Septic Pedal Osteitis - feeling hopeless

[blitzkrieg]

I posted a little while ago about my horse being diagnosed with septic pedal osteitis and am starting to feel completely hopeless about this whole situation. Wondering if anyone has input, ideas or has been through this before.

Brief background: horse is 19, has had a very long and wonderful career, previously as sound and hardy as they come and loves her job however my situation has changed recently and I had placed her as available for lease/sale to the right situation and had trial rides with potential new riders scheduled when this happened (naturally).

Two days before the first person was scheduled to see her, she had an abscess in the left front (second abscess in her lifetime) that took forever to burst. Had the vet x-ray to confirm that it was, in fact, an abscess - she was then 3 legged lame for over a week waiting for it to burst. Abscess navigated from the toe to the back of the frog where it ruptured. She began looking better and then tanked again after about 4 days so I had the vet redo the x-rays. Sometime between the 18th and the 31st, a secondary infection developed around the pedal bone which then demineralized and she lost about 13% of the pedal bone, possibly due to stomping at flies with compromised bone integrity. She immediately went on heavy antibiotics and we put padded shoes on (we suspected the original abscess was due to her being barefoot while waiting for hoof to grow after losing shoes). Around the two week mark of treatment, she looked remarkably better. She was walking comfortably but still visibly lame when taking a few trot steps but this was to be expected.

Yesterday my barn owner remarked that she looked super uncomfortable standing so I went out to check on her. She looked miserable - having an awful time with flies and lame once again at the walk. I called the vet and was told to call back in a few days if she’s not looking any better and they’ll come out and x-ray again and that the infection should be cleared up at this point but she might have aggravated things if she stomped too hard, tripped, etc. The vet said “this might just be how she goes” in reference to recovery. I went out this morning to check her and she looks worse than yesterday, bute isn’t touching the pain (she’s been on a daily dose since being prescribed the antibiotics and it just never seems to help her pain-wise). We had originally discussed that horses can lose up to 25% of the pedal bone and be fine but now I’m wondering if that’s a universal rule or if some horses just can’t stay sound with significant pedal bone damage. I’m at a loss of what to do.

[Saskatoonian]

I’m so sorry that you’re going through this. Was going to PM you but honestly, having been in your shoes, I’d have wanted to know the good and the bad, and there’ll probably be more of us in the future with the same question. I went through this with a lovely 9 year old a few years ago. Ended up doing surgery to debride the compromised bone, then multiple rounds of RLP, then carefully rehabbed. He fractured the coffin bone. Rehabbed that, but he didn’t improve. Took him back to the hospital for MRI / CT and more RLP, just in case. The vet said he might never improve and nerving might be the only option. I couldn’t do that. Turned him out for a year, and he was still dead lame at the walk. He’s retired and still lame. If I had to do it again, to be honest, I wouldn’t put him through it. But how can you know that at the time? Sorry again, and happy to chat by PM if you want.

Now, maybe someone bring on the happy ending stories?!

[IPEsq]

I’d call the vet back and have them come out now. Wonder if another round of abx is needed? Or surgery?

Is she just in the padded shoes now or do you have her in soft rides or anything like that?

[blitzkrieg]

@Saskatoonian

I’m so sorry that you’re going through this. Was going to PM you but honestly, having been in your shoes, I’d have wanted to know the good and the bad, and there’ll probably be more of us in the future with the same question. I went through this with a lovely 9 year old a few years ago. Ended up doing surgery to debride the compromised bone, then multiple rounds of RLP, then carefully rehabbed. He fractured the coffin bone. Rehabbed that, but he didn’t improve. Took him back to the hospital for MRI / CT and more RLP, just in case. The vet said he might never improve and nerving might be the only option. I couldn’t do that. Turned him out for a year, and he was still dead lame at the walk. He’s retired and still lame. If I had to do it again, to be honest, I wouldn’t put him through it. But how can you know that at the time? Sorry again, and happy to chat by PM if you want.

Now, maybe someone bring on the happy ending stories?!

Thank you for sharing that. If she’s subject to a lifetime of this level of pain any time she trips over a root or rock in the field, I cannot justify keeping her going. It might be one thing if the bute helped her but this is just torture and the rest of her body struggles to hold her weight with one leg completely useless. I feel like if this becomes even a semi-regular occurrence, the rest of her body is going to deteriorate quickly just due to compensating. I’m going to press for another round of x-rays and see where we’re at with the bone demineralization and I guess go from there. Thank you again for sharing your experience.

[blitzkrieg]

@IPEsq

I’d call the vet back and have them come out now. Wonder if another round of abx is needed? Or surgery?

Is she just in the padded shoes now or do you have her in soft rides or anything like that?

She was in cushioned easy boots until we were able to get pads on but once the shoes were on she could at least walk like a normal horse (until now). We had talked about surgery however the hospitalization is not doable right now and there’s no way she’d be able to safely load and trailer on 3 fatigued legs. I’m going to have them out to x-ray again and see where we are, I guess.

[knic13]

No comment on the underlying problem, but I’ve found shoo fly leggings to be enormously helpful in decreasing stomping from flies and they actually stay on as opposed to the other fly boots I have tried.

[Texarkana]

My horse lost a significant portion of her P3 after an open fracture that developed osteomyelitis at 19 years of age. No one ever quantified her percentage of bone loss numerically for me, but I would wager it was close to 20% at her worst, with a lot of joint involvement.

She is now 24 and completely pasture sound, barefoot. I had new films done of her hoof in 2017 because of an unrelated injury and I was surprised bone even reformed over those 4 years.

Hopefully your horse will beat the odds too!

[stryder]

My mare had the surgery and is sound. Surgery was done in the barn by an equine podiatrist. Although her turnout was limited, she was not on stall rest. She’s 21. She’s back in her usual leather v-pads on the fronts.

We started treating her for an abscess in late November. Once the coffin bone damage showed up in mid-January, surgery was presented as a reasonable option.

Good luck!

[Marla_100]

Friend’s horse went through something similar. Local vet was unsure what to do so they took horse to a lameness vet,
he went in and scraped out infection, cleaned and flushed and had his farrier put on hospital plate shoe so it could be
treated after he went home. After short stall rest, horse was as good as new. No long term effects at all and was still
showing last I heard.

So there can be good outcomes. Maybe a lameness vet can travel to your barn.

[findeight]

Sometimes the seniors just don’t mend as fast as younger horses and many owners cannot afford or chose not to spend thousands on surgery withiffy prognosis., MM insurance is not usually an option for seniors or very limited surgical only with many exclusions and a low lifetime cap.

I’d look into more X-rays and anything that can be done at home, standing. Maybe another blood run to make sure it’s nothing systemic except, maybe, age. She might be older if you don’t have the foaling date. Couldn’t stand watching one limp around thinking they were fine for years, no they aren’t, they hurt. YMMV on that.