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Orthopedic Surgery and Lameness Issues

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. I have a 9-year-old foxtrotter mare that recently foundered on fescue. My veterinarian described her laminitis as "severe" as it affected all 4 feet. I have not had her feet x-rayed yet because the mare is not ready to travel. Do you think the vet tec product would help her?

    (View Answer)

    Sorry to hear about your horse. Before proceeding with trying to treat with different products, I really think you should get some xrays of those feet to see how bad it really may be or not be? If there is significant rotation – greater than 15 degree rotation of the coffin bone away from the dorsal hoof wall, then the prognosis is guarded and keeping her sound may become a problem. Treatment with anti-inflammatories is also an important part of this process and you should talk with your vet about this as well. You really need to get a diagnosis before meaningful treatment can begin. Doing otherwise, may end up being a unconstructive use of your money and time. All the best! Chris Bell, DVM, Winnipeg, CANADA 

  2. My 20-year-old Paint cross gelding is due for his spring vaccinations. I worry because after he receives his vaccines, usually EW/Tetanus/West Nile, Rabies, Potomac Fever, he comes up lame. He barely wants to move and just appears painful all over. I have tried treating him with benedryl beforehand, which did help some. Any suggestions as to why this happens or which vaccine could be causing the issue?

    (View Answer)

    Vaccinations can have some side effects and occasionally we will see a horse with an adverse reaction. Each horse’s immune system is unique and some will respond adversely. We don’t always understand the reason why certain horses have reactions and others do not. Trying to determine which vaccine is the exact cause would involve breaking the vaccines up into individual injections and trying each independently. You may find that multiple single antigen vaccines may cause a similar reaction due to similar components in each vaccine. Discuss this further with your veterinarian and see if this is something that would be useful to determine with their help. Chris Bell, DVM, Winnipeg, CANADA

  3. I have a 16-year-old Paint gelding I have owned for 10 years. He is ridden two to three times per week with the occasional schooling dressage show and trail ride. I have used him to do very mild hunter jumper stuff but have not done any jumping in several years. He does get stiff at times and had just finished a round of Adequan in late winter. Then he has displayed obvious discomfort at the canter in both directions, particularly to the right - lots of tail swishing and hip-hopping, lead swapping behind. Upon examination and discussion with my veterinarian, we tried an SI injection a month ago. He has also been on Prevacox for the past month. Yesterday when first attempting the canter under saddle, the same problem persists. Last night I emailed my vet with this news, and am not sure where this might lead. It's possible it is a hock issue but I am wondering if I should try something less invasive before investing hundreds more in injections.

    (View Answer)

    The issue you are having could be a number of possibilities and certainly a thorough lameness exam is indicated. In general, I would wonder about if the horse is experiencing upward fixation of the patella (aka locking stifle). Some of the gait issues you are describing may fit with that. The other possibility to look at would be whether your horse may be having gastric ulcer issues. Gastric ulcers can cause a number of the issues that you are having and it would be worthwhile to have the vet do a cursory exam for ulcer and if indicated, then a gastroscope of the stomach to look for the presence of ulcers. The other option, if indicated, would be to treat with omeprazole (gastrogard) for 14 days and monitor for improvement (this is known as treating symptomatically rather than based on a solid diagnosis). A couple ideas for you. Chris Bell, DVM, Winnipeg, CANADA

  4. I have a 6-year-old Quarter horse mare that I run barrels. In September 2014, the (old) farrier had her in a size smaller shoe than she is currently in and drove hot nails in on a Monday. We competed that weekend Friday Saturday and Sunday. Friday she ran like a rock star, Saturday and Sunday not so much, but assumed it was from being stalled and stocked up since normally she is in a large pen at home. We hauled home and loaded back up Monday for an NFR qualifier to try her for a back up horse. We did not run Monday but decided to play around on her for a little more than an hour. This mare was in top notch fitness. She was off Monday but not too bad I figured she was stiff from hauling and running. We untacked pulled off bell boots and splint boots and she went 3 legged lame, the right front being the bad one. I met with the vet and farrier (new) we removed the shoes and puss FLEW all over the clinic I mean it exploded out of her hoof. Vet and farrier both very experienced said they had never seen puss fly like that. We soaked and wrapped the hoof for a month. At the end of November she blew an abcess at the coronary band. Reshod her and let her rest over winter pulled her out in January to go back to work and she was still off slightly. She was a little tender footed being in nebraska we though from the hard ground. So we brought her inside to be stalled w turn out in the indoor arena and put equipaks on just to give extra support and comfort. Gave her some time to adjust and jumped back on in February to see if we made any progress and we did not. So we did X-rays they come up clean, palated her tendons they come up clean. So I hauled her to kstate. They nerve blocked her and she blocked out in the hoof. They redid X-rays just to be sure with the shoe off. They thought it could be the equipaks putting too much pressure on the frog and sole, they suggested pulling both and reshoeing. We did still not sound. They are thinking its soft tissue possibly now. They want me to bring her back down to kstate to do more specific nerve block location. Any suggestions on options, treatment, or what to do? 

