What would you do? Neurectomy? IRAP? Pro-stride? Osphos?

[beau159]

Alright fellow COTHers. Help me make some sense of my thoughts!

I have a coming 12-year-old AQHA gelding. His primary discipline is barrel racing, although we do enjoy showing locally (showmanship, reining, ranch riding, horsemanship, etc). I may hit up a breed show someday for the experience but we’ll see.

I have owned him since he was 6-years-old. He essentially was greenbroke and fat and hadn’t had consistent riding. Without making the story too lengthy, I know that he has a “catchy” stifle on the right side (which has gotten much better the last few years). The “upper” of the lower hock joint is completely fused on the right side, and currently going through fusion on the left hock. We manage with injections, when needed. Since I live in North Dakota, he always gets the winters off.

But his main problem I am trying to keep under control is heel pain. Thus far, he has not shown any bony changes on x-rays but it’s time to do new ones this spring and check again. Now, he’s never been dead lame in his life, but I can tell when he’s “off” and those front feet are bothering him. This past year (2017) has been the worst for him, despite having the entire year off in 2016 (I had a baby).

So I’m trying to collect my thoughts and what I can do differently for him in 2018. While he has great feet and a great farrier, we do keep him in a 3 degree wedge pad with rim shoe on his front feet to “relieve” some of the heel pain. I’ve managed to only need to inject his front feet twice (coffin joint injections), by resting him when he needs it and being selective of where he runs. I do usually keep him on Adequan (although I can’t say I really noticed anything) and he usually needs to be on Equioxx.

I hate keeping him on the Equioxx but as expected, he moves much better with it.

To catch the question ahead of time, no, I have not done an MRI on his front feet. I believe the closest one is at least 8 hours one-way from my location and I think that one is only a standing one (less quality images). Based on the opinion of my usual lameness vet and also of a regional specialist (I did travel 6 hours to see him a few years ago), they both do not feel an MRI is necessary as it will not change the treatment protocol for him.

Of course, if his new rads show any bony changes at all, I am absolutely going to try Osphos without question and see how it works for him. My vet tells me it might also be beneficial to encourage his hock to continue to fuse, so I may try it anyway.

But if the new rads still do not show any bony changes, I’m not sure which route to go, as I don’t have prior experience with neurectomy surgery or with IRAP/Pro-Stride injections. I know that the neurectomy does not stop the disease process and that it is variable on how long it lasts, but if it makes him more comfortable, I would not hesitate to do it.

I’m willing to try IRAP or Pro-Stride and see if that gives better results than the typical steroid injections … but I also don’t like sticking needles into joints if I don’t have to.

I have no problem retiring him if he needs to be retired, but I guess I’m not ready to give up on him yet. He loves his job - he truly does. It would make my choice a lot easier if he hated barrels…

So long winded question – who has experience with other therapies for heel pain? Just trying to develop a plan of action for the year ahead.

[findthedistance]

You have a horse with a lengthy history of chronic heel pain and NO bony changes? Assuming the farrier work is appropriate, that’s most likely a soft tissue injury. The only way you’re going to diagnose that is with MRI, and I can totally appreciate not wanting to haul 16+ hours round trip for that. (I wouldn’t be turned off by the standing MRI, though. It’s popular here and generally gets the right diagnosis with less risk to the horse.) Personally, I would be concerned that continuing to work a horse with a possible soft tissue injury would cause further damage. I might ride lightly to tolerance, but nothing high-impact absent a diagnosis and treatment plan.

In my area, you can’t get a surgeon to do a neurectomy without an MRI, but we have good local access imaging. The concern is masking a DDFT injury, resulting in catastrophic failure. I have had good results with OsPhos for bony issues (navicular changes, kissing spine, etc), so that may still be a consideration to treat your horse’s hocks.

[BoyleHeightsKid]

My gelding gets sore in his heels upfront when he’s compensating from being sore behind. In his case it’s sore hocks and he’s ready for injections.

Can you get us some pictures of his feet? The best way to photograph them is with the horse standing square on a hard level surface with the camera sitting on the ground straight from the side/back/front. A solar shot would be great too.

Why the 3* wedge just to help relieve soreness?? Does he have low heels?

[2tempe]

not totally related but maybe…I have a mare who had a stifle issue - not “sticky” but inflammation in the joint, short striding. At vet’s recommendation I did IRAP twice - approx. 1 yr apart. It did help but I do not think it would have lasted as long had the mare been in consistent work - but she lost close to 12 weeks due to other, overlapping issues unrelated to her stifle. This was probably 6 yrs ago and the IRAP was pricy as compared to regular injections. Can’t say I was overwhelmed with the benefits. With current horse, who has minor hock changes at 16, I went with traditional injections.

