Soundest pony ever, now lame? Anything to see on these X-rays?

[fivestrideline]

I’m posting for a friend (seriously!); would anyone like to look at some basic X-rays? Or suggest things to ask the vet?

Background: this is a large pony, older teens QH, his owner has had him forever. He’s always been sound as a bell, working hard (for a hunter pony), jumping around barefoot with no maintenance. He lives at his owner’s family farm, and has been in light work recently (just wtc type stuff).

About two months ago, his owner rode him and he was great. She came back out a few days later, and suddenly he’s head-bobbing lame on the left front at the trot. Not obviously lame at the walk. They let him sit for a while, thinking stone bruise, but when he didn’t come sound after some weeks, they called the vet.

Pony didn’t react to hoof testers, but they blocked his foot and he came sound. Vet took some X-rays, said they didn’t see anything suspicious but that maybe his angles were a little off. Pony was due for a trim, though, and the farrier says angles are great.

Pony is still lame ~ 8 weeks since the initial issue popped up, despite rest and a bute trial. No evidence of a bruise or abscess (both of which he’s never had). The pony is still the same amount of lame as he was at the start.

The vet suggested putting shoes on, but this pony has never needed them despite a good workload and showing at some rocky venues.

Here are the X-rays:
Lame LF

Sound RF for comparison

I suggested a second opinion, with an ultrasound because it’s screaming soft tissue to me. But maybe not? Maybe it’s a trim/shoeing thing, and I’m just used to my own horse’s awful X-rays? Any input?

[Paint_Party]

I am certainly not a vet nor a vet tech, but there seems to be a little bit of sidebone. Yet ironically, it looks worse in the right front than the left. And I would think that sidebone, if it was bothering the pony, would have been helped by the bute. So that’s probably a nothing burger.

You know what doesn’t get helped much by bute? An abscess. And they don’t always produce a response to hoof testers if they’re really deep. Nor do they show up on an x-ray, until there is a pocket of gas and goo forms. I have been in more than one Abscess from Hell movie, so it may yet be that.

The other thing that comes to mind, which is soft tissue, is a deep digital flexor tendon strain, because the pony went sound once the foot was blocked. Yet why didn’t that show some improve with rest and bute?

Keep in mind that, like I said, I’m not a vet nor a tech, so I could be totally off base. I’m sure others more versed in x-rays will chime in. In the meantime, ((( HUGS ))) to your friend and her pony.

[OceansAway]

I’m not the best with x-rays, but aside from some sidebone, I don’t see anything too obvious. I’ve always heard sidebone is largely asymptomatic, according to our vet. Anyway, this sounds like something might be going on inside the hoof capsule, in which only an MRI is going to see anything. The DDFT runs down into there, so it is possible an ultrasound might see something higher up first, so I would start there at least.

If he lame in both directions up front? Worse on a circle?

[fivestrideline]

@OceansAway

If he lame in both directions up front? Worse on a circle?

He was better (but not sound) to the right. Worse to the left on a circle.

I doubt the sidebone would make him go from sound in light work to very lame in only a few days. But it’s worth noting for sure.

Good point about the MRI, and ultrasound limitations. I wonder if hauling to the vet school would be best if possible, in case a standing MRI is needed.

[Fiesta01]

@fivestrideline

Good point about the MRI, and ultrasound limitations. I wonder if hauling to the vet school would be best if possible, in case a standing MRI is needed.

That’s what I would do. Jingles to your friend and her pony.

[weixiao]

When they blocked his foot and he came sound, so you know which block or blocks they did (coffin joint, bursal, PDN)? Did they flex him at all? Is there an X-ray showing the P3 view?

[fivestrideline]

@weixiao

When they blocked his foot and he came sound, so you know which block or blocks they did (coffin joint, bursal, PDN)? Did they flex him at all? Is there an X-ray showing the P3 view?

I believe they just did some in hand trot/lunging before going to blocks. I did ask about which block was done, but the owner wasn’t sure. I believe only one “foot” block was done, vs starting at the heel and working out or what have you.

The X-rays I posted are all they took. I personally would’ve wanted a P3 shot but I have been down this road before and tend to ask for All The Images.

[Bonnie2]

I agree it sounds like soft tissue. An experienced lameness vet can specifically block the foot and get a pretty accurate idea if it is say coffin joint or collateral ligament. An MRI might be enlightening but will for sure be expensive!

