DR. CHRISTIANA OBER, a top lameness diagnostic veterinarian who works with Dr. Kent Allen, answers all your tough veterinary questions. Dr. Ober specializes in sport horse medicine, diagnosing lameness, imaging technology, and pre-purchase exams. For those actively competing, she’s also an expert in USEF drugs and medications rules!

Dr. Christiana Ober would like to stress that her responses to these readers’ questions about their horses are based solely on the information provided her. She strongly urges everyone to treat any equine medical condition in concert with their regular veterinarian.

Kathy,  Eagle, Idaho
I have a 5-year-old who had OCD in his stifle. Surgery was done when he was 8 months old, and was successful! He’s going great now and hasn’t had any lameness issues. I would like to know what to expect as his training progresses. Is that stifle going to be weaker than the other one? Should he be on any sort of preventative supplements? At the suggestion of my veterinarian, I’ve been giving him monthly Adequan shots, with a shot of Legend before a show or clinic.

Dear Kathy,
I would certainly expect that if there were going to be a problem with that stifle you would have seen it by now. Usually the issues associated with OCD become obvious as the horse is coming into work and training. If you haven’t already done it, it would be worthwhile to both take some baseline radiographs of that stifle post-operatively and have your veterinarian do a routine evaluation of your horse to both assess his gait behind and check for any effusion (joint swelling) in that stifle. If your horse is sound behind, flexes well and has minimal effusion (joint swelling) in that stifle in training then I would think it unlikely that he would have a problem in the future.

I think that Adequan and Legend always have some benefit for the horse in training, but unless he seems to have some mild degenerative joint disease or early arthritic change it might not be necessary at this time.

Alyssa,  Olney, Md.
What types of things should the average amateur rider do on a daily basis to help keep her horse sound? Cold hosing, liniment, joint supplements, turnout, etc.?

Dear Alyssa, I think the best thing an amateur rider can do is get to know your horse and what is “normal” for your horse. How much heat does he normally carry in his feet? What does his normal digital pulse feel like? How much effusion or joint fill does he routinely carry in his front fetlocks, his hind tendon sheaths? You can have your veterinarian go over some of these things with you and then develop a quick daily routine while you are grooming just to notice changes in his legs and tendons. Noticing a subtle change in a tendon shape/size or new fill in a joint can be instrumental in detecting the early signs of injury. As you get to know your horse better you will start to notice these subtle changes. Also, just start watching your horse jog. Have someone trot him for you on a firm level surface once a week. You don’t have to be a vet or an expert to notice an asymmetry, and you will start to know what sounds and looks normal for him.

I think developing a good relationship with your veterinarian is also a good idea. Have him/her check out your horse twice a year even if you think all is well to get a baseline moving examination and response to flexions. It is much easier to know what is abnormal if you have seen the horse several times before.

And you can’t go wrong with a daily oral joint supplement containing either glucosamine or hyaluronic acid. I always think turnout is great—horses are meant to be out and moving around–it seems to be good for both their body and mind.

I don’t really recommend routine use of cold hosing, liniment or wrapping but if your horse has an exceptionally hard day (gallop or cross country school) I think it is fine. Also if you start to notice more heat or swelling in a region, cold hosing/ice is always a good head start to reduce inflammation until your veterinarian can get out to check it out.

“Knowing” your horse is the best protection. Once you know what is normal, you will easily detect what is abnormal.

Alyssa,  Olney, Md.
Do intra-articular injections really cause joints to degenerate over time? I am specifically thinking about corticosteroid hock injections.

Dear Alyssa,
It all depends on how the therapy is used. For example, repeatedly putting corticosteroids in a fetlock joint with a floating bone chip will cause cartilage and joint degeneration. But injecting the lower hock joints biannually with hyaluronic acid and some corticosteroids to alleviate the inflammation is an invaluable therapy for the performance horse.

Usually the reason the therapy is recommended is degenerative joint disease. Remember, degenerative joint disease will continue to progress, with or without the injections.

