the injections, thank you for clarifying that. I was under the impression that the previcox or bute would help with that pain. I think I’m more inclined to proceed with it now because if it’s not going to help the pain he’s still going to find ways to compensate and compensation is why his entire body seems to be falling apart.
I did ask this vet if she thought he had DSLD and she said no he doesn’t. I asked her if she thought he had pssm and she said no he doesn’t. I will be asking Dr. Warnock these same questions tomorrow. My insurance is finally going to reimburse me so I will have more available funds to use tomorrow. If he says at all that he thinks he has DSLD then I’m going to be considering some tough choices tomorrow. Personally I would not be surprised if he had desmitis to all 4 limbs. Given that it’s incurable and progressive and he has gotten so much worse over the last few months, I would opt to put him down. I think that would give me a lot of closure and relief. Of course I’m still hoping that this is all secondary to castration adhesions but I know that’s a stretch and I need to be realistic.
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Thank you for sharing, this is such valuable information for the forum. My heart breaks for you! I hope tomorrow is clarifying at least. Kudos to you for continuing to explore his issues and seek new opinions
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Aww Spankie! He definitely has a few things going on for sure. I do not get the impression you have been blown off or this vet is not being thorough however. Maybe the SI reallly truly isn’t an issue. He definitely has some front foot issues going that appear to need intervention.
Good luck with the sports medicine vet appointment. 
Spankie is so adorable and what a great team he has caring for him.
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FWIW, my young DSLD horse had front end lameness that blocked to the foot as well (can’t remember if it was left or right but I think left). I ended up doing an MRI and it was a collateral ligament injury that did not improve with stall rest, controlled exercise, and shockwave.
His suspensory branches were worse on ultrasound than his proximal suspensories as well.
I too asked multiple very well-respected vets about DSLD and no one thought it was likely. One even said in writing, “I wouldn’t worry about that.” Good thing I kept doing my own digging! I am a little behind the times now but I believe it was Dr Sabrina Brounts at University of Wisconsin who can recommend a DSLD-specific ultrasound protocol for your vet to follow. I personally would be worried about it in your horse’s case.
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I supposed I should be somewhat reassured by that fact. That he isnt reactive to that kind of examination. It’s just hard to convey how and when it happens when I can’t replicate it at the vet. When I was driving home I was thinking of how to describe it and I texted her describing it as maybe a sort of muscle spasm? The symptoms of back pain diminish over time with consistent work, real work, w/t/c. That’s what reinforced to me it could be a strength or balance issue. The issue would be that even with strength, when he got emotional and tense all those symptoms would come back under saddle. If everything pans out, perhaps everything that we’ve done would lead to that going away and not coming back. Only time will tell it’s just hard because this rehab isn’t enough to strengthen him in his back in a way that will stop these behaviors. But I can’t make him fit like that because of the suspensory. Just like we’ve all agreed on that what we do for back pain is contrary to how we have to care for the suspensory.
Rough sailing!
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Pedal osteitis might explain how LF is presenting. Might also contribute to his lack of forward under saddle. I’d consider something like Equipak on his feet before injecting the coffin joints, based on the report. And still image the spine and rectal ultrasound of the SI.
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My horse had a left front lameness when dealing with right hind PSD. Xrays were fortunately not remarkable. I knew the front end was never the initial issue—I had video of the horse the day before he was visibly lame and when I jogged him out when he was lame and never was there a front end lameness so we were fairly confident it was compensation. I worried about a soft tissue injury in the foot and whether he needed an MRI and my lameness vet told me to not panic. He wasn’t and I quote “that lame” and to start trotting and see if he went away. It did about 2/3 weeks later. But I felt like a terrible owner asking him to work through it.
My horse both times was very responsive to a class IV laser. I’ve sung its praises on here many times. His suspensory that was inflammation/enlargement only—was just staying larger than it should. The laser within 5 treatments had the suspensory palpitating better and more defined. The rescan before we started trotting showed the inflammation was gone and the ligament was only slightly larger than normal—but this horse had a fasciotomy and as my vet explained we’ve purposefully allowed it to be a little larger so it doesn’t essentially have compartment syndrome. Oh and this horse tested positive for early onset Cushing’s. He’s 11. Cushings causes an over active inflammatory response so things make sense viewed in that lens.
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What is equipak? Is that like magic cushion? My wife (his lameness farrier) doesn’t see any evidence of pedal osteitis on his X-rays. I was surprised to see that verbiage on his report. She did notice that he could be developing some side bone. His vet sat down with me and went over his X-rays extensively and could only hypothesize soft tissue pain or inflammation. He also got reset in a larger shoe so hopefully that helps take some of the pressure off. This is his first time in shoes and he had a huge tendency to flare. His feet stayed beautifully shaped in shoes for the cycle but I’m sure it couldn’t be comfortable either. I do have magic cushion!
Is the class IV laser something available in the US? Is it cheaper than shockwave?
