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Living With Lameness

Written by Ray Miller
Category: Essays For Horse Owners
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When a healthy horse comes up lame, it is disturbing for everyone -- the owner, veterinarian, farrier and trainers, instructors and other riders. Whether it is a top-level show horse, local competitor or weekend trail companion a sore horse is heartbreaking, especially since many animals will continue with the same high effort, even though they are in pain. Lameness may mean an end to a career, and extended lay-up or time-consuming health care from the owner; all are situations every horse owner wants to avoid. A savvy owner, though, knows the facts of her horse's case, and armed with that knowledge, can make caring and smart choices about the future.

The first step when lameness appears is to get a complete medical work-up, regardless if it was a slow-developing problem or an acute onset of pain. A veterinarian can give a much more intensive examination, and will have the equipment necessary for diagnostic procedures. It is very important that the owner is prepared to give information regarding the animal's circumstance. How long has the lameness existed? What leg or legs are affected, and can it be narrowed down to a rough location? What are the symptoms -- an "off" feeling while under the rider; head-bobbing at the walk, trot or canter? Or an unusual stance? Having this information will often help the veterinarian pinpoint the area to observe and test, although some vets may prefer to go into the examination blind, leaving them with an open mind. Sometimes the source of the pain may be very different from where the lameness indicates.

Diagnostic procedures may vary some from one veterinarian to another, but will follow a general pattern. First is observation of the animal at rest and in movement. The horse's attitude when standing unbothered is very telling, as is his way of going when trotted on straight lines and circles. While the horse is standing his conformation can be assessed, and any correlations made between faults and potential problems. Certain conformational abnormalities may predispose an individual horse to lameness. A history can also be taken at this time, with the owner describing the horse's training program, competition schedule and any training or behavioral problems while under saddle (pain is often the reason for these problems). This time can also be used to evaluate the horse's symmetry and temperament. While the horse is standing firmly square, observe the balance of bones and muscles, and any appearance of atrophy or disuse. The horse's temperament has a very important influence on pain indication; a highly-strung individual will usually show stronger reactions to pain than a more stoic horse.

The horse's movement is watched while he is trotted on a hard, level surface. On hard ground the footfalls can be both heard and seen. With the horse's head unrestricted, the handler moves him off at a trot. The vet will observe his movement from straight on and the side as the horse moves toward and away from him. The foot of each limb should land squarely and with equal intensity. Each stride should be balanced, rhythmic and even. A short stride may indicate a problem with that diagonal. Circles are also a useful tool for evaluating a lameness. This will show the horse's flexibility and his ability to move each leg away from the body or toward the opposite leg.

Next the veterinarian will perform a flexion test. A joint is held partly flexed for about one minute and then the horse is immediately trotted off. This process will usually accentuate any existing lameness in the stressed joint. It is difficult to be specific about the sore joint since it is impossible to flex only one joint at a time, but it can still be very helpful.

At this stage, the lame leg should have been identified. To help pinpoint the exact trouble, spot nerve blocks are used. Local anesthesia is injected over a nerve, starting at the lowest point of the affected leg. The nerve impulses are temporarily stopped, allowing the horse to move pain free. If the pain persists, then further blocks need to be performed farther up the leg. In the circumstance where the lameness is only eased, not eliminated, then the problem most likely is not limited to only one location. In order for this process to succeed, there must be significant lameness to start with so that improvement can be evaluated.

Radiographs are used once the source of pain has been identified. This provides a two-dimensional view of the bony structures of the leg. Many views must be taken to get a complete picture. The radiographs do not provide much information about soft-tissue injuries or problems within a joint. Bony changes can be identified, though. Interpretation is a large part of making a diagnosis with radiographs, and they are most useful when considered with the other test results. Some very slight lamenesses may show up as insignificant alterations in the bone -- enough, though, to cause discomfort to the horse.

All these tests can be performed by a veterinarian in private practice, either at the barn or at the clinic. If at this point results are still inconclusive, it may be necessary to haul the horse to a teaching hospital where more in-depth testing is available. One of the more advanced methods of diagnosis is nuclear scintigraphy or bone scanning. A radioactively labeled bone-seeking substance is injected into the jugular vein and is distributed to the bones after several hours. The radioactive substance accumulates in areas of increased bone activity or blood flow to the bone, which is then detected by a gamma camera. This test is more accurate for acute injuries than chronic problems. Nuclear scintigraphy is potentially more descriptive than radiography, but cannot be used as a replacement. The two techniques should be considered complimentary.

