Bruise? Laminitis? HELP!

[ILuvmyButtercups]

Help! I'm at my wit's end here. Back in mid July my 16 year old gelding came up from pasture in the morning with a swelled up left front leg with lameness. I thought it was a strain, and hosed it, did him up that day and over night in Numotizine poltice. Next day, swelling gone, lameness still bad. Got the vet out. We got no reaction to the hoof testers, vet decided it wasn't an abscess. He nerve blocked him, finally decided it was "his ankle, give him time, go ahead and turn out", blah, blah.

So, I did turn him out, same schedule. STILL dead lame the next two days. VERY worried now, (this horse is NEVER unsound) I was able to haul him up to Very Big Name Vet for diagnosis next day. Radiographs revealed some slight rotation, no abscess, mild inflammation. I was told it was probably grass founder :confused: in one foot? Get him off the grass, give 1/4 gram Bute a day. I did that, restricted his diet, no pasture, feed only TC low starch senior anyway. Had him re-shod the next day, farrier said he looked good, no white line disease, no separation, no evidence of bruising. (He wears regular steel shoes, no pads or clips). He went sound after that - for three days.

AUGH! Back to lame. I'm tearing my hair out now, and hauled him back up to VBNV a week later for more rads. This time there was still a little more rotation..... ?????? We shot pics of both feet this time. The right front is fine, no problem whatsoever. Why is only this left front having problems? Why is the lameness so severe???? Vet ruled out tendons, knee, insists it's in the foot. Farrier back out - we put Natural Balance shoes with rim pads on - backwards, as per BNV's instructions. So, he's going around with an open toe and heel, with heels barred. Horse goes sound for - you guessed it - three days. All this while I'm keeping him up in restricted quarters, hay only, his Bute with a handful of the TC senior twice a day. No riding of course.

Well, here it is what, Sept 11th, and he's still only walk sound if on Bute, 1/2 gram, twice a day. Any trotting, or turns hard left makes him gimp.

I cannot believe it's grass founder. My pasture isn't the greatest anyway, and I always keep my guys in all day, out only at night. I've had this horse here for going on 5 years, never ever had any problem. Anyone have any ideas what this could be? I just want the poor thing comfortable! I cannot bear to see him drag around all sad and sore! I'm also worried about all the Bute I'm shoveling into him, over a long period, and for how much longer do I have to do this??????

I found this product in a catalog, anyone familiar with it? Should I try it?
http://horsehealthusa.com/details/HEIRO-Healthy-Equine-Insulin-Rescue-Organical/493-1.html#fragment-1

My boy does tend to pack on the pounds, has a thick crest, but always has... is the rainy spring weather we've had in the Northeast made pastures more lush and sugary, unlike in past years, where drought was common?

Please, any suggestions to make this guy's pain go away, I'm desperate!

Thanks in advance!

[Thomas_1]

You need to get weight off him and you need to do this by ensuring he's getting low grade forage only.

By low grade forage I mean something like low sugar hay.

I don't know the product you've linked to but I see it's just a supplement and with magnesium in it.

There is evidence that this can help.

But he needs to eat less.

Don't just rely on the supplement.

You might want to post on horseshoes.com with his x rays and photos for advice re shoeing and trimming protocol.

[eruss]

have you discussed soft tissue injury with your vet? Mri or ultrasound might be in your future. Horse coming in from field with swelling and lamesness, swelling goes down but still lame, change of shoeing makes him better for a few days, sounds like he slipped or something in the field and tore something.

Deep flexor tear near insertion of p3 and/or impar ligament tear are common. Also it's possible if there is pain in the rear of p3 that he is compensating and transferring his weight forward possible causing some rotation.

[Nanerpus]

Sounds like you are doing the right things to help him. I would think about soaking his hay to get the sugars out in addition to what you are already doing. Good luck and keep us posted!

[JB]

You need to get weight off him and you need to do this by ensuring he's getting low grade forage only.

By low grade forage I mean something like low sugar hay.

Glad you clarified that, because "low grade" really means "not nutritious". And that would not be beneficial for a horse ;)

[ILuvmyButtercups]

have you discussed soft tissue injury with your vet? Mri or ultrasound might be in your future. Horse coming in from field with swelling and lamesness, swelling goes down but still lame, change of shoeing makes him better for a few days, sounds like he slipped or something in the field and tore something.

