Signs of Soft tissue injury in front hooves?

[Helicon]

What were your horse’s signs? How did you diagnose and treat? What was outcome? I am asking because I am curious if any one has the coordinated symptoms to what MRI reveals.

My first case was a client’s horse and the main symptom was a reluctance to go forward, also - choppy when ordinarily had a very free shoulder, sensitive to shoeing angle. On xray her angles and bones looked good. An MRI revealed that the collateral ligaments showed signs of mild to moderate strain. Rest didn’t really help but a different farrier did.

Now I have another. He’s happily sound on hard footing but won’t go in soft and is very short and choppy in deep footing. He also can be a push ride. He gets sticky in tight turns. He has historically responded wonderfully well to Prostride in coffins but the cycle is getting shorter. X-rays are clean and angles are good. Now he’s wincing on unlevel ground.

Mri is so expensive and we didn’t really get magical insight that changed treatment with the first horse. Also, three vets interpreted the results quite differently in terms of significance of the findings.

My vet is on vacation this week so I have lots of time to overthink this.

[JB]

Have you done flexions, ultrasounded the ligaments and tendons in the leg, the typical first start stuff?

Leg soft tissue injuries seem to be more common than hoof soft tissue injuries, so I’d start there. Everything you describe on this current horse could easily be a mild to major tear in a suspensory, for example

What prompted the Prostride to the coffin joints?

Do you have the most recent xrays of his feet you’d be willing to post?

[RGFEventer]

I did an MRI on mine that showed similar symptoms to the first horse you mentioned. He also started toe pointing when standing. He had clean X-rays and blocked to the heel. He was. 1-1.5/5 lame so Davis said to rest and bring him slowly back into work. He was ok at first but the lameness came back exactly the same so decided bigger diagnostics were needed to find the cause. Diagnosis was a bit of everything and anyone’s guess as to which came first/was the main cause of lameness: mild collateral tear, mild DDFT strain and navicular bursitis.

We injected coffin joints for the bursitis and vet said to rehab the collateral tear and the DDFT strain should respond as well. Also changed shoeing a bit, though the vets agreed his angles were good to begin with.

Outcome is TBD. We are about a year from MRI diagnosis and rehab is done. He’s sound on the flat and working at his previous full dressage level. I haven’t tried jumping him again (he was my training level eventer)…not sure I will given his foot issues.

[Helicon]

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Here you go JB. Thanks for asking. I don’t have navicular series handy. This is at 4 weeks, just before reset. He’s on a 4 week cycle.

[Helicon]

RGF - thank you for sharing your horse’s history. Was he equally lame on both fronts, or did he have a more apparent lameness in one?

Did you do PRP and or shockwave for the collateral tear? Or just rest and hand walking?

Would you do the MRI again knowing what you know now, or do you think you would have done the same protocol anyway? What did you change about the shoeing?

Thats awesome that he is sound back in work, and I understand your trepidation about jumping again.

[Peggy]

Stabby movement, reluctance to go through turns, feeling “hoppy” in front, feeling not quite right when walking across a sloped surface (slope running perpendicular to the axis of the horses body)…

Though I think stabby movement had more to do with the neck that probably was the indirect cause of the collateral ligament damage.

DDFT might present differently than collateral ligaments.

Overall, I think the MRI helped, especially with the first horse (of the stabby movement and neck issues). We got a pretty clear-cut diagnosis and treated. Unfortunately we didn’t find out about the neck issues until the issue recurred and we got a second MRI (preceded by a second nuclear scintigraphy, this time of the entire horse). With another horse, the first MRI led to treatment that returned the horse to soundness, but that didn’t last. Second MRI was more of a head-scratcher that led to treatment that didn’t work. Ultimately turning the horse out without shoes for 6 months did work. But having an idea of what is going on in the foot does guide our management, or at least lead to a level of paranoia.

[Bonnie2]

The first thing that strikes me on the radiographs is those are some looong nails. Second thing is the rivets - assuming for pads. I have had horses that would be very uncomfortable shod like this. Definitely block first. Then ultrasound - which will probably need to wait a few days after blocking. Then if you need more information MRI. Good Luck!

[Helicon]

Peggy thank you for sharing your experiences. Very informative and helpful. My horse does have enlarged neck facets which we keep tabs on as well.

[Helicon]

Bonnie - he has rim pads. We thought maybe he didn’t like the feeling of footing on his soles and he hated full pads, so we tried rim pads. He seemed to be happier in them, but there are so many variables it is hard to know what is best. Please tell me more about what might make this shoeing uncomfortable.