Soft-tissue damage can be evaluated using diagnostic ultrasound. The ultrasound waves are reflected from the tissue and played back on a monitor. The images must be of high quality to accurately assess the damage. Enlargement of a tendon or poor definition of the structures can be determined with this as well. Progress is also monitored with ultrasound during periodic evaluations.

Once the veterinarian makes a diagnosis, the farrier can be a horse's best friend. With his expertise, many options may be open to the horse and owner. Therapeutic trimming and shoeing may make the horse more comfortable, usable once again, or even return him to his former level of activity. Many types of shoes exist that will relieve pain and allow the horse to move more naturally. However, it requires a very knowledgeable professional to perform this work, as well as one who can discuss the case with the attending veterinarian. The vet may write a specific prescription for the farrier or leave him to make the shoeing decisions. Either way, it is essential that the veterinarian and farrier maintain a good working relationship. The owner's patience is also an essential requirement for the farrier's success. Often there is more than one way to address a lameness; the farrier will usually choose the simplest and least expensive method first. If that does not work, he will move up the scale to more intensive methods. However, it will probably require several months to find the best therapy, and the owner must show patience through this process.

When a horse is diagnosed with a chronic lameness, the owner needs to take serious stock of his/her horse's life. It may be possible for the animal to remain at the same activity level with veterinary and farrier assistance, but usually some adjustments will need to be made. If the horse competes, it may be necessary to drop to a lower level or even leave the show ring entirely. In this case is the owner willing to scale back his/her own goals to fit with the horse's altered abilities? At this point, selling the horse is often considered. It is unfair to expect the horse to perform when burdened by lameness, and a more suitable home should be found.

Many times a horse that has a manageable lameness problem but is well trained with a kind disposition will make a good mount for someone learning the ropes of a sport, looking for a school horse. However, be certain to inform a prospective buyer of the problem and be sure that he or she is prepared to provide the care necessary, Sometimes a change in discipline is sufficient to keep a horse in work and useful. A show jumper with a forelimb lameness may perform in the lower levels of dressage. Or a performance competitor may find a niche as an equitation mount. And, using care and caution, most horses can be suitable trail mounts. Retirement is sometimes the only option for extreme cases, or with degenerative conditions.

Living with lameness is possible when the owner knows the facts. That is why a veterinary diagnosis is so crucial to the horse's well-being. Neither the owner nor the farrier can make sound decisions without that baseline. It is also essential that all three can work together in the horse's therapy and maintenance. But it is ultimately the owner's responsibility to keep the animal's best interests in the forefront and make the choices that will benefit the horse.

The most promising means of achieving a degree of soundness and usability is therapeutic shoeing. Therapeutic shoeing can be defined as a procedure undertaken to assist and protect a damaged hoof or limb to achieve more normal movement. This may be for a short-term healing period, or it may be necessary to continue the speciality work indefinitely or for the remainder of the horse's life. Therapeutic should not be confused with corrective. Corrective shoeing usually implies "fixing" a problem that may often stem from an inherent defect in the horse. In this case, the correction may not be in the horse's best interests, as incorrect corrective trimming and shoeing seeks to make a visual aesthetic improvement, rather than a functional one.

The major requirement when beginning a course of therapeutic shoeing is using a qualified farrier. First, he must be well versed in the anatomy and kinesiology of the horse's body. Every swipe of the rasp and pound of the hammer will change the individual's way of going, and he needs to associate those actions to the result.

The farrier also needs to be able to converse with the attending veterinarian. It is essential that all those involved in the horse's care can discuss options, potential problems, and prognoses. Some veterinarians will make a diagnosis and then write a shoeing prescription for the farrier to follow. Most farriers will proceed as directed and add their own comments and suggestions as time passes. Other vets will leave it up to the farrier to determine appropriate therapy once a diagnosis is made.

The farrier must also be available to provide long-term hoof care for the horse. This will usually mean additional cost to the owners since the farrier's time and knowledge are very valuable. But if the owner is willing to undertake the cost and responsibility, most farriers are willing to make a therapeutic horse a priority in their practice. If a special farrier is brought on the case to consult, it is vital that he confer with the regular farrier about proper procedures and be available for follow-up questions.

