Very long rehab & shoeing...

[alphamare4]

Unfortunately, long history of the horse…

16 yo TB gelding, which I’ve owned for 4 years.
2 year ago, the horse started shortening the stride a bit and had some mild lameness, maybe a .5/10 in both front feet. We had a full lameness exam with a sporthorse lameness specialist. Took rads and the vet didn’t see anything, suggested we inject the coffin joint and that took care of the issue.
1 year ago the horse pops up .5/10 lameness again and we thought it was the same issue, had coffin joint injected. This worked for about a month and the horse came up lame again, this time 2/10 lameness. We had a full lameness exam again with radiographs and nerve blocks, etc. etc. and the vet suggested giving the horse 2 weeks off. I get on the horse two weeks later and he is 4/10 lame, and this from a horse that has been EXTREMELY sound up until 14 years old (I knew his previous owner as well and have known him all his life). After another lameness exam where the vet blocks the issue to his left front foot, but finds he is not at all sensitive to hoof testers and has nothing on his radiographs, the vet suggests an MRI.
We have the MRI done and they find mild tendonitis in the left DDFT and mild bursitis in both navicular bursa. The vet states that these are both fairly normal findings and thinks that the horse must have a severe sole bruise and just doesn’t react much to the hoof testers. He suggests giving lots of time for the sole bruise and tendonitis and bursitis to resolve, and we do a round of IRAP in the area.
He suggests we give the horse 3 months off completely, followed by 15 min of handwalking 2 times a day for a month, then 40 minutes of handwalking per day for a month, then 20 minutes of walking under saddle for a month. This is the point we are at now.
About a month ago we had an MRI recheck and the bursitis and tendonitis were both decreased (to even more mild), though not completely resolved.
Since about a month into his handwalking he has been occasionally taking “ouchy” steps. These are sharp, lame steps that are random and do not continue to the next step. This continues to his under saddle rehab. Some days he will not shorten the stride at all or have any “bad” steps, some days he will have 10-15 bad steps or tons of shortening (which usually gets better about 10 minutes in). The ouchy steps are getting fewer and farther between, but as far as I can tell aren’t related to any particular footing, and he is pretty much totally on long straightaways and manicured footing.
We’ve tried everything I can imagine as far as toughening this horses feet up. He was in completely dry, indoor stall for a while at all times. He was getting his feet painted twice daily with durasole. He’s had Venice turpentine, keratex, etc. up the wazoo. He’s had hard plastic pads, leather pads, no pads. Now he is in leather pads in a deeply bedded indoor-outdoor stall and seems to be doing the best he has during his rehab with this situation, but he sometimes walks like he has flippers on (even with very good angles). I am wondering if the pads put more strain on the DDFT. He does take fewer ouchy steps though, I think because of the protection of his soles? He is also more likely to take ouchy steps if there has been mud going on, even with his pads on.
Here are my questions:

Does anyone have any experience with mystery sole soreness even with not very much popping up on MRI/rads?
Any suggestions as far as shoeing that would give his soles more protection but not add so much length to the toe? I was looking into eggbar shoes but know very little about them?
Does my vet seem to be prescribing a reasonable rehab? I’ve had several people remark on the length of the rehab with the mildness of the injury but the horse is so lame I don’t know what to think.
Thanks for the thoughts in advance! This horse is a wonderful soul and I just want him to be comfortable at whatever level of work he is capable of doing.

[walkinthewalk]

---

[QUOTE=alphamare4;n10485773

Here are my questions:

Does anyone have any experience with mystery sole soreness even with not very much popping up on MRI/rads?

Yes. Intermittent bouts of mild laminitis. Hoof testers don’t always tell anything. One week before my horse severely foundered, he passed the vet’s hoof tester test with flying colors — he shouldn’t have.

Any suggestions as far as shoeing that would give his soles more protection but not add so much length to the toe?

Shoes do not add length to the toe, a P-Poor farrier does. If the horse has long toes, your issues may very well disappear by getting a new farrier that knows something. Nobody knows how good their farrier is NOT until they can’t keep an apparently healthy horse’s hooves sound.

I was looking into eggbar shoes but know very little about them?

[B]Get your head out of the 70’s:). There are MUCH better options in today’s market --a highly qualified rehab farrier knows about them.

There is also a flexible liquid pour-in pad made by VetTec. My therapeutic farrier used it several times on my foundered horse, to help/protect his soles. Best thing since peanut butter and jelly sandwiches were invented.[/B]

Does my vet seem to be prescribing a reasonable rehab? I’ve had several people remark on the length of the rehab with the mildness of the injury but the horse is so lame I don’t know what to think.

