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Discussion on LT LH Treatment & Prognosis
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New Member:
rosieint
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Posted on Sunday, Aug 29, 2010 - 7:03 pm:
Hello,
May I take this opportunity to start by saying what a wonderful resource this website is. I have read many of the postings and your advice with gratitude as it opens up the understanding of clinical equestrian problems to lay people like myself. I am on this website as I have a problem I would be grateful for your assistance with.
My horse Pablo is a 16.1 WB x TB who is 17 years old. He has comepeted up until the age of 13 at the highest event competitions internationally and has therefore had a lot of impact on this body. At 13 he sustained a tendon injury to right fore which was treated with stem cell therapy and after 2 years he returned to competitions allbeit at a lower level.
He has recently (in the last 2 years when I did not own him and more accutely in the last 2months since I have owned him) suffered from low grade front lameness, more particularily on the left on the lunge on hard sufaces. It is intermitent lameness. Some days he will hojp in trot trying to break into canter and other days it is barely noticeable. More often than not he moves putting in a stride or two ocassionaly which is out of rhythmn but otherwise is sound.
I have consulted a vet and she conducted nerve blocks and localised his pain to his feet. He then had an MRI and x-ray examinations on both front feet.
After the MRI and before I had the full diagnosis he was turned out in the field with no front shoes (the MRI required them
to be taken off) and because of the wet conditions and his joy at being back home and tearing around in the field he damaged the hoof wall. After I had a brief chat with the vet but before she had been able to sit down and examine the images carefully I asked the farrier to put shoes back on him to prevent further damage (he is unable to stand in his box without banging his door and further damaging his hooves) and the farrier used filler and fitted wedge shoes.
A day later the two consulting vets advised me of the following:
"Nothing too dramatic has come up at all. A few minor things going on. On both front feet he has far too much toe length. This can cause lameness as it puts pressure on the heal length and having the foot put back in balance can have a big difference.
Nothing too dramatic on the x rays. Very mild changes in the navicular bone of the left fore. Not specifically consistent with navicular.
MRI left fore foot, nothing dramatic. A few wear and tear type problems. The surface of the deep flexor tendon as it passes over the navicular is a bit roughened and it can be the cause of low grade pain. It is a bit of wear and tear type injury. The lateral co lateral ligament of the coffin joint there are some mild changes in that which imply there has been some strain to the top of the ligament. It doesn’t look dramatic and active at the moment
In the right fore foot there is a little bit of swelling in the coffin joint but nothing dramatic. Very mild fibrulation of the tendon but on balance on both front feet; the fact that he has worked so hard they generally look very good there.
Advises getting his feet back into dorsal palmer foot balance and some treatment by injection in the coffin joint may help him too. Overall very hopeful that he can get back and sound and into back into normal work."
The vet then discussed their diagnosis with the farrier and the farrier advised leaving the current set of shoes (wedge shoes wioth pads) on for 2/3 weeks to let the feet settle down as they are likely to be sore. In 2/3 weeks the vet will show the farrier the x-rays so the correct dorsal palmer foot alignment can be achieved with the farrier in shoeing and then the alignment will be checked again with further x-rays.
I am in my experts hands that this is the correct treatment for him and I trust their judgment. I am concerned that after shoeing last week on Thursday he has become more lame than before and is now lame on a straight trot up (something that he never was before). I haven't been able to consult with my vet or farrier about this due to the public holiday in the UK at the moment. I gave him 1 gram of bute last night and he is still lame so upped the dose to 2.5 today. I would be grateful for your thoughts on Pablo's symptoms, the findings on the images, my treatment of him with bute and your opinion of Pablo's prognosis.
Many thanks again for such a wonderful website and your time in reading my letter.
I look forward to hearing from you.
Rosie
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Moderator:
DrO
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Posted on Monday, Aug 30, 2010 - 9:59 pm:
Welcome Rosie,
Without examining the horse there are many possibilities. Maybe something as simple as a close nail from the recent shoeing. It will take an examination to get to the bottom of this recent change.
Concerning the chronic problem I think the post suggests strongly that the sooner you get to getting your horses feet balanced the quicker things will get better. The article associated with this discussion area should help.
DrO
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New Member:
rosieint
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Posted on Sunday, Sep 26, 2010 - 8:02 am:
Thank you for your email. I wanted to ask you more aobut this as the poor horse now has other symptoms with the same leg.
11 days ago he was re x-rayed and it was seen that he was not balanced from left to right as well as slightly LTLH (problem wasn't too bad initially and the previous wedge shoes had done a some corrective work). He also has thin walls and thing soles.
He was shod on the front with natural balance shoes and with magic cushion pads. He also had an injection (I am not sure exactly of what but a cortisone)in his coffin joint.
Initially nothing seemed to change dramatically, i.e. still slightly lame and then 5 days later overnight he could barely put weight on the leg. The vet visited and decided that because there was swelling around the coronary band but not in the back joint capsule that it was not related to the injection and likely to be an abscess. We put him on bute. The following day he was much better and the day after that the vet visited again and confirmed his initial diagnosis and we took him off the bute and turned him out for half a day in the field.
