I am trying to rehabilitate a horse with a ligament injury and am following the protocol for hand walking. 6 months later the horse has not healed at all by ultrasound and is still lame at the walk. The vet gives a poor prognosis for recovery of the horse because of the arthritis. Does anything help? Shockwave? The horse is older, but I would appreciate any information before making a decision.
Thanks
One of mine tore his hind suspensory ligament at the point of attachment in the hock. There were bony changes showing that some fragments had detached. We did fasciotomy and neurectomy surgery and stem cells, followed by multiple shockwave treatments. Then we did IRAP and more shockwave. Today (3+ years on) the ultrasound looks quite good, and he’s sound in the pasture and for short rides at the walk. He is sound with a rider up at the trot, but doesn’t have the strength to actually go back to work. When we start a formal rehab program, he goes lame by the time we hit 5-8 minutes of trotting. So he is retired.
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Ligaments take much longer than 6 mo. to heal, IME. One of mine blew a suspensory in hind then 3 mo. later did the other hind.
Everything I read said give it at least a year and maybe more. He did come totally sound but was retired due to other problems.
Dr. Green is the best healer, IMO.
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I would like to change the title to ask what has been the outcome for a horse that shows no sign of healing after 6 months? He has been confined except for hand walking and is well behaved for his walks.
Which ligament, which leg, and is the arthritis a direct result of the ligament damage?
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The injury is in the front collateral ligament at the attachment to the coffin bone. The arthritis preceded the ligament damage, but was managed. He went from WTC sound to very lame overnight.
My experience with front collateral ligament injuries in the hoof, is they are very difficult to heal. What kind of shoeing, if any, has your vet advised?
I don’t think six months is long enough. The last horse I had with this injury took a year to show healing on re-eval.
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Oooooh, yeah, CLs in the hoof can be a beech to heal, and often just don’t, or at least not well enough for anything but a pasture ornament. And yeah, lots longer than 6 months
I seem to recall one of these having the hoof casted for many more cycles than is usually acceptable, for the whole purpose of limiting hoof flexion for a good while, so that’s something to ask anyone and everyone on your team about.
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My best mare damaged some soft tissue in a front foot. Not 100% where, as I wasn’t able to afford an MRI, and our vet could only guess based on blocks and rads.
We did stall rest, handwalking, PRP, shockwave, etc with no noticeable improvement over several months. She was never non-weight bearing, or even lame at the walk, so maybe not as bad as yours. However, I just turned her out. She still came in at night (or day in summer) with the rest of the herd, but I figured she could be retired for the time being, and I’d re-evaluate in the future. At some point, maybe about a year later, I noticed she looked pretty darn sound trotting in the field, so I conservatively brought her back into work. She stayed sound and we’ve had no further issues with it.
It’s been a few years since then, she’s still very sound, and just got a full workup with a great sports-medicine vet who recommended injecting stifles and hocks, but said she looked fantastic and 100% sound in front, even after flexions.
So I think with an older horse especially, healing can take longer than you think. I’d maximize appropriate turnout and not worry about progress / status until you’re at the year point. That being said, if your horse is very lame and in lots of pain, that may change your calculus. Good luck and hugs.
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I don’t have any experience with CL in the hoof, but have only heard of friend’s horses and they were very difficult to heal. I just finished rehabbing a hind suspensory successfully. I did a fasciotomy, PRP, shockwave, and class IV cold laser for 2 months. His ultrasound looks nearly normal which is amazing considering how gnarly it looked when it happened; he’s very sound and has been doing 6-8 minutes of canter work, and 20 min trotting 4-5 days a week. I will say he didn’t show much improvement until about 6 months on ultrasound. Then its like things took off. So I wouldn’t think 6 months is very long when these injuries take a year or more. I think I got lucky with a combination of factors, including that this horse is relatively young at 8, and he just responded to the treatments very well.
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My Arab had an injury to the lateral collateral ligament of the left hind fetlock. We didn’t find it until well after it had happened and the vet suspected that it probably wasn’t a single incident. He spent the summer on stall rest and when we started hand walking, he was a beast. Back to stall rest, then to turnout in a very small pen, then restarted some hand walking and walking under saddle. I wish I could remember the timing better, but I think he was off for almost 2 years due to a couple restarts. During that time his middle-aged hocks suffered from the lack of movement and he lost a lot of muscle that he never really got back. This year was probably the best in terms of being sound and happy trail riding over mixed terrain and some actual hills, though nothing like he was before.