Deep flexor tear near insertion of p3 and/or impar ligament tear are common. Also it's possible if there is pain in the rear of p3 that he is compensating and transferring his weight forward possible causing some rotation.

Wouldn't DF tears show on the rads? The vet shot the hoof from all sides, angles, and bottom view. I remember him saying the DF tendon was in good form. I'm more inclined to think maybe it is a problem elsewhere up the leg, and the rotation seen is perhaps old? I have nothing to compare these pics with, never had him graphed before. Will this just resolve itself if left to its own devices? I'm afraid of doing some drastic change, only to make it worse, or even cause more problems. Thanks for your reply, it's helping me rethink this. :yes:

[Thomas_1]

Glad you clarified that, because "low grade" really means "not nutritious". And that would not be beneficial for a horse ;) Low grade doesn't mean "not nutritious".

It's not possible to have hay so lacking that it's no benefit.

Heck I can keep horses in decent condition on barley straw. Indeed that's what I do to prevent mine running to getting overweight. I use straw as a low grade forage filler.

[ILuvmyButtercups]

You need to get weight off him and you need to do this by ensuring he's getting low grade forage only.

By low grade forage I mean something like low sugar hay.

I don't know the product you've linked to but I see it's just a supplement and with magnesium in it.

There is evidence that this can help.

But he needs to eat less.

Don't just rely on the supplement.

You might want to post on horseshoes.com with his x rays and photos for advice re shoeing and trimming protocol.

:yes: I've taken him off the pasture grass, but he gets some grass hay; the vet said that would be fine. Problem is, neither of my guys will eat Timothy hay, too woody or tasteless I suppose. They'll chew the stall walls before they'll touch even excellent quality Timothy. I do have him on Quiessence, a scoop in his handful of grain. How to keep them (both boys are fat and need restricted grazing) occupied while they can't mindlessly munch something? I don't imagine splinters would be good for their guts, and I'm very concerned about the days and days of Bute being put in the lame guy. Question: Would the pasture be safe for them later in the fall? Like by October? Since they've been off it so long, it's looking great, thick and plentiful. When does the richness leach out, the growing stop?

[ptownevt]

Soft tissue doesn't show up on x-rays. You need ultra-sound for soft tissue. Not the same thing, but we went through x-rays, joint injections, Adequan and nerve blocks to finally find a large sesamoid ligament tear on ultra-sound. It is likely an old injury so in our case it is a dead end. Soft tissue injuries need rest not turn out. And they need to be rested until they are completely healed, not just until the horse feels better. If they start working before complete healing, reinjury is a real possibility.

[eruss]

Wouldn't DF tears show on the rads?

I'm a farrier so I'm not an expert on rads. impar, deep flexor, collateral ligaments, all of these things are being diagnosed these days because mri can see them so clearly. So xrays and even ultrasound will miss these tears.

I'm more inclined to think maybe it is a problem elsewhere up the leg, and the rotation seen is perhaps old?

It's possible. A high percentage of injuries are in the foot so it's very safe to start there and work your way up. You wouldn't have seen a little bit more rotation the second time if it was old.

Will this just resolve itself if left to its own devices? I'm afraid of doing some drastic change, only to make it worse, or even cause more problems. Thanks for your reply, it's helping me rethink this. :yes:

Yes and no! Things heel over time and horses just like people will compensate and get around. Finding out what the problem is will allow you to get a plan for recovery and his future and yours. :)

[ptownevt]

One more thing. Soft tissue swelling doesn't go with laminitis in my experience. I have a pony with matabolic issues who has foundered twice. No soft tissue swelling either time. It is also unusual for a horse to grass founder in one foot. Founder in one foot only is usually the result of some type of excessive strain like supporting more weight on one foot due to an injury in the other foot. Think Barbaro. If the bone is rotating now, I'd guess it's due to a mechanical issue.

[ILuvmyButtercups]

Soft tissue doesn't show up on x-rays. You need ultra-sound for soft tissue. Not the same thing, but we went through x-rays, joint injections, Adequan and nerve blocks to finally find a large sesamoid ligament tear on ultra-sound. It is likely an old injury so in our case it is a dead end. Soft tissue injuries need rest not turn out. And they need to be rested until they are completely healed, not just until the horse feels better. If they start working before complete healing, reinjury is a real possibility.