    (View Answer)

    Sorry to hear about the trouble you are having with your barrel mare. Based on the history you have provided and the blocking pattern from KState, the issue is most likely in the foot or back of the pastern. There has been some work recently looking at nerve blocks and occasionally a foot nerve block can block out structures not intended up to and including the fetlock so that is probably why the vets at KState want to do a more specific nerve block to help determine for certainty the location of the pain response. Having said all that and assuming that the nerve block is good, the xrays of the feet do not show any abnormalities so the thought that this may be a soft tissue injury is valid. There are several structures in the foot that make up the soft tissues (ligaments, tendons etc.). The only reliable means to evaluate these structures is by MRI and that may be the next step for your mare once the recheck of the nerve block is complete. Given the history, I would wonder about the laminae structure of the hoof but abnormalities there usually show some degree of change on the xrays.  Bottomline, if the xrays are normal and the nerve block confirms that the lameness is coming from the foot, then an MRI is the next step you need to take to determine the cause for this lameness issue you are having. Once you get a solid diagnosis, then you can pursue meaningful treatment. All the best. Chris Bell, DVM, Winnipeg, CANADA

  5. Two years ago, I purchased a horse, sight unseen and without a vet check (I know that was dumb). As soon as he arrived, I could see he was off. After x-rays and nerve blocks, my vet determined the source of pain was probably a large sidebone on the outside of his left front foot. He was off and on lame for the first year I had him. We tried stall rest (2 months) and corrective shoeing (bar shoe with extra breakover), and he was much improved for a few months, but eventually the lameness returned. Two vets agree with me that he looks fine at a walk, and pretty good at a canter, but at a trot, he takes very short strides and has a head bob. We tried injecting the coffin joint, and that had almost no effect. He's been barefoot (with regular trimming) and on pasture rest for six months now with no change. Last summer and fall, we did some trail rides (almost all walking, but with significant hills) and that didn't seem to make him worse. My understanding is that nerving might be temporarily successful, but after a year or two the lameness would likely return; and that a surgical removal of the sidebone is difficult and not likely to succeed. Is there any other management or treatment you can suggest?

    (View Answer)

    Sorry to hear about the trouble you are having with your horse. Given the length of time this lameness has been going on and the medical management options that have been attempted so far, I would wonder about whether you should have the lameness exam revisited. Sidebone and sidebone fractures can cause lameness in some cases, however, generally not the long term lameness that you are seeing. It may be the case, but I would suggest having a second opinion on the lameness. It is certainly nothing against the first vet and they may very well be correct but a second set of eyes cannot hurt. If you are close to a university center, then perhaps they could help. Before proceeding to neurectomy (taking out the nerves to the foot) or surgically removing the sidebone, you should ensure that the source of the lameness is very well understood. Neurectomies typically last between 2-5 years before nerve regrowth occurs and lameness showly creeps back. Surgical removal of sidebone is possible and can have success but I think a confirmation of the diagnosis would be the next logical step before considering either type of surgery. Look for an equine specialist or equine veterinarian with interest in lameness/sports medicine. You can use the AAEP Get a DVM directory for your area as well. Chris Bell, DVM, Winnipeg, CANADA

  6. My 24-year-old horse was diagnosed with a torn Impar ligament in his left rear foot. The vet said he had a good chance of becoming sound enough to ride again in 8 to 10 months. It's already been 7 months and he's a long way from being sound. He walks with nice long strides, but is really lame at the trot. What are his chances of becoming sound? He's been x-rayed twice and ultrasounded twice. Thank you for any information you can provide.

