Shoeing/Trim Horse With Near Fore Suspensory Ligament Damage.

[RiderInBlack]

Just had a customer ring. Vet has diagnosed the horse as having damage to it's near fore suspensory ligament and has asked the hoof be trimmed/shod with a short heel and a long toe. I'm a bit rusty here, but seem to remember that a horse with tendon damage was to have a longer heel and an toe that easied brake-over. As I say I'm a bit rusty here and would like your advice.

[Phil Armitage]

I am not saying he is correct and I also do not know what would be correct however it sounds like the Vet wants to creat some reliefe in the front tendon not the rear. Think of it like this, you have cables and pullies in the front and the rear, to remove tension on the front cable raise the toe to relieve tension on there rear cable raise the heel. Simple concept, however will it work and would there be any problems caused? Personaly I would do what the Vets wants since he/she seems to have located the problem correctly and has a plan (I hope) ask the Vet a bunch of questions and make sure the owner also undertands the prognosis and after care.

[RiderInBlack]

[QUOTE=Phil Armitage]I Think of it like this, you have cables and pullies in the front and the rear, to remove tension on the front cable raise the toe to relieve tension on there rear cable raise the heel. [QUOTE]Is not the suspensory ligament one of the "rear cables"? Will be ringing the vet tomorrow. Have had problems with that vet before. He does not like being questioned. Hope we have a better relationship this time.

[Roy Amaral CJF]

The suspensory ligament inserts on the extensor tendon.

Lowering the hoof angle transfers it's load to the flexor tendons. Raising the hoof angle increases it's load.

Go check your anatomy books then come back. :)

[Rick Burten]

It has not been shown that trimming a horse out of balance does anything to help the tendons and ligaments repair.

Generally speaking, around here, we keep the foot trimmed for balance, effect the shortest phalangeal lever possible without soring the horse, and apply a blunt toed aluminum egg bar shoe. The leg is wrapped for support , the carbohydrate load is reduced to practically nil and the horse is given free access to a smallish flat, level and firm but not hard like concrete paddock. Bedding is kept to a minimum and the horse is kept out of any footing that is soft and/or could pull on the limb(mud, etc). Recovery time is a minimum of seven months.

rick

[caballus]

The suspensory ligament inserts on the extensor tendon.

From Adam's Lameness in Horses, "The suspensory ligament is predominantly a strong tendinous band containing variable amounts of muscular tissue. It originates from the palmar carpal ligament and the proximal palmar surface of the thrid metacarpal bone in the forelimb and descends between the second and fourth metacarpal bones. In the distal metacarpus it divides into two branches that insert on the proximal sesamoid bones. The extensor branches pass obliquely dorsad to join the common digital extensor tendon in the proximal phalangeal region."

Depending on where in the suspensory the damage is done affects the care and the prognosis. There are 3 types of SL injuries:

Proximal Suspensory Desmitis (Desmitis def.: inflammation of a ligament) is most noted when horse is worked on a small circle. Lameness may be slight or extreme at the onset. It can be dx with radiographs, nerve blocking and ultrasound. The lameness worsens in the 2 to 4 weeks following the injury and complete recovery takes up to 6 or 7 months.

Desmitis of the Body of the SL is less obvious with lameness but affects more heat, swelling and pain than PSD ... this type of injury is more common in racehorses than other sports. Dx is usually based on clinical signs. Ultrasound will pinpoint and detail. Prognosis is tougher in this injury and lesions may reside well after 12 months of rest.

Desmitis of the Branches occurs in both fore and hindlimbs. The injury and clinical signs can range from indetectable to moderate. Chronic injury is more detectable and has less of a favorable prognosis than the other lig. injuries. Series of ultrasounds is needed for determination of prognosis and continuing results of injury. Some injuries to the Body can also be detected with good xrays.

Treatment of all 3 conditions are basically the same and the total healing time can vary between 3 months and over 12 months. Treatments range from pinfiring and blistering to surgical splitting of the branches of the lig. Injection of bone marrow and shock wave treatments are also being studied and used.

--Gwen

[caballus]

In concurring with Rick's statement: It has not been shown that trimming a horse out of balance does anything to help the tendons and ligaments repair. I would add that when healing any part of a limb(s) one would want the injured 'piece' to be aligned and balanced according to the original state of that limb *at rest*. To allow the injury to heal in any other manner would affect an imbalance and possibly, an incomplete, ineffectual healing. Think of yourself breaking an ankle or leg and tearing ligs, tendons, etc. The leg is set in a cast positioned in the most natural manner for the particular limb at rest. This allows the bones AND the muscles, ligs, and tendons to repair to the original state allowing for the most effectual return to normalcy in functioning. Why would you want it any other way?

--Gwen

[calshoer]

The suspensory ligament inserts on the extensor tendon.