This was now 4 days ago and since then he has continued on a half day turnout in the field. His symptoms have not changed dramaticaly although his coffin joint capsule at the back has become sensitive and there is more swelling in the coronary band but not to a considerable degree. There is slight heat but barely detectible.
I am obviously concerned about a joint infection and so would be really appreciative of your views on this.
I would also be grateful if you could view the facts in the round and see if you can read from these collection of symptoms anything else that might be going on that may make all these seemingly unrelated (other than being on the same leg) symptoms make sense.
I want to do all that I can for this horse that has given so much to us humans and I really do hope that you can help us.
I look forward to hearing from you.
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Member:
rtrotter
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Posted on Sunday, Sep 26, 2010 - 2:55 pm:
Rosemary, Welcome To HA.
Sounds to me like your horse is brewing an abscess and that abscess is going to pop at the coronary band. Whether this was caused by the injection or this was a problem before the injection that the injection made worse, is an unknown. With an abscess,horses are so three legged lame that they appear to have broken bones.
Get the shoes off, (all of them) and have an equine podiatrist look at your horse and balance his feet. Do not put a shoe on the bad foot until you can figure out what's going on! Read Dr.O's articles on dealing with abscesses and go from there.
Also, if there is one thing I've learned over the past 4 years, its that you can not fix a lameness problem with corrective shoeing( unless the horse is on stall rest with a broken coffin bone although many people have tried. Most likely, your horses thin walls and soles, as well as the LTLH problems are the product of continuous shoeing over a long period of time and unless his feet are allowed to be out of shoes for a certain amount of time and his feet are balanced those problems will not go away and will affect his performance.
I wish you luck!
Rachelle
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New Member:
rosieint
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Posted on Sunday, Sep 26, 2010 - 3:08 pm:
Hi Rachelle,
Thanks for the post. It is really nice to read your thoughts especially as they are just what I want to hear i.e you think it is an abscess not a joint infection!
I have been reading a lot about infections and abscesses. What makes you steer towards it being an abscess? I have never dealt with an abscess before but thought it would get more painful as it built up. I find it really hard to understand why he was very lame 4 days after injection and slight swelling in coronet, day 5 on bute and not very lame, day 6 non on bute and not very lame, day 6 - 9 not very lame but swelling increased to just thickening in small area but still nothing major. I would have thought that the lameness would increase with the swelling not be a case of slightly more swelling, slightly less lameness... Could this be because the pus is travelling into the coronary band and therefore less pressure on the hoof and less lameness?
I too have through t about taking his shoes off and seeing if there is a sign of anything. The vet was keen to keep his natural balance shoes on as he thought that the abscess could come out the coronary band and the balance shoes are helping him balance correctly so didn't want to take them off as he doesn't have a lot of length to cut back if nothing could be seen and the shoes have to go back on again.
I would love to hear your thoughts.
R x
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Member:
rtrotter
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Posted on Sunday, Sep 26, 2010 - 3:58 pm:
Rosemary.
From your posts, this is why I think abscess.
"It is intermitent lameness. Some days he will hojp in trot trying to break into canter and other days it is barely noticeable. More often than not he moves putting in a stride or two ocassionaly which is out of rhythmn but otherwise is sound".
There is a thread here on Horse advice talking about long brewing abscesses, where the horse is NQR but nothing can be found, until the abscess blows and the horse almost immediately becomes sound again.
"tearing around in the field he damaged the hoof wall. After I had a brief chat with the vet but before she had been able to sit down and examine the images carefully I asked the farrier to put shoes back on him to prevent further damage (he is unable to stand in his box without banging his door and further damaging his hooves) and the farrier used filler and fitted wedge shoes".
If there was a defect in this horses hoof from the wall damage and the farrier filled it and trapped dirt under the filler and then put shoes on him. This is a perfect scenario for the start of an abscess.
"I am concerned that after shoeing last week on Thursday he has become more lame than before and is now lame on a straight trot up (something that he never was before)".
Getting worse.
I am concerned that you misunderstand what Natural Balance shoes are. Just because you put them on a horse does not balance the horse's feet.
What they are meant to do is move the breakover point back to a more natural point for the horse. However, if the horse you put the shoe on is not balanced, no shoe of any type is going to help.
The other thing that concerns me is that if your horse has LTLH, why wedge shoes. That only makes the condition worse. Makes the feet appear to look better, but in reality over time it shifts the hoof capsule and makes the condition deteriorate more rapidly.
And the fact that your vet doesn't want to take the shoes off, makes me question the vet and the farriers ability to correctly back up this horses toes.
Rachelle
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New Member:
rosieint
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Posted on Sunday, Sep 26, 2010 - 4:25 pm:
Hi Rachelle,
Thanks for the quick reply. Just thinking through what you have said and some more info on it:
The intermident lameness was what made me send him for the MRI. An abscess would have shown up then wouldn't it - therefore the initial intermident lameness wasn't caused by the abscess.