    (View Answer)

    Impar ligament tears do typically heal well even when there is an avulsion fracture to accompany the tear. If this diagnosis is based solely on xray and ultrasound, it may be that there is more going on than an impar ligament tear. In some cases, the impar ligament avulsion fractures that are seen on xray are actually silent or incidental findings and do not correlate with any lameness – something else is going on in those cases. To definitively determine if there is an impar ligament tear, an MRI would need to be done to confirm the diagnosis. Given the amount of time you have already invested in treating and rehabilitating your horse, I would pursue further diagnostics with MRI to ensure you are treating the correct problem and allow you to pursue further treatment options such as directed platelet therapy (PRP/ACP) or use of IRAP for any osteoarthritis that is present. Hope this helps. Chris Bell, DVM, Winnipeg, CANADA

  7. I have an off-track english Thoroughbred, with colic pain and a swollen back leg, which has burst and now pumps puss fron several places. I have treated him with antibiotics, painkillers and stomach protection. The blood tests show low blood cells with liver as well. He seems better now as he continues to walk, eats, etc. However, one of the abscesses have left a large hole draining puss. It doesn't look infected, but how should I treat it? I currently have been using betadine (iodine) solution and peroxide of hydrogen spray since it burst (couple of days). Should I fill the opening with betadine covered gauze and wrap with bandage or wait till the drainage decreases?

    (View Answer)

    Very sorry to hear about the trouble you are having with your horse. I am not sure exactly what is going on with him and I would recommend first and foremost that you seek the attention of an equine specialist veterinarian and/or take him to a University Teaching hospital or large referral center to be further examined and worked up as his condition sounds like it could become life threatening if not appropriately dealt with. In general, it sounds like your horse is suffering from an infection or chronic disease condition (such as an autoimmune issue). The low red blood cells may be the result of blood loss or lack of blood cell production depending on how long this has been going on and the root cause. The best treatment at this point very much depends on the diagnosis! If this is an autoimmune complex problem then steroids may be indicated and if this is infection then they could make it worse. You really need to get him to a specialist center to get a diagnosis. Cold water therapy (cold hosing the limb) will be helpful and keeping the legs clean/dry will be good as well in the meantime. He may need some anti-inflammatories as well but that needs to be prescribed by a vet after they get a chance to see him. Best of luck! Chris Bell, DVM, Winnipeg, CANADA

  8. Could you advise on a suitable rehabilitation and exercise program for a grade II SDFT injury? 

    (View Answer)

    The rehab programs would depend very much on the degree of injury, time frame from when the injury initially occurred and treatment options (Shockwave, Platelet therapy, laser etc…). In general, you would be looking at 4-6 months until return to athletic use. The programs we use involved a step-wise progression through various stages of handwalking to ridden walk, trot and eventually canter work. All are timed specifically for the type of injury. You will need to sit down with your veterinarian and determine the type of program best suited to your horse. Providing one to you without knowing more about the exact type of injury may not be beneficial to your horse and could cause harm. If your vet needs assistance with developing a program, they could contact a referral hospital for consultation and advice. Chris Bell, DVM, Winnipeg, CANADA 

  9. My 12-year-old Spotted Mountain mare was diagnosed with founder, her coffin bone has rotated and she is quite sore. We have taken off some of the toe, she is walking better. What should I expect for her prognosis & how best can I treat her?

    (View Answer)

    Sorry to hear about your horse. Rotation of the coffin bone can be measured in terms of degrees of rotation away from a line taken along the front of the hoof capsule or better yet, some digital xray systems will allow to actually see the laminae interface between the hard hoof tissue and the sensitive soft laminae tissue that holds the coffin bone in place normally. In any event, rotation of the coffin bone greater than 15 degrees is an indication of poor prognosis for continued soundness and use. There are a myriad of farrier techniques and shoes that can be applied to help improve the prognosis but greater than 15 degrees tends to result in poor outcomes.  So the first step in getting your prognosis would be to talk to your vet about the degree of rotation. If there is less than 15 degree of rotation and the horse is comfortable walking now, then the next step is to get in touch with an experienced farrier to start getting the foot properly trimmed and shod (as necessary). The general conventions are to load the center of the foot and decrease loading of the walls so heart bar shoes are popular, however, depending on your farrier and their level of expertise in this area there are tens if not hundreds of different shoes to be used to treat and manage laminitic (foundered) horses. If she is currently sore on the foot and there is less than 15 degree of rotation, then you should discuss with your vet about some anti-inflammatory medication and discuss ice therapy for her feet. During the severe or early phase of founder, there is a lot of inflammation in the foot and this can be managed with ice (very cold water) therapy as well as anti-inflammatories. There are some schools of thought that acepromazine and vasodilators could be used as well but my preference is for ice and anti-inflammatories in managing acute founder cases. There are many possible treatments out there, discuss with your vet or an experienced equine vet to help get the right advice for your particular horses case with full review of the xrays and a thorough exam of the horse. Chris Bell, DVM, Winnipeg, CANADA

