Skip to main content

November 2017 - AAEP is on Stall Rest

AAEP is taking the month of November off from "Ask the Vet", but will be back in December to answer your equine health questions concerning winter weather care for your horse with expert, Dr. Christine Tuma.



Click here to read this month's questions and answers.
  1. My 20-year-old, 14.2 Quarter horse mare became lame after moderate lunging. Her knee developed a rock-hard knot that looks like half a baseball glued onto it. My veterinarian took radiographs and found minor arthritis in the joint and inflammation in the bone. We treated (per vet's advice) with hyalon-90, cosequin, chinese herbs, Bute and months of stall rest. Unfortuantley, she has gotten worse instead of better and I am at my wits end. Before this injury, she was sound and very athletic, but now she is in pain all the time. She does better out of the stall in the paddock where she can keep her joints moving. Any additional advice?

    (View Answer)

    Sorry to hear about your mare: poor girl! It's difficult to make any recommendations specific to her without having seen her or her X-rays, but definitely speak with your veterinarian and get them to come out and have another look at her if she isn't any happier.

    In general, treatment choices and success rates do depend a little bit on exactly what she's done and whether the lowest joint of the knee or one of the top two, where there is more motion, is affected. The higher motion joints tend to respond better to injection of medications such as corticosteroids or regenerative therapies (irap or stem cell products), which aim to reduce inflammation and halt or slow the progression of the disease. The lower joint (carpometacarpal joint) doesn't tend to respond as well, and arthritis can be a real pain to deal with here. The most severely affected horses can end up needing the joint fused surgically.

    It's probably worth getting your vet to re X-ray the joint to see if anything has changed. Sometimes small fractures are hard to see initially but become more obvious a few weeks later as bone becomes reabsorbed at the fracture margins.

    There are also some soft tissue structures in the knee (intercarpal ligaments etc) that might be affected and obviously wouldn't show up on X-ray. An MRI would show these structures; however, they are pretty costly.

    It sounds like you need to chat with your vet regarding pain management for your girl. Bute may give her more pain relief than the buteless powder. Corticosteroid injection will also alleviate the pain, but you need to make sure there are no fractures and no infection before you put steroids in the joint.

    Best of luck and I hope you can make her feel more comfortable soon! Rochelle Lewis, DVM, New Zealand

  2. My 10-year-old Thoroughbred gelding was stumbling a lot for about a year with no improvement from trimming/shoeing changes and he had bruises. He was quite lame on the right front. After several days of no turn out, due to weather, I assumed he had developed an abscess. However, no improvement after one week of soaking and poulticing. The veterinarian exam revealed nothing significant so we administered bute, stall rest, hand walk for 10 days and still no improvement. We then did blocking, radiographs and ultrasound and found a negative palmar angle, no navicular changes, soreness of the DDFT but no lesions. My farrier shod him in 3½ natural balance pads which showed significant improvement. I gave my horse 30 days of increasing turnout and then began to slowly return him back to work with a normal flatwork load after 90 days and have been slowly adding jumping. He has been fantastic with no lameness, soreness or stumbling. He moves much more in balance now and his jumping form has also improved. We are about a year out from when the lameness began and my veterinarian says to leave the pads on him. Why change what is obviously working? However, my farrier says the pads need to come off as I am just setting my horse up for soft tissue problems down the road. What is your opinion on pads and how long they should they stay on? My horse also has a history of long toe low heels.

    (View Answer)

    Great to hear of the improvement in your horse's condition; what a fantastic and encouraging result!!!

    In some ways I agree with your veterinarian; this method is clearly working at the moment for your horse, and if everything else (foot shape, hoof health, other soft tissue structures in the limb) are happy and healthy and well maintained, I don't see too much reason not to continue.

    However, your farrier's professional opinion is super valuable too, as he or she will see aspects of the foot each time the hooves are trimmed and the pads reset that your vet may not be able to visualise externally (as in when pads are in place). He or she may also be a more regular visitor to your horse than your vet is (let's hope so right?!)and may have noticed your horse's feet changing shape, hence the worries about keeping the natural balance pads on.

    Correctly applied natural balance shoes or pads can really help horses with foot pain from a variety of causes, especially those with long toe low heel conformation. 

    One thing farriers sometimes see with ongoing use of wedge pads of any variety is collapse of the heels. Does your farrier feel that this is happening to your horse? If so, it might work to try other methods of achieving the same angles (for instance a wedge or natural balance shoe with an alternate method of frog support) without using the full pad. Wedged heels of any form CAN further damage collapsed heels, but do not do so in all cases.