There were findings on the MRI which the MRI as above and the vet advised cortisone & remedial shoeing.
He then lost a chunk of hoof wall when out in the field without shoes post MRI. It was about 6 weeks ago he had filler in his hooves - wouldn't an abscess have come through before then?
I understand what NB shoes do. Sorry for using muddled terminology. I think the vet felt that having think soles and wall and them only being cut back a week and a half ago that it would not help him to have them taken off again and that the abscess could come out the coronary band.
My feeling is that an abscess gets progressivly worse or goes away. If in his case the lameness has got better but the swellling worse this does not seem to be the typical symptoms of an abscess does it to you?
The only other thiing that I discussed with the vet is the possibility of it being a coronary band injury. If this was the case wuldn't the swelling be in line with the lameness? Why non-weight baring lame day 5 after the coffin join infection and then lamenss getting better but swelling getting worse (swelling is not particularily noticeable except if you are looking and feeling for it but it is there nonetheless)?
I don't want it to be a coffin bone infection as that spells all doom and gloom. The vet didn't want to tap the joint and test the joint fluid for infection as if it is an abscess the abscess finds the easiest way out and could easily infect the joint.
I don't know where to go from here. I am going to call the vet again tomorrow. I am considering a second opinion as the longer you leave an infected joint the more cartillage damage that is caused. If it is a joint infection I would rather deal with it sooner rather than later.
I hope to hear from you soon with your thoughts. I really appreciate your time for whatever reason you are thinking about this with me.
R x
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Member:
scooter
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Posted on Sunday, Sep 26, 2010 - 4:53 pm:
Hi Rosemary, I have been battling this LTLH thing for years with my horse, it recently came to light that the synDrOme can cause irreversible damage to some tendon and ligaments.
I'm with Rachelle, I would get him out of the shoes and padding, sometimes that can be the problem in itself as I have found out the hard way! IF it isn't an abscess it could be many things. The wedges changing the angle putting upward pressure on the Coronet band, Having to much packing causing pressure on his thin soles, the injection, the shoe making sole contact, Natural Balance shoes need to be applied properly by someone who has learned the protocol to work.
My horse had an abscess not long ago, some days he was very lame, some days not, his coronet band swelled. I had the vet out he dug out a track from his white line, he said it was probably going to come out coronet band, it drained a tiny bit, horse remained lame for a week or better. Finally he was sound, never came out his coronet band, didn't see any drainage. This all took about a month
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New Member:
rosieint
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Posted on Sunday, Sep 26, 2010 - 5:20 pm:
Hi Diane, It is really interesting to read your post. I suspect that he has got soft tissue damage to a certain extent from his international eventing he must have some wear and tear but the MRI has ruled out anything major.
The mystery in all of this is the swelling in the coronary band and the 2 day non-weight bearing lameness several days after the cortisone injection.
Do you think that if the shoes were uncomfortable they could have caused swelling in the coronary band? I didn't consdier that. When he first walked in the nb shoes he looked like he was short in front and was wincing a bit. I thought that he would adjust to them but perhaps they are causing the problem. It is just weird how 5 days after the injection and box rest he is non-weight bearing lame and then 2 days after that much better but swelling still there.
I think the vet wanted to give the nb shoes some time but perhaps the best thing to do is to get them off and to start looking for an abscess firstly. If one isn't there to then wait for his feet to have grown to reshoe and see what that brings.
What do you think? Could nb shoes cause non-weight bearing lameness 5 days after having them put on, then 2 days later be much better but the swelling to have got a bit worse? Do you think day 5 was the peak of the shoes being uncomfortable and now he is getting more used to them? I am mightyly confused! What do you think?
I am so grateful for this resource and to meet people like yourself who I can discuss with. Which part of the world are you from? I am in England. I don't know if you can see a photo of my boy in my profile. I did put one on. Have you got a photo of your horse?
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Member:
rtrotter
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Posted on Sunday, Sep 26, 2010 - 6:40 pm:
Rosemary,
I am not sure if an infection leading to an abscess would show up on an MRI( someone enlighten me please!) and some of these things can hang around for quite sometime, where you know the horse isn't 100%, but can't quite put your finger on what's wrong. There is a good possibility, that this was there and what was causing the original problem and what was seen on the MRI was normal wear and tear for him.
I am not a fan of joint injections in general unless absolutely necessary, since in a lot of cases, most of the problems are caused by unequal use of other limbs and joints. Where a problem actually shows up is not necessarily where the problem began(primary and secondary lamenesses)and until you find the primary problem and treat that, your secondary problem will keep coming back.
The reason I do not think this is a joint infection is that your horse would still be miserable. These types of infections usually do not get any better unless they get aggressively treated and if he is better and not any worse then there is a possibility that the abscess popped and what you are seeing is the residual swelling that will eventually resolve.
