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  Discussion on PENETRATION OF THE NAVICULAR BURSAR AND DAMAGE TO THE DEEP DIGITAL FLEXOR TENDON
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Member:
astbury

Posted on Friday, Mar 26, 2010 - 1:58 pm:

Hi all

My friend's horse picked up a nail in his near hind while my friend was hacking out on a quiet country lane some ten days ago now. The horse apparently DrOpped a leg briefly, then walked on ok and then obviously went lame and my friend dismounted and found a nail sticking out of the foot. She immediately pulled it out and led the horse home and at that point he was sound. Unfortunately she didn't make a note of where the nail penetrated, didn't note the angle, or the depth.

By evening he was extremely lame and my friend decided to call the farrier after the weekend, not realising how serious the injury could be. In the intervening period she still turned the horse out with a hoof boot on :-(

The farrier came out on the Monday evening and said a vet was required. The vet was called the following day and immediately admitted the horse to our local Veterinary Hospital. There xrays were taken and the horse was put on antibiotics. Xrays were fine and the horse was discharged two days later with instructions that if he wasn't totally sound in a week to take him back. I believe the horse was on phenylbutazone and antibiotics when discharged, but no further medication was prescribed for my friend to give to the horse at home. The vet said that he thought the horse probably had an extremely badly bruised sole.

Three days later I got an email from my friend saying the horse was still very lame and she wondered if she should get some bute to make him more comfortable. She told me the horse was only supporting the weight on the affected foot on his toe. I replied that I thought she should get him straight back to the vet.

She phoned the vet, the horse was admitted again that afternoon, and by evening she had been referred to Newmarket Veterinary Hospital. There they took further xrays and carried out an MRI scan and the horse was operated on the following morning (yesterday). The surgeon called my friend last night and said that the nail had penetrated the navicular bursar and the deep digital flexor tendon was also damaged. He had done everything he could to clean out the infection, but said the next ten days would be critical in fighting the infection. The horse is obviously remaining at Newmarket.

I guess the lesson here is never ever delay calling the vet when a nail penetrates the hoof - however minor it appears. Better to be safe than sorry. Secondly, keep hammering on at your vet if you aren't happy with treatment or progress. My friend has learnt the lessons in a very hard way and is distraught that she might have made matters very much worse.

A question for Dr O - Do you think there is any chance this horse will become sound and be able to work again? He was being brought on as an eventer. My friend is extremely fond of the horse and if he can no longer be ridden will keep him as a "paddock ornament" as long as he is comfortable.

What a nightmare.
Member:
astbury

Posted on Friday, Mar 26, 2010 - 2:33 pm:

Oh No. I've done it again. Capitals on the heading. Is there any way I can change it to lower case please!!
Member:
paardex

Posted on Friday, Mar 26, 2010 - 4:15 pm:

Jenny I think this post AND warning is important enough for capitals[but hey I am Dutch so the intricacies of offending in English are lost to me]
What a nightmare with your friends horse!
Jos
Member:
astbury

Posted on Friday, Mar 26, 2010 - 5:42 pm:

Thanks Jos.
Moderator:
DrO

Posted on Friday, Mar 26, 2010 - 7:49 pm:

Jenny without examining the horse we have no clue as to your friend's particular horse's prognosis but I suspect Newmarket has a very good bead on this, I would listen to them.

In general, cases where a synovial membrane (including the navicular bursae) has been penetrated and infection ensues there is a approximately 24 hour period where aggressive treatment, including in and out flushing and/or drainage of the infected synovial space, yields a good prognosis. Treatment delayed after the first 24 hours results in a increasingly poor prognosis. Developing degenerative joint disease is the reason.
DrO
Member:
astbury

Posted on Saturday, Mar 27, 2010 - 5:44 am:

Thanks Dr O for your posting. Fully understand the difficulty in making any prognosis but appreciate your general view.
Member:
36541

Posted on Saturday, Mar 27, 2010 - 9:54 am:

I would have made the same delaying mistake last week with my mare had I not come inside and read the HA article that classifies punctures - thanks Dr. O yet again! Jenny, perhaps your friend will join the site? We both know how this bunch can support a horse person in an indefinable way...best money I ever spent for my horses.
New Member:
paladin

Posted on Saturday, Mar 27, 2010 - 10:13 am:

I had a very similar experience 3 years ago with a few major differences.

My horse also had a serious nail puncture to the right rear. The nail was embedded in a small piece of wood still stuck to the horse's hoof/shoe. I also removed the nail because I feared more damage would be done if the horse knocked the block of wood on the ground and moved the nail. Horse did not appear lame at this point.