  10. My 14-year-old gelding came up lame two summers ago. Without doing xrays, the first vet was unable to diagnose what it was, but told me to stall rest him and that he would be fine. We rested him and exercised lightly for two months, and he seemed to come around. We trail rode him in the Black Hills and he came up lame again. I took him to another vet, who did an ultrasound and found a lesion on his DDFT. We stall rested, treated, wrapped, per the vet's instructions, for a couple months before finally turning him gradually back out into a small pasture. For the next year he seemed to favor the leg off and on and I noticed that the hoof on the sore front leg was smaller than the other hoof. Although he was not limping anymore, another ultra sound still showed a lesion was there. Now it’s 9 months even later, and he is no longer limping and we have started lightly training again, only allowing light riders at this point. My question is if it is likely that this gelding will ever be 100% sound again. It seems I can never get a straight answer from anyone.

    (View Answer)

    The question is complex as I would need to review the ultrasound and examine the horse to give you a reasonable answer about the soundness and potential for soundness in the future. In general, tendon injuries will heal with time – usually 8-12 months for healing of damaged tendon of the DDFT. The tendon fibre that heals inot the injured area will be more fibrous in nature and does not have the same strength as normal health tendon. Scar tissue in tendon is considered only about 80% as strong as normal tendon. This weakness can be compensated for by properly conditioning the horse to ensure that the structures that the DDFT supports and rely on will be strong and ready to absorb the weakness. The other thing to consider is whether the DDFT injury is the cause of the lameness. If the horse has never been nerve blocked (process where the vet desensitizes each area of the leg to determine the location of the lameness), then it may not be the tendon causing this lameness. I would recommend having an experience equine vet examine the horse and review the current history to help determine the next steps for your horse. There are no guarantees when it comes to horses but we can try our best to minimize the risks and provide meaningful treatment where needed. Chris Bell, DVM, Winnipeg, CANADA

  11. I have a 5-year-old Thoroughbred mare that has developed a locking patella after spelling for a back injury. She has never shown any signs of a locking patella before. She is still unable to be ridden to help build up her muscle mass, although she does live out in a paddock (never stabled). Do you have a general rehab programme you could recommend for this situation? Is she now likely to develop locking patella every time she is rested or spelled? Thank you in advance for taking the time to read and answer my question!

    (View Answer)

    Locking patella or upward fixation of the patella is a condition of disuse and certainly, many athletically conditioned horses that end up rested for a significant period of time are at risk for developing this condition as the hind quarter muscles lose tone and become more lax at the stifle.  In general, I tell my clients to rehabilitate the horses with extended trot in deeper footing and uphill work to engage the hindend. If the horse is mildly painful at the beginning, I usually administer some anti-inflammatories for the first 7-10 days of the program. Most horses will be reconditioned and in tone within 6 weeks. Your horse may be more prone to locking patella in the future, however, if it becomes a chronic issue, there are surgical and medical management techniques to decrease the likelihood of recurrence and you can discuss that with your equine veterinarian. Chris Bell, DVM, Winnipeg, CANADA

  12. I almost bought a horse several months ago. I had ridden her for many hours, and she never showed any kind of lameness whatsoever. But before I bought her I had her taken to the vet. She failed the "tail-pull" sway test. Since she is from Missouri, they suspected EPM, but she's been tested since and is negative for that. She also has a big lump on either side of her neck above her withers that the vet said is not normal. Could that be the cause of failing the tail pull test? And what might cause that? Is it fixable?