If you would like to see a picture of my horse, you can do search on "road rash" ( her treatment and recovery from a racetrack accident) also you can do a search on "out of defeat comes victory"( I think part 1 may have the picture) my trials and tribulations with attempting to train a barefoot standardbred
Anyway, I hope this all resolves with a good outcome and you and your horse can get back to doing what you love.
Rachelle
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Member:
scooter
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Posted on Sunday, Sep 26, 2010 - 8:31 pm:
Rosemary I think the problem is, as you know it could be any of the things I named above or none . Dr.O. always tries to steer us towards diagnostics and not guessing games If you pull the shoes a hoof tester would probably tell you where the pain is in the hoof and a pretty good diagnostic of an abscess, if not in the hoof then I would suspect the injection.
Did your vet use hoof testers on your horse at all?
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Member:
scooter
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Posted on Sunday, Sep 26, 2010 - 8:43 pm:
BTW where are my manners welcome to HA. Your picture didn't show up in your profile.
My horse Hank is splattered all over HA, especially in the hoof sections We have had a long battle, and with the help of HA members and Dr.O. he is finally sound and barefoot...took 13 parts!!! If you care to read the long saga it is under hoof care...the four point trim... hoof Critique 1-13.... lot of good info in there how to help/trim this LTLH synDrOme.
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Member:
rosieint
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Posted on Sunday, Sep 26, 2010 - 9:13 pm:
I will have a look at your journey. It is nice you are still on the site giving advice to others who are in themidle of crisis mode!
The vet did use the hoof testers but I don't think that he found anything specific. The only source of tenderness was in the coronary band. He was very sore on his hoof wall the week before when the farrier used his clenches around the area that he lost his hoof wall before. I am not sure if that problem has gone away. I presume he would still be sore through the NB shoes to hoof testers if there was an abscess? There are lots of pieces to this jigsaw I just wish I was wise enough to piece them all together!
Maybe it is useful to put the summary jigsaw pieces in order:
2 year of low grade lameness;
MRI results showed pretty minor stuff, very mild changes in the navicular bone not specifically consistent with navicular disease, lateral co lateral ligament of the coffin joint there are some mild changes in that which imply there has been some strain to the top of the ligament, surface of the deep flexor tendon as it passes over the navicular is a bit roughened, and far too much toe lenght;
before could be treated for above he was barefoot for 3 days and tore the wall of his hoof;
shod with filler and wedges and lamer than usual; suspected bruised soles and wall from being barefoot and damage to hoof wall;
lameness subsides then injection and NB shoes put on, shoeing showed very sore on hoof wall;
after shoeing and injection lamer than usual for 2 days but improved;
5 days after shoeing he is non-weight bearing lame and slight infection to coronary band;
7 days after shoeing he is less lame but more swollen on coronary band but nothing dramatic still just a little puffy...
I am going to ring the vet tomorrow and will keep you posted. I am going to ask the vet the following I think
1. whether a long brewing abscess would show up on MRI. how long can they brew for?
2. whether the magic cusions pads could have pushed up a long brewing abscess caused perhaps through bruised soles or hoof wall crack
3. whether the fact he is always slightly lame after shoeing has any baring on diagnosis
4. whether if we take off the shoes we could rule out abscess by using hoof testers
5. whether if we take off shoes and no response to hoof testers we should tap the joint for fluid to test for infection
6. whether to give anti-biotics in case it is a joint infection will be helpful
7. whether I should try and draw the abscess out by doing anything?
Is there anything else that you would ask? I really appreciate your being there. Sounds silly but this evening has given me a lot of hope. Thank you :-)
 R x
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Moderator:
DrO
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Posted on Sunday, Sep 26, 2010 - 10:05 pm:
Hello Rosemary,
I cannot rule out joint inflammation from the information given, tapping and examining the fluid in the joint should be considered. Yes removing the shoe and using hoof testers would be a good way to rule in or out an abscess. If the lameness remains unknown I would localize it using the principles in the article HorseAdvice.com » Diseases of Horses » Lameness » Localizing Lameness in the Horse.
DrO
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Member:
juliem
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Posted on Sunday, Sep 26, 2010 - 10:10 pm:
Welcome Rosemary. Others will tell you I am always quick to blame farriers, but in your case you have the vet's opinion as well as radiographical evidence his toe has been left too long and the palmar angle is wrong. I also would suspect a "hot nail" given the time frame of the worsening lameness. At any rate, I can't think of a sound reason to leave him in shoes with the toes too long and the angle bad. That alone will exacerbate navicular synDrOme. You should of course wait for Dr. O's opinion, and you will find the rest of us are quick to give our opinions. I come down on the side of getting those shoes off, the angles corrected as much as possible and the toe backed up. A natural balance shoe that is improperly placed can put pressure on the sole right under the tip of the coffin bone. Add to this that the palmar angle is wrong and that alone could cause worsening lameness. The sole under the wide part of the NB shoe needs to be relieved and if this wasn't done, it will cause pain. I'd be looking for another farrier, but then I have no tolerance for a horse being worse after a trim or a set of shoes being applied. That just should not happen!
