Shoeing or ??? How to help a severe buckling fetlock

[Rococoms]

Firstly, let me apologize for the length of this post- unfortunatley, to understand my problem, you have to have some history.

Begining of December I wound up rescuing a 3 year old QH that had been found wandering down the street a "stray" on three legs- his LF was so severly contracted that the weight bearing surface of his leg was actually almost the front portion of his coronet band (http://www.geocities.com/t-aarf/stt1.jpg). Our suspicion is that this was a horse born with severe contracted tendons, which had gone untreated his entire life until he was finally dumped/thrown out.

Truncated story: went to the hospital, stayed there 3 months, had surgery to cut the DDFT on the LF, casted for 1 month, brace for another month, slowly but surely the leg has been improving.

Now, all the time we were dealing with the "bad" leg (LF) we have been aware of another problem, that is the buckling forward of the RF, which we suspect is also a result of contracted tendons (See http://www.geocities.com/t-aarf/ttlateral1.jpg). As soon as he could handle the stress on the other leg, we planned to do surgery to cut the check ligament on the RF to help relax the tendon, but once we had him laid down, it was determined that the RF DDFT was also the culprit. We cut it, he recovered well, and all seemed perfect- for about 4 weeks, he didn't buckle once. We made plans to finally take him home.

Flash forward another two weeks. He starts getting progressivley sore again, to which we attribute to trying to get him out walking more, and cut down on bute levels. We take him home, and make our first shoeing appointment, and take FF lateral xrays on a whim so that they'll be on hand for his ridiculous first trim of the most awful feet you've seen. And my vet almost dies getting the films out of the processor- now he's got two dislocated coffin bones. Instead of foundering and sending his coffin bone down, his are tipping upwards at a 30 degree angle. No freaking wonder he's sore again! Oh yeah, he's also buckling forward on BOTH his FF again suddenly, Right more than left.

We go ahead with shoeing, with lots of modifications. My farrier, bless him, gamely goes along with this farce ("well, you can cut 2" of toe off the LF, make the heel extend 3" so it actually is under his foot, the tip of his coffin bone is actually 2.5" above the bottom of the hoof".... you get the picture). Flash forward two weeks more. Horse is as happy as we could have ever hoped for on his supposed "bag" leg. Not buckling, will let me pick up the other leg easily etc. But his Right leg is getting worse and worse. The extreme to which he is buckling foward is scary. I can't seem to find any item or combination of items which works to support the fetlock enough to keep it from falling foward. Cutting the DDFT, while it worked at first, just served to give this leg farther forward to go now. He's painful on it, and I have to stop watching him walk, I'm just waiting for that one step to take him out. When first applied, an extremley rigid standing wrap helps, but they always stretch out with too much give after a short amount of time, but we do keep him wrapped 24/7.

There is a question buried in here somewhere, and this is it. Has anyone on here dealt with something similar to this? I so want to find ANY information on this problem, good or bad, but it seems (no surprise) that I'm the only one on earth to have an adult horse with such an issue- they are all fixed as babies or killed, I suspect. If they have, what if anything, helped/Fixed the problem. According to my vets, I have a few options left, but no one is sure which is the best:

1) Surgery again, and cut the proximal check and see if that releases the tendons enough to leg him find some angle to his fetlock (he is as upright as you can possibly imagine- it's a straight line from the back of his knee to the back of his fetlock to the heel bulbs. My fear here is that we'll go through surgery again, be fixed temporarily, then for whatever reason it did it before, it will come back again.

2) Try to fashion or purchase a fetlock support brace such as: http://alternativesanctuary.port5.com/Products/ProdIMG/Fetlock_Support.bmp My problem, besides what I am sure is ridiculous cost that we can't afford, is that it's one thing to do it long term when it might help, it's another thing to commit to him having to live in that forever. I originally rescued him with the sidebar that the goal was to get him pasture sound and comfortable. Ironically, the original problem IS more than that, but now this is the bigger problem which may take us out.

3) Any other ideas/experiences/etc! Shoeing has helped the LF, but hasn't really helped the right- and it's been the much more balanced, "normal" looking foot, although also quite dislocated from the radiographs. We are retaking radiographs tomrow before retrimming the feet, and I will try to scan them, as well as take new photos and post them for anyone who is interested.

