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  Discussion on Injury to plantar ligament & avulsion fracture
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New Member:
Lizv

Posted on Monday, Mar 14, 2005 - 9:09 pm:

I have a 9 year old friesian/TB who was injured on a hunt in early October of last year (2004). A nuclear scan followed by x-rays revealed a soft tissue lesion involving tearing of the origin of the plantar ligament with related avulsion fracture. The horse received 3 sessions of extracorporeal shock wave therapy, 6 weeks of small area individual turnout (stall rest was not a possibility). After 6 weeks walking under saddle began and continued for 6 weeks at which point trot work - long sides only was started. At this point I would have expected him to be sound however he is still dragging the toe at the trot - especially on a circle (introduced after 2 weeks of long sides only).
Since the vet who treated him does not seem to have seen this injury before I am curious as to how common it is and what the chances are for a full recovery. Is there anything else that you could recommend - i.e special shoes etc.. that might improve the way he is travelling on that leg? Should he be further rested or should work be continued?

Thanks for any help you can provide.
Member:
Gillef

Posted on Tuesday, Mar 15, 2005 - 4:50 am:

Hi Liz
I have a part bred arab mare(TB/Arab/Hanoverian who was diagnosed with a very similar injury in August 2002. As it was in her hindleg I was told it was unlikely that she would come sound again.
The only "treatment" advice given was to use Graduated heel shoes with a rolled toe. The Farrier made the fist two pairs and then found some ready made raised heel shoes which are hollow in the heel section. This has the benefit of reducing the weight in this area to lessen the force the heel hits the ground with as heel weighted shoes can be detrimental to hoof heel growth.
She was shod in this manner, box rested for a month with nsaid. Then "yarded" till the following spring. At this point she was no longer obviously lame (8 months rest) so I started a rehab and fittening programme and she came back to sensible hacking (up to 2hrs ) and competed western tail and pleasure and show classes.
She has remained sound from that injury to this day. We used the raised shoes until late 2004 but with hindsight we could have changed back to ordinary ones a year earlier. I feel the shoes helped her a lot as during the first 9 months as she looked uncomfortable without the shoe while the farrier was working on her. This discomfort diminished during the first 9 months.
I believe forelegs have a better outlook than hindlimbs.
I hope this helps-good luck
Gillian
You may also like to read the thread "does ultrasound have to return to normal....."
Member:
Lizv

Posted on Tuesday, Mar 15, 2005 - 9:12 am:

Gilian,

Thanks for your reply.
This horse is only visibly unsound at the trot - at walk he looks 100% sound. I am wondering if perhaps the extent of damage in your case was more extensive?
The idea of raised heel shoes is interesting though - it was suggested that we put round or heart bar shoes on the hind but the vet has asked me to wait on that for a couple more weeks to see if he comes sound without them.
I will check out the other thread you mentioned - again thanks for the info.

Liz
Moderator:
DrO

Posted on Wednesday, Mar 16, 2005 - 8:56 am:

Hello Liz,
Is this the plantar ligament of the hock or the pastern? I am afraid neither injury is common and so I can only relate what I can find in the literature concerning the prognosis. As a general rule with avulsion fractures: as long as the horse is still displaying signs of lameness, rest should be continued.
DrO
Member:
Lizv

Posted on Wednesday, Mar 16, 2005 - 8:57 am:

I was hoping that Dr. O would have some feedback for me or some experience with similar injuries. I do have a full vet report that I could e-mail if it would be useful.
Member:
Lizv

Posted on Wednesday, Mar 16, 2005 - 9:08 am:

It is the plantar ligament of the hock.
Would the vet report be useful to you?
Moderator:
DrO

Posted on Wednesday, Mar 16, 2005 - 6:17 pm:

Yes it would Liz, send it to horseadvice@horseadvice.com and I would be glad to review it.
DrO
Member:
Lizv

Posted on Saturday, Mar 26, 2005 - 8:35 am:

Dr O,

Did you have a chance to review the report I e-mailed to you?
Just curious as to your thoughts on the situation.

Liz
Moderator:
DrO

Posted on Saturday, Mar 26, 2005 - 9:31 am:

Liz, I do not see the email try again putting Veterinary Report in the subject line.
DrO
Member:
Lizv

Posted on Saturday, Mar 26, 2005 - 9:23 pm:

DrO, I have resent it.
Liz
Moderator:
DrO

Posted on Sunday, Mar 27, 2005 - 9:11 am:

Got it Liz, I will review it tommorow.
DrO
Moderator:
DrO

Posted on Tuesday, Mar 29, 2005 - 11:06 am:

Neat report Liz but not as helpful as I would like. Both the scintigraphy and thermography are quite clear: there is a hot spot at the location of the posterior calcaneous but neither give an impression of the extent of the tearing and size and displacement of the avulsion. Both essential to forming a prognosis. The report lists it as a small fracture, if we can translate small as to not complete and minimally displaced this is encouraging. Checking the literature this is apparently a rare injury as I can not find any case studies nor have I had such a case.

Studing the anatomy I would say the main concern for such a small injury here is not persistant desmitis but possible calcaneal bursitis as the proximal aspect of the plantar ligament is intimately associated with the bursa. Now that you know exactly where the lameness is coming from can you see swelling or palpate pain? Key to preventing persistant lameness would be adequate rest as I see they describe in the report. Important is not to begin work under saddle until all lameness is resolved.
DrO
Member:
Lizv

Posted on Tuesday, Mar 29, 2005 - 11:33 am:

Thanks for having a look at the report DrO.
In terms of swelling and or pain - this horse has a capped hock from a kick he received as a yearling, so it is difficult to determine whether there is swelling as the hock is always bigger that the other one. He does not seem to have any pain at the site but there is heat after he is trotted.
I am currently walking him under saddle 15 minutes 3 or 4 times a week. I was adding some trot in but stopped doing so a couple of weeks ago.
My regular vet took x-rays last week and when comparing them to the old x-rays (from a year or so ago) he sees nothing that wasn't there previously. I think he is starting to think it might be the tendon damage that is causing the continued lameness. He is going to block the joint tomorrow to see if he comes sound. I will let you know the outcome.

Liz
Member:
Lizv

Posted on Thursday, Apr 7, 2005 - 10:37 am:

DrO
My regular vet did an ultrasound of the hock last week and found no major holes or damage to the tendon. Everything in that hock is much larger than in the normal one - tendon is very much thickened and there are some fluid pockets around it but other than that it gave us really no new information.
He then watched the horse trot and thinks he looks very much better than the last time - the toe is still dragging so to me not much has changed.
The vet feels that the problem may have something to do with the footing in the arena - it is quite deep as is common at dressage facilities. Does this make any sense to you?
Moderator:
DrO

Posted on Friday, Apr 8, 2005 - 7:49 am:

From a weight bearing lameness standpoint, not really considering the history presented in your first post. Deep footing can increase toe drag however. Be sure the foot is balanced and the toe squared off to minimize the drag.
DrO
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