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Discussion on Need help localizing lameness
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New Member:
equinkel
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Posted on Thursday, May 7, 2009 - 9:03 pm:
About 8 weeks ago my farrier recommended wedge pads for my low heeled ottb. After 3 days he developed grade 2/3 lameness. He looked ok at the walk but he looked very off in the trot. To the untrained eye it looked like the LF shoulder would dip when setting LF hoof down. After giving him 2 weeks off I contacted a well respected vet in the area. He blocked left hoof and left suspensory, and did flexion test. After all testing he declared right hock issues. 4 weeks later we did a follow up, he looked the same. This time, more blocks and flexion test and he declared LF suspensory. Sore after palpation. 2 weeks later still the same now he thinks it might be in the feet or declared possible knee chips given he had a racing career, he based this on the "wandering" lameness. Here are the overall symptoms that I observe on daily basis.
Very sore on rocky ground, both knees buckle often but the left is worse, hooves, tendons, and knee all seem warm to me. LF tendon has pressure and small windpuff. He looks more sore when going in a circle, and labors more in deep or unsure footing. He also has a big twist in the RH when pushing off that my new farrier pointed out, he says this could be a major problem. The farrier thinks he is major hoof sore due to improper shoeing. In the last 3 days I started poultice with standing wraps and 2 grams of bute. It seemed to help a little. Sorry for the heavy info but I want you to have all the facts. I'm hoping Dr O will have some advice on what to do next.
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Moderator:
DrO
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Posted on Thursday, May 7, 2009 - 10:11 pm:
Welcome eqinekel,
What happens when the front feet are blocked out? Have any of the other blocks resulted in soundness?
DrO
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New Member:
equinkel
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Posted on Thursday, May 7, 2009 - 10:38 pm:
The blocks never created soundness. The farrier thinks he's really foot sore from bad trims and shoeing. My horse is two weeks into new shoes I'm hoping to see results. Do you think the twist in the RH is anything to be concerned about?
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Moderator:
DrO
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Posted on Friday, May 8, 2009 - 7:08 am:
Slow down a litte bit equinekel. From what I see the chief problem seems to be lack of a logical step by step examination that leads to accurate localization of the lameness.
It strikes me on re-reading the initial veterinarians exam that the horse had a left fore head bob but the veterinarian believed this to be a red herring and a rear limb lame that is creating a head bob. Though rare this does happen however he went to the contralateral rear limb. When this happens the rear limb is on the same side as the front limb that looks lame. You can read about this in the article on diagnosing which leg lame. I don't know which is the red herring however as none of the theories have panned out when tested with diagnostic anesthesia.
Let's go back one more step: does everyone (you, vet, farrier) now agree which leg is lame and which leg is it?
DrO
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New Member:
equinkel
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Posted on Friday, May 8, 2009 - 8:44 am:
I don't believe that everyone agrees which leg is lame. The vet, who has a good reputation for localizing lameness, offered 3 different diagnosis 3 different times. After the third time I became frustrated b/c the diagnosis kept changing but the solution was always the same. 2 weeks off and check again. The third time the vet said I can turn him out but I decided against it b/c if it really is a suspensory issue I don't want to make it worse. I think initially the vet thought it would clear up quickly but it has not. My new farrier only watched him at the walk, and thinks he is so foot sore he doesn't know which foot to put down first. It's pretty obvious his hooves hurt just by watching him walk on the rocks. But it's hard to say what's causing the lameness at the trot. I have not trotted him in about a 2 weeks but I have just started walking him while I'm in the saddle. It doesn't seem to bother him but I'm not sure if its the right thing to do.
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Member:
shanson
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Posted on Friday, May 8, 2009 - 12:28 pm:
Can you post photos of the feet?
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New Member:
equinkel
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Posted on Friday, May 8, 2009 - 12:54 pm:
I'll see if I can get some photos tonight.