How would I know..... ? I've tried keeping him on stall rest for a few days, even reduced the Bute, just to see what would happen. Or I'd let him wander a small paddock, nothing fresh to graze on, just some clean but ancient hay. Nothing makes a difference, except the Bute! If off it, he's lame, once back on that, he goes walk-sound. Should I haul him back up to VBNV for ultra sounds? I wonder why this vet didn't suggest that when I was up there, TWICE in two weeks? sigh. I'm so frustrated! :(

[ILuvmyButtercups]

One more thing. Soft tissue swelling doesn't go with laminitis in my experience. I have a pony with matabolic issues who has foundered twice. No soft tissue swelling either time. It is also unusual for a horse to grass founder in one foot. Founder in one foot only is usually the result of some type of excessive strain like supporting more weight on one foot due to an injury in the other foot. Think Barbaro. If the bone is rotating now, I'd guess it's due to a mechanical issue.

This is what vexes me, the one foot only. My other gelding, about the same age, gets too big if he's allowed unrestricted grazing. His soles are flat, feet grow too fast, he's been diagnosed with hypothyroidism, and is on Thyroxine L, has bee for over a year now. He's doing GREAT! If anyone is going to grass founder, it'd be him! So, now I'm just afraid to use my pasture at all, for either of them! Poor dears, they hang over the paddock fence, wistfully longing for the big field. Will they ever be able to graze out there again????

[eruss]

How would I know..... ? I've tried keeping him on stall rest for a few days, even reduced the Bute, just to see what would happen. Or I'd let him wander a small paddock, nothing fresh to graze on, just some clean but ancient hay. Nothing makes a difference, except the Bute! If off it, he's lame, once back on that, he goes walk-sound. Should I haul him back up to VBNV for ultra sounds? I wonder why this vet didn't suggest that when I was up there, TWICE in two weeks? sigh. I'm so frustrated! :(

First I'll let you know it is very easy for us to sit at a computer screen and make up scenario's as to why your horse may be lame.

You have to think about it for a minute. Your horse came in from the field with a swollen leg and lame. Does this sound like laminitis to you?

Continued on/off lameness in only one foot. Laminitis?

xrays look good (besides the slight rotation). What's left? (soft tissue)

Horse is only lame in one leg. Is this common with laminitis?

Before hauling back to clinic I'd make a phone call. Ask the vet if it's possible your horse could have a small soft tissue injury which didn't show up on xrays.

Something I see regularly is people hauling to the clinic spending a fortune, when you add it all up an mri from the start would have been cheaper and gotten to the bottom of things immediately. Just something to think about before you start spending too much money on different diagnostic approaches.

[ILuvmyButtercups]

What about these horrid shoes I have on him? The Natural Balance ones, put on backwards with open toe and sole, closed heel on rim pads?

I detest these things! One, I dislike any device that covers the frog - I've always been rabid about keeping the frogs fat, full and clean, free of any debris that would cause junk to get trapped. Every day I clean around and under the heel bar, as best I can, with diluted peroxide, and mild detergent, squirted in with a syringe. Can't get the frog seat though! I'm concerned a very bad thrush will generate there. The poor horse clunks around like a gaited show horse - ugh! Won't the heels get too long, with the toe cut so far back? If I have regular shoes put back on the next time, will it hurt anything either way? Founder or tendon issues? Sorry to drop this on you, I guess it's hardly fair to expect you to diagnose without seeing the rads and foot. :yes:

[eruss]

[quote=ILuvmyButtercups;4369696]What about these horrid shoes I have on him? The Natural Balance ones, put on backwards with open toe and sole, closed heel on rim pads?

More rotation after second visit? At the very least I would have his foot supported with soft impression material, specifically built up at the back of the foot.

I detest these things! One, I dislike any device that covers the frog - I've always been rabid about keeping the frogs fat, full and clean, free of any debris that would cause junk to get trapped. Every day I clean around and under the heel bar, as best I can, with diluted peroxide, and mild detergent, squirted in with a syringe. Can't get the frog seat though! I'm concerned a very bad thrush will generate there. The poor horse clunks around like a gaited show horse - ugh! Won't the heels get too long, with the toe cut so far back? If I have regular shoes put back on the next time, will it hurt anything either way? Founder or tendon issues? Sorry to drop this on you, I guess it's hardly fair to expect you to diagnose without seeing the rads and foot. :yes:

Sorry to say, you're going to have to get over not wanting the frog covered for a while. :) You're going to need the entire back of the foot to help support the limb. There are plenty of products on the market to keep thrush away. The heels may grow quicker as a response to pain not from letting the toe hang over. Shoeing would be dependent on what the problem ends up being. Assuming it's something going on in the back of the foot or leg, you will want to support the back of the foot while reducing leverage at the front of the foot. The goal would be to reduce any stress on the tendon and/or ligaments while the horse is moving (assuming it's a soft tissue injury).