Thanks in advance for getting this far in this ridiculous post, and for any insight you can put to this problem. Let me just address this last thing quickly: I have three vets with whom we have all agreed to say so if and when we decide that enough is enough and we need to let this boy go. At the moment, despite all his problems, when we turn him out in the bullpen, the horse takes off bucking, running and always has a bright look in his eye, and is throughly spoiled and loved, and I have commited to providing for him for the rest of his life.

Thanks again

Mina and "Oliver" (http://www.geocities.com/t-aarf/ttgood.jpg)
sharptpe@yahoo.com

[fairweatherforge]

Is it possible that he has a tight superficial flexor tendon? By cutting the ddft did it let the sft really contract and dislocate the coffin joint? Just a guess. You don't hear about it much (probably because it doesn't distort the hoof capsule that much) but its fairly common.

[Jason Maki]

Mina,
Eric may be on to something here. Cutting the dft would aggravate a contraction of the sft. Years ago( not a ton, I think 8) when I was in school, Chris Gregory worked on a horse that looked very similar to yours. It was finally discovered she had adhesions between the sft and dft.
Since you found the horse, you would not know the story, but if the horse was overfed before 2, he could have suffere epiphisitis in the distal radius, pulling the radial check ligament tight, thus pulling the sft tight. This would pull the pasturns upright and smash PIII way down. Maybe Mr. Russel has given you an avenue to pursue!
Jason Maki CJF

[Rococoms]

Thanks- I will bring this up with my vet in the morning. Originally, when trying to figure out which structures to cut, we decided against SFT *along* with DDFT because of the lack of support he would then have, and worried about him flipping up his toes. Now that he's basically done that anyway, and we're dealing with it, what would be the implications of cutting the SFT? Have you seen horses with both cut that do OK? Is there enough soft tissue support of the leg with both these vital structures gone?

[Ronald Aalders]

.
1) Surgery again, and cut the proximal check and see if that releases the tendons enough to leg him find some angle to his fetlock (he is as upright as you can possibly imagine- it's a straight line from the back of his knee to the back of his fetlock to the heel bulbs. My fear here is that we'll go through surgery again, be fixed temporarily, then for whatever reason it did it before, it will come back again.

2) Try to fashion or purchase a fetlock support brace such as: http://alternativesanctuary.port5.com/Products/ProdIMG/Fetlock_Support.bmp My problem, besides what I am sure is ridiculous cost that we can't afford, is that it's one thing to do it long term when it might help, it's another thing to commit to him having to live in that forever. I originally rescued him with the sidebar that the goal was to get him pasture sound and comfortable. Ironically, the original problem IS more than that, but now this is the bigger problem which may take us out.

3) Any other ideas/experiences/etc! Shoeing has helped the LF, but hasn't really helped the right- and it's been the much more balanced, "normal" looking foot, although also quite dislocated from the radiographs. We are retaking radiographs tomrow before retrimming the feet, and I will try to scan them, as well as take new photos and post them for anyone who is interested.
Mina and "Oliver" (http://www.geocities.com/t-aarf/ttgood.jpg)
sharptpe@yahoo.com

Hi Mina,

No need to apologize for the length of your post Mina. In fact I'm sure we all feel this is a typical case on which we can share our thoughts! Thank you for posting!

I have a few remarks, but I am no vet. Also I would like to point out that when I see things in a certain way, this does not necessarily mean I'm right. God knows I've been wrong more than once....... And also, obviously, these boards can never substitute the views of the vet treating your horse. At the very best it may just help you understand a little better and come up with some question you could ask your vet and shoer.

I can see that on the LF DDFT pull caused the position of the foot and the way the horse uses it. With a contraction as bad as this one a DDFT cut seems to me a reasonable thing to do. What I wondered about is the place where the DDFT got cut. Would that be somewhere in the middle of the cannon bone? I learned thanks to Dr. Rooney that when DDFT is cut mid cannon, there is still a connection between DDFT and SDFT. This connection prevents the toe from flipping up after DDFT is cut. It would also prevent luxation of the coffin joint, to a certain extend at least. I have seen several X rays of horses with a cut DDFT and most of them show a coffin bone having somewhat of a "dislocated appearance" The wings of the coffin bone drop down a little, leaving a "gap" at the palmer aspect of the coffin joint.