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Member:
scooter
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Posted on Sunday, Sep 26, 2010 - 11:22 pm:
The fact that he is always lame after shoeing speaks volumes... I had the same problem, whether Hank was being shod or just trimmed, took quite a few parts but we did figure out why
The shoes always had to be routed out for Hank to relieve sole pressure as Julie stated above, worked beautifully. When we finally went barefoot Hank was ALWAYS sore after a trim even if the farrier was conservative, he was doing this weird bevel that left Hank on his soles at the toe, he couldn't tolerate that due to his thin soles and many pathologies...That part is called the farriers Trim and shows pictures of it...Once that problem was resolved things started to get a little better after the farrier trimmed him...he has a touchy hoof!! Dr.O. stated in his last part #13 ( I hope) LOL, that when a horse has had a long standing LTLH it can change some of the tendons and ligaments, he didn't specify which ones YET, but I suspect they are some of the ones you mentioned that the MRI showed changes in.
Getting your horses hooves as balanced as possible and start bringing that toe back a lot of your problems may disappear, it is a long process and educating yourself so you know that your farrier is doing a good job helps. If this is the farrier that has been trimming him all along I would consider looking around. I wish I would have ditched the farrier that left Hanks hoof like that long before I did, I just didn't know better....Julie did and many others. Good Luck let us know what your vet says.
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Member:
rosieint
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Posted on Monday, Sep 27, 2010 - 3:21 pm:
Hiya,
Quite a good day with the vet and Pablo. Pablo's swelling in the coronary band is down and he is less lame. Here is a summary of the vet's diagnosis today.
1. That it is unlikey to be a join infection as this would not clear up on its own - phew! Once you have a degree of lameness with a joint infection it doesn't getter better it gets worse.
2. It is not likely to be an abscess as the swelling is going up and down. one an abscess starts to appear in the coronary band it doesn't go back down it fights its way out.
3. It is likley to be a reaction to the anithestic for the injection or is as a result of the new NB shoes putting different angles through the feet which has caused the swelling in the coronet band.
4. Pablo was sensitive around the navicular area today to hoof testers. The vet thinks that this may have actually been the cause of the lameness recently and that the swelling around the coronary band was a read herring. The vet thinks this may need addressing once the injection and NB shoes have been given time to work i.e. 2 more weeks.
Thankfully the MRI has shown what is going on in his foot so I know from the hospital vet what is going on in the navicular area "the surface of the deep flexor tendon as it passes over the navicular is a bit roughened and it can be the cause of low grade pain."
I think that this diagnosis is much more likely as I have noticed him a bit on his toes at times over the last few months which would be significant with navicular area pain.
Has anyone had any experience with this type of injury and can tell me what to expect? How easy is this to fix? Do NB shoes throw this problem up and is it likely that the pain will settle down or is he going to have to potentially go on meds or have rest to ease this pain in the navicular area?
The NB shoes have been fitted correctly I think... It is a reputable diligent farrier with a lot of experience so hopefully that can be ruled out.
All in all a positive day I think though. It seems that the joint infection is less and less likely so at the very least he could have a pain free life in the field if I can't get him sound enough to ride. Although I have my fingers crossed we can have more adventures together soon.
I am looking forward to hearing your views and experiences.
Rosie
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Member:
scooter
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Posted on Monday, Sep 27, 2010 - 4:00 pm:
Hi Rosie, glad things went well
IMHO as stated above by all including Dr.O. a good balanced trim, and getting the LTLH synDrOme under control will help your horse as much as anything.
Was your horse sound barefoot or at least as sound as with shoes, before he ripped his hoof wall apart??
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Member:
rosieint
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Posted on Monday, Sep 27, 2010 - 4:13 pm:
It is hard to remember what he was like barefoot as I was looking for any lameness as he has just got back from a thorough testing at the hospital. He went out the next day and that wasthen the wall was torn. I think the farrier also thought his soles were bruised from this as he has thin soles.
The LTLH didn't look too bad apparently in the last xray 10 days ago according to the vet. It was about 6 weeks ago that he first had the trim and wedges to address the broken back dosral palmer balance so perhaps they have corrected quite well already. They wern't shockingly bad before.
Perhaps the navicular pain is caused by the shoes?
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Moderator:
DrO
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Posted on Monday, Sep 27, 2010 - 6:01 pm:
Hello rosemary,
Concerning a accurate answer to your questions much depends on the severity of the deep digital flexor tendonopathy that you describe showing up on the MRI. Even more important might be the condition of the overlying cartilage surface of the navicular bone in contact with the tendon.
What does the radiologist who read the MRI say about the degree of damage, treatments, and prognosis?
DrO
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Member:
rosieint
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Posted on Monday, Sep 27, 2010 - 6:10 pm:
Thank you so much for your response.
This is what the vet who read the MRI and xrays at the hospital said
"Nothing too dramatic has come up at all. A few minor things going on. On both front feet he has far too much toe length. This can cause lameness as it puts pressure on the heal length and having the foot put back in balance can have a big difference.