Most farriers today use keg (factory made) shoes for therapeutic horses, since the manufacturers have advanced to produce shoes that are well-designed and well-researched. A qualified, professional farrier will carry a large selection of therapeutic shoes. At other times it may be necessary to forge a set of specialty shoes; again, this will require additional time and knowledge, and the farrier's rates will increase accordingly. Hot-fitting may be necessary to get an exact fit for an individual horse or if special modifications need to be done. In many situations, though, cold shaping a keg shoe is sufficient.

Bar shoes are regularly used for many lameness conditions. A straight bar is connected at the heels. It has a larger surface area for bearing weight and thus relieves mild cases of lameness, such as ringbone, sidebone, laminitis, sheared and crushed heels, and tendon injuries. The bar aids in relieving tendon pressure, adding heel support and moving pressure off the toe and coffin bone.

An egg bar is similar to a straight, but the bar connecting the heels is curved, forming a continuous oval; it extends farther back behind the foot than the straight bar. This shoe is used for the same conditions as a straight bar, but is effective in more serious cases.

The heart bar shoe has a straight bar or egg bar connecting the heels, along with a solid plate that completely covers the frog. For cases of laminitis, this is the most effective shoeing therapy. It provides support at the heels, allowing a release of pressure at the damaged, painful toe. The frog plate also serves to support the coffin bone within the hoof capsule.

One other specialized bar shoe is the GE-N. With a rolled toe and tapered egg-shaped wedge heels, this shoe seems very effective for horses suffering from navicular syndrome. The design allows the horse to shift the balance and position of the foot to a stance that is most comfortable for him. The GE-N shoe may also be used for cases of laminitis, ringbone and other arthritic conditions.

Many other therapeutic shoes are variations of the basic keg shoe but with modifications that make it useful for specific conditions. Some of these shoes are manufacturer designed, but some farriers prefer to build these less-often-used shoes on order.

The rocker toe and rolled toe shoes are built on the same principle, but the rocker toe is more severe. These shoes have a curved piece that sits at the toe of the shoe on the ground surface. Because of this rolled piece, the foot's breakover speed and position are changed. Horses that suffer from laminitis and arthritis are often helped by this shoe, since the way the foot takes off and lands is altered. Gait abnormalities are also aided, especially forging and overreaching, where the hind legs reach forward and clip the forefeet.

A slippered heel shoe is one in which the heel is beveled, or slanted, to the outside. This configuration makes the heels of the foot expand. Contracted heels, a condition in which the heels fold inward, are set with this shoe. A farrier shoeing a wry hoof, where the entire hoof wall sweeps off to one side, may choose to use a slippered heel shoe.

Several lameness conditions are handled with a wedge shoe. The heels are built up and tapered from the heel forward. The degree of wedge varies, depending on the severity of the condition. A wedge shoe can be either an egg bar or straight bar. Long-toe, low-heel syndrome, ringbone and navicular syndrome may all be relieved by using some type of wedge shoe.

Pads may also be useful for the treatment of a lame horse. A specialty pad is usually paired with a basic shoe, but the farrier may use some creative license when shoeing a particularly difficult case, or one in which many problems need to be addressed. Pads provide protection for the sole and hoof wall and may be used for white line disease. Regardless of the condition, all full-coverage pads contribute to the growth of fungus in the frog, since it is impossible to clean the area regularly.

A wedge pad serves the same function as a wedge shoe. The elevated heels ease the strain of navicular syndrome, ringbone and some tendon stresses. This pad may be used with a regular shoe or a bar shoe.

Rim pads are cut to follow the shape of the shoe along the hoof wall, leaving the sole open. It elevates the foot even farther off the ground and may be used alone or together with a full pad. A rim pad is commonly used for sole abscesses, pedal osteitis and frog injuries. This pad may also be used with a hospital shoe. A removable plate is screwed to the bottom of the shoe that allows the sole to be doctored.

The lily pad is a plastic pad with an extension that covers the frog like a heart bar shoe. The extension adds frog support to the horse suffering from navicular syndrome and laminitis. It is used with a regular shoe or with an egg or straight bar.

Any time a lameness develops that demands therapeutic treatment, many different methods may be employed. A specific problem may have many solutions; when more than one problem is present, the choices of treatment multiply. It will usually take a period of trial and error on both the farrier's and veterinarian's part to find the method of treatment that will be most effective for each individual. The owner must be willing to allow the time necessary to devise the therapy that will help the horse most. Without that cooperation, the horse's chances of recovering to even partial usability are jeopardized.