There are a couple of fallacies about joint injections: 1) If used appropriately (one to two times per year, with high quality hyaluronic acid), the joint injection does not speed up the degeneration. It actually improves the quality of the synovial fluid by reducing the inflammation. Usually, hyaluronic acid and a steroid are combined for the joint injection. The corticosteroid is a potent anti-inflammatory and the hyaluronic acid promotes health of the synovial fluid and hopefully will extend the effects of the joint injection. 2) Injecting a joint once doesn’t mean you’ll need to inject that joint more and more frequently. Sometimes a synovitis (acute inflammation within a joint) will resolve with one therapy. But repeat therapy will most likely be needed because of the disease process already in motion.

Intra-articular therapy is still an invasive therapy and should only be used when necessary. But it can help your horse to have a longer and more comfortable performance career.

Anastasia,  Nashville, Tenn.
Is it possible for abscesses to last longer than several weeks? If so, what would cause this?

My horse developed an abscess last summer that seemed to heal several times and for the last two months has seemed to be gone (it even drained out of the coronary band). Now he has heat in that foot again and does not want to engage that hind leg. Could he still have the abscess after all this time?

Dear Anastasia,
Sounds like a long time for a simple abscess to continue causing problems. I would highly encourage you to have your veterinarian do a further examination.

Sometimes there can be an underlying problem causing a continued source of inflammation and infection. For example, if your horse had such a severe abscess/infection that affected his coffin bone they can almost form a sequestrum or a dead piece of bone that can be a cause of reoccurrence. After the lameness has been localized to his foot region, I would recommend taking radiographs of the foot (coffin and navicular bone) to rule out these other problems. A radiograph would also give you some insight on sole depth and foot conformation/hoof balance. A moving examination could also give insight into other gait asymmetries or reasons the horse may be overloading that foot/particular region of the foot.

Kat,  Sharpsburg, Ga.
In today’s horse show world, you hear of so many horses battling ulcers. I know Gastrogard is at the top in ulcer treatments, but for 30 days, it’s almost $1,000. Now you hear veterinarians advising to only treat for two weeks, then start them on Zantac, etc. What is the most thorough, and cost effective ulcer treatment out there?

Dear Kat,
Fortunately or unfortunately, Gastrogard (omprazole) is still head and shoulders above the other ulcer therapies. To effectively treat horses whose ulcers have been confirmed via gastroscopy, it takes a full tube of Gastrogard for 30 days. Although expensive, it’s often the only therapy that seems to heal these horses. Certainly the cost of the therapy encourages a diagnosis by gastroscopy before investing in treatment.

Unfortunately it seems that horses that develop gastric ulcers are prone to develop them again and again if they’re kept in the same program. We will often see certain horses beginning to show symptoms at the same time each competition season. After the initial treatment course, many stay manageable and happy on 1/4 tube of Gastrogard or Ulcerguard (they are the same medication) a day.

And talk to your veterinarian about other management changes you could make for your horse.

Cammy,  Kent, Wash.
The Depo-Provera implant is being used to keep geldings quiet (anxiety attacks) for their amateurs who ride and to help keep more weight on them. Is this legal to show on? What is your feeling about the use of this?

Cammy,
My feeling is that putting geldings on Regumate or using the Depo-Provera implant does not work well at all. I have not found it to be helpful, and I think you should look for other ways to minimize anxiety and improve condition. I would make sure your gelding is not affected by gastric ulcers. I would also examine his diet for appropriate amounts of fat/protein to keep his condition but not make him “hotter.”

As far as I know the Depo-Provera implant is not labeled for this use. There are not restrictions for hormone usage in show horses at the U.S. Equestrian Federation competitions, but it’s a different ballgame in FEI-level competitions.

I would certainly exhaust my other options for both minimizing anxiety and improving condition.

Beverly, San Diego, Calif.
We just had my trainer’s prelim/intermediate eventer’s front feet MRI’d. He blocked out on both feet so we gave him four months off work; no change. He was given Equithane; no change. MRI shows that he has bursitis of the navicular.
The navicular actually MRI’d really clean and well defined—it was a very sharp/clean line around it; it was the bursa that they were concerned with. What would you suggest to bring him back to working form? Isoxsuprine? Should we inject the bursa with something? If so what? Is he doomed? Can a horse with this condition come back into competition form?