The Vet was onsite within 40 minutes, the horse was at the horsepital within 2 hours. They were able to find the penetration site and used a flexible probe to determine the extent of penetration. The discharge papers described it as "the nail communicated with the navicular bursa". They elected to do a street nail procedure. He remained in the hospital after surgery for 2 weeks with regional perfusions of the area daily. He became quite lame a couple weeks after discharge and returned for another week in the hospital. There were no signs of infection but he was anesthetized and flushed as well as regionally perfused again as a precaution. He was put on a 9 degree wedge (prescribed for 4 weeks) and discharged.

To make a long story less long, he was on 6 months of stall rest and another 6 months of restricted turn out with a very intense, careful rehab and handwalking only. After the second hospital discharge, I brought in a well-known Vet/podiatrist. He dealt with bringing the horse off a 9 degree wedge. The horse began to rapidly improve under his care.....maybe it was just time.

From what I read today, the street nail procedure is fairly controversial with adhesions being a major problem with recovery. This horse became quite lame after the surgery hence the 9 degree wedge. He was frequently tested (fluid taps) and radiographed with no signs of infection or any changes/damage in the foot.

He became quite sound again but has some sensitivity that I only really notice when the farrier holds the rear leg up for an extended time. The sensitivity appears to be mostly in the opposite leg. Farrier mentioned arthritis in hock, vet thought more stifle, I'm wondering if maybe some compensational injury or something sustained going under or coming out of anesthesia. Doesn't seem to have a problem at all when ridden. Just when we were getting ready for a full lameness eval, he developed a laminitis (front) last fall (no known cause) but responded to treatment quite rapidly. All these issues are probably totally unrelated but I feel like there's something going on we haven't quite put our finger on yet. Regardless, we need to distance ourselves from the laminitis episode before figuring out the back end which so far has been fairly minor.

My horse did not develop an infection probably because of the extremely aggressive treatment but the treatment itself required a pretty difficult rehab. I might consider, depending on how quickly it is caught and treated, that the regional perfusions/antibiotics may also be an adequate treatment if started early. In the end, I would go with my Vet's advice but this would be a discussion we would have.

BTW..this horse was 6 at the nail puncture and will turn 10 this summer.
Member:
astbury

Posted on Saturday, Mar 27, 2010 - 11:26 am:

Thanks for your posting Paladin - your very rapid reaction to the injury was obviously vital to the horse's recovery.

Hi Stacy. Will recommend the site to my friend - I have tried to filter information through to her, but she says she is avoiding reading anything at present as it is depressing her even more.

Lot of guilt all round. I wish now that when she first told me about the nail - which was the day after it penetrated the horse's sole - I had pushed her more. I asked her what the vet had said and she just said she had been in touch with the farrier and he was coming the following day. I know now I should have really pushed her into taking immediate action - if necessary by telling her what the worst case scenario could be. (A horse at our yard was put down last year following the same set of circumstances). Hard to be hard?
New Member:
paladin

Posted on Saturday, Mar 27, 2010 - 12:20 pm:

Jenny - I hope I didn't sound judgemental of your friend. I know she's going through a terrible experience that I can relate to.

I believe recovery is possible. I hope if she's dealing with the same surgery I did, and the infection clears, maybe my experience and Dr. O's interpretations can help her prepare/execute a better post-surgical rehab. She may also have had a completely different surgery.

My guilt is over whether or not I responded maybe a little too aggressively. The difference is that it sounds like she's dealing with an established infection. Having been through it once, I may have afforded myself another 12 hours of research before jumping into a street nail procedure.

On the bright side, your friend will never get to know her horse better, or have the opportunity to establish a stronger bond, than living through this with him. My horse was on bute for months. I got the ulcers. He recovered.
Member:
astbury

Posted on Saturday, Mar 27, 2010 - 4:48 pm:

Hi Paladin - you didn't sound judgmental at all and your postings are really helpful and appreciated.
Member:
astbury

Posted on Tuesday, Mar 30, 2010 - 5:47 pm:

Just a quick update: my friend is travelling down to Newmarket every day to see her horse - a 200 mile round journey. Just spoken with her and today, he is brighter than previously. Thursday will be seven days since the operation. Thoughts are with her....
Member:
canter

Posted on Wednesday, Mar 31, 2010 - 7:06 am:

Pass on our best wishes to your friend, Jenny. I sure hope the horse will recover with minimal damage
New Member:
paladin

Posted on Wednesday, Mar 31, 2010 - 8:56 am:

Thanks for the update. Wishing the very best for your friend and her horse.
Member:
stek

Posted on Wednesday, Mar 31, 2010 - 11:48 am:

Best of luck to your friend Jenny. Having lived through a couple sole punctures myself (though thankfully missing the critical internal structures) I can relate at least somewhat. Nothing to do at this point but look forward, she is obviously doing everything possible for her horse.
Member:
astbury

Posted on Saturday, Apr 3, 2010 - 3:17 pm:

Thanks for all your good wishes for my friend which I have passed on.