[matryoshka]

If it is soft tissue, it is going to take more than a few days of stall rest to show improvement. You need a Dx and an idea of how long the horse should be on stall rest. I used to work at a layup farm, and soft-tissue injuries take longer to heal than fractures.

[rcloisonne]

I would have serious doubts regarding the competency of any vet who would prescribe a reverse NB shoe for any reason. Certainly their designer never meant for them to be used in that way. :eek: I'm surprised your farrier went along with it.

And no, you can't see soft tissue injuries on a radiograph. It is also darn near impossible to get a good image of soft tissue through ultrasounding a hoof capsule. Too many solid structures in the way.

[ILuvmyButtercups]

First I'll let you know it is very easy for us to sit at a computer screen and make up scenario's as to why your horse may be lame.

You have to think about it for a minute. Your horse came in from the field with a swollen leg and lame. Does this sound like laminitis to you?

Continued on/off lameness in only one foot. Laminitis?

xrays look good (besides the slight rotation). What's left? (soft tissue)

Horse is only lame in one leg. Is this common with laminitis?

Before hauling back to clinic I'd make a phone call. Ask the vet if it's possible your horse could have a small soft tissue injury which didn't show up on xrays.

Something I see regularly is people hauling to the clinic spending a fortune, when you add it all up an mri from the start would have been cheaper and gotten to the bottom of things immediately. Just something to think about before you start spending too much money on different diagnostic approaches.


I feel more educated at least..... still don't know the cause of his lameness, but don't feel so in the dark at the possibilities. OK, so I won't worry about the likelihood of his getting trush, you're right, that's not worse!
But from reading everyone's comments, it appears it is indeed a soft tissue issue. I guess I still need to keep his heel elevated, regardless of whether or not he has the shoes on correctly or backwards. If I insist on regular shoes next time, ACK! What a disaster that might become.

So do I just keep him stalled forever? Insist the vet give us an MRI? Good point about spending endless bucks only to do too much, make it worse!

Right now he's in all night, but gets to wander a small dirt paddock in the day. Mostly he just stands in the shed, bored. But he's walk sound.... again, if I keep him on some Bute. But he's lame in the morning, after being in all night IF I don't give him the 1/2 gram of Bute at dinner. Bute seems to make all the difference, nothing else does!

:no::no::no::no::no:

[ILuvmyButtercups]

I would have serious doubts regarding the competency of any vet who would prescribe a reverse NB shoe for any reason. Certainly their designer never meant for them to be used in that way. :eek: I'm surprised your farrier went along with it.

And no, you can't see soft tissue injuries on a radiograph. It is also darn near impossible to get a good image of soft tissue through ultrasounding a hoof capsule. Too many solid structures in the way.

:( I was not happy with the vet's recomend on those icky shoes. Letting the toe be unrestricted seemed prudent though - he was soooooooooooo lame, acted like he had a terrible briuse or abscess. And the silly shoe job did make that go away. Now he's just slightly gimpy, at the trot and on left turns. I'm still keeping him stalled mostly, with acess to a small paddock for a few hours a day. Maybe the vet didn't suggest an MRI for the reasons you stated; it'd be inconclusive, and a money drain. But what to do??? Just keep him in close quarters all winter, and hope he's better on his own by spring? I can easily do that, but I wonder about the shoes.... just keep the heel elevated, the toe short, and let nature do her thing I guess. ARGH!

[Laurierace]

Well I apologize for adding to your mystery but I would be surprised if that small amount of bute would do that much if it was solely in the foot. The foot isn't as vascular as the rest of the body so it generally take a larger amount to mask/reduce severe foot pain.

[ILuvmyButtercups]

If it is soft tissue, it is going to take more than a few days of stall rest to show improvement. You need a Dx and an idea of how long the horse should be on stall rest. I used to work at a layup farm, and soft-tissue injuries take longer to heal than fractures.