Lowering the hoof angle transfers it's load to the flexor tendons. Raising the hoof angle increases it's load.

Go check your anatomy books then come back.

Ditto.

The only part of the vets prescrition I disagree with is the long toe. I lower heels as far as posible on these, but I still maintain the breakover point in the correct antomical place (just ahead of the end of the coffin bone) to prevent exess strain in the tendons for breakover. Patty

[Phil Armitage]

[QUOTE=Phil Armitage]I Think of it like this, you have cables and pullies in the front and the rear, to remove tension on the front cable raise the toe to relieve tension on there rear cable raise the heel. [QUOTE]Is not the suspensory ligament one of the "rear cables"? Will be ringing the vet tomorrow. Have had problems with that vet before. He does not like being questioned. Hope we have a better relationship this time.

Hey I am just trying to make sense of the whole thing. The best thing you can do is talk to the vet, heck for all we know the owner heard long toe low heel and thought this is what you need to do when actually this is what the vet saw as the problem :confused: Ask the vet. to explain to you what is going on.

[Roy Amaral CJF]

It has not been shown that trimming a horse out of balance does anything to help the tendons and ligaments repair.


Wasn't Dr. Redden putting wedge pads on backwards to do just that? I thought I read that somewhere. :confused:

[RiderInBlack]

Thanks Guys & Girls. Good info. I hate just going in to jobs like this blind and ****. By the way yes I do know where the suspensory ligament is. I'm just a bit rusty and needed to refresh the old grey matter.

Just though I'd attach this diagramme from my old ratty Hickman's;)

[RiderInBlack]

Have e-mailed the vet earlier in this week. No reply, it's now 7:30pm Friday and I have the horse booked on for tommorrow Sat. Great:rolleyes:

[Ronald Aalders]

Wasn't Dr. Redden putting wedge pads on backwards to do just that? I thought I read that somewhere. :confused:

I don't know where you read that Roy, but I did once try and derotate a clubfoot with a reversed wedge, before applying a banana shoe. I posted it too somewhere here.

I thought it was definitely brilliant, but Dr. Redden did not like to idea too much. :o By the way the horse did not do much different with the reversed wedge. Somehow I still like the idea.

Derotation (or realigning) can sometimes require a raise of the toe. Like on a flat low heeled (TB type) laminitic horse, you'll find you can not lower heels to derotate at all. Here you'll need acrylics to glue on a shoe to allow realignment of P3, like Dr. O'Grady describes. A long time ago Redden mentioned somewhere a welded on strip on the toe of the shoe that would allow the use of screws in the dorsal hoofwall to keep the foot in a correct position. Obviously the correct position being the one where P1, P2 and P3 are correctly aligned.



Ronald Aalders

[Roy Amaral CJF]

From Adam's Lameness in Horses, "The suspensory ligament is predominantly a strong tendinous band containing variable amounts of muscular tissue. It originates from the palmar carpal ligament and the proximal palmar surface of the thrid metacarpal bone in the forelimb and descends between the second and fourth metacarpal bones. In the distal metacarpus it divides into two branches that insert on the proximal sesamoid bones. The extensor branches pass obliquely dorsad to join the common digital extensor tendon in the proximal phalangeal region."



Nice right out of the book.

:confused: Anybody know what's missing from this description? :confused:

Ronald - I don't know where I read/heard/saw that either. ??

[Jason Maki]

Ron,
the quote tacitly states that the extensor branches course dorsodisdad bilateraly, but does not state that explicitly. Also, the function is not stated: to catch and reverse the downward movement of the fetlock under load, and to provide impetous up from maximum load until the DFT can flex the limb. The sprig up also releases the extensor tendon which allows the horse to extend the limb.
Is any of this what you were looking for? :confused:
Jason
PS: Could I have your email address, I want to send you a photo of my first attempt at a lateral balance hind, fullered to the heels, hammer finished. I am not 'puter literate enough to set my gizmo to post pics on the web. Thanks!
Jason

[jamesrooney]

Ladies and gentlemen, this way is confusion! There was good advice about going to the anatomy books but insufficient advice. Whatever the merits of the Adam's book, it is not an anatomy text and much of what it says about "functional anatomy" is either wrong or insufficient.
In general, lowering the hoof angle, however done, makes the pastern move upward which decreases tension in suspensory and both flexors. Raising the heels, increasing the hoof angle, does the reverse.
The branches of the suspensory do attach to the common extensor tendon on the dorsal surface of the pastern and play a variable role in resisting the rotation of the coffin joint as the load comes on the leg. Those branches play no role in what the rest of suspensory does and contribute not at all to what happens when the suspensory has been damaged.
Cutting to the chase; there is no evidence whatsoever that changing hoof angles has any effect, good or bad, on the healing of tendon or suspensory damage. A well-balanced foot is the best you can do; and feel free to tell your veterinarian that this veterinarian said so!
There is much more to be said- perhaps another time.