Yesterday the horse seemed brighter when she went down to Newmarket. And today I have just got a text message saying she has just got home and he is even brighter still. They have still to take the original bandage off - which I guess they are keeping on to ward off infection. Each day the nurses are walking him out briefly and he apparently gets better each day. Today my friend said he rested the off hind leg while supporting full weight on the injured foot.

So things are looking positive - my friend is reluctant to get excited in case things go wrong again but so far so good. I just SO hope it turns out well for her.
Moderator:
DrO

Posted on Monday, Apr 5, 2010 - 7:49 pm:

Thanks for the update Jenny.
DrO
Member:
astbury

Posted on Wednesday, Apr 7, 2010 - 6:58 pm:

Newmarket still pleased with horse's progress - responding to antibiotics and apparently very playful in himself. Shortly they will be stopping the antibiotics and painkillers to see the response. We are all keeping our fingers crossed and will keep you posted.

My friend is seriously wrecked after more than a week of travelling down to Newmarket each day. Yesterday she was back at work and unable to go down and was so stressed out - while she is with the horse she can cope but goes to pieces when without.

She did go today again but haven't heard - and because of my "Joker" problems didn't get home until too late to call. Will call her tomorrow am to see how things are.
Member:
stek

Posted on Thursday, Apr 8, 2010 - 10:59 am:

Excellent news Jenny, keeping fingers crossed for her on this side of the pond!
Member:
astbury

Posted on Thursday, Apr 8, 2010 - 4:09 pm:

Update on my friend's horse. The surgeon at Newmarket, Ian Wright, called her today. Plan is to stop the 2nd antibiotic on Friday. The horse is still walking out ok and the surgeon is happy with him.

He has said they will keep an eye on him over the weekend and then possibly put shoes on him early next week. He is going to phone my friend on Monday to discuss the horse's possible return home.

He also said that he would be very disappointed if my friend's horse did not make a full recovery.

My friend asked the surgeon about the dragging of the good back leg which she had noticed and he said it was due to the excessive strain of the past few weeks and was to be expected.

On return home, it will be another month (at least) of box rest and gentle walk out exercise and bute.

So we are keeping our fingers very firmly crossed of not just a good outcome but an excellent one. It will be just so good if he returns to full soundness.
New Member:
paladin

Posted on Thursday, Apr 8, 2010 - 8:35 pm:

Excellent! That's wonderful news.
Member:
frances

Posted on Friday, Apr 9, 2010 - 12:22 am:

So glad to hear it!
Member:
canter

Posted on Friday, Apr 9, 2010 - 6:57 am:

Great news, Jenny. Your friend must be VERY much relieved.
Member:
vickiann

Posted on Friday, Apr 9, 2010 - 10:26 am:

Good news! Hope things continue to improve, Jenny.
Member:
astbury

Posted on Monday, Apr 12, 2010 - 12:45 pm:

Hi all - an update on Pol - still at Newmarket but still improving and tomorrow the dressing will be changed again and if all well, he will have shoes on and be allowed home in the next day or two.

Thank you for all your interest and support for my friend and her horse. We are all hoping to see them both back competing again at some stage in the future. I am attaching a couple of photos of Apollo - as you will see, he is a very unusual colour!

Cheers

Jenny
Pol1Pol2
Member:
stek

Posted on Monday, Apr 12, 2010 - 1:24 pm:

Neat looking horse Jenny, thanks for the pic and glad he is doing well. I see he has the typically sparse appy mane and tail .. or did he get a haircut at the hospital?
Member:
leslie1

Posted on Monday, Apr 12, 2010 - 3:46 pm:

hes a cutie.
New Member:
paladin

Posted on Monday, Apr 12, 2010 - 6:36 pm:

Handsome boy! So happy to hear he's doing so well.
Member:
frances

Posted on Tuesday, Apr 13, 2010 - 8:03 am:

I like his looks. Sending best wishes for a FULL recovery.
Member:
astbury

Posted on Friday, Apr 16, 2010 - 5:35 pm:

Thanks for all your good wishes. After a particularly fraught couple of days when my friend had been advised that her horse was a little uncomfortable after having back shoes on - tonight she called me to tell me that she has had a call from Newmarket to say the surgeon is very happy with his progress, and she can pick him up to bring him home tomorrow. I am SO happy for her. Will keep you informed on how he progresses.

