Can wedging cause ringbone?

[jlthompson]

Hi all,

I have an 11 year old Arabian gelding that was diagnosed with a torn medial supensory ligament of the navicular bone two years ago (shortly after I bought him), in his right front foot. It was diagnosed via bone scan and a CT scan. He was about a grade 2 lame on a circle, much less lame on the straight. Digital x-rays at the time showed no arthritis anywhere. X-rays also showed some moderate sidebone, but the vet didn't seem concerned about that - just said to make sure he got a very balanced shoeing job from then on. Protocol was six months stall rest, a bar shoe with 2 degree wedge pads for several months, then down to 1 degree for a month or two, then back in flat NB shoes. I gradually returned him to work before he went into the flat shoes and all was going well until then. After a month or so in just the NB shoes with no wedge, he showed a slight lameness on his right front again when circling left, but still sound on the straight, even after rides of 25 miles or more.

At this time, I switched farriers, to a very competent NB farrier. He has worked with Gene, and knows so much about the anatomy of the horse's foot, that I feel completely secure with him shoeing my horse. I love his work. He took the heels down more, did a more correct NB trim, put 2 degree wedges back on, with frog support and Magic Cushion. Horse immediately improved, then successfully competed in numerous CTRs for the last half of 2005, without lameness (even on a lunge-line circle for the ride vets). I was thrilled. We have stuck with this shoeing protocol since then.

Several months ago, I had my vet x-ray him immediately after a shoeing, so my farrier could check his angles, etc. We were suprised and dismayed to see the beginning of ringbone on P2, on his right front (the one with the injury). It is not near the joint at this time, and is just a tiny bump that shows up on the oblique view, about midway down on P2. He was still sound though, on both the straight and circling both directions.

I read in another thread that wedging can exacerbate ringbone. Can wedging maybe cause it too? I feel like now I'm between a rock and hard place. Do I continue with the wedging to relieve the strain on his navicular suspensory ligament, or take him back down in hopes of stopping further progress of the ringbone?

Btw, he is still fine on flexion tests of the pastern joint, so I don't think the boney growth is bothering him yet. I plan to take more x-rays in six months to see how fast it is progressing and if it is getting near the joint.

Also, to throw in a monkey wrench to the whole thing...vet was just out for shots this past Friday, just hours after the farrier left, and we put him on the lunge for a quick lameness check, and he was slightly off on the circle again...right front foot again...he is still in the wedges. :( I'm hoping it's a coincidence, and that it is unrelated, but I guess it's unlikely since it's the same foot. He was recently moved to a full turnout situation and has been romping with his herdmates quite a bit, so maybe he tweaked it. Also, bad cir***stances caused me to let him go to 10 weeks before being re-shod this time. He was re-shod just hours before the vet came. Maybe his angles changed because of the horribly long time he went, and then the sudden change caused him to be a little gimpy when the vet checked him right after? Btw, that won't happen again. I usually go no longer than 7 weeks.

So now I really don't know which direction to take. He is still sound on the straight and only a .5 to 1 grade lame when circling left, according to the vet. He seemed a little better when I circled him in the round pen last night, but I could still see it a little. I haven't discussed this with my farrier yet, because he left before the vet got there and did the lameness check.

Any ideas? I guess my main question is whether wedging can cause ringbone to start up...and what does one do when their horse has both an old injury to a navicual suspensory ligament, and the beginning of ringbone appearing on x-ray? Help!

I am also wondering if his sidebone has been playing into this all along. Can sidebone be irritated and cause an intermittent lameness? Seems like since he's still sound trotting in a straight line, there is something about circling that is bothering him - like something on the medial side of his foot. A second bone scan and digital x-rays showed his ligament had healed with practically no calcification, so... ?

I'm so depressed to see him lame again, even if it is very slight. I thought we had this whole thing licked!

Thanks,
Jennifer

[Rick Burten]

I have an 11 year old Arabian gelding that was diagnosed with a torn medial supensory ligament of the navicular bone two years ago (shortly after I bought him), in his right front foot.
At this time, I switched farriers, to a very competent NB farrier.
Let me see if I got this right. Farrier #1 follows the prescribed veterinary protocol, improves your horse's way of going, and as a reward, gets fired, right?