    (View Answer)

    The tail pull test is a neurological test used to help a vet determine if there is a problem with the horse’s strength and coordination in the hindend. Your horse seems to have weakness in the hindend and the cause could be related to the ‘lumps’ on her neck. These swellings on the neck may be related to a fracture of a vertebra or arthritis of the facet joints of the vertebra or may be a mass of some sort impinging on the cervical spine in the neck. Any large swelling in the neck could result in pressure being put on the spinal cord and this can result in weakness in the hindend. The spinal cord is very long in a horse and the longest connection travel to the hind legs. These long connections are most sensitive to damage from pressure on the spinal cord and thus it could be a reason for your horse’s issue. You need to have an experience equine vet, internal medicine specialist or surgeon examine your horse and determine what you are dealing with before any meaningful treatment or conclusions can be made. Chris Bell, DVM, Winnipeg, CANADA

  13. My horse had an arthroscopy surgery for an OCD stifle and to remove bone chips on July 14, 2014 at the age of five. He was brought back into work in December with walk and trot work but his toe dragged behind and was not happy in canter work. We stopped work and physio revealed significant back pain especially around the withers. My question is should I treat the back with physio and re start work or rest the horse longer and try again in a few months? How do you know whether the problem is a post surgical rehab issue or just too much damage to the stifle joint? He had one steroid injection after surgery as no budget for stem/iwrap.

    (View Answer)

    You will need to speak with the surgeon that did the OCD surgery and try to find out if there was a lot of damage to the joint from the OCD fragments and discuss with them the current problem you are having. The back pain could be primary or secondary to something else going on in the limbs. If primary, there may be a injury to the SI region or spine (such as kissing spine), which is causing the problem and can be managed if properly diagnosed. If secondary, it may be related to hocks or stifles and you would want to have an experienced equine veterinarian perform an exam to look for the root cause. My other suspicion would be that your horse may be experiencing a condition called upward fixation of the patella. This is a condition that results in some post-op cases where the muscles of the hind quarters begin to lose tone and do not lift the patella as they should resulting in stifle pain and a toe dragging gait. There will be a hesitation in his gait in transitions from canter to trot and in canter lead changes. This would be a rehabilitation issue and can usually be managed successfully with a particular set of exercises used to condition the hind quarters again. You would need to have a vet out to confirm this diagnosis though before beginning treatment. Until you have a diagnosis, meaningful treatment cannot begin. Chris Bell, DVM, Winnipeg, CANADA

  14. My 16-year-old OTTB supposedly has had an abscess in his front left hoof/leg and again now for the 3rd time and in 2 years that has never popped or showed itself. We presume it's been absorbed? I've had a veterinarian examine and take x-rays showing nothing. The area around his coronary band is warm and he has had varying degrees of lameness. He also does NOT show any soreness on the hoof test. I soak his hoof daily in Epsom salts and warm water; pack with Epsom Salt Poultice or Icthamol and wrap it with a diaper and duct tape. I also hand walk him and lunge him daily. I\'m told some exercise is good for his circulation and to bring out the abscess. Is there anything else I can/should be doing? Is there a possibility of it being something else?

    (View Answer)

    I think there is a reasonable possibility that this is not an abscess that you are dealing with. Generally abscesses do break and drain at some point. Occasionally, an abscess will absorb or be mistaken for a sole bruise that does not break anywhere but given the history you present, I think you need to have a vet examine the horse and perform some nerve blocks to determine the source of the lameness. Without a proper diagnosis, you cannot begin to treat him properly and the abscess diagnosis you currently have may be incomplete. Chris Bell, DVM, Winnipeg, CANADA

  15. I have a 17 HH OLdenburg gelding. He jumps 3' to 3'6'' hunter classes. Recently, we had radiographs taken of his legs and they found a bone cyst on his right front pastern. I've been told it might not bother him ever -- he has never been lame a day in his life. I have also been told it could be a career ending time bomb. What is the usual prognosis? Is there treatment available? 

    (View Answer)

    Thanks for the question. To properly answer it I would need to review the xrays and examine the horse but I will give some general thoughts. Warmbloods seem to have a higher incidence of these pastern, fetlock and coffin bone cyst compared to other breeds in my practice. I have seen many pastern cyst and in general, they rarely cause a problem. The concern would be that the cyst may weaken the surrounding bone and potentially make the bone more easily fractured but I have not seen this to be the case. The other issue would be the cyst breaks or communicates with the pastern joint resulting in arthritis. This is possible and I have seen this occur. If this does occur, there are options to correct problem such as fusing the pastern joint surgically. This procedure has a high success rate at returning horses to athletic pursuits. As far as treatments available to correct the cyst currently, it would depend on the exact location in the bone whether a steroid injection into the cyst may be possible through a drill hole made into the bone or whether shockwave therapy or similar modalities may be used to try and treat any inflammation of the bone in that region of the cyst. Generally, leave it alone and monitor with xrays on a 6-12 month basis for any change. Chris Bell, DVM, Winnipeg, CANADA

  16. My horse has a patella ligament issue. It's mostly noticeable when you pick up his foot when you notice the catch. As long as he is in shape he does pretty good though he does have more trouble when stalled. It's only confined to the one leg. I wanted to know at what point do you consider examination and how long is recovery time?