[fivestrideline]

I was wondering that - if a good vet could get an idea without an MRI. I’m not sure if pony is insured (he is older and wasn’t doing much), but maybe he is. My friend may decide to do one out of pocket, but I don’t even know how much they cost these days.

I am going to suggest they go to the vet school if possible, or at least get the best lameness vet in that she can. I did not think this was something to be fixed by shoes (like the first vet said), and I’m at least partially validated that I’m not alone in that sentiment.

[IPEsq]

Unless there is something that could be seen on solar view or navicular view, or if pony is positive to hoof testers, then it’s probably not something shoes will help given pony’s history. I’d have done more images too, as MRI is not without its own risks, even though it is the best way to see the most of the foot. You can see some things on ultrasound but it’s limited. Like if they did a heel block, maybe that would be worth a try at ultrasound first. But it doesn’t sound like the block was very localized?

[fivestrideline]

No, just a single “hoof” block. If the vet did something specific, the owner wasn’t sure. They could certainly ask.

I obviously wasn’t there, and don’t know this vet. They are well regarded in the area, but I suspect not a true “lameness vet”, in the sense of having dealt with a lot of weirdness. At least that’s my impression, based on the vet not wanting more imaging and suggesting shoes.

They did a week of bute, but pony is still the same amount of lame. Two months is a long time for no improvement or change, IMO, and pony has just been going out in his solo paddock and coming into the stall in that time. No work.

[Bonnie2]

Totally validated. A sound pony lame two months with no change is unlikely to have an abscess or be cured by shoes. He hurt himself. And truthfully the two months no change part doesn’t make me optimistic about recovery.

[joiedevie99]

The only thing that jumps out is the sidebones, which certainly didn’t show up overnight and are rarely an issue. However, I see what is probably a shadow on the left inside, but some outside chance it is a fracture of the sidebone? Otherwise, I’d be thinking about an MRI of the foot to look for a soft tissue problem - or something like a cyst that an x-ray could miss if it isn’t at the perfect angle.

[IPEsq]

I dunno… the sidebone looks pretty minor to me and is worse on the foot pony is sound on, so I would think unless there’s a P3 fracture or something else I bony going on you can’t see on these views, soft tissue seems the list likely problem.

[starsandsun]

Any chance the timeline is more compressed, and they did xrays too quick to see a fracture?

If not, I’m definitely thinking soft tissue and would consider further diagnostics. Has he been on stall rest at all?

[mroades]

In my experience a foot that blocks out but xrays ok and does not react to hoof testers is usually a soft tissue injury in the foot

[fivestrideline]

@starsandsun

Any chance the timeline is more compressed, and they did xrays too quick to see a fracture?

No, pony was xrayed ~2 weeks ago (so 4-6 weeks after the injury, in case I’m off by a week).

He also has not been on stall rest. Just solo turnout (his usual) and stall.

I have to agree with everyone that it really seems like soft tissue, or Abscess From Hell. I think the owner is trying to figure out if the lameness vet can come out or if they need to find a trailer to borrow to get to the vet school.

Is there a good chance of this getting worse/lowering recovery prognosis if the pony doesn’t get seen for a week or two more? Obviously the owner wants the horse sound and rideable, but I don’t know how fast they’re moving per se. What’s the conservative approach should this be a DDFT or check ligament? Stall rest?

[IPEsq]

Yes conservative approach is some period of stall rest maybe with controlled exercise like hand walking.

But if the owner would be inclined to do something like inject biologics in there (if possible for the location), then waiting would probably not help things. If it’s something that would benefit from being cleaned up surgically, waiting is probably also not pony’s friend.

I’d say most commonly, waiting for an appointment and turning pony out in the meantime for something that already hasn’t improved at all over some weeks, the risk is that not taking a conservative approach while continuing to wait would result in worse injury, worse prognosis.

[Ryde_XC]

I’d love photo of actual hoof- particularly heels- as the heels are not under the bony column in this image. (Look at left vs right) Suspect uncalcified sidebone and chronic strain of the collaterals with slight narrowing of joint space.

[IPEsq]

I took another look and read everything again. I wonder if pony has some pedal osteitis (see circled part). Again you’d want to take a solar view of P3 and possibly just block the medial side of the foot.