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New Member:
equinkel
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Posted on Friday, May 8, 2009 - 8:10 pm:
These are the pics I took today
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Member:
equinkel
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Posted on Friday, May 8, 2009 - 8:16 pm:
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Member:
equinkel
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Posted on Friday, May 8, 2009 - 8:18 pm:
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Member:
equinkel
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Posted on Friday, May 8, 2009 - 8:44 pm:
Here is a pic of his left front my thumb is close to the area of the most pressure occurs. 
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Member:
equinkel
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Posted on Friday, May 8, 2009 - 8:47 pm:
4 weeks ago, before I switched to the new farrier.
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Member:
equinkel
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Posted on Friday, May 8, 2009 - 8:52 pm:
I'm interested to hear everyone's opinion on how his new trim and shoes look. Or anything else for that matter...
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Member:
scooter
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Posted on Friday, May 8, 2009 - 9:28 pm:
equinkel, This is coming from someone who has/had major hoof issues and tried to get help here (and I did) but you have to take better pics. I take horrible hoof pics myself . Which doesn't help anyone see the problems, hoof pics can be deceiving at their best!
What I have been told is level ground, lay on the ground (don't get stepped on!) for true laterals. Try to include part of the leg. Something like this
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Member:
scooter
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Posted on Friday, May 8, 2009 - 9:37 pm:
Forgot to ask did the vet or farrier use hoof testers on him?
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Member:
equinkel
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Posted on Saturday, May 9, 2009 - 9:30 am:
The vet used hoof testers and he did respond to them but the vet didn't make a big deal about it. So I assumed it was a low level response. I'll try to take some better pics.
I'll try to get some better pics. People were already looking at me funny for taking pics of my horses hooves with my iphone... wait till I start laying on the ground
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Member:
scooter
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Posted on Saturday, May 9, 2009 - 9:46 am:
Did you see the area of the hoof your horse responded to? IMHO it would be a good place to start.
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Member:
equinkel
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Posted on Saturday, May 9, 2009 - 10:19 am:
The vet didn't point it out. Is there anything I can do to relieve the pain in the hooves? packing with poultice... or some other method?
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Member:
ajudson1
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Posted on Saturday, May 9, 2009 - 10:34 am:
Get a good side view showing his shoulder, leg and hoof; it appears he's standing under himself. I am not an expert on trimming, just do my own, but if he has heel wedges, I am not sure why he appears to be standing under himself.
Same with the hip, back leg, and hoof.
One good photo from the side is good, have him stand normal, don't try to square him up.
If you can get a good digital camera, set the camera right on the ground, and take front views of each hoof, and back views too, to show heel height, and levelness.
I don't know anything about shoeing, but good pictures will be a start. If the hoofs are not level, heels too low, etc., that can cause all kinds of lameness troubles.
I've spent lots of time laying on the barn floor, lol! Please be careful, use the zoom, and stay back as far as you can. Have a helper too.
Personally, I'd take the shoes off...but that's just my opinion. I'd start over from the bottom of the (bare) hoof up with the whole diagnostic process.
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Member:
scooter
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Posted on Saturday, May 9, 2009 - 10:50 am:
Equikel It really depends on what the problem is.
If IF it is his hooves many things can cause soreness. I don't quite understand your post...was he 2/3 lame immediately after this recent shoeing when the wedges were applied? IF SO logically it would seem that's where the problem lies (tho horses never seem to be logical )
I'm definitely not against shoes, my horse has thin sole ect. and it is the one thing that keeps him comfortable during riding season...he is barefoot otherwise.
One year the farrier did something wrong and he could hardly walk shortly afterward. I had the shoes pulled a couple days later, then reset a few days after that and he was good to go...still don't know for sure what the problem was. Possibly a hot nail, tho IMHO it looked like the shoes were too small...we went up a size, left some in back for heel support and he was good to go.