    (View Answer)

    Thanks for the question. As you are aware, your horse has a condition called upward fixation of the patella. It is usually noticed in one leg predominately but actually present in both in most cases. As you mentioned, if you can maintain your horse fit and in work, the condition will become less noticeable. Stall rest will cause the muscles of the hind quarters to lose condition and the problem will return. Surgery or other therapy should be considered if the horse continues to have the problem despite conditioning the hind quarters or as a means to attempt to permanently treat the problem. Surgery involves fenestration (punching small holes) into the medial and middle patellar ligament. As these small incisions into the ligament heal, the ligament will shorten and decrease the likelihood of the patella becoming fixated. There are other options to attempt to shorten the ligament as well. This includes internal blisters (usually peanut oil with an irritant added) injected along the ligament – again the goal being to have the ligament shorten. Hormonal therapy with various esterone’s have been used for those that want to minimize the invasiveness of the other procedures. All therapies can be effective but surgery and internal blisters tend to be most effective. The rehabilitation time following surgery is generally 6-8 weeks, however, the horse is encouraged to move and engage the hind quarters starting dasy following surgery to ensure that the condition is not lost and maximal shortening of the ligaments can be attained. This surgery can be performed under standing sedation and is usually performed as an outpatient procedure in most hospitals. It can be performed on the farm, if necessary, but I would recommend having an experienced veterinarian or surgeon perform the procedure as there are some risks operating so close to the large stifle joint in a standing sedated horse. You may read about an older surgery technique where the patellar ligaments were actually completely transected/severed. We do not recommend or perform this technique any more due to some significant complications with fragmentation of the patella occurring in the months following surgery. Seek the expertise and advise of a experienced equine veterinarian or board certified equine surgeon in your area to ensure you are getting the right procedure for your horse. Chris Bell, DVM, Winnipeg, CANADA

  17. I have a 24-year-old Warmblood that tore a ligament in his left front just under his forelock. It was healing but, while on stall rest, he injured himself again between his fetlock and knee. I am still struggling to reduce the swelling and heat. Surpass and bute are not working. Any other suggestions?

    (View Answer)

    I am sorry to hear about the trouble you are having with your horse. If I am following correctly, your horse has two separate injuries. The first is to the tendons and ligaments below the fetlock (pastern region) and the second, newer injury, is to the flexor tendons between the fetlock and carpus (knee). The newer swelling of the flexor tendons between the fetlock and knee needs to be further addressed. Your horse needs to have a vet examine this new area of swelling as it may or may not be related to the first injury. There may be an injury to the tendons along the back of the leg between the fetlock and knee. Injury to these tendons can be significant and needs to be properly diagnosed before meaningful treatment can begin. Without knowing what you are dealing with for an injury, treatment with surpass and bute may not be working because there is a problem that those two anti-inflammatories will not treat. In general, wrapping the leg with a quilt and polo bandage between the fetlock to knee will be helpful in reducing the swelling of those tendons. There are numerous sweats including furacin, DMSO etc, shockwave treatment, cold laser therapy and other options are available but without knowing what you are treating, a mistake could be made. Have a veterinarian out to check things over and then proceed with their recommendation. Chris Bell, DVM, Winnipeg, CANADA

  18. My 19-year-old, 16 hand gelding has developed off and on lameness in his right front foot. No swelling or heat, but I flexed the hoof to touch the back of his forearm, held for 20 seconds, and trotted him off. He was very lame at the trot but not so noticeable at the walk. I was told it was the deep flexor tendon due to his age and bad confirmation. I don't ride him hard. I will feed MSM with time off. How long should I give him to heal before I take him to a vet for an ultrasound?