[RGFEventer]

@Helicon he was lame on right front only, and we only did the MRI on that leg. Although we did inject both front coffin joints in the end. His only shoeing change was some padding up front to help with concussion. We’re in CA and the ground is especially hard in the summer, so the vet thought the padding may alleviate some of the bursitis.

They didn’t see much benefit in doing PRP or shockwave on his collateral injury for some reason. And honestly after the price of the MRI, I was relieved to hear that. He healed well, but whether or not he holds up long term remains to be seen. Perhaps PRP or shockwave would increase those odds, I’m not sure.

Yes, I would absolutely do the MRI again if it was an expense I could afford given what I learned from this experience… He was so minimally lame at the first onset of the lameness that vets didn’t recommend the MRI, just rest and slowly back to work (which seemed a reasonable approach at the time). But 6 months later after resting and slowly bringing back to full work he went lame again. The MRI showed chronic inflammation at that point that could have possibly been addressed in its acute stage had we done the MRI the first time around. He’s a tough little guy so my guess is once he showed a mild lameness the first time around, the damage was more than it appeared from the outside.

[Bonnie2]

The horse you describe sounds “footy”. You also say he has responded well to prostride in the coffin joints in the past, so that is a known issue. Or it may not be in the feet at all, that’s where blocking comes in. If it is in the foot it could be any number of things or a combination of issues. Rarely simple and that is no doubt why you are considering an MRI. The rim pad is a good idea but the rivets create pressure points. You could try rim pads without the rivets and see if they shift/he is more comfortable. “He hated full pads” - were they packed underneath? Sometimes it is the packing creating sole pressure that is uncomfortable. You could try leather full pads with a couple holes drilled in the center. No packing. They will protect the sole with less pressure. You can hose out any debris that collects. And they dry so you don’t get the damp hoof issues like plastic pads. Medicating the horse and light work for a couple days post shoeing has also helped my sensitive souls ease into their new shoes.

An MRI will show something, perhaps several things. Often they confirm what you already suspect. Sometimes it muddies the waters. Rarely does an MRI offer amazing insight. Whether to pursue an MRI is a question of the ratio of pain to your pocketbook vs your curiosity.

[Helicon]

The pads were not packed underneath. That’s interesting about the rivets.

I realize I did not mention something significant- he has quartercracks on the outside of both front feet, presumably because he prefers to land toe first.

[JB]

The lateral LF view indicates chronically long toes. There’s a shift in the angle of growth about 3/4 up the hoof wall

You can also see how the distance between the face of the wall and the coffin bone increases - 9 lines vs 10

So, IMHO, until that toe is brought back, every single trim, and the straighter new growth line continues to grow down, things won’t get (much) better, and he will continue to land at least a little toe-first

[Pally]

Has anyone (and their vet) used standing on blocks with various parts of the hoof supported where soft tissue concerns in the foot are suspected? Not as diagnostic per se, but as a clue if you are on the right track to spend the $ on the MRI of what not (think very similar to flexions).

I think I first heard it mentioned in some kind of vet webinar and it made a lot of sense. Then in a presentation from a farrier, he said he was using them to do some navicular research and “accidentally” came across some ‘navicular’ horses who were really collateral ligament horses.

Very curious to hear if anyone has tried this.

[Bonnie2]

Personally, I wouldn’t spend money on an MRI until the quartercracks are healed. They bother every horse I’ve seen with one (especially on unlevel ground) and can be a bear to get healed. This may be what is causing the increase in discomfort you are seeing and if not will complicate the diagnosis.

[wildlifer]

Yes, my vet routinely uses wooden blocks in this way. It was super useful to identify a DDFT injury in one of my horses.

[Lunabear1988]

I’ve never heard of this. Can you describe it a little more or do you have a link to what you were talking about? Just trying to learn. Thank you!

[Pally]

@Lunabear1988

I’ve never heard of this. Can you describe it a little more or do you have a link to what you were talking about? Just trying to learn. Thank you!

I actually found an article about it, that will describe it so much better than I. https://thehorse.com/111213/using-flexion-and-wedge-tests-to-diagnose-foot-pain/

I’ve never seen it done in person, but it makes a ton of logical sense to me.

[Helicon]

Thank you Patty / great link and great idea! My farrier did something similar once but I love having the systematic process described.

[Helicon]

JB thank you for the feedback. I have been concerned about my horse’s angles but wasn’t sure how to enunciate it, so I appreciate your detailed explanation.