We didn’t do any fancy interventions because by the time we determined what the problem was, we were past the point where the intervention I could afford was going to make much difference. He was never dead lame, but just not moving well and hinky and sore and crabby, and we watched his behavior and his attitude as much as his movement. We’re fairly certain the ligament injury was compensatory for something else, maybe in the right front, but we haven’t found that yet…
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What is the “arthritis” ? Spurring? IA ringbone? How is the horse shod? What surface is he walking on? Did you lock him up for any period of time when the injury was acute? Has your vet suggested IRAP or Noltrex? Are you able to do an MRI?
An MRI is really the gold standard for imaging soft tissue in the foot. Ultrasound cannot even access most of the soft tissue in the hoof capsule. It’s not cheap, but it would give you the best idea for prognosis and treatment. It can be done standing and as an outpatient procedure, depending on which area of the country you live in.
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Horse needs an MRI.
My mare had a non-healing collateral ligament tear at the cannon bone attachment. An MRI found the issue - an avulsion fracture and subchondral bone injury not seen on ultrasound or X-ray. She required quite a bit more strict stall rest due to that injury. The instability in the joint (Fetlock to Cannon bone) kept the ligament from being able to properly heal.
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If it is not healed yet, I would not think that Shockwave would be an option yet. The way I understand it, Shockwave is to “break up” or loosen scar tissue. But if it’s not scarred down yet, you wouldn’t want to do that.
Have you tried PEMF treatments? I had great success with a tendon injury with my horse.
Agreed that 6 months is probably not long enough. Hang in there.
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That is one possible use of shockwave, but more commonly its used to increase blood flow to the injured area to speed healing.
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How have you used ultrasound for that injury? I thought MRI was the only imaging available for soft tissues in the hoof capsule?
My gelding had a collateral ligament strain on his coffin joint and he had to be retired after two failed attempts at rest and rehab. I’ve started riding him lightly again just this past summer (COVID boredom) and he is sound again 6 years later.
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Two weeks ago I PTS a heart horse who completely tore the collateral ligaments of the coffin bone. 😔
She came in from the pasture very lame, no swelling, vet said to treat as an abscess as there was some heat in foot. No improvement. Gradually began to get fill in the leg as she was completely standing off of it. I made the comment to vet that her whole foot rolled when she rocked her weight back instead of the foot sitting flat.
X rays showed her coffin bone had completely floated up and away from her P3 about a half of an inch. Hoof had also quickly remodeled in just a week. He was amazed she didn’t founder.
After thorough consult with surgeons at Cornell I decided to PTS.
Treatment per the surgeon was a high degree wedge in a cast for at least 6-9 months to try to float the coffin bone back where it needed to be for ligament healing to occur. I didn’t have the heart to put her through it.
I’m sorry I didn’t have a better story for you, although yours sounds not as bad as mine. Have you consulted with another vet aside from the one that suggested stall rest? My vet and the surgeon seemed pretty adamant that there was a lot more involved in the recovery than just sticking her in a stall.
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Thanks all for the heartfelt responses.
Will try and answer some questions. Although MRI will give a full picture, the ultrasound will show the ligament above the hoof. Both the lateral and medial ligament are torn, but not ruptured.
There was a second option vet, who thought that he might heal with shockwave.
What bothers me is that most recovery protocols will say that if the horse hasn’t recovered at all at six months, they will not become rideable.
Long ago, I heard that the number of months to heal corresponded to the number of letters- t-e-n-d-o-n = 6 months. l-i-g-a-m-e-n-t =8 months
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I have never heard of or had a case where a CL injury in the hoof healed in under 6 months. This injury is a real hard one to heal well right away. It takes a year minimum. I’d advise looking at some threads on this forum, there’s been a couple. Strict stall rest for the first several months with Dr Green for a year or two seems to be the universal treatment. SW won’t hurt but won’t make it heal any faster, my two cents its an area that’s difficult to rehab well.
There is also a CL in the hock + hind pastern, not to be confused with CL in the hoof. The former has a much better prognosis and return to previous work than the latter, as well as shorter healing time.
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