[Jason Maki]

Dr. Rooney,
You would then advise basic, balanced shoeing and rest? I think I read that somewhere here. Did I not Mr Burt-n-Ernie ? :D
Jason

[Rick Burten]

[QUOTE=Jason Maki]>Dr. Rooney,
You would then advise basic, balanced shoeing and rest? I think I read that somewhere here.

:D "I coulda' been a contender.... I coulda' been a contender" M. Brando

>Did I not Mr Burt-n-Ernie ? :D
>Jason

I like that--Burt-n-Ernie! Jason, me thinks you have solved the riddle of at least two of the remaining unknown/named characters that rattle around in my skull. Sadly(at least for my waistline), I have always felt that the Cookie Monster was one of my alter egos. Along with Oscar the Grouch.

Rick,( no, Two Dogs, no, El Magnifico, hey you guys, shut up and eat those new Oatmeal Raisin cookies before anyone else does, no, no, no. Would someone please pass the Pynchk lemonade. Puhleeze)

[jamesrooney]

Basic Mechanics of the Hoof and Horseshoe at rooney on the web site here.
Yes, Jason, that is precisely it. As for the next post, I confess I have no idea what the gentleman is talking about.

[Rick Burten]

Basic Mechanics of the Hoof and Horseshoe at rooney on the web site here.
Yes, Jason, that is precisely it. As for the next post, I confess I have no idea what the gentleman is talking about.

Dr. Rooney, who ya' calling a gentleman?

Regardless, see post #5 in this thread.

Because of my admittedly skewed(warped and multi) POV, my subsequent reply to Jason reply becomes obvious. At least to me.

Burt-n-Ernie

[Roy Amaral CJF]

From Adam's Lameness in Horses, "The suspensory ligament is predominantly a strong tendinous band containing variable amounts of muscular tissue. It originates from the palmar carpal ligament and the proximal palmar surface of the third metacarpal bone in the forelimb and descends between the second and fourth metacarpal bones. In the distal metacarpus it divides into two branches that insert on the proximal sesamoid bones. The extensor branches pass obliquely dorsad to join the common digital extensor tendon in the proximal phalangeal region."



Jason, you're digging to deep.

A hint (stuff in red). :D I don't think this is widely known. At least I didn't know it until the subject came up at one of those useless forging clinics where we don't learn anything worthwhile. ;)

I'll PM you my address. If I put it up here I'll get a hundred E-mails advertizing "natural male enhancement" and the like.

[Jason Maki]

Let me see if I can recall the lecture Chris Gregory gave (I'll be peering through eight years of stuff, but I"ll try!):
The suspensory lig. is a broad oval band with muscle tissue in its make up it originates at the proximal cannon bone(3rd metacarpal) courses disdad, (here it would be between the splint bones, 2nd and 4th metacarpals?) bifrucating and inserting at the proximal to midline of the sesamoids. It bifrucates again, courses dorsodisdad and attaches to the main extensor tendon at distal PI. It absorbs the downward movement of the fetlock, and provides impetous via its muscle tissue for the upward movement of the metacarpalphalangeal joint. It is also an odd Ligament as it connects bone to tendon and bone.
I think thats a basic overveiw, and SHOULD be wideley known and understood by anyone who trims or shoes a horses foot. Do you think its not known and understood! :eek: :o :D
Jason

[Roy Amaral CJF]

No, what what your notes and Adam's say is 99% correct and I think well understood.

It inserts on the proximal surfaces of the second and fourth metacarpals as well. Kind of a broad flat attachment to all three bones.

Makes you wonder if this is the mechanisim by wich horses "Pop splints"

[Jason Maki]

Interesting thought! If the interoseous ligaments of the splints have not ossified, then a major overloading of the suspensory apparatus could definatley 1)challange the proximal attachment(very solid) and 2) find the weak point, or the attachment of the 2nd and 4th metacarpal via the interoseous ligs. of the splintbones on horses under 5 or 6, depending on the breed. :cool: This, in theory could cause a splint. You learn something everyday. Thanks Roy!
Jason

[Roy Amaral CJF]

Don't thank me, thank Mitch Taylor. He's the one who showed me that little gem. One of these days I'll have an original thought. :o

[Jason Maki]

I think we are all in the same boat here! Everytime I think I've "discovered" something, I find out very quickly that someone else has told me the gem; I just lacked the knowledge at that time to glean the height and depth of the information. When I finally have enough knowledge to understand what I've already been taught, I have a moment of elation, then an epiphany that I already knew that, but had never put the parts together...
We are all simply students! :rolleyes:
Who ever had the "original thought", its a good and usefull application of anotomical knowledge.
Thanks again,
Jason