Nothing too dramatic on the x rays. Very mild changes in the navicular bone of the left fore. Not specifically consistent with navicular.
MRI left fore foot, nothing dramatic. A few wear and tear type problems. The surface of the deep flexor tendon as it passes over the navicular is a bit roughened and it can be the cause of low grade pain. It is a bit of wear and tear type injury. The lateral co lateral ligament of the coffin joint there are some mild changes in that which imply there has been some strain to the top of the ligament. It doesn’t look dramatic and active at the moment
In the right fore foot there is a little bit of swelling in the coffin joint but nothing dramatic. Very mild fibrulation of the tendon but on balance on both front feet; the fact that he has worked so hard they generally look very good there.
Advises getting his feet back into dorsal palmer foot balance and some treatment by injection in the coffin joint may help him too. Overall very hopeful that he can get back and sound and into back into normal work."
I have read that there are various types of shoes that can be tried, and it is a not a case of one size fits all as there are various different issues under the banner of "navicular". Barefoot even to stimulate blood in frog, various meds that can help and if all else fails a neurolectomy (although I am hoping that I can get this international eventer back comfortably on his 4 feet without that!).
I look forward to hearing your views. I am so grateful for this resource and if my horse was called Ed and could speak I am sure he would say so too. This website has given me a lot of help and advice already and peace of mind and I am more grateful than words can express for your resource.
All the best
Rosie
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Member:
vickiann
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Posted on Tuesday, Sep 28, 2010 - 3:53 pm:
Good luck, Rosie.
Many of us here have found that when our horses' feet are put into proper balance laterally and medially some rather long-standing problems can be entirely repaired or greatly improved.
After years of various types of fancy shoeing all of mine are now barefoot and sound, including one old guy who had never been sound for many, many years and had been diagnosed with navicular. It is amazing how much remodeling can take place with proper trims.
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Moderator:
DrO
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Posted on Tuesday, Sep 28, 2010 - 5:45 pm:
Thanks for the kudos rosemary. I have a whole article of views, opinions, and recommendations on this subject and you have posted in the discussion area of this article just select Correcting Long Toe Low Heel Foot Conformation off the navigation bar at the top of this page.
DrO
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Member:
scooter
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Posted on Tuesday, Sep 28, 2010 - 5:47 pm:
"far to much toe length" can't be fixed in one trim FME, or if it is you will have yourself a sore horse usually, unless they have a very good hoof over all, with some concavity.
Can you post pics of your horses hooves? I'm rather neurotic about hooves and like seeing other peoples horses hooves, IF they are good Dr.O. may be able to give you an idea if they are long or imbalanced. Of course we all would have to throw in our 2 cents worth
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Member:
rosieint
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Posted on Tuesday, Sep 28, 2010 - 6:40 pm:
Hi Dr O,
I have read through the articles and I was also hoping that you would be able to give me your view having asked "What does the radiologist who read the MRI say about the degree of damage, treatments, and prognosis?"
I think I have answered that question above but if you need any further information do let me know. I would be grateful if you could let me know what you think about the symptoms, diagnosis, and prognosis having read the case as a whole. I am afraid it is rather spread over a few long posts but I hope you will find it interesting. I really look forward to hearing from you.
Diane, I will take some pictures tomorrow of his feet and upload them. Are there any views in particular you want to see? I don't think that he was in terrible shape but needed some adjusting.
Rosie
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Member:
scooter
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Posted on Tuesday, Sep 28, 2010 - 8:17 pm:
The views that are common are from the side, with camera level with the ground or near as possible, straight on, and solar view. Good lighting and clean hooves help too.
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Member:
ajudson1
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Posted on Wednesday, Sep 29, 2010 - 9:22 am:
Hi Rosie, and welcome.
I am another member who is a self taught barefoot trimmer and continue to study all and anything hoof related.
I always add "I am not an expert!"
First of all, please post pictures. It will help all of us see what is going on with the current trim. And help us learn too. To add to what Diane says:
Pictures from the side showing the whole horse is helpful too so we can see the shoulder angle.
Pictures from the heel looking towards the toe shows if there are any high spots, and shows the bars. Even a frog that is high in the middle can cause a problem!
LITTLE things can mean make a huge difference in a horses soundness. My one gelding, for example, who tends to paddle, paddles worse on his one leg if I leave so much as a smidgeon of extra hoof wall on that hoof!
I don't know if you mentioned it but has he been on a hoof supplement? What about a good all around vitamin and mineral supplement? I don't get into all the having my hay tested and such, but I do think that if something is lacking in horses diets it sure can make a difference on the hoof factor.
I am very anti-shoe! NO NO NO...lol! Boots yes, foam and duct tape, yes, lol!
It might take months with a good barefoot trim to see soundness. It might turn out to be something else all together. But I say start at the hoofs and go from there.
You can't post too many pictures to start out with. And save them on your computer. Oh, and it's helpful to mark each hoof. LF, RF, etc., on the sole, with magic marker and then label them in your folders, with the date.