    There is a useful article, written from a farriers point of view, in the American farriers journal that might be of interest to you. 

    https://www.americanfarriers.com/articles/137-love-them-or-hate-them-wedge-pads-are-effective-tools

    Best of luck: moral of the story is that if your horse is doing well at the moment, you may decide not to change anything (and continue to celebrate!!) but talk to your farrier about his or her concerns and how they feel best to address them. Rochelle Lewis, DVM, New Zealand

  3. My 14-year-old Anglo Arabian had been "irregular" in the hind end on and off for two years, and then came obviously lame in a foreleg. She was diagnosed six months ago (via x-rays, scan, etc.) with a mild to moderate suspensory ligament strain in the right fore, plus slight osteoarthritis in her fetlocks, stifles and sacroiliac. After ultrashock treatment for the former and joint injections for the latter, plus rest and gradual reintroduction of exercise (hacking at a walk little trot, no canter as yet), she is now sound in the front but slightly stiff in both hinds. She gets a turmeric, oil and pepper mix in her feed to help with inflammation. I'm not sure how to proceed with her exercise program as she needs muscling up again to help her joints, but the ligament injury is still relatively recent. Any suggestions or other advice concerning her condition?

    (View Answer)

    Thanks for your question! First and foremost I'd recommend to discuss the management of your mare's rehabilitation program with your veterinarian, as he or she has had the benefit of examining her and is familiar with her X-rays, etc. and are better able to offer case specific advice than anyone of us who haven't seen her. I'm sure you've done this already, but my advice won't be as specific to your girl without having seen her.

    If you have given her six months rest, you would hope for a fair amount of healing to have occurred in her suspensory ligament by now. As I'm sure you are aware, ligaments and tendons often repair themselves with scar tissue as opposed to new tendon or ligament tissue; the shockwave treatment aims to stimulate the cells to repair themselves in a more correct fashion than a disorganised mass of scar tissue. It would be advisable to get a repeat ultrasound examination of her suspensory before you start upping the workload to substantial amounts of trotting or canter work. Your vet would then be able to give you a more informed plan of how to proceed from here as far as the extent of healing of the ligament goes. Often times, the last stage of ligament or tendon repair needs to be a dynamic process; the horse needs to start moving more in order to fully remodel the healing tissue.

    Depending on the level of arthritis in her hind end, it may be necessary to inject her joints again at some time in the next six months in order to reduce inflammation and provide some pain control. I also have found that many horses with mild to moderate arthritis do better when moving daily, and a low level consistent daily exercise program will be of benefit to both front and back ends of your horse! If you are looking for a low impact way to build up hind end muscle, ask your vet whether he or she thinks that the healing of the suspensory could tolerate work over poles (initially at the walk) and then progress to hill work. Long and low exercise should be performed initially to allow her to build up strength.

    If the arthritis is fairly mild, you may find that supplements such as chondrotin and glucosamine give her enough relief to resume light ridden exercise. Other supportive treatments include Adequan, Pentosan or Hyaluronic Acid injections. These are a bit more powerful than oral supplements, and definitely worth chatting to your vet about.

    Some of our clients here have had some good results with using massage machines to relieve transient muscle soreness when a horse returns to exercise after a period of time out in the paddock. It might be worth a go if you think the muscles themselves are sore? Rochelle Lewis, DVM, New Zealand

  4. My 10-year-old Arabian has been diagnosed with stifle catching. What can I do to help him strengthen and resolve this issue?

    (View Answer)

    Stifle catching, or locking patella, is a common condition caused by the kneecap shifting out of the groove and its associated ligaments getting hooked over the bony prominence.

    Modern treatments concentrate on tightening up the ligament strength in order to keep the patella (knee cap) in the groove and stop it from slipping.

    First of all, I would recommend increasing your hill work or hind end collection/engagement for instance working over trotting poles etc, in an attempt to increase muscle definition and strength.

    This can be combined with mild farriery changes; a study recently showed that rasping the inside toe edge slightly more than the rest of the foot can prevent a lot of mildly affected horses from locking their stifle.

    For cases where this doesn't work, we carry out a ligament splitting procedure. This involves making micro-lesions within the medial or middle ligament to encourage scar tissue formation and effectively tighten these ligaments. It has been really successful in most cases.

    Historically, stifle locking horses use to have the inside ligament cut completely in order to prevent it from being able to remain hooked over the bone. Some of these horses went on to later fracture their kneecaps and therefore, would not recommend cutting the ligament unless all else fails and the condition is extreme. Rochelle Lewis, DVM, New Zealand

  5. My horse has been diagnosed with sidebone and ringbone in her front right. She also has some amount of navicular in both front feet. She is very uncomfortable and particularly on hard surfaces is extremely lame. She currently receives 1 gram of bute/day and we have tried eggbar shoes, balanced shoes, and next are trying soft riders (this week, I hope). She also receives isoxuprene and adequan. She has better days (when she can walk short strided and limps only when turning) and worse days (when she heaves up and over the sore leg with almost every stride). Everyone I speak with tells me to try "their" farrier, as if that is the problem. What else can I try? How long is it fair to keep trying to get her comfortable?