He’s 30-45 minutes north and a straight shot from Navasota too if you decide you need it.
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Yes—it’s available in the US. Is it cheaper than shockwave? Probably not. Major medical insurance will cover shockwave but not the laser. So I did both shockwave and the laser. I believe 5 shockwave treatments. For the RH I did a package for the laser and he was done 3x a week for 2 months. For LH I didn’t because cost went up substantially but we got 8 treatments in which was all he needed to a vast improvement. Mind you I didn’t have any fiber disruption or fiber pattern irregularity and that was an acute injury with no chronicity. The RH was chronic with a core lesion and needed more treatment.
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Side bone is suggestive that the hoof is not handling concussion well. My problem horse also developed huge side bone (during a period of time when he seemed totally sound in the front feet, for whatever that’s worth—discovered on later imaging after he was no longer sound, though intermittent).
Equipak is a pour in pad material.
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Pedal osteitis can be very painful. Interested to hear what sports med recommends. Supports the theory of being sounder on soft vs harder ground. Shoes and pads may be needed to better support those front feet.
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When the hoof flares, it’s telling you something. Basically that something is wrong, “off”, or needs compensation from higher up in the horses body (higher than the hoof, usually). The body creates flares for support/for a reason. So when you see flaring, and it’s not just due to poor trimming, it’s a decent idea to ask yourself what is going on there.
I find it a bit “funny” because I had a horse who’s hooves weren’t “coping well with concussion and pressure” so we did all sorts of relief shoes, fancy packing materials, pour ins/Equipak, and so on.
Then one day I said, eff it, we’re taking off the shoes because things weren’t going that much better and I switched farriers as well. It was the best thing I could’ve done for him. His hooves improved, he was comfortable, and we never looked back.
Naturally, the hoof has some level of shock absorption and expansion capabilites when pressure is applied (there’s a good article about this that features how the hoof naturally works, unshod, in jumping horses). When we put a shoe on, we essentially take that away. Then we add things such as pour ins to help when the horse can’t cope. So we sort of artificially try to add back what we’ve taken away.
Now, I know some horses cope in plain ol’ shoes just fine, and some cannot go unshod for one reason or another, but every time I’ve gotten carried away on some crazy hoof thing with fancy shoes and other material, stripping things back down to basics has been what works (sample size of 3 though!). A good trim is very important, as is hoof healthy nutrition. Without those two, fancy shoes and materials are just bandaids.
It depends on the condition you’re treating though. The horse may need “help” in the form of shoes and pads, but I’ve seen some impressive “bare hoof rehabs.” Ultimately, you do what’s best for the horse and the condition that you’re treating.
I’m not saying that this horse or all horses should go unshod, but just don’t get too carried away reinventing the wheel, and if your unshod horse is doing something funky, such as growing flairs, listen to what the hoof is telling you.
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Can suspensory issues cause back soreness? I always thought they tend to go hand in hand?
OP, I feel for you. I have been there. Where I felt something was wrong and I took everybody else a year or more to be able to see what I saw. But I do wonder if there’s just some compensation pain going on and that maybe you do need to just stay the course and see what happens for a bit longer, first. Wishing you luck!
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Yes and that’s why we kept him barefoot until we got this diagnosis because we were tracking what the feet were telling us. When he stood camped under for 9 months he crushed his heels on the hind feet. In spite of trimming he would continue to flare. More of this was blamed on his fitness and that his chest was narrow. His feet were sound barefoot with great concavity but he needed the shoes for his hind feet so he is shod all around now. Especially since he crushed his heels and even though his PA was either slightly positive or neutral I think he needs to be way way way more positive in the hind feet. The pasture I ride him in is grass on top of sugar sand. We haven’t had enough rain so the grass is sparse, it’s a softer ground.
I think we still need to experiment with what set up in the hind end is going to be best. We started with the suspensory shoe that is a bar shoe with a small trailer that was set back. Then we did a set back open heel shoe with a small trailer. Both of those shoes prevented him from standing camped under and his heels grew like gang busters but farrier noticed how tight it made the stifles and back, like he couldn’t get relief. Then with this new set it’s set with clips so it’s not a set back shoe but is rolled for break over and it has a small trailer. I don’t know if this one is good because I feel like he has more lame steps than with the other ones but also it’s so hard to tell what causes what. He might have presented more foot lame this last visit because he was reset 2 days before but who knows! He doesn’t go on hard ground except when we’re at the vet. Then for his front set, his left is set with extra room medially to encourage growth that way and for support. We were discussing last night what the implications were for shoeing him correctly, which seems to make him more uncomfortable, versus shoeing him where he’s comfortable but would not appear balanced.
I remember what equipak is now. I also have a thing of hoof armor I never used. We’re about to head out in an hour or so. I don’t think I slept at all last night.
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To re-iterate what another poster said up earlier in the discussion, a suspensory shoe is commonly known to have a toe plate, not egg bar. My farrier has tweaked the toe plate-- it’s not as wide, but still provides support and is set back.
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