But I agree w/ other posters - you need to get a good diagnosis as to what the problem is - hind end discomfort causing front end problems or just a front end problem. Personally, I would only go to neurectomy as a last resort.

[beau159]

@findthedistance

You have a horse with a lengthy history of chronic heel pain and NO bony changes?

Correct. No bony changes in the front feet thus far, but I do plan to do new x-rays this spring.

**For the record, I am currently 33 weeks pregnant so it’s going to be late spring before we get going.

@findthedistance

In my area, you can’t get a surgeon to do a neurectomy without an MRI, but we have good local access imaging. The concern is masking a DDFT injury, resulting in catastrophic failure.

Correct, you wouldn’t want to do a neurectomy if there is a problem with the DDFT. I have not directly asked the surgeon if he would require an MRI before doing surgery but I’m sensing that he might not. He was the one who told me my horse would be an excellent candidate for a neurectomy in the event that injections no longer helped him. Of course, if he wanted an MRI before doing the surgery, I’d find a way to make it happen.

While I know it is possible, it is extremely unlikely in my gelding’s case that he has a bilateral DDFT hole or tear.

Yes, there is something going on with a soft tissue structure in his front feet. But again, the reason I haven’t done an MRI yet (besides the lack of availability in my area) is because finding out what soft tissue structure is affected would not change how he is being treated.

@findthedistance

I have had good results with OsPhos for bony issues (navicular changes, kissing spine, etc), so that may still be a consideration to treat your horse’s hocks.

After further discussion with my vet, I think I will try Osphos in the spring anyway to maybe help his hocks – it will just be a matter of what his front feet x-rays look like and WHAT ELSE I need to do for him.

@BoyleHeightsKid

Can you get us some pictures of his feet? The best way to photograph them is with the horse standing square on a hard level surface with the camera sitting on the ground straight from the side/back/front. A solar shot would be great too.

Why the 3* wedge just to help relieve soreness?? Does he have low heels?

Normally I’d have no problem taking some pictures of his feet to show you all, but being pregnant myself and the middle of winter, I currently have my horses with my parents 2 hours away.

Yes, the wedge is strictly for his heel pain. He has good feet and good heel (not low and not underrun).

I am lucky to have a fantastic farrier and I am very confident he is being taken care of in that aspect. I do pull shoes for the winter, so my mom doesn’t have to deal with that, but during the season when he is shod, we are at the farrier every 5 weeks on the nose.

@2tempe

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But I agree w/ other posters - you need to get a good diagnosis as to what the problem is - hind end discomfort causing front end problems or just a front end problem. Personally, I would only go to neurectomy as a last resort.

Oh we have a good diagnosis. He has BOTH hind end problems and front end problems.

The only discrepancy would be exactly what soft tissue structure is affected in his front feet, again, that would be confirmed via MRI. But minus a rare bilateral DDFT issue, the other soft tissue structures would have the same treatment plan regardless of the structure.

[Madison]

@beau159

Oh we have a good diagnosis. He has BOTH hind end problems and front end problems.

The only discrepancy would be exactly what soft tissue structure is affected in his front feet, again, that would be confirmed via MRI. But minus a rare bilateral DDFT issue, the other soft tissue structures would have the same treatment plan regardless of the structure.

Based on your description, I have a hard time agreeing that you have a “good diagnosis” on the front end problems. In which case I would never consider a neurectomy without having a better understanding of the underlying cause of the heel pain, the current status, and the likelihood of further degeneration. Neurectomies got a bad reputation because people used the procedure for inappropriate cases, if your horse were my horse I would want to know more specifics before I concluded it was an appropriate case. If nothing more can be done to alleviate the condition, and it is not going to get worse, then it absolutely could be a helpful solution for making the horse comfortable. But based on your description I would want to know more about what is causing the heel pain up front first before I put that option on the table.

If your vet feels there’s a chance the hind end problems are contributing to the front end soreness, you may have to treat this like peeling an onion. Get the hind end comfortable, then see what you have left in the front end. And if the Equioxx/Previcox is helping the comfort level, I would not feel bad keeping him on it while you work through this - plenty of older horses are kept on it for longer periods to help them with the aches and pains of aging, and do fine. It is easier on their bodies than bute!

[BoyleHeightsKid]

@beau159

Yes, the wedge is strictly for his heel pain. He has good feet and good heel (not low and not underrun).

Was the wedge recommended by the vet? How long has he been in them? A wedge done on a foot that doesn’t need them or isn’t done correctly is IMO only going to cause more issues. I wouldn’t be surprised if that was contributing to the soreness. All it does is load more pressure on the heels unless there is some sort of frog and comeseur(sp) support.

This really makes me what to see pictures of his feet.

and I’m with @Madison I would be willing to bet the hindend is causing the frontend problems. Get those figured out first, then see what happens after about 2 months.

also… I would take him out of those wedges if his angles don’t need corrected. Pads should help but the wedges aren’t going to do anything.