I would take the horse to a lameness vet for a second opinion. If this vet is a lameness vet, find another one – along with finding a new farrier that will shorten the toes and won’t try to sell you the phony Bill of Goods about shoes causing long toes:)

Thanks for the thoughts in advance! This horse is a wonderful soul and I just want him to be comfortable at whatever level of work he is capable of doing.[/QUOTE]

---

[Obsidian_Fire]

I agree. You need a new farrier and a new vet.

[Zu_Zu]

^ Agree with the above posters ӢӢӢӢӢ

adding !

SOONER THAN LATER …

please … for your gelding …

JINGLES & AO ~

[JB]

@alphamare4

Since about a month into his handwalking he has been occasionally taking “ouchy” steps. These are sharp, lame steps that are random and do not continue to the next step. This continues to his under saddle rehab. Some days he will not shorten the stride at all or have any “bad” steps, some days he will have 10-15 bad steps or tons of shortening (which usually gets better about 10 minutes in). The ouchy steps are getting fewer and farther between, but as far as I can tell aren’t related to any particular footing, and he is pretty much totally on long straightaways and manicured footing.

Steps like these might be proprioception reactions, rather than “ouch” reactions. As in, the second he feels his foot is going to land wonky enough, he decides not to take a chance on fully weighting the foot. Or, it is a pain response, but not about the foot, since any time the foot doesn’t land balanced, it affects structures above it. I mean, it CAN be about the foot, just not necessarily.

We’ve tried everything I can imagine as far as toughening this horses feet up. He was in completely dry, indoor stall for a while at all times. He was getting his feet painted twice daily with durasole. He’s had Venice turpentine, keratex, etc. up the wazoo. He’s had hard plastic pads, leather pads, no pads. Now he is in leather pads in a deeply bedded indoor-outdoor stall and seems to be doing the best he has during his rehab with this situation,

An unbalanced landing doesn’t have to elicit a contact pain response, as it can tweak internal structures like a collateral ligament or the attachments of suspensories or tendons, and that might help explain who treating his feet isn’t helping (enough).

but he sometimes walks like he has flippers on (even with very good angles). I am wondering if the pads put more strain on the DDFT. He does take fewer ouchy steps though, I think because of the protection of his soles? He is also more likely to take ouchy steps if there has been mud going on, even with his pads on.

By “flippers” do you mean more knee action to raise his leg higher as it moves forward? Can you post pictures of his feet?
Good Hoof Photos - How to take Good Hoof Photos

Here are my questions:

Does anyone have any experience with mystery sole soreness even with not very much popping up on MRI/rads?

Did the MRI(s) show anything about the collateral ligements?

Any suggestions as far as shoeing that would give his soles more protection but not add so much length to the toe?

Properly placed shoes on properly trimmed feet (which may only be “as good as can be done” for feet that have too much overgrowth to correct in 1 trim), put the breakover exactly where it belongs, regardless of where the actual foot has the breakover.

I was looking into eggbar shoes but know very little about them?[quote]
They have their place, which is mostly to help the back of the foot. Is it the best option? No idea.

[quote]Does my vet seem to be prescribing a reasonable rehab? I’ve had several people remark on the length of the rehab with the mildness of the injury but the horse is so lame I don’t know what to think.

To me, this is much less about the degree of lameness, and much more about the length of time it’s been going on.

[S1969]

I’d like to see pictures also. Because I would be thinking more about the trim/toe length as being a factor, not the pads. The pads shouldn’t change the stride, but the angles would.

Has he always been in shoes? What about pads? Always, or just recently? What kind of sole depth does the horse have? Xrays should show whether the horse even needs pads. (Being a TB, I wouldn’t imagine he has a ton of sole depth, but this is one way a vet/farrier decides on whether to use pads.) Not all horses tolerate pads as well.

It’s not really possible to “toughen up” feet much. A little bit, maybe. But in general - the horse has what it was genetically given.

I find it interesting that the vet injected the coffin joint without any findings on the xray. Are you sure they saw “nothing”?

[Peggy]

By walking with flippers do you mean stabby? Or hypermetric (bringing leg forward of its eventual landing place and then back)? Or something else? Either of those two could be consistent with a neck issue. And neck issues can cause additional lameness. Something to talk about with a vet.

[alphamare4]

You all have some very good questions.

The vet is a lameness specialist that has brought several 5* horses back from injury to the Advanced level. He is no dummy. But I have scheduled a second opinion with another lameness specialist at a different practice in the area this week.