In cases where the DDFT is cut below the deep fascial connection between DDFT and SDFT you'll see a much bigger dislocation, up to a full luxation of the coffin joint. The amount of movement of the coffin bone in such cases is in my view limited by the shape of the hoofcapsule only. The hoofcapsule is in my view the only structure limiting further forward motion of the coffin bone. So within a normal shaped hoofcapsule, the dislocation will stay within limits. But within a distorted hoofcapsule you described, the hoofcapsule will not "curb" the coffin bone too soon so the dislocation will be much more severe. Further I guess it would be reasonable to suggest that the deep fascia connection between DDFT and SDFT is not indestructable either. I did understand that when after performing a mid cannon tenotomy, horses may flip up the toe when put in deep bedding without enough caudal support. This would suggest some stretch in the deep fascia connection between DDFT and SDFT.

Although I am, by no criteria whatsoever, an expert here, I would think that some dislocation (sub luxation) of the coffin joint after perfoming a DDFT tenotomy is not uncommon. After healing of the cut tendon, the dislocation should improve too, since DDFT pull will to some extend pull back the coffin bone in its normal position.

What I did not understand is why the DDFT on the RF was cut too. It would seem to me (me horse shoer remember......) that here SDFT could cause the clinical findings. And maybe not as much SDFT being pulled too much (I was given to understand SDFT only has a small muscle attached to it) but DDFT being too flacid in relation to the SDFT. Before performing any surgery I wonder if wedges on that foot could have improved the situation. It would have been worth a try. At this point, after the DDFT tenotomy, wedges are out I guess since you do not want to run the risk of the DDFT healing and shorten in stead of gaining some length.

From your post I learned that the DDFT tenotomy did help the horse for a few weeks. So from the looks of it the vets were right after all, however the horse becoming sore after 4 weeks should have reason. This could be caused by the tenotomy itself, but no doubt your vets checked up on that.

As a possible reason for this soreness I was thinking about the impar ligament that got torn or damaged because of the DDFT tenotomy. But then again I wonder if that could be the case looking at the angle of the dorsal hoofwall on that RF.

As to cutting both DDFT ánd SDFT I would not recommend it. I never heard about it being done, but that does not mean too much.......

I wondered about the brace. I would think you could try and make a brace out of a plastic pipe of some sort you may find at Home Depot or some hardware store. The kind of pipes I'm thinking of you can cut in half lengthwise and shape using a heat gun. You should shape it to suit the leg and put it on after applying cotton to the leg and fix it with elasticon or maybe just ducttape. Be aware though that such braces are known to cause pressure sores easily! Use a lot of padding before getting any kind of brace on.

Please keep us informed! Post pictures, X rays, ultrasound images if you can!

Thanks and good luck Mina.


Ronald Aalders

[Greg Thomas]

I know I shouldn't but here goes:

Exactly what are you rescuing this horse from? Pain and suffering?

Will it ever be able to be a horse?

Did you lessen it's pain and suffering or prolong it and added to it?

The simple fact that a bunch of time and money is being spent does not always equate compassion-especially from the horse's viewpoint.

Personally, if it is for educational experimentation reasons I might could justify it to myself but otherwise I would consider myself to be cruel to prolong this beast's life.

Greg

[Phil Armitage]

OK, here are my thoughts, short and simple. That much stress on the joints has got to cause a lot of problems in the joints. I would think the joint would be stressed and damaged permantly because of the age of the horse is old enough that they probably cannot repair themselfs after surgery and getting them back into alignment. This horse probably has more stress his joints than an older horse that has jumped his whole life. Cuncussion from severe misaligned limbs even pressure from standing around has to cause problems that will cause pain for the rest of its life. What are the odds that this horse can ever do anything without pain? Personaly I would not have put this horse through this, just my opinion. We all see things differently and like to be optomistic, but lets be real.

[djones612000]

For previous history on this horse please see thread by ROCOCOMS 3/05 headed "Shoeing or ???? How to help a severe buckling fetlock". I adopted this horse 8/05 and sadly had to euthanize him this past 12/8/06.

I have some questions the types of surgeries that my horse received and if this could have caused the fetlock buckling problems

After 18 months of trying to obtain all the xrays mentioned in Minas post and complete medical records regarding the exactly what/where/how tendons/ligaments were cut on Oliver,on 12/12/06 my vet received this by fax from the surgeon who performed the surgeries

12/9/04 check ligament desmotomy (left front limb)
1/20/05 SDFT Tenotomy (right front limb)What do the above surgeries entail, eg cutting or thinning the tendon?