Good Pics can help the hoof gurus critique his hooves. Personally it seems horses that have Long toe high heel synDrOme, also tend to have thin soles. Dr.O. has a good article in here about it and how to go about fixing it...it's a long journey and takes a good farrier.
https://www.horseadvice.com/horse/messages/4/151283.html
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Member:
scooter
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Posted on Saturday, May 9, 2009 - 10:52 am:
Sorry meant long toe low heel synDrOme
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Member:
equinkel
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Posted on Saturday, May 9, 2009 - 6:42 pm:
When I posted 2/3 lame what I ment was he was between a 2 and 3 on the lameness scale. Yes, 3 days after putting wedge pads he went lame. I rode him on day 1 and 2 he was fine and day 3 was when I noticed something was wrong. I called the old farrier that put the pads on and he took them off and replaced the left front with a bar shoe and a regular shoe on the right front. Two weeks ago the new farrier trimmed and put regular shoes on as you can see with the photos.
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Moderator:
DrO
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Posted on Sunday, May 10, 2009 - 10:41 pm:
equinkel, there is no reason to believe that the cause of the lameness at the walk is not the same thing causing the head to bob. If this pain is coming from the soles of the horses feet we have recommendations for examination at Diseases of Horses » Lameness » Diseases of the Hoof » Problems Following Shoeing or Trimming. Treatment for sole bruising is linked to from within that article. If this does not start getting better I would suggest a referral to a veterinary school or large referral hospital.
DrO
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Member:
equinkel
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Posted on Monday, May 11, 2009 - 7:55 am:
I've been using bute and wrapping his les and yesterday for the first time in weeks his legs and hooves were pretty cool except for the LF there continued to be pressure in the tendon area. The soreness of the hooves is a little strange because he only does it on the rocks and once I remove him from rocks he goes immediatally back to walking normal again. I haven't tested him at the trot yet because I was waiting for the pressure in the tendon to go down.
I forgot to mention that he was not foot sore on the rocks until after the new farrier. But I will say his hooves look much better, he is starting to look a little higher in the heel, and he doesn't appear to be walking on his toes as much. I was thinking the new farrier had to trim more then usual to make corrections, he trimmed the frog and the inside of the hoof looks "cleaned out". Where as the old farrier did not, hence causing the sensitivity to the rocks. But that's just my theory on that one.
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Moderator:
DrO
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Posted on Monday, May 11, 2009 - 8:23 am:
Though it is best to test the hypothesis it is a logical explanation for the observation of sensitivity on hard irregular ground following a short trim equinkel.
DrO
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Member:
equinkel
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Posted on Tuesday, May 12, 2009 - 6:31 am:
I ran into the vet at the barn yesterday and told him my horse was doing better. He palpated the tendons and agreed that he was not as sensitive as he was a few weeks ago. He also said he looked better when turning in a circle. I asked him if it would be ok to ride him at an easy walk and said yes. At this time the vet and I agree that it is most likely a strain in the suspensory given all the signs. Currently I am using poultice and standing wraps every 2-3 days, bute every 3-4 days, and riding him at the walk 3-4 days a week. Do you thing this is a good recipe for a suspensory strain?
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Member:
scooter
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Posted on Tuesday, May 12, 2009 - 7:12 am:
Dr.O. I have heard if you have a horse in wedges, then put on a flat shoe without slowly lowering it can cause suspensory strain. Is that true?
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Moderator:
DrO
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Posted on Tuesday, May 12, 2009 - 9:56 am:
No I don't think this is a good plan for suspensory strain. For more on what I consider a good plan see, Diseases of Horses » Lameness » Diseases of the Lower Limb » Suspensory Desmitis, Strain, & Sprain.
DrO
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Member:
equinkel
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Posted on Tuesday, May 12, 2009 - 12:22 pm:
I read the info on the diseases of he lower limb. Very interesting info and I like the way they break down all the tendons and ligaments. But it kind of gets you thinking...how do you know exactly which one was tweaked? Anyhow, you did said you didn't think my rehab plan was a good one. I'm assuming you don't think it's a good idea to ride at the walk. What about the bute and wrapping? He has currently had 2 months and 1 week off.
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Moderator:
DrO
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Posted on Tuesday, May 12, 2009 - 9:39 pm:
Rather than poke at it in this manner, consider the whole section on treating a horse with suspensory desmitis it deals with the issues you bring up in proper context and detail. As to the diagnosis of suspensory desmitis that is covered also, basically the exam findings of pain and swelling on palpation in the structure followed by visualizing the damage with ultrasound.
DrO
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