Hadn't thought about his tail, Shannon - I don't know much about Appaloosa's but yes - it is sparse and he has a very fine mane too!
Member:
astbury

Posted on Wednesday, Apr 28, 2010 - 7:13 am:

Just a brief update on my friend's horse. He is now back at home and on 10 minute walking exercise 4 times a day. My friend's vet came out to check him out yesterday and is very pleased with his progress. If all goes well he will have turnout in a small paddock on May 12 for a month or so and then come very slowly back into work. All is looking good and we are keeping our fingers crossed for her.
Member:
paladin

Posted on Wednesday, Apr 28, 2010 - 7:28 am:

I'm so happy to hear he's doing well and walking several times a day. Sounds like he had/has excellent care. Great work by all (vet, owner, and of course, the horse).

Thanks for the update.
Member:
frances

Posted on Wednesday, Apr 28, 2010 - 8:20 am:

Wonderful! Let's hope he continues to progress.
Member:
stek

Posted on Wednesday, Apr 28, 2010 - 10:54 am:

Great news! Thanks for the update, and best wishes for a full recovery!
Member:
vickiann

Posted on Wednesday, Apr 28, 2010 - 7:31 pm:

Cool horse!

Glad that things are going better.
Member:
astbury

Posted on Sunday, May 9, 2010 - 4:02 pm:

My friend's horse is still sound - things are looking very positive. Should be able to be turned out shortly. Will keep you posted!
Member:
lilo

Posted on Sunday, May 9, 2010 - 9:48 pm:

Jenny - that is good news. Lilo
Member:
canter

Posted on Monday, May 10, 2010 - 6:57 am:

thats great! so glad to hear it.
Member:
astbury

Posted on Thursday, Jun 3, 2010 - 6:14 pm:

Apollo - or Pol to his friends - is still doing well. Now on relatively unrestricted turnout - although because he has been a bit wild recently, his paddock area has been reduced, and his retired friend has been paddocked adjacent - also in a smaller area.

He is now doing some 30 minutes walking exercise twice a day - my friend is getting very fit!

He has had a couple of "set backs" where his hoof has been warm and he has been slightly lame following a) walking down a fairly steep hill (not repeated) and also following a particularly fraught episode of in hand exercise on the road when he became rather fraught and spent quite a lot of time trotting sideways and generally being silly.

He returned to soundness within 24 hours after both of these episodes. Whether they are an indication of long term lameness I guess only time will tell....
Moderator:
DrO

Posted on Friday, Jun 4, 2010 - 5:57 am:

Thanks for keeping us appraised Jenny.
DrO
Member:
astbury

Posted on Monday, Aug 16, 2010 - 4:19 pm:

Hi All

Have just been speaking with my friend, Pol's owner. Pol had been walking out sound for over 40 minutes per day - and was doing really well. Unfortunately though he became lame on the near hind, where the nail penetration had been. Pol went back into our vet hospital for further diagnosis - vets thought it would be problems within the affected hoof and it turned out that the hoof was fine - and the problem was a curb on the hock. Oddly, there was no curb present before Pol went to Newmarket, but a photo of him (may be the one shown above) clearly shows the curb.

Anyway the vets were concerned that Pol remained lame so long after the curb had appeared and today he went in for further tests.

The results to date show that the lower two bones in the hock (are these the distal intratarsal bones?) are completely fused on BOTH hind limbs. Pol remains in the vets and tomorrow they are checking the larger joints in the hock (tarsometatarsal? or was this the other way round).

The vet says that the most my friend can possibly expect from the horse is light hacking - and I believe even that might worsen the condition. He says that the deterioration in the hock is not something new.

I will post again once I get the final diagnosis but as you can imagine my friend is pretty devastated....
Moderator:
DrO

Posted on Monday, Aug 16, 2010 - 6:23 pm:

The largest joint is the tibiotarsal joint. A horse can have the two bottom jts fused and be sound so hopefully the upper joints will be fine.
DrO
Member:
astbury

Posted on Wednesday, Aug 18, 2010 - 9:12 am:

Thank you for your response Dr O.

My friend collected her horse yesterday and was given the following discharge notes - although she was unable to speak with the vet. Subsequently, she has spoken with her normal vet who says that the horse's career would be very short. Apparently he was quite difficult to pin down when my friend tried to get a prognosis.