Dear Beverly,
Horses that “block to the foot” or suffer from caudal heel pain can encompass many different structures and diagnoses. MRI has certainly become the “gold standard” for diagnosis because there are so many different soft tissue structures in that region. MRI is a fairly recent diagnostic to be incorporated into many equine practices, and the learning curve for reading them has been steep.

The information gained from the MRI in your case is critical for both management and prognosis of this horse. If the soft-tissue structures previously mentioned appear healthy in the MRI, the prognosis should be better. Sometimes, however, navicular bursitis can be seen in addition to one of these other soft tissue lesions–then the prognosis is not as good (especially with a DDF lesion).

Navicular bursitis (inflammation of the navicular bursa) can be treated with a radiographic guided injection of the bursa. At our practice, we use digital radiography to guide us as we place the needle in the bursa. After proper placement is confirmed, a combination of hyaluronic acid and a steroid (similar to what is put into a joint) is injected. The horse usually has several days off after the injection. The needle does have to pass through the deep digital flexor tendon but this trauma can be minimized with radiographic guidance.

We also combine therapeutic shoeing (to minimize stress on the bursa, especially in the low-heeled horse, and sometimes high-energy shock-wave therapy to help return these horses to work.

Isoxsuprine seems to have varying results in these horses. Our general guideline is to do a therapeutic trial of 90 days (30 to 35 tabs a day) to see if improvement is noted. If the horse improves we keep the horse on the isoxsuprine; if the horse does not improve, we discontinue therapy. Please be aware that there is a significant withdrawal time for isox in FEI-level horses.

In general if navicular bursitis is the ONLY component of the caudal heel pain, these horses seem to have a fairly good prognosis for return to work with therapy and proper management.

Jelena, Golden, Colo.
My 3-year-old Thoroughbred had surgery to remove a chip in his right knee. He received two Legend injections and is on Cosequin. It has been more than nine weeks since the surgery (as of Jan. 22), and he still is not quite right. I think it may not be the knee that is bothering him.

He has mild swelling in his gaskin from a kick that occurred about a week ago. Is there a way, short of joint blocks (which I read are not entirely effective) to figure out whether it is the surgery site or another area that is bothering him? Would shoeing him with pads be a good step to take?

Dear Jelena,
It sounds like to me you need to have a very thorough lameness exam done on your horse to localize the lameness. By “knee” I assume you are referring to his carpus. Your veterinarian would probably start with a good physical exam to feel for excess effusion or joint inflammation especially in the joint post operative. The examination would then progress to a moving examination, including watching the horse on the longe line and response to flexions. This should give your veterinarian both a leg (or legs) to focus on and some idea of the region to start with. I think that blocks (nerve and/or joint) would be incredibly beneficial to localize the lameness. An intra-articular (or joint) block would be very effective in telling you whether or not it is the carpus that’s still bothering him.

I am confused by your idea of joint blocks not being “effective.” They are very effective in being able to localize a source of lameness. However, after you have localized the lameness with the block you will still need to pursue other imaging techniques such as radiographs or ultrasound of the joint to gain a definitive diagnosis. Unless he blocks to the foot, I can’t imagine that pads would do him much good. I would highly encourage you to pursue an in-depth lameness exam to localize the lameness before spending any more money on either Legend or shoeing changes.

Gabrielle, Columbiaville, Mich.
I would like to know how a diagnosis of navicular disease is arrived at? What symptoms would be seen; what special imaging techniques are necessary? Can navicular disease be “stopped” by changing hoof trimming and/or shoeing techniques? What else can you tell us to help us better understand about navicular disease and its impact on a horse’s future?

Dear Gabrielle,
You should also read the above answer to Beverly’s question!

Navicular disease or a horse with caudal heel pain ends up usually being a horse that blocks to the heel region with a palmar digital nerve block. There are many structures in that region and it is impossible to tell which structure is affected with the nerve block. You need to pursue additional diagnostics to gain definitive information about the affected structure.

