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  Discussion on Sesamoiditis- ANY feedback appreciated!!
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Member:
Qh2244

Posted on Monday, Aug 9, 2004 - 1:31 pm:

First off, for anyone reading: if you have any experience with this I'd love to hear about it!

I have a 9yo QH gelding who ended up with 2 swollen front fetlocks after a show in the middle of June. I believe it happened during "slamming on the brakes" in front of a jump repeatedly, something he does not normally do at home.

After the first couple weeks the swelling would change dramatically within the space of a half hour, swelling up during more during turnout (mostly just walking and eating!).It would be almost gone the next day. The swelling also appearred only in specified areas around the sesamoid region. I tried stall rest for a few days, but the swelling actually got worse and moved up his leg, looking more like stocking up than swelling in particular areas.

I had my vet take a look at him, and she said it was sesamoiditis...that he may have some hairline fractures in there. She made the diagnosis by putting pressure on the area and by my description of the swelling and how it changed.( She said she has some jumpers in her barn that have it and they showed the same swelling etc. )

I am a "poor college student" and really do not have the money to be getting a bunch of things done to confirm the diagnosis, and seeing as the horse does not appear to be in pain I don't want to go forth with it unless I have to. He hasn't seem bothered by it. If he is lame, it must be only slightly and the same in both legs because I can't tell.

I was just wondering if this sounds like it could be an accurate diagnosis and if it is how I should proceed. The vet made it like I could start riding again, but cautioned to always wear supportive boots, even during turnout, and not to jump anymore.

I always wear boots when riding, but he gets turned out for 4 or more hours at a time, and others would be putting on the boots and taking them off...I'm afraid they will do more damage in the way of injuring tendons if they put the boots on incorrectly or forget to take them off once he comes in. (Sports medicine boots).

What do you suggest as far as protective boots during turnout periods that are that long and when I don't have control over how they are applied? Should I provide boots or not?

If it is sesamoiditis do you suggest more time off with just turnout? Or if not, how heavy should the workload be?
I was also told to put him on a joint supplement and that he may eventually need corrective shoeing.
Is this accurate? I looked through the sesamoiditis articles, but the seemed to all be geared towards racehorses and particular diagnosis, which I do not have.
Thanks so much!!

Moderator:
DrO

Posted on Tuesday, Aug 10, 2004 - 9:48 am:

Cassandra, first be clear about what you know and don't know.
You know:
The vet has made a diagnosis of sesamoiditis. Though I cannot judge the accuracy from here, this judgement can be made by careful physical exam.

What you do not know:
Without radiographs you cannot assess the severity which the vet feels may even involve nondisplaced fractures. I would also include suspensory branch desmitis has not been assessed. These are the ligaments that attach to the sesamoid bones and without ultrasound difficult to assess.

Your resources:
You are unable to do further diagnostics.

Now you questions:
Obviously without knowing how severe the damage to the bones, ligaments, and joints we cannot really give specific advice on most of your questions. At this point it really comes down to your goals which could range from:
I want to ride no matter what as long as the horse is sound at the trot even though I might risk further damage to I want to do everything to be sure this horse gets well before I ride.

I agree leaving boots on out in the pasture in risky business. Concerning corrective shoeing and intra-articular treatments (this would include oral joint supplements) there are specific recommendations in the article on sesamoiditis.
DrO
Member:
Qh2244

Posted on Tuesday, Aug 10, 2004 - 11:30 am:

Thanks DrO. I am not sure what to do as far as getting the radiographs done. My vet made it like it wasn't worth getting them done, saying that some people in her barn went to a "big time" vet that deals with it and he just put the horses on bute for a while after the diagnosis.

I am perfectly fine with giving my guy as much time as he may need off, but as I know and as you pointed out it is hard to say how long that is without knowing the severity of the injury.

Do you have any round about idea of how much radiographs and the ultrasounds would run for both front legs? ( My vet is impossible to get a hold of unless it is an emergency!)
Thanks!
Member:
Canter

Posted on Tuesday, Aug 10, 2004 - 4:30 pm:

Cassandra, I'm sure costs for treatments vary widely across the contry, but to give you an idea of costs: For 6 recent x-rays (not front legs, probably doesn't matter what leg) on my mare: $160 + farm call charge. Can't help with the ultrasound.

Hope that helps.

Fran
Moderator:
DrO

Posted on Wednesday, Aug 11, 2004 - 9:40 am:

Prices vary so much depending of locale and individual it is really hard to say and any number may be misleading for you personally. Your vet really should be available to answer such questions, if not I would consider finding one who will.

