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Discussion on Pedal Osteitis?--images attached
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New Member:
besis111
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Posted on Wednesday, Jul 22, 2009 - 11:29 am:
Hi, Dr. O. Please let me know your thoughts on a recent finding.
I called the vet out to do a hind end lameness exam on my 13-year old warmblood because under saddle he had started to feel weak/slightly off and also because my farrier was concerned about the possibility of him having a negative plantar angle (I wrote to you under a different heading about this). The end result of this exam (2 days ago) was a finding of inflammation in his LF coffin bone -- not at all what I was expecting.
The first part of the exam consisted of using hoof testers on all 4 feet. He was positive in the medial aspect of his left fore. He was fine in all other feet. Next, I put him on a lunge line... he was off on that same foot. The vet then flexed both front legs; he was negative to flexion. So... we decided to go ahead and x-ray his feet. (I decided to go ahead and have pictures taken of all 4, since his hind feet were also in question, and it was an opportunity to have a baseline record.)
I've read your article on pedal osteitis. Below are the images of his front feet. Please tell me if you'd agree with the diagnosis of pedal osteitis. Do you see similar patterns in both feet, or just in the area marked? Is there any way of knowing if this is a chronic condition, or an acute trauma? My farrier seems to think this has been a chronic condition; my vet seems to think it could just be from the dry weather and hard ground. My horse has NOT had on-going lameness issues in the front to my knowledge.
I really appreciate your opinion.
Below is right front for comparison. I only have this angle.
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Moderator:
DrO
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Posted on Thursday, Jul 23, 2009 - 9:14 am:
As to the reverse angle the images show fairly normal solar angles in my opinion however because the images are not shot aligned with the sole so hard to calculate any numbers. We know this because the bars of the shoes are not superimposed.
As to the irregularities noted, I would note these type changes common and that it is bilaterally symmetrical. The possible association with any lameness issues unknown.
For more on the diagnosis of lameness I recommend studying Diseases of Horses » Lameness » Localizing Lameness in the Horse.
DrO
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New Member:
besis111
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Posted on Thursday, Jul 23, 2009 - 9:44 am:
Thanks for taking a look. I noticed the same thing -- that the shot wasn't taken at a level angle with the foot. But the point of the front x-rays were to see if there was anything obvious that could be causing him to be sensitive to hoof testers on the medial side of his LF as well as making him lame on that leg. He flexed negative. I will re-read the article on diagnosing lameness. To be clear, you're saying that--based on these pictures--there's no indication of what could be causing the soreness and that there's nothing that appears abnormal, correct?
Thanks, again for your help. I'm getting different opinions from the farrier and vet, and so your thoughts are very much appreciated.
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Moderator:
DrO
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Posted on Friday, Jul 24, 2009 - 9:31 am:
I would not say there are "no abnormalities". Almost every radiograph has some abnormalities whether the horse is sound or lame. Your vet has pointed out two abnormalities. However I don't think they can be used to diagnose a lameness by themselves, first because the horse has not been found lame in this leg and second, such changes are commonly found in sound horses.
But that is not the same as saying they are not a cause of pain. If the horse was lame in this leg and it blocked out to the foot I would be looking for support for such a finding such as pain over these abnormal area with the hoof testers, possibly followed up with other views.
Because of the nature of posted radiographs I avoid doing general surveys and reads of radiographs Amy. While remarkable lesions can be discussed to rule a set of radiography as normal requires the best possible viewing conditions.
DrO
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Member:
besis111
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Posted on Friday, Jul 24, 2009 - 11:27 am:
Thanks, Dr. O. However, as I mentioned in my first post, he WAS lame on his front left the day my vet came out to do a hind end lameness exam (4 days ago). And, according to my vet, there was inflammation of the coffin bone in that foot. So, while he WAS lame on that leg the day the vet came out, he is NOT normally lame on that leg (and is NOT lame now). The reason I had the vet come out in the first place was to do a HIND end exam, because there was a concern that hind foot problems could be causing the weakness that I was feeling in his hind end under saddle. Or that perhaps problems in his hocks were the cause of bad angles in his hind feet coffin bones (that was what my farrier speculated). I was shocked when he was lame in the front, as that's nothing I'd ever seen/felt in the past.