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Moderator:
DrO
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Posted on Wednesday, Sep 29, 2010 - 3:01 pm:
rosemary, I apologize for not being clear, my question was rhetorical and meant to indicate that your radiologist assessment is what you must rely on. Here is why. I strongly believe the biggest strength of this site is what I don't do (and though only partially successfully try to discourage our members from doing): avoid strong assessments of individual cases. In these type cases much of the value of this site comes in educating you on "how" to evaluate your horse and then the best treatments based on the conclusion you have reached from your evaluation. But part of that education is teaching you to beware of assessments of your horse made by folks who have not examined him.
So we can discuss how to go about doing a good lameness exam, the specifics of what constitutes good proof of joint inflammation, and ways to approach horses with long toes and short heels, as we have above. What I cannot say with any accuracy is how this might or might not apply to your particular horse. That requires I examine the horse. I can say that from the information you have provided I have no good basis for disagreeing with the assessment of the images given by the radiologist or your veterinarian's diagnosis, treatment plan, and prognosis.
As described in the article on LTLH many horses with long toes and short heels and vague front foot lameness improve dramatically with correcting the foot conformation faults. Using the information I have provided in these posts and referred articles you and your veterinarian must decide how this may apply to your horse.
DrO
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Member:
rosieint
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Posted on Wednesday, Sep 29, 2010 - 4:18 pm:
Dr O,
Thank you so much for your reply. I am very grateful for the site's resources and personally find it very valuable for reading up on the typical problems in the hoof, the various symptoms, recommended diagnostics for assessment, and the experiences of others when treating veterinary confirmed problems.
I am thankful that I havce a good team on board with me and together we are trying to get on top of Pablo's lameness. I too believe that clinical diagnosis is the best way of establishing a problem. It is often very difficult when the horse is unable to feedback on how it feels and in this way the owner can be very useful in looking out for symptoms and feeding information back to the vet. It is only the owners who are able to collect the day to day symptoms and give them to the vet and therefore it is useful for owners to be clued up on what to look out for. I think that in particular owners can have a large part to play in lameness related issues if they watch the horse responding to day to day activities and veterinary treatment. Sadly as most owners are not veterinary trained nor have the ability to get a thorough breakdown of the issues, symptoms and treatments available from their vets due to time, that is when this site becomes an incredibly valuable resource to owners like me. We have come a long way since I when I first owned a horse as a responsible adult and tried to find out about my horses veterinary problems and was limited to the books at the local library!
Back to Pablo - Having established that after his cortisone injection in the coffin joint his foot pain is now in the navicular area or heel area I am considering what options there are to treat this. I wonder if you can help me with this. He is currently in his 3rd week with natural blance shoes and is due to see the farrier tomorrow for new back shoes, his natural balance shoes are not due to be changed for a couple of weeks. I would like to talk to the farrier about other types of shoes that may be good at easing heel pain. Since he has been in these shoes he has been lamer than ever. At first we thought that it was due to an abscess but having ruled this out as being the cause for him being more lame post the cortisone injection, I wonder if it is the natural balance shoes that are just not suiting him. I have read mainly that nb shoes are good for heal pain but here is one article that I read which suggests otherwise. I would be grateful for your view on this...
"The Natural Balance shoe is supposed to increase the Breakover (moment your horses foot leaves the ground). Instead of the shoe fitting along the border of the white line, it is set further back, just over the navicular bone. When the horse’s foot goes into breakover phase, the torque is placed directly over the navicular bone, increasing torque on the entire joint causing more pain and damage!" https://carnerequinepodiatry.com/NavigatingNavicular.aspx
The only thing that makes me thinks these shoes are not good for him is that he is more lame than before the cortisone injection and natural balance shoes. He is tender in the navicular area, I can see him not putting as much weight on the heel as the other front heel when he walks. I would be grateful for your views on all of this.
}
If a different set of shoes does not ease the pain I understand that there is an option for a cortisone injection in the naviular area - is that right? I also understand that there is medication that I can put him on that is typically used for navicular disease - is that right?
Of course the trim is a key aspect to how he feels on his feet. I thought that perfect foot balance was essentially putting the bone column allignment right and xrays are the best way of establishing this. Pablo has had his feet xrayed and his balance is ok but can be improved. I know that an external appearance of the hoof is a good basis to go on if you don't have xrays but if you do have xrays should you really be annalysing the exterior of the hoof to ascertain good foot balance? I may have this all wrong so please correct me if I am not right!
I look forward to hearing from you.
Rosie
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Member:
juliem
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Posted on Wednesday, Sep 29, 2010 - 4:45 pm:
Rosemary, I think you could go to Gene Ovenic's site www.hopeforsoundness.com and get some answers. You could email of call him I think. Gene is the originator of the Natural Balance shoe and trim. If your farrier did not relieve the sole under the shoe, it could very well be causing pain. This isn't the fault of the shoe, but of the way it was applied.