    (View Answer)

    Sorry to hear about your horse. Farriery is very important in treating all of the conditions that you have mentioned, although often has to be combined with other treatments in order to get inflammation under control and alleviate pain in severe cases.

    Both navicular disease and ringbone (arthritis of coffin joint is low ringbone, pastern arthritis is high ringbone) respond to some degree to corticosteroid injection into the joint. This helps alleviate pain and reduce inflammation. High ringbone tends to be less responsive than low ringbone although it depends on the degree to which the horse is affected. It will not reverse the disease but can give a lot of relief and slow down the progression. I would definitely talk to your veterinarian about giving this a try into the coffin joint.

    Some horses with navicular changes have responded well to injection (into the joint or via intravenous regional limb perfusion) with Tildren, which is a drug that slows bone reabsorption and changes how the bones remodel. I have had some cases where corticosteroid injection has failed to be enough pain relief, yet the horse has become comfortable after Tildren. Disappointingly, though the drug doesn't seem to change the appearance of the bone on X-ray.

    Some joint supplements can help alleviate some of these conditions; have you tried chondroitin/glucosamine for instance?

    It is a really hard call to make as to when is it all too much. Every horse has a different pain threshold, and some seem more willing to keep fighting than others. You know your horse better than anyone so talk to your vet about your point at which you don't think it's fair to keep going. If she is making progress and is happy to walk around a little to eat and drink it is easier to keep going than when the light goes out of their eyes and they don't want to get up anymore. Some horses just seem to reach a point where they are trying to tell you they've had enough. If you have tried everything that your budget and your resources allow and she is still in pain every day you may decide to let her go gently. Speak with your veterinarian and have faith in your own judgement to be your horse's best advocate. Rochelle Lewis, DVM, New Zealand

  6. My 20-year-old, 14.2 Quarter horse mare became lame after moderate lunging. Her knee developed a rock-hard knot that looks like half a baseball glued onto it. My veterinarian took radiographs and found minor arthritis in the joint and inflammation in the bone. We treated (per vet's advice) with hyalon-90, cosequin, chinese herbs, Bute and months of stall rest. Unfortuantley, she has gotten worse instead of better and I am at my wits end. Before this injury, she was sound and very athletic, but now she is in pain all the time. She does better out of the stall in the paddock where she can keep her joints moving. Any additional advice?

    (View Answer)

    Sorry to hear about your mare: poor girl! It's difficult to make any recommendations specific to her without having seen her or her X-rays, but definitely speak with your veterinarian and get them to come out and have another look at her if she isn't any happier.

    In general, treatment choices and success rates do depend a little bit on exactly what she's done and whether the lowest joint of the knee or one of the top two, where there is more motion, is affected. The higher motion joints tend to respond better to injection of medications such as corticosteroids or regenerative therapies (irap or stem cell products), which aim to reduce inflammation and halt or slow the progression of the disease. The lower joint (carpometacarpal joint) doesn't tend to respond as well, and arthritis can be a real pain to deal with here. The most severely affected horses can end up needing the joint fused surgically.

    It's probably worth getting your vet to re X-ray the joint to see if anything has changed. Sometimes small fractures are hard to see initially but become more obvious a few weeks later as bone becomes reabsorbed at the fracture margins.

    There are also some soft tissue structures in the knee (intercarpal ligaments etc) that might be affected and obviously wouldn't show up on X-ray. An MRI would show these structures; however, they are pretty costly.

    It sounds like you need to chat with your vet regarding pain management for your girl. Bute may give her more pain relief than the buteless powder. Corticosteroid injection will also alleviate the pain, but you need to make sure there are no fractures and no infection before you put steroids in the joint.

    Best of luck and I hope you can make her feel more comfortable soon! Rochelle Lewis, DVM, New Zealand

  7. Could you please tell me your opinion of Goldic stem cell regeneration therapy (by Arthrogen)? I have a 15-year-old gelding that has had lameness problem first diagnosed a year and a half ago as EPM. After two courses and three months of EPM medication and no improvement, he was then diagnosed with RF suspensory branch lesions and SI joint subluxation (received a SI joint injection). He is currently three months into a four month rest period. He is no worse at this point, but not significantly better. I have recently read a little about the Goldic therapy and wondered your thoughts about it (as opposed to PRP or shockwave therapy) for my horse.

    (View Answer)

    Thanks for your question and sorry to hear about your boy. It sounds like he may have several different issues going on. Has the sacroiliac joint problem been resolved? I would want to make sure before I spent a lot of money on any treatment modality that the cause of ongoing lameness was the suspensory. I'm sure your veterinarian has performed nerve blocks, etc. to elucidate which problem is currently causing the lameness, but I would want to make sure that in treating the suspensory I was concentrating on the correct problem.