After nerve blocks and hoof testers, most veterinarians would first do a radiographic exam of the foot and navicular region. This is helpful for diagnosing such things as a navicular bone fracture and severe degenerative navicular change. Unfortunately soft-tissue structures cannot be seen on a radiograph. Sometimes you can also try to use ultrasound to see some of the structures in the foot region such as a small part of the deep digital flexor tendon (under the frog), the impar ligament, the navicular bursa, and the collateral ligament of the coffin joint. Unfortunately many of these structures are shielded from view by the actual hoof capsule. Any of these structures can be affected and create a horse with the same presentation.

Because of the hoof capsule and the number of soft tissue structures in the caudal heel region, MRI has become the diagnostic of choice for navicular disease. Luckily in the past year, MRI has become much more readily available. Although still very expensive (generally $1200-1500 for both feet), it is now possible to acquire images without general anesthesia. There are multiple centers now that offer standing MRI across the country. This would be the most sensitive way to diagnose abnormalities in the caudal heel region–both involving bone and soft tissue. Nuclear scintigraphy (or bone scan) is also very sensitive in diagnosing early boney navicular disease. But again the bone has to be involved for a diagnosis via bone scan. It, like radiographs, will not detect soft tissue involvement. I think it is safe to say that we are seeing more and more horses that block to the heel region, have normal radiographs, and show significant soft-tissue abnormalities on MRI.

You asked about symptoms: Generally you will see lameness (often bilateral or involving both front feet) exhibited when the horse is longed or ridden on a small circle, usually worse on hard ground. The lameness can be varied in degree. You also might see sensitivity in the heel region or across the heels to hoof testers, pointing of the feet in the stall, packing up the shavings underneath the feet, coffin joint effusion (fill in the coffin joints).

Stopping “navicular disease” depends on the specific diagnosis. Generally, disease involving the bone itself is degenerative and will continue to progress, although its symptoms can sometimes be managed. If the horse ends up having a soft-tissue lesion, prolonged rest would be in order.

Laura, Aurora, Colo.
I have a friend who has a 4-year-old, warmblood mare. She has been in training now for about 5 months under saddle. She has some very odd behavior that could be telling us something hurts.

She is lovely on the ground—she follows you around and is easy for grooming, shoeing, trailering, etc. But the moment she thinks you’re going to ride her, she starts getting weird about the bridle, acts like she wants to pull back, then gets cinchy or even freaks out about having the saddle put on her. She is always longed lightly before the trainer gets on her to make sure she is warmed up—never lame on the longe line. Then once on her, at no particular given moment, she will just explode into bucking.

Once the bucking is over, she seems terrified; she never does anything mean but she is definitely scared. You usually have to walk up to her and walk her off with the trainer riding or she will start bucking again. All this behavior is getting worse and worse—and nothing seems to help. She has vetted completely sound (although no x-rays yet), and my friend has had her teeth checked, changed saddles, changed bridles, changed her feed (off of sweet feed and alfalfa onto grass hay and oats). It’s totally baffling.

Dear Laura,
That does sound like troubling and frustrating behavior. It is sometimes difficult to distinguish behavioral issues from pain/musculoskeletal issues. I do have a few ideas for you, though.

First I would have another very thorough lameness exam done on her to check for any signs of lameness or positive flexions. I would pay extra-special attention to any signs of back soreness (especially over the dorsal spinous processes or in the lumbo-sacral or sacro-iliac region). Most of the horses that come to us exhibiting this sort of behavior end up having a primary back issue often associated with sacro-iliac disease. These back issues can be difficult to diagnose and can take additional diagnostics. We often start with radiographs of the back region and then progress to do a rectal ultrasound to examine the lumbo-sacral and sacro-iliac regions to look for evidence of arthritis or other abnormalities.

Radiographs can also be taken of the neck to assess the joints for arthritic change. Certainly I would first want to rule out abnormalities of the axial skeleton—meaning back or neck disease. If this round of diagnostics was unrewarding, you could then progress to a full body nuclear scintigraphy or bone scan to look for any other sources of pain or bone inflammation such as stress fractures or other hot spots. Other things that could be investigated would be blood work to check for elevations in muscle enzymes or a reproductive ultrasound to examine the ovaries.