    (View Answer)

    I am glad you have contacted us about your horse. You are rightfully concerned about the lameness problem you are having with him. Any lameness that is significant enough to be seen at a trot following the type of flexion text you performed should be followed up with a veterinarian. It could be a flexor tendon issue and you are correct that an ultrasound should be performed to determine the severity of the problem and help develop an appropriate rehabilitation plan. Without a solid diagnosis, meaningful treatment cannot begin. You need to have your vet out to have a look at that leg. The vet will be able to perform some tests and determine whether the lameness is coming from the deep digital flexor tendon or fetlock or coffin joint. It is important for your horse that you have a vet check him out so you can treat him the best possible way. Chris Bell, DVM, Winnipeg, CANADA

  19. We are fostering a beautiful Freesian filly rescue that has been diagnosed with a torn cruciate ligament. We have been giving her Adequan but we've been told there is no possibility of repair and euthanasia has been suggested. Is there any new treatments that look promising? What about stem cell?

    (View Answer)

    Sorry to hear about your filly. Cruciate ligament injuries in horses are very difficult to treat but depending on the severity of the tear, some will at least partially recover. To determine the severity of the tear you have several options, ultrasound can be performed by an experienced equine veterinarian or radiologist to try and determine the amount of injury to the cruciate ligament and remainder of the joint, or alternatively you could find an equine surgeon that is performing standing diagnostic needle arthroscopy. This is a new type of diagnostic that allows the surgeon to assess the stifle joint with the horse standing with only sedation. The benefits are that you can confirm the diagnosis, assess the level of damage and determine a treatment plan without the need for general anesthesia. MRI and CT are available at some veterinary schools and referral equine hospitals that can sometimes also provide valuable information about the structures within the stifle. Finally, traditional arthroscopy of the limb under anesthesia can be performed and if there is an injury that can be repaired, it can be done at the same time. Treatment options for cruciate injuries in horses are much more limited than those of humans and dogs. The limitation of cruciate repair in the horse is related to the size of the structures involved and significant forces placed on the stifle of the horse. In humans and dogs, when the repair is made the limb can be placed into a minimal weight bearing situation and allow for the repair to heal adequately before full weight bearing is attempted. In horses, immediately following the repair, the horse must bear full weight on the limb during recovery from general anesthesia and this is where most repair attempts fail. Stem cells are an exciting new area of research and although the advent of their use has come a long way in helping heal injuries in horses, if the cruciate is completely torn, the stem cells will have no scaffold upon which to develop new tissue and to date we have not been successful at growing stem cells into complete equine cruciate ligaments.  New implants and techniques are surely to be develop but as of date, we do not have an effective means to repair completely torn cruciate ligaments in the horse. Chris Bell, DVM, Winnipeg, CANADA

  20. I have an extensive question that I was hoping you could help give me some insight. My friend has a middle-age mare that is somewhat lame in her left front leg. She was bred a few years ago and the stallion was very rough with her, resulting to damage to her knee. Unfortunately, the proper action wasn't taken to help properly heal and rehabilitate the knee and now she trips when moving above at a trot and is generally quite sore. My friend has been trying to figure out how to help her, but she is a first time horse owner. I have been personally telling her that she needs to get a thorough vet examination done and it will probably take some use of muscle and joint supplements and regular exercise in order to help return her to better health. Sadly, time is running out for the mare because my friend is running out of patience and resources to care for her and to pay for her regular farrier visits. She will soon be putting the mare up for auction. I personally am trying to vouch for the mare and am considering taking her on myself. My main questions at the end of this story are what are some of the things that I can do to start helping her out? It's a case that her leg is quite stiff and sore. What would be a good way to start going about treating her since it has been so long since the incident?

    (View Answer)

    It is admirable of you to look out for this mare and help your friend. Injuries to the knee can be very complex as there are many small bones and several different joints that can be involved. The first step you will need to take is to get a confirmed diagnosis of the exact problem. It may be that the mare has a injuries that is manageable with conservative options such as anti-inflammatories and joint supplements, which would be ideal. I suspect based on your description that there may be some significant arthritis or structural damage to the knee (carpal) joints. This being the case, you may need to look at joint injections or potentially surgery to correct the problem. Until you have a solid diagnosis of the problem, meaningful treatment cannot begin. Your next and most important step will be to get the mare looked at by an equine veterinarian and have the diagnostics completed to reach a diagnosis. Chris Bell, DVM, Winnipeg, CANADA