Regarding Farrier #2 you said: I love his work. He took the heels down more, did a more correct NB trim, put 2 degree wedges back on, with frog support and Magic Cushion.
1. How do you know it was "a more correct NB trim"?
2. Evidently F#2 went back to an earlier part of the protocol instituted by F#1, right?
Horse immediately improved, then successfully competed in numerous CTRs for the last half of 2005, without lameness (even on a lunge-line circle for the ride vets). I was thrilled. We have stuck with this shoeing protocol since then.
But you didn't give Farrier #1 the same opportunity to attempt remediation, right?
Several months ago, I had my vet x-ray him immediately after a shoeing, so my farrier could check his angles, etc. We were suprised and dismayed to see the beginning of ringbone on P2, on his right front (the one with the injury). It is not near the joint at this time, and is just a tiny bump that shows up on the oblique view, about midway down on P2.
And the vet offered no insights as to why the problem had appeared? (note) the location of the lesion seems to preclude diagnosing it as ringbone.
I read in another thread that wedging can exacerbate ringbone.
That would be, 'the incorrect use of wedges can exacerbate ringbone'.
Can wedging maybe cause it too?
The incorrect application of wedges could certainly be a factor. However, what you are describing is not what I would consider ringbone. There is apparently some osteophyte formation mid p2, and its cause has yet to be accurately determined.
I feel like now I'm between a rock and hard place. Do I continue with the wedging to relieve the strain on his navicular suspensory ligament, or take him back down in hopes of stopping further progress of the ringbone?
Since it does not appear to be ringbone, then one could extrapolate that if the wedging is keeping the phalangeal alignment correct, the wedges are not responsible for the onset of the osteophyte.
Btw, he is still fine on flexion tests of the pastern joint, so I don't think the boney growth is bothering him yet.
I would fully expect that absent any other joint pathology, the flexion tests would be negative.
I plan to take more x-rays in six months to see how fast it is progressing and if it is getting near the joint.
In the interim, it might be wise to try and discover what caused the osteophyte in the first place. True ringbone does not start well above the joint and then migrate to the joint, it either is periarticular(surrounding but not invading the joint), or, articular(involving the joint).
Also, bad cir***stances caused me to let him go to 10 weeks before being re-shod this time.
May well be a significant factor.
So now I really don't know which direction to take.
Perhaps a consultation with a different vet?
{quote]Any ideas? I guess my main question is whether wedging can cause ringbone to start up...and what does one do when their horse has both an old injury to a navicual suspensory ligament, and the beginning of ringbone appearing on x-ray?{/quote]
1. Incorrect wedging can be a factor in a whole host of pathologies.
2. Make sure that the old injury is not still an issue.
3. Your horse does not appear to have ringbone at this time.
I am also wondering if his sidebone has been playing into this all along.
You are wondering down the right path. Did your vet not say anything about the sidebone? Do you have photos of the radiographs that were taken? If not, can you get some and post them here. Also, some pics of the horse, limb and hooves, front, side and solar views, would be quite helpful.
Can sidebone be irritated and cause an intermittent lameness?
"99 and 3/4 percent guarenteed." 'Oh, The Places You'll Go", Dr. Seuss.
Seems like since he's still sound trotting in a straight line, there is something about circling that is bothering him - like something on the medial side of his foot.
And your vet has responded, how?
A second bone scan and digital x-rays showed his ligament had healed with practically no calcification, so... ?
So, the diagnostics need to look elsewhere.

Considering why (apparently) you fired farrier #1, I'm somewhat suprised you have not done the same to your vet. And, perhaps, farrier #2.
I'm so depressed to see him lame again, even if it is very slight. I thought we had this whole thing licked!
Stuff happens. The good news is that if it is indeed the sidebone that is currently causing the problem, then once that sidebone ossifies, you should have no more problems from it. If the problem originates with the osteophyte, then until you are able to figure out what is causing it, and how to remediate it, your quest will continue.

[jlthompson]

Gosh Rick, how about asking instead of assuming I "fired" the first farrier? Sheesh! I didn't fire him....he moved too far away to continue using him. He tried to keep coming out, but it was just too hard to keep a decent schedule when he had a 3+ hour drive. And yes, he followed the vet's protocal and we made good headway. It was only after taking away the wedge pads (which had no frog support, btw - my only real complaint) that the slight lameness returned.

After I realized I need to find a new farrier, I used this site to get a list of NB farriers in my area, and was lucky enough to get added to the schedule of a super guy, who was also referred to me by Patty (Calshoer).

As far as what I meant by a more correct NB trim: second farrier is trimming according to the sole plane, taking his heels back further (first guy was hesitant to do too much in that regard, and oblong feet, underrun heels and long toes are a problem with this horse). New farrier also leaves more sole....first guy was paring it pretty thin. Oh, and his hind feet were way out of whack....very stretched with bruising in the quarters that would never go away. New guy is really working on that, and his back feet look more normal now, with no new bruising on the walls, and he seems to travel much better, especially down hills.

So, that all said....I am fully confident that the farrier I am using now is doing a good job. I never said first farrier was doing a bad job, and I did not fire him. He just could not travel that far to get out to me every 6-7 weeks.

About the sidebone....both the vet at the clinic where we had the CT and bone scan done, and my regular local vet, said that sidebone probably wasn't causing his lameness.... but since sidebone is calcified lateral cartilage, I'm thinking it could maybe "break" periodically and then heal back up, or just cause soreness if a lot of torque is place on it... I will ask my vet again about it. Maybe he'll give the sidebone possibility more merit, since the original injury seemed to heal up very well without complications.

I am at work right now, and the only x-rays I have on this computer, that show his sidebone, were taken when we were first investigating his lameness in 2004. His current x-rays are probably different since we have improved his shoeing from what the previous owners were doing....but you can definitely see the sidebone in these. You actually looked at these back then when I first posted them, Rick, if I recall correctly.

http://community.webshots.com/album/136620501MsjRRD

As an aside, I put him in the roundpen again last night, trotted him both directions, and did not see any lameness. I guess I'll keep working him lightly and see how he goes.

Jennifer