    As far as the suspensory branch lesions, I have had some good success rates with treating these lesions with PRP; the horse still requires a lengthy rest period, but it has seemed like the healing time has been improved slightly and the quality of healing (more closely resembling normal ligament architecture on repeat ultrasound examinations) has been better than those horses treated with rest alone. It obviously also depends on the level of damage, and success rate can also vary with where in the branch the lesion is located.

    We recently treated a very valuable racehorse that sustained a hind suspensory lesion with a combination of PRP and a different stem cell product and he has returned to winning races, albeit after a long period in the spelling paddock and extensive physio/rehab.

    I have not used the GOLDIC system myself as it is not available over here. I have used other stem cell products (both fat derived and from those from the bone marrow) on tendons/ligaments and I was initially impressed with the lesions appearance on early scans, although found that the end result wasn't much better and wasn't achieved any quicker. 

    One of my good friends in the UK was involved a few years ago with being a part of the trial for the GOLDIC product and he told me that veterinarians from his clinic were impressed with the results, although found that they worked best in tendons and ligaments when utilised early in the course of the injury (ideally within the first week or two), and that a strict attention to sterility was necessary in order to achieve the best result.

    Hopefully this helps, and if you decide to go ahead with the product in your horses case make sure you let us know how you get on! Rochelle Lewis, DVM, New Zealand

  8. What are the best treatments for arthritis of the coffin bone?

    (View Answer)

    Arthritis of the coffin joint (otherwise known as low ringbone) is potentially a career ending condition for the horse. Treatments and success rates depend a little bit on how advanced the condition is when it is diagnosed and on the pain level of the horse. The most common treatment is injection of anti-inflammatory medications such as corticosteroids into the joint. This decreases the inflammation and thus slows the progression of the disease and also reduces pain levels. Depending on the severity of the arthritis and the medication used, joint injections may last six months to a year before they need repeating. Your veterinarian may combine the corticosteroids with other medications such as hyaluronic acid; a natural component of joint fluid, which has both anti-inflammatory and lubricating properties and works synergistically with corticosteroids. 

    Changes in shoeing may also be prescribed; rolling the toe of a shoe and using a wider web may both offer some relief. Some farriers find that rolling the edge of the shoe most of the way round allows the horse to choose its point of break over and alleviated pain in some individuals. Ensuring that angles of the foot are maximised to prevent pinching at the joint margins (such as might occur if the foot is allowed to become excessively broken backed) is also helpful.

    Joint supplements such as chondroitin and glucosamine may help slow the progression of arthritis.

    I personally haven't had much success with shockwave therapy for this condition although I do know of other veterinarians who belief that is has helped some cases.

    New therapies such as irap and stem cells are regenerative medicines and may be injected into the joint in a similar manner to corticosteroids. Some cases have responded favorably to this method but both seem to be more helpful early in the course of the disease. Rochelle Lewis, DVM, New Zealand

  9. When a horse is trimmed too "short" and is lame afterwards, what is actually causing the soreness? If the shoe is fitted properly and not touching the sole, why would the horse be sore? 

    (View Answer)

    There are a number of reasons why a horse might be sore right after shoeing, one of the most common of which is too much sole pressure as you mentioned. Other possible reasons include a hot or close nail (a hot nail is directly touching the sensitive part of the foot whereas a close nail has just been placed a little closer than it should be to these sensitive bits and the pressure from that nail on the tissues of the foot causes pain). The is also mild laminar pain due to concussive force of hammering in the nails (more common in horses that have had laminitis episodes in the past). Sometimes overtightening the clenches can cause some pain from excess pressure as well.

    If the farrier has had to take off a lot of foot or has placed a different type of shoe to the horse's last set, some horses will experience mild pain for a few days due to the angle change and mechanics of the foot: a bit like someone who feels sore legs the day after wearing high heels for an evening and they aren't used to them! Different angles of the feet change the loading pattern of not only the bones of the foot but the soft tissues of the foot and whole limb, and this causes soreness in some horses as they adapt.

    There are a few horses out there that have been shod appropriately, no big changes, nails all correctly placed, properly clenched and no sole pressure that are still mildly footsore, but usually diminishes in a few days. It is comparable to when you have forgotten to trim your fingernails for a while and finally do, then the tips of your fingers feel odd for a while! It is probably a similar feeling for these horses, and partly due to a change in mechanics of the foot. It may also expose areas of hoof wall and sole that are less keratinised and therefore, more sensitive. The hoof becomes harder when it is directly in contact with the air, so these newly exposed areas are slightly softer and take a few days to harden into normal horn like tissue.

    I hope this information is helpful and thank you for your question! Rochelle Lewis, DVM, New Zealand