I would really encourage you to get her back and spine checked out very thoroughly. If I had to guess I would think it highly probably the problem might be somewhere there. After a diagnosis is made, there are some therapeutic options, such as ultrasound guided sacro-iliac injections or mesotherapy on her back.

Anne, Baltimore, Md.
I note from your bio that you are licensed to do equine acupuncture. What has been your experience with acupuncture treatment for navicular syndrome? Also, with all the corrective shoeing available, what have you found to be helpful—including any insight you have on the barefoot option?

Dear Anne,
Certainly acupuncture is an excellent alternative modality and very successful in making many navicular horses more comfortable. However, I have also found that it often times must be combined with conventional therapies such as shoeing changes, non-steroidal anti-inflammatories, and injections. I believe that it has its place in attempting to make the navicular horse more comfortable, but I have had little success with acupuncture alone in these horses.

Navicular disease is a very complex process and the term can be used as a descriptor for any number of structures and injuries. Oftentimes the shoeing plan depends on the exact diagnosis and what level of work the horse will be kept in. For example if the horse has a significant lesion in the deep digital flexor tendon and will be stall rested for six months, we might put him in a two- or three-degree wedge pad with a bar shoe to try to alleviate strain.

I think your question is probably more related to shoeing of the chronic heel pain horse that might be suffering from pain due to degeneration of the bone. Shoeing can also depend on the conformation of the foot and feet (if the horse has two different feet). We often start with a set of radiographs to assess the navicular bone and coffin bone and to look at amount of toe, sole depth, medial to lateral balance and palmar angle (the angle of the coffin bone to the ground.) Many of these horses that suffer from caudal heel pain have very low heels and a negative palmar angle. These horses might need more heel support than your average horse. Certainly all of these horses benefit from a shortened toe to ease breakover. Often times the longer the toe and the lower the heel, the more strain that is placed on the caudal heel region. Sometimes we attempt to ease breakover and shorten the toe with a “natural balance” shoe, which is wider in the toe region and can be pulled back farther. Sometimes we will combine the premise of a wider toe with spread heels as well.

This shoe, “the onion shoe” has been probably our most successful shoe in management of the navicular horse (you can search literature published by Dr. Jean-Marie Denoix for more information about the biomechanics of this shoe). Obviously the conventional bar shoe also has its place for additional caudal heel support.

The shoeing recommendations depend both on the structure affected and the horse’s hoof conformation. Your veterinarian and your farrier working together will have the best chance of coming up with an appropriate shoeing plan. Most of these horses need to be on a four-week shoeing interval as there discomfort can sometimes increase at the end of the shoeing cycle (as the toe gets longer).

I haven’t had much luck with keeping performance horses with caudal heel pain sound barefoot. I think maybe if you had an older retired or pasture horse it might be appropriate with very routine trimming.

Kristie,  Dayton, Ohio
I am trying to accurately diagnose my horse, who seems to be having a very serious metabolic problem. I’ve been with my veterinary practice for three years, my account is paid up, vets agree that something is not quite right, and I have spent thousands in the last two years. What I want is copies of my horse’s blood results to compare certain things to certain seasons. I’ve consistently asked for the results for a year, and now I’m getting upset over just getting numbers over the phone when I’d like the results mailed or faxed to me. Is there a reason to guard blood work results like Fort Knox?

Kristie,
Your situation certainly sounds frustrating but I’m sure it is just a miscommunication. I would recommend putting your request in writing with reasons for wanting copies of the bloodwork and sending it to the veterinary office manager. Sometimes we vets get a little busy and things like that can drop out of our mind. After you mail your request, you could follow it up with a call to the office. I am sure your veterinarian will be happy to release all blood work to you as long as you are the “official” owner of the horse.

Generally, for legal purposes, records can only be released to the name of the owner who is both paying the bills on the horse and who has the account. If the horse is under another name you will just have to get that person to officially call and release the records to you. There is no reason you shouldn’t be able to get copies of the bloodwork. I am sure it is just a miscommunication. I am sure your veterinarian wants the best for your horse. You might want to seek out an internal medicine specialist to consult about your horse’s metabolic problem and go over the results with you.