Front Foot Lameness: Don’t Forget the Exam

Michael St. Blanc, DVM, MS, DACVS (LA)

Lameness arising in the feet is extremely common in equine practice. While these issues have been occurring for centuries, advanced imaging and diagnostics have allowed for vast improvements in treatment options and outcomes over the years. With an accurate diagnosis, the veterinarian can formulate a proper treatment plan and provide more accurate information on the horse’s prognosis.  

Examination and History 

Some of the most important components of your horse’s assessment are a solid lameness examination and history. Knowing the performance and medical history of the horse is extremely important in helping your veterinarian diagnose the source of lameness, in addition to predilections that occur with certain breeds, ages, and disciplines. From here, a lameness exam is vital. This includes observation of the horse under a variety of surfaces and conditions, thorough musculoskeletal palpation, hoof tester application, flexion tests, and confirmation evaluation. 

Local analgesia (i.e. nerve and/or joint blocks) are also invaluable to help localize the source of lameness. Once a lameness is detected, this is usually the first step towards definitively localizing the source. A local anesthetic is applied either to the nerves that innervate a certain region of the limb (i.e. the foot) or directly to a joint (such as the coffin joint). This allows the veterinarian to determine the area in which the lameness is originating. For instance, if eliminating sensation to the foot improves the lameness drastically, this suggests that the primary lameness issue is stemming from that area. Once a location is determined, diagnostic imaging is an appropriate next step. 

Radiography (x-ray) is usually the first line of diagnostic imaging. This can provide valuable information and, in some cases, can be sufficient to diagnose the issue. In some cases, advanced imaging such as magnetic resonance imaging (MRI) may be utilized. In most instances, this requires general anesthesia. However, the information that it provides about the structures within the hoof capsule is invaluable, and it can be a great asset in certain cases. Working closely with your veterinarian is key to determining which imaging modalities and diagnostics are best for your horse. 

Common Conditions 

Conditions affecting the foot which result in lameness are numerous. Subsolar abscesses are extremely common causes of acute, severe lameness. These are usually resolved with local debridement, soaking, and packing of the foot in addition to anti-inflammatories for pain management. Confirmational issues are also common causes of lameness. Terms such as long toes, sheared heels, medial/lateral imbalance, and contracted hooves may be used to describe conditions which affect the feet. Working with both your veterinarian and farrier is key to maintaining ideal foot health and confirmation and treating podiatry issues which may contribute to lameness. 

Osteoarthritis of the coffin joint (or pastern) are also common causes of foot-associated lameness. In many cases, these are identified radiographically. Injuries to the soft tissue structures within the foot such as the collateral ligaments are best identified on MRI. And of course, no discussion of the foot is complete without mentioning degenerative changes of the navicular apparatus, or so-called “navicular syndrome.” This is a topic in and of itself and is identified either radiographically, or in many cases, on MRI. 

In summary, front foot lameness is common in horses and continues to frustrate owners and challenge veterinarians. Fortunately, owner-provided information and a thorough lameness examination can help practitioners start meaningful investigations. Advanced imaging has greatly improved our knowledge of the equine foot and helped to identify more effective treatment options. Working closely with your veterinarian and farrier are paramount to maintaining optimal foot health and soundness in your equine companion.  

Article provided by AAEP Media Partner, The Horse.