[TequilaMockingbird]

Have you ever had him blocked incrementally to see where the pain is originating from? What about ultrasounds?

I’ve personally had good results with Osphos but it is not a cure-all. But it is cheap and may help address some other issues your horse may be having.

An MRI should still be your next step if Osphos doesn’t make a huge difference.

I personally wouldn’t bother with IRAP unless you’ve already had an MRI done and IRAP has a strong track record for that particular injury. I’ve known a handful of people who tried IRAP as a last ditch effort when all other options failed and it made no noticeable difference in every case.

[beau159]

@Madison

Based on your description, I have a hard time agreeing that you have a “good diagnosis” on the front end problems.

I can go into more detail on his front feet - I didn’t want to write a novel right off the bat.

Purchased age 6 (2012) - no problems noted but really only focused on general riding. Rode pretty much every day, 4+ miles, from May until October. Due to lack of sunlight and snow my horses usually get the winter completely off, with an occasion light ride once in a while on the weekends if it’s not icy and not too cold. They are on pasture 24/7.

Age 7 (2013) - started riding again in March (when the daylight increases!). Started noticing he was slightly “off” in front in June. Couldn’t even really call it lame - just felt that something wasn’t quite right. This is when the heel pain was first diagnosed. Vet called it a bursitis. Vet recommended wedge pads/shoes to help alleviate the pain, along with a week off. This helped dramatically and he was fine the rest of the season on his front feet. Around September, I noticed he was cross-firing in the hind end on his barrel turns. Went back to the vet and discovered mild catchy stifle on right hind. We were at the end of the season, so opted no treatment at that time.

Age 8 (2014) - Tried injecting stifle in the spring but still was having problems in the hind end in his barrel turns. Despite flexing normally, did x-rays of his hocks to find out the right hind was fusing. Injected in June and it helped tremendously. I took him for a second opinion of his front feet shortly thereafter (to a regional specialist … same guy that would do the neurectomy surgery), as he was starting to be a little “off” again. This vet agreed with everything current vet said (bursitis) and had done thus far. Recommended he say in the wedge pad with shoe, and we injected coffin joints. Also added Previcox because he was still flexing a little off on the right hind, despite injections. Specialist said I could do an MRI if I wanted, but that it would not change the treatment protocol so he honestly didn’t recommend I spend the time or travel on one (he does not have one). If I did choose to do an MRI, he recommended NOT to do a standing one because the quality is not as good.

Age 9 (2015) - Front end did not require any extra maintence this year. He did well with the wedge shoes. Started to get a little bit off by the fall, but I just stopped hauling him then because it didn’t make sense to do coffin joint injections before winter. We did not need to do hock injections because the right hock had fully fused. Stifle has been fine.

Age 10 (2016) - I had a baby in June, so he had more than an entire year off, from about Sept 2015 to April 2017. Pasture turnout.

Age 11 (2017) - Strangely, after having all that time off, he did not feel that great on his front feet this year. Did coffin joint injections in the spring, followed by hock injections about a month later (discovered his left hock is now fusing). Stifle has still been doing fine. Kept on Equioxx the whole season. Stopped riding after Labor Day when I couldn’t fit into my riding jeans anymore. :lol:

And here we are. It just bothers me that he was actually his worst on his front feet after having all that time off. That part doesn’t make sense to me. I get that the other hock is now fusing, but there wasn’t really much improvement in his front end after addressing the hind.

So long story short, nothing has drastically “changed” in his front end since I have owned him, which is why in my mind we do have a good diagnosis of (assumed) bursitis. Again, it would be so unlikely for him to have a hole or a tear in the DDFT that would contraindicate doing a neuroectomy. And if the inflammation is not in the DDFT but it somewhere else in the front foot … again, it just does not change the treatment protocol. You treat the inflammation the same, even though some horses may have the inflammation in slightly different structures.

And again, not decided that I am going to do the surgery. Just want to explore my options and hear what others have done/experienced with their horses with heel pain. I just want to do what is BEST for him. I definately want to try osphos for his hock, and am really leaning toward trying IRAP injections in his front feet and see what results that gives him.

He has never been 3-legged lame in his life. It’s just that I can tell his stride is short and he is “off”.

[beau159]

@BoyleHeightsKid

Was the wedge recommended by the vet?

Yes.

@BoyleHeightsKid

How long has he been in them? A wedge done on a foot that doesn’t need them or isn’t done correctly is IMO only going to cause more issues. I wouldn’t be surprised if that was contributing to the soreness. All it does is load more pressure on the heels unless there is some sort of frog and comeseur(sp) support.

