Re: ongoing mystery lameness

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Comments:
: : I'll try to be concise about this problem which has been going on since July. : : Previously sound thoroughbred mare, attended week long eventing clinic in early July, doing advanced level jumps on hard ground. Shod with pads due to flattish feet. Threw left front shoe one day, and reshod by clinician, who was trained as farrier. Threw R front shoe next day and reshod again. went extremely well at clinic, with no suggestion of lameness. : : Came home, had several days off, came out of stall looking 'stiff', gave a gram of bute in pm , and again in am, went sound. : : Sounds like she was stiff and sore from the clinic and probably had some sole bruising to boot. : :attended Pony Club 'b' test, jumping 3'6,lunged, some cross country, hard ground- very sound. : Considering that she had been so stiff/sore and was only sound on bute, this was not a smart thing to do. : : Two days later, came out of stall lame in L front. Oddly, no heat in feet, no digital pulses, all joints and tendons fine. Vet saw, and could find nothing. Blocked L front foot, went sound in L, but also lame in R front! Blocked R front, and went sound. : So, in reality, she was still hurting on both fronts, the left worse than the right, which only showed up when she was blocked. Given the previous history, this does not suprise me. : :A few days later, x-rays done to rule out navicular- no pathology found! : Radiographs are the least precise way to determine Navicular disease, and are of even less value in determining if Navicular Syndrome is present. : :examined with hoof testers- no reaction to pressure anywhere, frogs, sole, walls included. : Deep bruising or inflammation does not always show up with hoof tester usage. : :Large heel cracks present in bulbs of heels- working diagnosis, bruising of both front feet, plus or minus soft tissue infection in heels. Treated with soaking, cleaning heel cracks rigorously, one gram of bute/day and rest. Dramatically better on small bute dose, but not quite sound. Over time, this gradually resolved, and the horse went sound. Competed at the prelim level : : ( 3'6) at 3-day event, and went extremely well- no suspicion of lameness. : It appears that the inflammation in the feet had subsided to a sub-clinical level but was still present. : : 3 days after show, came up dramatically lame in L front foot, with heat, increased digital pulse. We felt that this was probably an abcess, possibly secondary to being close nailed by clinician at eventing clinic.Soaked foot, bandaged and poulticed with animalintex, and after three days blew huge absess with a lot of pus out the coronet band ( leaving 1 1/2 inch exit wound). Much sounder, but not quite sound. Treated by soaking wound, and maintaining cleanliness for 3 days, as horse gradually became sounder. We stopped treating the foot, as the wound appeared to be healing well, and the horse was almost sound. The horse then gradually became more lame- the vet saw, and felt that the exit wound had become secondarily infected, and prescribed 5 day course of oral anitibiotics. The horse gradually improved, to the point of trotting nearly sound on concrete, and being lame in the turns both directions, then became increasingly lame again. Vet saw, and prescribed higher dose of antibiotics, over a longer course. Again, the horse responded, becoming increasingly sound, but deteriorating after anitibiotics were stopped. Throughout, we continued to treat the foot by cleaning the heel cracks, which are almost resolved, soaking the foot in warm water and epsom salts 2x per day, and keeping it bandaged and clean. The horse then blew small abcess out bulb of heel, close to crack, and proceeded to become more sound. She was reshod, and the farrier found old bruising in the R front, which would fit with our theory about initially bruised feet. She also identified corns in both feet, R worse than L. : : The horse has currently improved to the point where she is almost sound, and is being handwalked on the theory that this will increase the circulation in her feet, : Good idea, and not a theory, but a fact. : :and aid in resolving the infection. She appears sound at the walk and trot when going straight, and somewhat lame in the turns both ways. Undersaddle though, you can feel that she is not quite sound on the concrete at the trot. : She is still lame, stop riding her. : : My questions: : : -is there a possible diagnosis which we are overlooking, or does all this fit with an abcess due to shoeing? : It may or may not be related to the shoeing, but is definately related to the jog you asked her to do. : : -if the horse does not progress to being sound, what might the next steps be? : A further and complete lameness evaluation. : : -Our farrier is a bit concerned that her heels are slightly contracted ( not very much), and is wondering if egg-bar shoes will help support her heels. ( long term, I am reluctant to have her event in egg bars, as she is short backed and long legged, and pulls shoes as it is.) : Egg bars do not appear to be indicated at this time. However, she may have some pedal osteitis and if she is long toed/low heeled(and especially if she is thin soled), some trauma in the navicular region. : : - any suggestions about how we could have handled this better?- thanks- Marta : Personally, I think the horse needs to be shod with hospital plate shoes and rim pads and medicated packing, given free choice exercise with no riding, and her diet adjusted such that her carbohydrate load is reduced while the protein level is maintained or even increased. Once all the issues have be satisfactorily resolved and the horse is back in work, she should not be worked over hard ground or big jumps unless she is wearing both a rim and a full pad and there is no sole pressure and the structures of the foot are adequately supported. : Rick