Without further diagnostics you must use the clinical signs of disease that you can observe to judge when healed. First is the swelling (and lameness?) still resolving with rest and antiinflammatory treatment? If so I would continue until there is no improvement for at least 3 weeks. If a fracture is possible then 2 months would be better. At this point you could try slowly building the horse back up. A good regimen to follow might be that decribed at Equine Diseases » Lameness » Rehabilitating Injuries to the Tendons and Ligaments. You don't have the imaging to help guide you but the article also describes clinical signs to watch for.
DrO


DrO
Member:
Qh2244

Posted on Wednesday, Aug 11, 2004 - 12:19 pm:

Thanks DrO and Fran!
The swelling still changes slightly. Thanks for the time table as far as how long I should wait. That is what I really was wondering. I'd rather not put money I don't really have into getting the radiographs and ultrasounds to find out how long to rest him when I could just wait the longest possible time for it to heal since I'm not in a hurry to ride and since it does not seem to bother him any.
One other question: I am not having people put sports medicine boots on him when they turn him out, but I have been putting them on him when i turn him out for short periods (1/2 hour to an hour and a half) and can do it myself.

He always swells up a little when turned out, but it goes down by the next morning.(stall rest with only handwalking makes it swell more with each day, so I've chosen to continue turnout).

I've noticed that the swelling actually seems to be worse if he wears the boots than if he is turned out without them, or in the very least it changes where he gets swelled up. The "extra" swelling resolves itself by the next morning though( sooner I'm sure, but that is when I see him next).

Do you suggest that I should put them on him or could this actually be agitating something and causing more damage. I'm not too concerned about him not wearing them for turnout, but what about when I eventually ride? My vet stressed that he should be wearing them during any activity to help prevent re-injury.

Thanks for all the help!
Moderator:
DrO

Posted on Thursday, Aug 12, 2004 - 11:03 am:

I cannot specifically recommend whether or not you should use the boots and this should be done in consultation with your vet. Have you told your vet the horse swells when the boots are put on?
DrO
Member:
Qh2244

Posted on Thursday, Aug 12, 2004 - 10:46 pm:

No, I did not tell her about the swelling with the boots yet. I had never put boots on for turning him out until she adviced me. I will consult with her.

Thanks again for all your help.
Member:
Qh2244

Posted on Wednesday, Oct 20, 2004 - 10:01 am:

I have yet another sesamoiditis question. I recently started to ride my horse again after a diagnosis of sesamoiditis (just diagnosed by feel). He has not been ridden since July and has been stalled with daily turnout.


He moves normally over soft ground, but on pavement or on rocks or gravel acts as though he is walking on egg shells and trips a lot--much more than the average horse. Could this be due to the sesamoiditis? On the way home he is in a rush and seems to forget (mostly) that the rocks/pavement hurt him, though I still sometimes feel a slight change in his gait. If it is from the sesamoiditis is it hurting him to occasionally have to walk on these surfaces on trail rides or is he just sensitive now and always will be.

I wasn't sure whether the "symptoms" are accurate with sesamoiditis or if it was due to something else.

Another quick question: He swells slightly after being ridden sometimes. My vet said to wrap him and as long as it goes down after a day or two that it was ok. I've been giving him a bute the night after riding and wrapping him. According to your experience,is slight swelling (sesamoid area) normal? I have not been riding him more than once or twice per week.

Thanks!

Cassie





Moderator:
DrO

Posted on Thursday, Oct 28, 2004 - 8:56 am:

No Cassandra, your horse has tender soles, are you shoeing him? Many horses swell around the ankles following exercise, particularly if stalled over night. If cool and bilateral I would not worry too much, just be aware if it seems to get worse. Have you tried not using the bute?
DrO
Member:
Qh2244

Posted on Monday, Nov 1, 2004 - 5:19 pm:

He is shod in front, but not behind due to the fact that he hasn't been able to hold shoes on behind for the whole 6-7 weeks since early summer. The farrier said his feet are in bad shape. The only change the horse had gone through was daily de-wormer for the past 6-8 months, so we took him off of that as a precaution. (I posted on here after-the-fact and know their is no evidence of it causing problems)

Are their any supplements/things that may help him?

So the swelling is normal as long as it goes down after a day or two? He is always swelled slightly their ever since the injury- is that normal?