I realize this situation is a bit convoluted, and I know that you aren't able to make a diagnosis based on uploaded images. However, IF a horse is lame, and IF there are abnormalities on the radiographs which correspond with the lameness, what would be the recommended course of action? Would you recommend bar shoes and/or pads? My concern is that I don't want to 'fix' something that's not broken. My farrier is ready to put bar shoes on him and I'm afraid that needlessly putting corrective shoes on will cause additional problems. Your thoughts are appreciated, and I apologize for this odd post!
Amy
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Moderator:
DrO
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Posted on Saturday, Jul 25, 2009 - 6:49 am:
Amy in your first post you state that he was out for a hind limb lameness and that there were some exam findings on the front limb but you don't state him as being lame on the front. How long was he lame on the front?
Your question is a bit confusing and suggests we are still not on the same page here. If you have a diagnosed lameness, whether you have radiographs or not, you treat it and the specific treatment will depend on the cause of the lameness. However your horse is not lame on the feet that were radiographed and I would not consider any major changes in trimming and shoeing indicated based on a few days of undiagnosed lameness.
How is that back leg lameness doing?
DrO
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Member:
besis111
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Posted on Saturday, Jul 25, 2009 - 5:00 pm:
I'm sorry... I know it's confusing. I did say "he was off on that same foot" but I'm sure I could have communicated what was going on more clearly. So the point is the day he was lame and sore on the left front, is the day they took the x-rays I attached. He's not lame now, but has been on bute since Monday, and has only been ridden walk/trot and had light turn-out. So I'm still uncertain if there is in fact a problem.
As far as his back end goes, the vet said he would be unable to make a diagnosis or evaluate his back end as long as he was lame in the front. He's not lame in the front now, but I've been told to only walk/trot for a couple weeks. So... as far as his back end goes, it's hard to say (as it's most obvious to me at the canter and over fences). He's not noticeably off in the back, but, I know my horse well, and have been feeling like he's doesn't have the impulsion that he normally does under saddle. When I took him for hock injections in March, the hospital noted that he was lame on flexion, although it wasn't severe. So, now I'm wondering, if there's something happening in both front feet, might that show up as hind end weakness?
I will stop rambling now... I'll just take one issue at a time and be conservative with his treatment, and not make any major adjustments (like bar shoes), although I might go with pads. Thanks for trying to follow along... I'll let you know how he's doing, and if I have any other questions for you! 
Thanks.
Amy
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Moderator:
DrO
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Posted on Sunday, Jul 26, 2009 - 9:31 am:
You are not rambling Amy, it just takes time to fully understand the condition. And now that you point it out I see you did indicate the left fore was lame, my apologies for missing that twice.
Hmmm, did you know that some horses with rear limb lameness will have a unilateral head bob making the horse look lame on the front also? For this reason horses with a lame front and rear on the same side should be evaluated for rear lameness first. This is explained further in the article on the diagnosis of lameness.
It would be so easy to rule in or out the LF foot by a simple nerve block or two.
DrO
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Member:
besis111
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Posted on Sunday, Jul 26, 2009 - 10:41 pm:
Thanks, Dr. O. The challenge is not knowing what is an actual problem vs. a red herring. I'm more inclined to believe, as you've presented as a possibility, that his back end is causing the apparent front end lameness. But with the radiographic findings, it's become even more confusing. The nerve block would have been helpful, but my vet was trying to save me money by skipping that step and going straight to the x-rays. I guess that was a mistake.
Thanks, again, and I'll keep you posted.
Amy
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