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  Discussion on Tendon injury within the hoof
Author Message
New Member:
Kowal

Posted on Saturday, Apr 16, 2005 - 6:43 pm:

My horse injured his right front foot free lunging 9 weeks ago. There was no abnormal heat or swelling initially but I later noticed heat on the inside heal area. I had my local vet out, and he thought it might be an abscess, but because the horse had pads on couldn't access the sole area. Horse was stall rested for 6 days. Farrier comes out 8 days later, sees no evidence of abscess, uses hoof testers, no response, believes it's soft tissue. Horse continues to improve and comes sound at about 5 weeks, heat is gone from the foot. Two weeks later he re-injures, more heat this time particularly around the coronet, lameness more severe than original injury (2/5 trotting to right). Horse was on pasture turnout.

I took horse to the clinic last week. He improved 90% after a high PD block. Fluoroscope of the fetlock and foot showed no abnormalities. Vet says soft tissue, but he needs an MRI to really see whats going on within the hoof. Says there is a 60% chance it's an injury to the deep flexor tendon. Recommended 4 weeks stall rest to start, but indicated a lengthy stall confinement would be likely.

Unfortunately I am unable to afford the $2000 required for an MRI, and I know without it I can't get a definitive diagnosis. I will confer with my vet again at the end of the 4 week period regarding a detailed rehab schedule; in the meantime, I have been searching for more general information about tendon/ligament injuries within the hoof...such as general prognosis for such injuries, and rehab schedules, I have been unable to find much information at all. Would the rehab schedule be similar to that of a flexor tendon injury higher up the leg? My feeling is that the injury should be rehabbed very conservatively given that I am not certain exactly what I am dealing with.
Moderator:
DrO

Posted on Sunday, Apr 17, 2005 - 9:20 am:

Well you are in luck Karen, we are in the middle of a edit to the diagnosing foot lameness article that includes the statistical findings on a large number of MRI results in undiagnosed foot pain. It should be up tomorrow. The only problem I see with the above is that the rule outs is significantly different between the simple procedures of a low and high PD block, what was the result of a low PD?
DrO
New Member:
Kowal

Posted on Sunday, Apr 17, 2005 - 7:17 pm:

Hi Dr. O, thanks for the prompt reply. The vet did not do a low PD block. He did encourage me to return to the clinic for further blocking of the foot when he found out that I couldn't afford the MRI. In his defence, he was extremely reluctant to even attempt a diagnosis given the information he had. I was the one who pressed him, because I figured in light of my financial limitations, and the fact that I might never get a definitive diagnosis, the best I could do would be to rehab the horse based on the worst case scenario...
My Thoroughbred cross gelding just turned 5 this month and has been under saddle less than a year. He has been worked very lightly, and had never been lame prior to this injury.
Member:
Brandi

Posted on Monday, Apr 18, 2005 - 9:13 pm:

Dr. O., why can't Karen use ultrasound to diagnose? My horse has a mostly healed DDFT tear and a brand-new impar tear in the other foot (don't ask), and both were diagnosed with ultrasound, using a specialist, which costs me about $300 or $500 if I do both feet (which I now get to do!). I realize the MRI might give a clearer picture, but I've never had any reason to believe that my ultrasound isn't giving me the information I need. I'd love your feedback.
Brandi
Moderator:
DrO

Posted on Tuesday, Apr 19, 2005 - 8:35 am:

When someone starts a new discussion under an appropriate article to their question I usually assume they have read it before posting. The article associated with this discussion describes the appropriate use of ultrasound in the diagnosis of foot lameness. In case Karen didn't, your post should be a good wake up call to read the article.
DrO
Member:
Brandi

Posted on Tuesday, Apr 19, 2005 - 3:40 pm:

DrO,
The ultrasound section of this article is unclear to me, other than that one needs to have the right equipment, but I don't see where it says what ultrasound is 'good' for, just that it is a relatively new tool for this application. Is the fact that I'm making use of it for my horse's soft-tissue injuries a poor choice? I don't have any reason to doubt our findings regarding my horse, it seems perfectly valuable and the pictures have supported my horse's symptoms/prognosis, etc. But the article doesn't seem to make it sound particularly viable. Am I misinterpreting this, or am I just one of a lucky few who has access to the equipment and the specialist to provide good results?
Thanks,
Brandi
Moderator:
DrO

Posted on Wednesday, Apr 20, 2005 - 6:36 am:

Brandi,
When we give the ultrasound measurements to all the soft tissue structures of the hoof they are meant as a method by which to evaluate the results one gets from an ultrasound exam. However the correlation between changes and lameness are not thoroughly investigated. Ultrasound can add important information to the diagnosis but should be interpreted in light of the whole exam and information available on the specific abnormality identified.
DrO
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