I have only ridden him a few times since his time off after diagnosis and I believe I have given him bute at least 2 of the 3 times. I have been scared to ride him until I got to the bottom of the ouchy foot problem in case it was somehow due to the sesamoiditis.

What are your recommendations as far as riding after a diagnosis of sesamoidits. Should I stay away from anything besides jumping and fast stops/turns? Would deep mud bother him any more than the typical horse on a trail ride?

After riding I was told to wrap him overnight. I was also told to wrap him the night before a big show or ride with alcohol. What is your take on this and also what do you think of special shoes? I was told he may need them, but should I leave him be unless I see any lameness problems?

Thank you so much for all your help! Sorry for all of the questions at once!
Moderator:
DrO

Posted on Tuesday, Nov 2, 2004 - 8:25 am:

Taking your questions one at a time:
  • For the hoof problems seeEquine Diseases » Lameness » Diseases of the Hoof » Poor Horn Quality: problems with the wall and soles.
  • I cannot assess your horses swelling Cassandra, just tell you about swellings in general, see my earlier comment.
  • This has to be taken on a case by case basis. Many diagnosis of sesmoiditis are based on nonsense (see article on sesamoiditis) while others are clear cases involving torn ligaments or fractures. The rehab and prognosis would be different within this range so you should follow your vets recommendations here.
  • I cannot evaluate these recommendations without seeing your horse just provide you with the general principles that we outline in the various articles we have on swelling and bandaging. You have to decide how to apply them, for more see Equine Diseases » First Aid » Pressure Wraps, Poultices, Cold and Heat Therapy for Swelling in Horse Legs.

DrO
Member:
Qh2244

Posted on Tuesday, Nov 23, 2004 - 10:46 am:

I know that joint supplements are recommended for sesamoiditis cases. My question is this: My horse does not seem to show any lameness, but does swell after working and usually some slight swelling always remains in the sesamoid area. Would a joint supplement still possibly be of help to him even though I am not having lameness problems with him? Thanks DrO
Moderator:
DrO

Posted on Wednesday, Nov 24, 2004 - 7:55 am:

If the swellings are intraarticular yes the supplement would be indicated, if the swellings are extraarticular it would be uncertain.

When your vet first examined the horse did she explain exactly what was swollen Cassandra? We have an article that helps define the various kinds of swellings including several that occur around the ankle, see Equine Diseases » Skin Diseases » Diagnosing and Assessing Swellings in Horses. Though you should read about swellings in general you will want to differentiate "stocking up" from "windpuffs". IF you remain uncertain from the descriptions, perhaps a call to your vet would clear it up.
DrO
Member:
Qh2244

Posted on Wednesday, Nov 24, 2004 - 1:42 pm:

No, my vet did not. I don't know that I entirely trust my vet, and the others in my area are no better. Unless I take him to a "specialist" i'm out of luck (and I'd rather not do this since he is not lame) She diagnosed him with sesamoiditis. I told her about how he swells, showed her where and the changes and she just said "yes, that is it" referring to the sesamoiditis. At another time (without looking at my horse) I told her that he was still swelling up and she just said "he will always swell then" and left it at that.

It is definitely not stocking up and I do not believe it is windpuffs either, as the swelling does not fit the description in the article.

I know I keep asking you questions you can't really answer since you haven't seen my horse. I can't find a brief "overview" of sesamoiditis. I have read the article, though I admit once it got into case studies I slacked off. I can't find just a brief summary of sesamoiditis as it relates to a pleasure horse anywhere.

My question is this: In a typical sesamoiditis case where the horse is not showing lameness somewhat what would you suggest as far as prognosis, ways to manage it (supplements, wrapping etc) and other important things I should know. Can the swelling be normal with these cases? I know that this may not fit my horse in particular, but I can't seem to find any usable information anwhere.

THANKS!!!! :-)
Moderator:
DrO

Posted on Friday, Nov 26, 2004 - 6:38 am:

The reason you cannot find usable information Cassandra is because you are uncertain what is wrong.

I don't see cases of sesamoiditis without lameness. Treatment and prognosis would depend of the severity of the radiographic and ultrasound lesions. From your descriptions I still cannot tell the nature of the swelling so cannot comment on whether this is "normal swelling" or not. It seems clear that the swelling started from the initial trauma of the rapid stop but what is not clear is what was injured and to what degree. Since the horse has not been lame it is likely the injury was minor but other than the advice already given above don't know what other objective advice to give: see my first 2 posts.
DrO
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