:yes: Oh, it's been a lot longer than a few days! This happened late July, and it's still on going. I keep him in mostly, with some outings in a small paddock so he can roll and not become crazy bored. It's still hot here, so he mainly stands around under the shed, wanders very little. He's not nearly as lame, just gimps when he turns left, and if he trots up to the gate when I bring in his buddy. I'm certainly willing to give him the entire winter off!

I'm just going back and forth on finding the cause. If I take him to the vet's again for more expensive tests, and get the exact same results, what's accomplished? I hear you on the soft tissue vers. fractures lay up! I used to be heavy into race horses, and oh man, and how! Some horses seemed to spend their entire lives in a stall it seemed!!! :eek:

[matryoshka]

Well I apologize for adding to your mystery but I would be surprised if that small amount of bute would do that much if it was solely in the foot. The foot isn't as vascular as the rest of the body so it generally take a larger amount to mask/reduce severe foot pain.Good point.

[ILuvmyButtercups]

Well I apologize for adding to your mystery but I would be surprised if that small amount of bute would do that much if it was solely in the foot. The foot isn't as vascular as the rest of the body so it generally take a larger amount to mask/reduce severe foot pain.

:yes: This is why I have my doubts about the original dx. Every abscess or problem in the hoof casing I've seen in decades of personal experience or observation has proved that - pain maskers simply do not have much if any effect in these cases. But so what about this strange rotation in just this one foot? If it is a ligament tear, would that make the pedal bone drop in the toe, or rise in the heel? If the problem is higher up the leg, I suppose there is no harm in just doing what I am, give him the winter off. :(

Thanks for the hint. I hadn't thought of that until you mentioned it! :)

[matryoshka]

Here's another question for you: are the feet mismatched? Does the foot on the injured leg have a higher heel and steeper angle than the other? If so, it is possible it has been that way for a long time and nobody really mentioned it, especially if it doesn't look like a club foot. The rads may be showing an alignment that has been there all along, especially if your farrier isn't seeing any stretching at the toe. I've got two horses who have one foot steeper than the other, and neither looks like a club. In fact, I'd prefer if both fronts looked like the steeper foot, since the low foot on each is very flat.

The difference in alignment might make your vet think the steeper foot was a new rotation rather than having been pre-existing. I trim for clients who did not realize their horse's front feet were different until I pointed it out to them.

[Rick Burten]

The foot isn't as vascular as the rest of the body.....
It's not?? How then do you account for the vast network of blood vessels--arteries, arterioles,veins, venous plexus, etc?

[ILuvmyButtercups]

Here's another question for you: are the feet mismatched? Does the foot on the injured leg have a higher heel and steeper angle than the other? If so, it is possible it has been that way for a long time and nobody really mentioned it, especially if it doesn't look like a club foot. The rads may be showing an alignment that has been there all along, especially if your farrier isn't seeing any stretching at the toe. I've got two horses who have one foot steeper than the other, and neither looks like a club. In fact, I'd prefer if both fronts looked like the steeper foot, since the low foot on each is very flat.

The difference in alignment might make your vet think the steeper foot was a new rotation rather than having been pre-existing. I trim for clients who did not realize their horse's front feet were different until I pointed it out to them.

:confused: His feet have always been perfectly matched in size, shape and wear evidence. Good pasturn angle, and even now there is no dishy dip in the injured hoof, like you see in horses whose pedal bone has rotated rapidly. The shoes are 4 weeks old now, in fact my farrier is coming this morning to re-do the kids. His heels are longer now, because of the barred heels, and I trust he'll be trimmed down today. I don't want him to come out of this in the end with a severely altered angle, all high-heeled with a straight toe! My farrier puts rocker toes on my horses anyway, and it works well, they don't stumble or hit themselves when in motion. I guess I don't mind a slightly longer heel, if necessary, but I want the frog in contact with the ground, as nature intended. Nothing hurts a horse more than having boxy, stumpy feet, with shriveled frogs, has been my observation over the decades I've been in this business.
But since he has rotation now, old or new, I wonder if he'll ever be able to go back to having regular shoes, with open heels and proper angle. He's much better now.... isn't nearly as lame, but I so fear a set back if I don't continue with what we are doing! Ugh, I really detest these horrid correction shoes - they are clunky and heavy and unnatural - I'm always afraid he'll knock one off with a hind foot. Thank goodness his horn is in super condition, strong, no cracks, excellent density. We have the normal foot in the same set up of course, for balance... I wonder if that foot will start having problems because of the restricted heel? :confused: