|
|
Discussion on Derotation of pedal bone in both front feet
|
| Author |
Message |
Member:
Meggles
|
Posted on Sunday, May 14, 2006 - 6:25 am:
Hi Dr O. I've suspected for around a year now that things weren't 100% with my mare. Her stride shortened up this time last year and I brought her in for two weeks box rest as she'd put on some weight and it was an opportunity to rest her and get the weight off. She was fine afterwards but has continued to be short striding on and off and is now struggling over uneven ground, down steep hills (unusual as she normally strides out downhill) and looks choppy and uncomfortable on the lunge. The advice last year was that she is jarring up on hard ground and that I should give her a bute a day through the summer months. My personal view was that this didn't seem right so last week I took her to my local practice for a work up and xrays.
On the work up, she was clearly not 100% and the diagnosis was that she is mildly lame in both front feet. In fact 1/10 in her RF and 2/10 in her LF. She was also not tracking up with her hind limbs although we felt that this was because her stride was so choppy in front due to foot pain. We nerve blocked her LF and she continued to be 1/10 lame in the RF but sound as anything in the LF.
We then did the xrays which I have attached and would like your opinion on please.
They showed that she has slight derotation of the pedal bone, more so in the left fore but definitely in both. My vet has spoken to my farrier about corrective shoeing to rebalance the heel:toe as she is flat footed. Yesterday Meg has her toe rolled shorter and she has a silicone / gel type sole pack put in to absorb concussion and to support the sole and frog. This pack goes in runny (a clear gel) and sets hard. Its been put into the sole and all the way back to the base of the frog, including over the frog. She was sore from the trimming yesterday so is now on bute for a couple of days which I will then withdraw to check soundness. We will assess in one week whether she is still lame.
What are your thoughts? Can this really be corrected? Also, the navicular bone looks cloudy in the right fore xray. Does this have any significance?
The pictures look a bit big on the preview - sorry. Not sure how to make them smaller.
Thanks
Sarah
|
Moderator:
DrO
|
Posted on Sunday, May 14, 2006 - 10:01 am:
Hello Sarah,
The radiographs are under-exposed or underdeveloped making then difficult to judge. About the only thing we can say is that the coffin bone is not aligned with the pastern and it has lost some of the normal obliquity with the ground. But because we cannot place the front wall on the image the amount of rotation there is unknown to us. Since these are pre-trimming radiographs we cannot make recommendations on what needs to be done next however these problems are most often correctable.
The question is, "What is causing the lameness?". Is this navicular synDrOme or is this a chronic founder case? They both present with symptoms as you describe and the information you have provided so far does not differentiate the two. A really low PDN block, under the edge of the lateral cartilages, might help if this question remains in your veterinarians mind. For more on this go to the hoof lameness section and see Overview and the specific articles on these two conditions.
DrO
|
Member:
Meggles
|
Posted on Tuesday, Oct 3, 2006 - 6:48 am:
Following the diagnosis from my previous post, Meg has continued to suffer from problems and her lameness has started to worsen so I booked in for an MRI scan on both feet. This has been with a different veterinary practice who have been excellent to date. The prognosis was as follows:
History - the horse has a history of bilateral foot pain, not helped by remedial shoeing. The lateral walls of the forefeet are higher than the medial walls. Bilateral lameness in both feet at approx 1/5 was abolished with palmer digital nerve blocks placed in both forelimbs. Navicular bone sclerosis was judged to be present, more prominantly in the left foot.
MRI results (same for both feet) - A small core type lesion was observed in the medial collateral ligament of the distal interphalangeal joint, near the insertion on the distal phalanx.
Treatment plan - remedial farriery in conjunction with a period of restriction. Critical is the maintenance of foot balance to avoid a reoccurence of the injury.
I discussed the treatment in detail with the specialist and agreed that we would keep the shoes off but trim the foot appriopriately to restore balance. Hopefully with her shoes off, the feet will start to develop themselves better anyway. Meg has epilepsy and so i am nervous about prolonged box rest. We have concluded that rest could consist of either 3 - 6 months of total pasture rest or 3 - 6 months of day time turnout and stall rest at night. The shoes will stay off and she will be trimmed every four weeks.
I'm interested in your views on this issue generally, particularly in respect of the treatment plan and future prognosis based on your experience. I'm unsure of which of my options is the best in terms of ensuring a positive outcome. I should say that Meg is very quiet in the field but, as they all do, she will have the odd short burst of canter every now and again when outdoors. If she is turned out, i don't have the ability to restrict the area.
Any other members experiences would also be appreciated.
Thanks
Sarah
|
Moderator:
DrO
|
Posted on Tuesday, Oct 3, 2006 - 9:40 pm:
I hate to not be of much help here Sarah, but I don't see much that I can comment on. I cannot see the MRI nor examine the lame horse and I only know what you tell me. I never disagree with balancing the feet and as to stall or pasture that decision is best made by someone who can see the lesions. However collateral ligament lesions in general have a better prognosis with enforced stall rest. Bilateral core lesions to the ligament is a bit odd: does this horse have poor bilateral conformation of the front feet?
I sense you do not trust the diagnosis and treatment. If you are skeptical have the MRI reviewed by the radiology department of a university veterinary school that does MRI exams.
|
Member:
Meggles
|
Posted on Wednesday, Oct 4, 2006 - 6:38 am:
Yes, she does have poor conformation in her front feet. She has short upright pasterns and in a straight line she clearly steps onto the front outer quartile of her foot first. This apparently is what has caused the damage as they related it to her turning over on her ankle with every foot fall. When looking at her from the front, the outer wall of her front feet is shorter from coronary band to ground than the inner wall and also grows down from the coronary band at a steeper angle than the inner wall.
My concern with the prognosis of box rest is that vets here in the UK seem to recommend it for everything. Natural methods of turning horses out or taking their shoes off to allow them to heal naturally are considered to be quite alternative and a last resort when all else has failed. I want to make absolutely sure that box rest is necessary by exploring all avenues before making such a decision.
The specialist that examined the MRI scans is a partner of the University of Nottingham (as is the practice) so I'm unlikely to get a better diagnosis. The recommendations were varied, really leaving the decision to me as to what treatment to choose by way of rest. The emphasis from the specialist was on getting the feet balanced, after which, they felt that she may come sound, she may not, as they have seen inconsistent outcomes from this type of injury. I think the problem is that these type of injuries haven't commonly been seen and as MRI scans are relatively new here, there aren't lots and lots of case studies to compare to by way of outcomes. Not so long ago Meg would no doubt have been diagnosed with navicular synDrOme. I do trust this vet but to his own admittance he is limited by not having seen too many horses with this type of condition.
I appreciate you can't see the scans and so its difficult to make a judgement, but in your experience how long would you suggest she might need to be stall rested for for this type of injury? Are we talking a couple of weeks, or months?
Sarah
|
Moderator:
DrO
|
Posted on Thursday, Oct 5, 2006 - 8:14 am:
That is a question I can answer. Yes collateral ligament injuries need stall rest to get well. In fact lack of healing of these injuries in the past, often with a poor diagnosis because MRI was not available, has been attributed to not enough stall rest.
DrO
|
Member:
Meggles
|
Posted on Thursday, Oct 5, 2006 - 9:23 am:
Thanks for this. Meg was seen today by an excellent farrier who was to make a decision about barefoot vs shoes to help resolve the problem. He decided on shoes in the end in front, and off behind. He didn't feel that the ligament problem would right itself fast enough by trimming her correctly and waiting for the foot to grow into the correct shape on its own. He's put a shoe on with a packing material between the shoe and hoof to raise her foot on the inside wall. With a T Square she looks perfect with the new shoes and is walking better already. What is has shown is that she throws her right foreleg out slightly when she walks naturally so i guess that may cause her problems later in life.
The vet committed to a treatment regime after being pressed and has recommended 5 weeks box rest and a review back at the practice with him and the farrier after that time to see how she is. I really hate box rest but if its the only way to help her condition then I will grit my teeth and get on with it.
If she doesn't cope and needs to go out for a couple of hours a day in a smallish paddock, is that likely to be detremental, given that she will be standing in for 22 hrs a day?
|
Member:
Canyon28
|
Posted on Thursday, Oct 5, 2006 - 12:42 pm:
I owned an older brood mare that came to me with the same problem in both front feet at 18 years old. We did xrays to confirm, and then she was always kept shod in front with shoes that were long enough to come all the way back to the end of the heel bulb, so they were a little long, but she never pulled them off. It was very important that they be long behind the heel to support the heel, where the pain is. Also her toe was kept short and in line with the slope of her pastern, like it should be. I believe that years of long feet in wet pastures is what caused her pedal bones to deteriorate, because too long of feet pull on the pedal bones and tendons. A lot of folks dont feel that broodmares need any foot care, and what she developed was the result of years of farrier neglect. She was a very good riding horse at one time, so it was a shame. I rode her once, not long after I got her, and realized at once she had a severe foot problem. The shoes also had double thickness welded on at the heels for several inches, so her heel was raised up quite a bit. She remained pasture sound and got around real well for the rest of her life. We tried some of those balance shoes and they didnt work on her at all. I lost her this spring two days after she foaled from a nicked uterine artery. She was 24 years old. Getting her shod this way every 6 weeks was not cheap, but she gave me three super quality foals, the oldest is a good show horse with earnings in the NRHA and NRCHA, as well as AQHA points. It was definitely worth the expense to keep her comfortable all those years. you farrier might have to experiment with several different shoe styles and heel heights , toe lengths, etc to get your mare comfortable again. Also once we got my mare walking without pain, I kept her out in a pasture almost year round and made sure the water was a good three or four hundred feet from where I would feed her in the winter. I think that keeping them moving is very important.
|
Moderator:
DrO
|
Posted on Friday, Oct 6, 2006 - 7:44 am:
Christine the problem you describe, chronic founder, is different than the eventual diagnosis made of this horse.
Sarah, that is really a question best asked of the one who has made the diagnosis but for help with stall resting your horse see, Training Horses » Behavioral Problems » Stall Resting Horses.
DrO
|
Member:
Canyon28
|
Posted on Friday, Oct 6, 2006 - 1:11 pm:
Dr O, my mare was never foundered, she had absolutely no rotation what so ever. She had a lot of heel pain because of the years of strain on her pedal bones from years and years of having feet that were left grossly over long. She came from the Pacific North west where pastures are wet and lush and their feet just dont wear down from normal walking. I have another mare that came from the same area that has almost the same problem. Her feet were at least two inches too long when I got her hauled here years ago.
|
Member:
Frances
|
Posted on Friday, Oct 6, 2006 - 1:29 pm:
Sara - do you think Meg would still have the "odd short burst of canter every now and then" even if she was in the small paddock (rather than the field) for just two hours a day? I agree with you so much, it really goes against the grain to keep them in 24/7, especially when you're ALMOST certain they'll be calm outside.
And then of course when the time comes to put them out in this same small paddock AFTER they've been incarcerated for weeks or months, there's no way they'll be calm, possibly undoing some of the healing that's been achieved.
Very difficult decision (sigh). I feel for you!
|
Member:
Meggles
|
Posted on Saturday, Oct 7, 2006 - 8:01 am:
Yes, I agree, there's no guarantee. Even the quietest ones go stir crazy after being in for a few days. I think she'll probably be fine in the box as long as she's overfaced with food the whole time and the other horses on the yard have different routines, coming in and going out at different times so that should keep her mind occupied too. Luckily we have really nice hay so she can chomp on that all day long. The big problem I have with her is that she's epileptic and so I try to keep her outdoors as much as possible. She's safer outdoors as a full blown seizure means her going up and over backwards. She's never had a seizure indoors despite coming in all night through the winter months and hasn't had one at all for 6 months now. However, if she's in all the time and feeling stressed, who knows what will happen. My last resort if she starts to get stressed is to put her on PCP and hope it takes the edge off her a bit. Having said that, I'd only do that if things got really bad.
If only things were straight forward!!
|
Moderator:
DrO
|
Posted on Saturday, Oct 7, 2006 - 9:53 am:
My apologies Christine, I read your first 2 sentences to be confirming with the title of this post and the treatment for mismanaged chronic founder is very similar to mismanged chronic heel pain synDrOme. Both often have some amount of rotation and in both try to return the pa balance and relation of the coffin bone to the hoof capsule back to normal. Christine's comments about horses with chronic heel pain synDrOme doing better out and moving around is very frequently true.
DrO
|
|
|