A wedge does NOT load more pressure onto the heels when it is done correctly. Yes, it will redistribute the pressure elsewhere as a result of moving it off of the heels, but for a horse that needs the heel relief, that’s your best option.

Yes he does have frog support. This is why we are doing a wedge pad with a regular shoe, so that he has frog support.

[beau159]

@TequilaMockingbird

Have you ever had him blocked incrementally to see where the pain is originating from?

Of course! That is part of his lameness exams.

He is sound on flexion with the first and lowest block on the front foot. His left is slightly worse than his right. As expected, when one foot is blocked and “cured” then the other foot (not yet blocked) is worse.

@TequilaMockingbird

What about ultrasounds?

Yes have done them, and have always been normal. Of course, they aren’t imaging deep structures - only more superficial ones.

[BoyleHeightsKid]

Take care of the hindend… see what you have in a couple of months. Treat the cause not the symptom.

Being pregnant gives you plenty of time to get this figured out. Like was said above… it’s going to be like peeling an onion.

[Melissa.Van_Doren]

Do you have any pics you can post or link that would let us see his feet? They don’t have to be perfect ground level… even just standing in the wash stall would be okay.

ETA: an overall conformation pic would be great, too

[luvmyhackney]

I would love to see pics of his feet, but honestly I would look at shoeing him differently if this particular shoeing setup is not helping him. Good farriers have a pretty expansive tool kit of how they can change breakover and angles, then add all the different shoeing options on the market now.

Great article regarding horses with heal pain.
http://www.equipodiatry.com/article_palmar_pain4.htm

[beau159]

I dug through my PhotoBucket account. These are OLD PHOTOS from 2015. I believe this was shortly after I had his shoes pulled for the winter if I remember correctly. They are of the left front.

I could not find any on my PB that shows his shoes. I can look on my home computer tonight and see if I had anything stashed there.

[IMG2=JSON]{“data-align”:“none”,“data-size”:“full”,“src”:"http://i84.photobucket.com/albums/k27/r_beau/Saltys%20Red%20Rock/06%20Red%20foot%209-25-15_zpssx0ncqtg.jpg)

[IMG2=JSON]{“data-align”:“none”,“data-size”:“full”,“src”:"http://i84.photobucket.com/albums/k27/r_beau/Saltys%20Red%20Rock/01%20Red%20foot%209-25-15_zpsf9yy5cmr.jpg)

…and just because, here’s the dude in question!

[IMG2=JSON]{“data-align”:“none”,“data-size”:“full”,“src”:"http://i84.photobucket.com/albums/k27/r_beau/2017%20Horse%20Pictures/Red%20western%20pleasure_zps1jrr79vz.jpg)

[Dressagelvr]

It sounds like he has had a lot of starting and stopping in what sounds like a demanding career “in season”.

Horses, especially as they age, don’t typically do well with a “no work” - “intense work” - “no work” plan.

It is just like a person trying to go from the couch to track and field competition. Other soft tissue takes MUCH longer to get fit than cardio and muscles.

​​​​​​Youth can compensate for some of this, but as a body (human or equine) ages, it must be treated carefully and consistently or it will fall apart.

Something to consider as you explore veterinary and farrier treatment options.

[beau159]

@Dressagelvr

Horses, especially as they age, don’t typically do well with a “no work” - “intense work” - “no work” plan.

It is just like a person trying to go from the couch to track and field competition.

If you think I’m pulling him out of the pasture in the spring and going to a barrel race the very next day, you are quite mistaken.

[Dressagelvr]

I’m not saying that you pull him out of the field today and race tomorrow.

What I’m saying is that a performance horse needs to be in some form of work all year long, especially as they age.

Your horse not only has winters off, he’s had 18+ months off recently and is now off again. You also say he was never worked consistently before you got him at age 6.

This kind of stopping and starting takes a heavy toll on tendons/ligaments and the like.

[meaty_ogre]

No real advice or suggestions for you OP, but I had a bilateral neurectomy done on my first horse a long time ago. It worked, and I continued to ride him right up until he passed away from a severe colic episode. He showed 1st level at age 24. There’s a lot of bad endings and a lot of misinformation when it comes to neurectomies, but also a lot of times where it worked very well. My only advice if you do decide to have it done is to really do your homework on practitioners. The vet who did my horse has done hundreds of these procedures.

It’s a lot like when I had my own knee surgery. When I was in physical therapy, there were 4 of us who had ACL repairs done. My incisions and healing time were far, far less than anyone else’s, and I’m a 30-something unfit, overweight lady. I know the reason I fared better than the 2 high school athletes was because my surgeon was a former NFL team doctor and knee guru and theirs was a local doc who had done probably 1/10 as many surgeries as my doc or fewer.

[IPEsq]

http://www.thehorse.com/videos/38481/from-hoof-testers-to-mri