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  Discussion on Unexplained lf lameness
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New Member:
Jlovejoy

Posted on Sunday, Aug 17, 2003 - 8:07 pm:

HELP! I have a 19-yr-old Arab/Quarter gelding that I have not ridden since the end of April when he began showing gradually increasing left forefoot lameness, which we have experienced here and there in the past with various different diagnoses to explain it. For the past 6 years he basically has had very light riding 2-3 times a week. He has been shod for the last 7 or so years with eggbars with a 3 degree pad on the left to equalize his heels. He has long-toe low-heel type conformation. The eggbars were to support his tendons (my daughters wanted to jump him some, which we never really ended up doing) although when I got him, he was barefoot. The previous owner makes a point of keeping all her horses barefoot. To try to make a long story shorter, after April, a different vet called out for a 2nd opinion on the lameness pointed out the contracted heel on the inside, somewhat under-run left heel and the shoes were pulled. X-rays showed no bony abnormalities other than some probable old sidebone - no navicular, no arthritic changes. The horse was barefoot for @ 3 wks, showing only mild tenderness at the walk on turning to the left. No bute was needed at this time. Then he suddenly came out of his stall distinctly lame and painful one morning. An abscess was dx'd and found, opened. I only saw blood, apparently no puss. The foot was treated for a week and a half for the abscess and the horse was on 2g/day bute. After 2 weeks or so, new shoes were put on - regular shoes with wedge bar pads and equipack. I think the shoer and the vet were pretty sure this would relieve the horse, even though he was still ouchy when the new shoes went on. After 4-5 days with the new shoes, it was apparent that there was no improvement, in fact perhaps increased tenderness as evidenced by the increased need for bute to keep him comfortable. In the mornings he now (after a week and a half on the new shoes) comes out of the stall practically hopping to keep off the left foot, but after half a dozen steps seems to improve a bit, then he gets the bute. I am wainting for the shoer to come out and remove the shoes, and the horse will be ultrasounded later this week; I think the vet suspects collateral ligament something, or maybe bursa (although his activity level has only been VERY light riding for years and really no excercise to speak of since the end of last April) - and my burning question is whether if it IS something like this, will my poor horse ever be able to be comfortable and be a normal horse again? What would the treatment be? Thanks for any light you can shed!
Moderator:
DrO

Posted on Monday, Aug 18, 2003 - 3:23 am:

Hello Jayma,
Not knowing the cause or even the location of the lameness I cannot answer your questions. It certainly sounds like an acute inflammatory process and the most common would be a foot abscess. The location of the pain must be carefully localized and only then can a list of possibilities be entertained, treatment suggested and a prognosis offered. The article associated with this forum explains how this is done is great detail.
DrO
Member:
Jlovejoy

Posted on Saturday, Aug 23, 2003 - 8:44 pm:

Hi Dr. O -
Just an update: ultrasound of my horse's lf foot showed what the vet called a "roaring" bursitis. Forgot to mention that xrays showed no bony changes, except for evidence of old sidebone, and he blocked out sound at the heel with what I think is called a pdn. The vet administered 2 cortisone shots -one in the center front of the hoof at the coronet band and one in the center back of the heel. When the needle was positioned in the back of the heel preparatory to pushing the meds, a good deal of bursa fluid spilled out, so there was a lot of pressure in there. Not surprising he has been in so much discomfort. The plan is now to watch him for 4 or 5 days and see how he does. If he does OK, then to put regular shoes on him with wedge bars. I am rather afraid to put shoes back on him at this point since this whole problem appears to have been brought on by years of the wrong shoes for him (eggbars with a 3dg pad to even out the left) which has left him with a partially contracted heel, which is complicating his problems, I guess. Anyway, is this bursitis the same as saying he has "navicular synDrOme"? The vet said an abscess would theoretically show up on the ultrasound and he didn't see anything. Would canker show up on ultrasound, as well? I am going to do more reading on that. There doesn't seem to be any particular digital pulse in that foot and no particular heat in the foot compared with the other one. Thanks for any more clarity you might be able to give.
Moderator:
DrO

Posted on Monday, Aug 25, 2003 - 8:34 am:

No, once diagnosed you no longer have a synDrOme and your history is not consistant with navicular synDrOme. You can see canker by careful inspection of the sole. What changes did he find on ultrasound to diagnose the bursitis?
DrO
Member:
Jlovejoy

Posted on Monday, Aug 25, 2003 - 11:35 am:

Thanks for the update, Dr. O. Here's what the vet had me write down for him: DDF thickness 5.5 mm at the impar ligament. Bursa thickness 4.0 mm. DDF 5.1 at the navaicular bone. Impar ligament 2.5 mm. He thought the DDF was thickened also, probably. Lots of fluid in the navicular burse. The horse has been trimmed twice within the last 6 weeks and still has a lot of toe. I'm wondering if this could be irritating the situation further, but the farriers seem reluctant to take off very much toe and I'm reading that as short a toe as possible is better when there's irritation like this on a horse with long toes/low-underrun heels. And the cortisone shots he received last Thursday a.m. don't seem to have done anything dramatic. How long would it take to show if they are working? I have been giving him 1 and a half to 2g of bute just at night to keep him perhaps a little more comfortable when he has to stand around. He does seem to do much better when he can move around during the day outside, but then there's always the possibility of him trying to do too much and maybe make things worse again!
Aaargh!
Moderator:
DrO

Posted on Tuesday, Sep 2, 2003 - 8:22 am:

Hello Jayma,
I posted a reply last week that apparently did not stick! Let's try again. Hmmm the most important thing here is that the imformation you have provided is not diagnostic for bursitis. Then again it does not rule it out either. The bursal thickness apparently has a wide range of normal on ultrasound. Though normal values of 2.7 mm have been reported a very thorough rexamination of ultrasound values of the foot last year found the variation as much as 5 more mm's in the normal foot
(Ultrasonography of the soft tissue structures of the equine foot;
EQUINE VETERINARY EDUCATION / AE / AUGUST 2002).

No matter what is wrong with the foot, a proper balance and a short toe should help (see navicular synDrOme for more). If sensitive to the hoof testors protection of the sole may be helpful too.
DrO
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