If the horse does become sound, do you think my friend would be causing harm by working him at a certain level or would it be likely to exacerbate things. I know she just wants to do the best for the horse and if it is in his best interests simply to retire him she will do so and he can be a companion to her (already retired) mare.

The notes are:
Member:
astbury

Posted on Wednesday, Aug 18, 2010 - 10:00 am:

Oh dear. Notes haven't uploaded. Will try again....

Discharge form contents:

The horse had a smaller/boxy foot on the left hind compared to the right. Although he has an unusual action, there was an obvious 3-4/10 LH lameness in a straight line and similar level of lameness on a circle – obvious toe drag RH, low foot flight, slightly shortened anterior phase of the stride.

Nerve blocks:

Low 6 point – Negative
Sub-tarsal – marginal improvement
Tarso-metatarsal joint – margin improvement
Tibial peroneal nerves ~ 75% improvement

Next day

Tarsal crural joint – no change

Radiography/Ultrasound:

A scan of the curb region did not show any change compared to the previous scan – and the swelling is of questionable significance.
Radiography of both hocks showed marked changes of the tarsometatarsal and distal intertarsal joints, consistent with advanced cartilage loss, degenerative joint disease and probably fusion of most of the lower hock joints. Similar changes were found in the right hock.

Diagnosis:

Advanced joint disease of both hock joints, bone spavin.

Management:

As there has been no improvement to the final nerve block there appears to be limited treatment options. There is a chance that the horse will improve with further rest and bute – presuming that he has flared up a problem following recovery from the recent general anaesthetic.
I would advise shoeing the horse wide and long behind, preferably with a lateral extension or trailer on both hind shoes.
Please administer 1 ½ sachets of Equipalazone twice daily.
He should be confined to box rest or a small yard if possible until middle of September. He could have short walks in hand (up to 10 minutes twice daily if desired) and from 15 September he could have restricted turnout or increasing walking activity. He should be re-examinated around the end of October to assess the lameness and then adjust on future management.
Member:
astbury

Posted on Saturday, Aug 21, 2010 - 2:19 pm:

Hi Dr O and everyone. My friend is currently looking at all available possibilities in terms of treatment for her horse to stop any further deterioration in terms of the arthritic condition of the joints. Has anyone had experience of this in a horse of only 5 years? She is very confused as the vet was very negative when talking to her but the discharge notes she received from the hospital indicate increasing walking exercise. Anyway, any advice would be very welcome. Many thanks.
Moderator:
DrO

Posted on Monday, Aug 23, 2010 - 6:19 pm:

Hello Jenny,
We have much information at HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Upper Rear Limb » Overview of Diseases of the Hock (Tarsus). Be sure to follow the more link to the Overview of Arthritis article. You would be welcome to share those with your friend.
DrO
Member:
astbury

Posted on Tuesday, Aug 24, 2010 - 5:55 am:

Thanks Dr O - that is very kind. Will check the articles out.
Member:
astbury

Posted on Thursday, Jun 21, 2012 - 6:52 am:

Just a brief note here as a follow on - I will then post elsewhere. Shortly after the diagnosis of arthritis,my friend's horse developed severe colic and was operated on. He recovered from the operation and a month ago my friend achieved her ambition and got him out to compete at dressage - achieving a 74% first time out. She was so delighted - has worked so hard and so carefully with the horse to give him the best possible outcome after all of his problems.

Then last week disaster struck again - the horse developed lesions in the mouth and around the coronet band and was depressed. Currently no firm diagnosis but auto-immune disorder is suspected (Pemphigus?) What a nightmare for them. And how sad for one still young horse to be plagued with so many problems. I am keeping my fingers crossed for her but the horse is on steroids and recently reduced to alternate days. Whilst the coronet sores have not become angry again the gums lesions are reddening. I believe the next stage is for the vet to take samples for testing, Having looked at auto-immune disorders on line I noticed that appaloossa's are more prone to these than the general horse population. Will move over to another disease area with further postings.
Member:
lbrnm

Posted on Monday, Jun 25, 2012 - 4:43 pm:

Greetings Jenny,

What part of the country is the horse in? Here in New Mexico, we are dealing with an outbreak of Vesicular Stomatitis. VS causes blister-like lesions in the mouth, on the coronet band, and on the sheath.

Has your friend gotten the results back from the testing the vet was going to do?

Nicole in New Mexico
Ladybug Ranch
Member:
astbury

Posted on Monday, Jul 2, 2012 - 8:49 am:

Hello Nicole. Sorry for delay in response. I don't think my friend has the results back yet but will check. We are in the UK - will check out Vesicular Stomatitis. Thanks for that.
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