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Member:
rosieint
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Posted on Wednesday, Sep 29, 2010 - 7:30 pm:
Thanks Julie. It was very intesting to read the articles on the website. I am not sure what it means by "relieving the sole" as you put in your post. Do you mean giving a good trim? I can only hope that he has been trimmed well - it is hard for me to know...! I will certainly have a good look at whether he is trimmed according to the principles on the website i.e. "by evaluating the hoof mass distribution from the bottom of the foot to ensure there is more mass behind the widest part of the foot than in front, or at a bare minimum, a 50/50 ratio". It is intesting what is said in that if this is not the case "the hoof capsule has lost or is losing its relationship to the coffin bone" as this is a nice practical way of checking the basics. There is a good drescription on there of how to check this which I will do tomorrow.
It is just these types of tips that are so valuable for keeping a good eye on your horses and spotting things before they deteriorate. I have never had to look out for this before as thankfully I have not had any chronic albeit low grade lameness issues before.
Thanks again Julie
Rosie
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Member:
gramsey1
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Posted on Wednesday, Sep 29, 2010 - 9:21 pm:
Rosie,
We have had three horses with hoof problems. All three were better off bare. Two of the three are doing well with a barefoot podiatrist trained with K.C. La Pierre. One rescued from a kill pen is now working under saddle.
The other, an OTTB, once explosive and violent, now quiet and sane in a Dressage program.
I think the differences between the various barefoot methods is less important than the ability of the care giver to do exactly what Dr. O. and HA members cannot do: Make correct, authoritative , assessments of individual cases and execute effective treatment.
We can only encourage and point the way.
Is your guy ready to step back and help young riders go where he as been? Is it within his spectrum of useability?
It sounds to me like you have one of those really special horses that will do about anything you ask.
Listen to him, he will tell you what he can do.
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Member:
vickiann
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Posted on Thursday, Sep 30, 2010 - 5:36 pm:
Well said, Guy.
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Member:
rosieint
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Posted on Thursday, Sep 30, 2010 - 6:46 pm:
Thank you for the messages. Yes he is one of those really special guys who aims to please and is a lovely horse for everyone, I have even had a child friend of mine on him to inspire her for greatness as he is so easy and willing.
Unfortunately the vet came again today and after ultrasound ruled out an abscess the joint was tapped and found to be infected. I am on my way back from having just taken him to hospital and he will be operated on in the morning. Hopefully he will fight the 50% odds of successful cases and the infection can be flushed out. I feel in my gut that it will be ok but perhaps this is just positive thinking after the tears.
I don't know much about joint infections caused by cortisone injections so if anybody does have any information it would be gratefully received. All I know is what the vet has told me which is the odds and that the next 5 days will show with his ability to be comfortable on it whether they have got out the infection and he will make it.
Rosie
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Member:
vickiann
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Posted on Thursday, Sep 30, 2010 - 6:58 pm:
Wishing you and your horse a good outcome, Rosie.
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Member:
rosieint
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Posted on Thursday, Sep 30, 2010 - 8:51 pm:
Thank you. I am so very worried about him and don't want to lose him and have cried so much today.
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Moderator:
DrO
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Posted on Friday, Oct 1, 2010 - 7:34 am:
rosemary, I am so sorry to hear about the joint infection. Can you tell us what the cytology report of the fluid said? Concerning information on infected joints see HorseAdvice.com » Diseases of Horses » Lameness » Joint, Bone, Ligament Diseases » Joint Infection, Joint Ill, and Septic Arthritis.
The article does not specifically address infection following a steroid injection but there is more information at HorseAdvice.com » Treatments and Medications for Horses » Anti-inflammatories (NSAIDs, Steroids, Arthritis Rx) » Intra-articular Steroids, use in Arthritis. In one large study there was no greater incidence of infection in joints being injected with a steroid and those injected with other medications. So it may not be correct to think of this as "caused by the cortisone". But that is not to say it may not effect the course of the disease. It will help ameliorate the inflammation which you can conjecture will have the positive effect of sparing the joint some of the effects but on the negative side it may make treatment more difficult.
DrO
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Member:
frances
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Posted on Friday, Oct 1, 2010 - 7:57 am:
Oh Rosie, I'm so sorry and I really hope Pablo pulls through.
I think that there is always the slight possibility that bacteria which normally live harmlessly on the horse's skin may get carried into the joint with the needle if the skin hasn't been prepped sufficiently. Once inside the joint the bacterial population can explode because the cortisone has done its job and switched off the immune system.
Pablo sounds like a warrior - I'm sure he's going the fight this off.
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Member:
lilo
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Posted on Friday, Oct 1, 2010 - 9:32 am:
Just want to add my best wishes for a good outcome.
Lilo
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Member:
rosieint
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Posted on Friday, Oct 1, 2010 - 5:22 pm:
Hi Everyone,
I have posted in the secton under septic arthritis https://www.horseadvice.com/horse/messages/4/354883.html
The surgeon was really pleased with how the operation went and Pab's chances of success have gone up to 70:30 for coming home :-)
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