By walking with flippers, I should be more clear. He seems to be more likely than ever before to catch his toe. This causes a sharply lame step, followed by sound steps. It’s possible he’s always done this and I’ve just never noticed the slight grazing of his toe on the ground because he never showed any pain before, but he didn’t do it with just plain shoes 6 weeks ago.

S1969, he’s always been in just plain shoes for as long as I’ve had him. The second year I had him was when he started to get the very mild lameness and shortening of stride which caused us to do the injections. He’s only had the leather pads on for this last shoeing cycle. I have definitely noticed he is more comfortable over gravel and slightly uneven footing with the pads on, just more likely to catch his toe since the pads have been put on. He has moderate sole depth-- it’s definitely on the thinner side, being a TB, but I specifically asked the vet about his sole depth and the vet said it was unremarkable. The whole thing really has the vet scratching his head over what the cause could be as he blocked to the PDN on several different occasions and there’s no one glaring issue apparent on the MRI.

S1969, you’re right, the x-rays showed mild demineralization of the navicular bone and he blocked to the PDN. The vet said without more diagnostic tools at the time, like MRI, we wouldn’t be able to know the cause of the lameness for sure because the structures were inside the hoof and vet suggested injecting the coffin joint as it was the most common solution to similar issues he’d seen. Since the horse was 14 at the time and only very mildly lame (seriously, barely .5/10), that’s what we did and it seemed to work. If it hadn’t, I would’ve done more diagnostics. It may have been foolish, but at the time I wasn’t ready to shell out the money for an MRI when the horse was barely lame.

walkinthewalk, the farrier hasn’t been saying anything about the pads increasing the length of the toe, that was all me-- I should’ve chosen my words more clearly to say that I’m saying pads increase the total length of the foot, and I was wondering if that was possibly increasing pressure on the DDFT tendonitis the horse already has, or if the toe-catching is unrelated.

JB, I just reread the MRI report and it did indicate mild desmopathy in medial collateral ligament. The two vets that I’ve consulted with about the MRI report weren’t interested in that as a finding, but it certainly could be the culprit when combined with other issues. The steps he’s taking definitely do seem exactly as you describe, like he doesn’t want to take the chance of fully weighting the foot if it will land wrong. At that point it’s more of a question as to why those structures aren’t feeling better with 3 months off and mild walking regimen and a round of IRAP.

Thank you all for the suggestions about intermittent laminitis and collateral ligament issues. At least that is something I have in the back of my mind for now.

Here’s a link to the pictures of his feet, I’m hoping it works. He is 6 weeks post-shoeing:
https://www.flickr.com/photos/184722827@N04/

[JB]

@alphamare4

By walking with flippers, I should be more clear. He seems to be more likely than ever before to catch his toe. This causes a sharply lame step, followed by sound steps. It’s possible he’s always done this and I’ve just never noticed the slight grazing of his toe on the ground because he never showed any pain before, but he didn’t do it with just plain shoes 6 weeks ago.

This is almost always due to heel pain - they don’t want to land flat or heel first, so they toe-stab with a toe-first landing. And that heel pain can be from a number of factors, including long-term trimming for long toes and contracted heels

walkinthewalk, the farrier hasn’t been saying anything about the pads increasing the length of the toe, that was all me-- I should’ve chosen my words more clearly to say that I’m saying pads increase the total length of the foot, and I was wondering if that was possibly increasing pressure on the DDFT tendonitis the horse already has, or if the toe-catching is unrelated.

Pads increase vertical height of the foot, but properly applied pads and shoes, on a properly trimmed foot, do not increase figurative toe length. But because of how feet grow, the breakover will move farther and farther out as the trim cycle goes on, especially with shoes (pads or not) which don’t allow the toe to wear

JB, I just reread the MRI report and it did indicate mild desmopathy in medial collateral ligament. The two vets that I’ve consulted with about the MRI report weren’t interested in that as a finding, but it certainly could be the culprit when combined with other issues. The steps he’s taking definitely do seem exactly as you describe, like he doesn’t want to take the chance of fully weighting the foot if it will land wrong. At that point it’s more of a question as to why those structures aren’t feeling better with 3 months off and mild walking regimen and a round of IRAP.

MCLs can take a REALLY long time to heal, and some of them never do, though those have always been pretty major injuries in the ones I know about. Even milder injuries have taken a year or so to be resolved, in the ones I know about.

