Treatment for/Experiences with very mild sesamoiditis?

[wintersmith13]

My 10 y/o mare has been intermittently grade 1 lame for the last 6 weeks, and was finally diagnosed two weeks ago with extremely mild sesamoiditis (one line of remodeling showed up on the x rays). The vet recommend 2-4 weeks off (24/7 turnout with the usual buddies), then a month a gradual rehab before returning to regular work (2’6" jumpers). This seems like a much rosier prognosis than anything I’ve seen online when googling and searching this forum for sesamoiditis experiences. Is this realistic or should I seek a second opinion?

Beyond the vet’s recommendation for rest, the trainer wants me to get the joint injected, but otherwise has similarly rosy expectations.

Background: very mild tear in opposite leg’s suspensory last fall recovering uneventfully until now. Following vet’s instructions, had been back in full flatwork for 4 months and light jumping for 3 months when the lameness first presented. Neither trainer nor vet can see any lameness trotting in hand/on the lunge line, it only shows up under saddle and quickly improved during the vet’s ~5 minute observation. It’s been getting slightly better over the past 6 weeks of rest, but still isn’t near gone.

[wildlifer]

I got a horse off the track with “mild” sesamoiditis. No soft tissue involvement but a pretty pronounced line on rads. After talking to my vet & doing a full literature review, I took a very conservative approach & am glad I did. I kept him on small pen rest for 8 weeks, then he went to regular turnout (I keep horses at home). We did an initial injection to stomp down inflammation to protect the joint cartilage. He was a baby (still 3 when I got him), so I was going very slow with him anyway. Those bones are very isolated, so have poor blood supply & take ages to heal. The year I saw estimated seems reasonable to me now.

I did very very light stuff with him, groundwork & walk / trot under saddle for most of a year. I wanted to bet on the “long game,” & give him the best chance of soundness 10 yrs from now.

I’d have to go thru detailed notes to know for sure but it was at least 6 months before that ankle quit puffing up - granted, I stared at it every day, so my “puffy” might not be as visible to someone else, but even subtle changes made me cranky. It was never very sore, it was just a subtle limp when he turned just right, nothing on a straight line or even a wide arc, & even that didn’t persist beyond the 2nd month, but I knew what that bone looked like.

It’s now been 20 months. He’s 5 & I honestly can’t remember the last time I stared at that ankle. It’s given no trouble w/t/c/2’ jumps on hard ground this summer. Vet (very good, with long experience) says we don’t need to worry about it anymore.

Like I said, we were being super conservative, with a young horse who was still building his body. His was due to concussion on the track. He’s tall & leggy. But based on my research & my experience, yeah, I would say be conservative with sesamoids. I know it’s hard to wait, but I always tell myself that a little extra rest & light duty never hurt, but you can’t undo too much too soon. If you can keep the soft tissue out of it, prognosis is decent. If you can afford it (I couldn’t), you can monitor the bone healing on rads too.

[wintersmith13]

Thanks. That goes along with a lot of the reading that I’ve been doing.

I’m don’t compete and am in no rush, so I’m having trouble understanding why my vet’s opinion is so radically different from everything else I’ve read.

Did you ultrasound or MRI to confirm that there was no soft tissue involvement?

[wildlifer]

@wintersmith13

Did you ultrasound or MRI to confirm that there was no soft tissue involvement?

That’s out of my budget (esp MRI), but he did have an ultrasound of that leg before I purchased him that confirmed that soft tissue was good - person I trust witnessed it, so I was comfortable with that. I would have been willing to pay for an ultrasound myself if it had been needed, since that’s critical information.

I hope your horse is healing well - it feels like forever when you are in the middle of it & sounds like you had already had plenty of rehab from the previous injury. My two recently got tangled up in some fence a month ago & I still have daily nursing duty on 1, so you are certainly not alone in bad horse luck! I tell them daily that they are lucky they are adorable otherwise I might give up on them!