Minas personal correspondence with me and information she gave me and posted on here states that the DDFT were cut in each leg, and that was it.

I did manage to meet with the surgeon on 11/28/06 and still without any medical records told me by drawing an outline indicating that both legs received same surgery. DDFT cut.

I should point out the reason why I insisted upon having the records (apart from the obvious) was the horse started to show the same severe buckling of right fetlock joint as did with Mina over a year ago. Oddly though the surgeon discounted my concerns over the right leg and continued to direct me to the arthritis in the left leg. Which again as Mina points out was always the 'bad' leg but turned out to be the 'better' leg of the both. It continued to be that way due to the joints calcifying. Not an ideal situation I agree but more comfortable in weight bearing than the right turn out to be.

Many of you who responded to Minas post questioned the DDFT being cut in the right leg, and indicated that this could weaken the support to the fetlock joint and cause the symptoms Mina (and now I) describe.

Could you please refresh your memories by re-reading Minas thread and your responses and then answer my questions. I tried to attach photos but they were too big. I have sent them to Thomas who said he would resize and post. Photos were taken October this year, clearly showing his right fetlock joint problem. Incidentally, this became much worse in the weeks that followed. My vets and farriers tried everything to make him more comfortable but nothing seemed to help. I was now going through the same thing Mina went through and could not put him through anymore 'try this, try that' whilst it did work for over a year, nothing was permanent and without ever having the information from the surgeon, I was not going to put this poor horse through any more 'experiments'.

Now that I have a little more information than I had, here are my questions

[B]To ease the knuckling forward and popping of the fetlock joint .. would SDFT tenotomy be the way to go, vs cutting the DDFT?

If so, would cutting the DDFT eventually cause the coffin bone to rotate upwards with, under run heels, and a dislocated fetlock joint (forward) because there was not enough support?

Unfortunately, I did not think of taking the drawing with me that the surgeon did when I met him, so I cannot recall where he indicated the tendon was cut on either leg. I know that Mr Alders had questioned this in his response to Mina, as he felt this may have made a difference to the fetlock joint. I am going to attach a bunch of photos pre and post op on both legs, perhaps your keen eyes can tell by the scares where the tendon was actually cut in reference to the right leg (behind pastern or cannon bone)

Another question.. how long does it 'usually' take for a cut tendon to grow and the ends reconnect? On a website that was created for him (I will try to post the info here) referring to the surgery on the LF, indicates that once the DDFTwas cut the leg straigten out to about 85% and the cut ends created a 5" gap.

Have you come across any cases where the cut tendon (DDFT or SDFT) did NOT grow back to join ends and thus also cause the fetlock joint to continue buckling forward?

I ask this because Oliver was 2.5yrs old at time of surgeries, and not the usual young foal whose bones and soft tissues are still in early growth phase and probably heal quicker..

Could it also be possible that scar tissue build up may have also created the fetlock joint to buckle forward via pressure and the inability to move freely?

Lastly, I wanted to say that I agree with those of you who said he should have been euthanized and never put through any of this. However, I will say that he was a very happy and loving horse right to his last day. He had many wonderful vets and farriers who did great work in making him comfortable but because we never had access to his records it was a constant guessing game, taking regular xrays to find the best solution for him. :confused:

It is heartbreaking for me to think that there may have been a mistake in the surgery and had all his information been given to us when I first adopted, he may have been still alive.

I welcome as many of your experiences and knowledge and look forward to your replies.

Thank for your time.
Deborah

[djones612000]

I am having a problem sending photos, says files are too big? Can anyone help.

Thanks again
Deborah

[Thomas_Ride&Drive]

Resize them prior to posting them and if you're not sure how to do that I'm happy to help if you want to email them to me on:

carriage@freeuk.com

[djones612000]

Resize them prior to posting them and if you're not sure how to do that I'm happy to help if you want to email them to me on:

carriage@freeuk.com


Thanks Thomas I will send them to your email address directly, not via the forum, if this helps.

PS. I am a fellow Brit also (Bristol born and bred (Badminton to be precise).. been in S. Cal since 1990)

Thanks again
Deborah