Here’s a link to the pictures of his feet, I’m hoping it works. He is 6 weeks post-shoeing:
https://www.flickr.com/photos/184722827@N04/

Either his feet grow really fast, and he needs to be a on 4 week schedule, or he’s not being well trimmed each 6 weeks. There’s SO much foot there. The heels are quite tall and underrun (small blessings they don’t crush much), and the toes look like their flare is chronic, going all the way up the foot.

[wildlifer]

My older gelding had a DDFT tear around navicular bone & some bony changes. Yes, they take a very very long time. Easily over a year.

Pads can increase pressure on the back of the foot, some horses mind it more than others. I see a lot of red flags for heel pain in your description (tripping, front toe dragging, funny walking), since that’s something on my hot button radar (my other horse is VERY heel sensitive).

My gelding does really well in a polyurethane natural balance shaped shoe - nice short toe & wide breakover surface. He did so well in it, he’s actually barefoot now, which vet didn’t think he could do (great vet, he was glad to be wrong about that). The polyurethane was a great shock absorber for him when I could tell he wasn’t comfy with so much concussion from metal, even in pasture (he’s mostly retired now). We combined those with pourin pads to protect his flat soles without adding any heel pressure on that DDFT area.

Best of luck with your guy, I know how frustrating it is to try & figure it all out when the horse can’t just explain it to you. A good, creative farrier is an important tool!

[Postandrails]

@JB

Either his feet grow really fast, and he needs to be a on 4 week schedule, or he’s not being well trimmed each 6 weeks. There’s SO much foot there. The heels are quite tall and underrun (small blessings they don’t crush much), and the toes look like their flare is chronic, going all the way up the foot.

I agree with the above. Your horse has A LOT of hoof, with low toe angles and underslung heels. This puts the breakover too far forward and is a possible cause of catching the toe when breaking over, and the “walking with flippers” appearance you mention.

Not cleaning out the dead sole and bar material, leaving lumps and bumps can be a cause of the “sole soreness” you talk about. Soreness is even more likely to happen when pads are added because you will have more constant pressure on the sole. Given the amount of hoof your horse has, this could be a real possibility. Have you noticed whether your farrier cleans out the dead sole and trims the bars prior to shoeing?

[JB]

@Postandrails

Not cleaning out the dead sole and bar material, leaving lumps and bumps can be a cause of the “sole soreness” you talk about. Soreness is even more likely to happen when pads are added because you will have more constant pressure on the sole. Given the amount of hoof your horse has, this could be a real possibility. Have you noticed whether your farrier cleans out the dead sole and trims the bars prior to shoeing?

I agree there’s a strong possibility there’s a wad of false sole there, which is a major cause, IME, of farriers ending up letting feet get longer and longer, because they are trimming to an invalid landmark.

[onthebit]

OP, I rarely get into hoof related discussions as everyone has such strong opinions, but after looking at those pictures I’m not surprised there is persistent discomfort within your horse’s hooves. Crazy long toes, underrun heels, and just so much hoof in the wrong places. I think farriers often get unfairly beat up on this board, but if your current farrier has been working on these hooves for more than three cycles you have a farrier problem.

[OneTwoMany]

Not to pile on, but I’d be getting a second opinion on that farrier job.

[jonem004]

Wowza! Time to shop around farriers. You can see up by the cornett band that the hoof wants to grow down straighter but then it immediately flares forward. How is his coffin bone angle? I bet he’s heel sore. When you have his shoes pulled I’d really encourage you to take the time to do a white lightning or kleentrax soak to address any funky microbes that might be living in his central sulcus.

[alibi_18]

And the prominent vet hasn’t said a thing about the shoeing job?

I will add that your horse is wearing the wrong shoe size as well. Is you farrier trying to create big feet to your horse?

[JB]

He might have on the right sized shoe for the footprint his hoof should have, but that foot print is just all in the wrong place, and there’s too much foot.

[Natalie]

@JB

Either his feet grow really fast, and he needs to be a on 4 week schedule, or he’s not being well trimmed each 6 weeks. There’s SO much foot there. The heels are quite tall and underrun (small blessings they don’t crush much), and the toes look like their flare is chronic, going all the way up the foot.

YES to this. His feet look a bit like my horse’s did when I got him (though my guy’s were worse)–just “tall” overall with underrun and in my case, crushed heels. Chronic thrush to go along with that mess, plus poor lateral balance.

So yes, either your horse needs to be trimmed significantly more frequently, or you need a new farrier. Well maintained feet should not look like that, ever. You will most likely end up with a chronically lame horse, if not one with arthritic changes caused by crap foot function (as me how I know).