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soft tissue injury and underrun heels (update 1/29)

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  • soft tissue injury and underrun heels (update 1/29)

    When I bought my horse a few months ago he had pretty bad slipper feet -- not sure what originally caused them but he was on a sort of minimal farrier schedule in the months before I got him (owners didn't want to spend money on him) that undoubtedly exacerbated the problem.

    Over the past few weeks he has exhibited on/off lameness in front (sometimes pretty bad, 3/5 according to the vet) that gets worse when he is in regular work. Prior to purchasing him he was being hacked casually but not much else. He has not been working hard since I bought him, but he is being retrained for dressage. My trainer has been bringing him along at what I consider an appropriate pace and not asking too much of him, but it is definitely more regular work than he had been in for a while.

    We've done a couple of lameness exams and x-rays of the front feet (which were clean). The vet's best diagnosis is soft tissue injury due to stress caused by his super-low heels and long toes. My horse is currently on stall rest and bute, hand walking only for exercise, and my vet is talking to the farrier about a long-range plan for dealing with my horse's feet.

    My understanding is that dealing with this hoof morphology is a long-term project, and that's OK with me because I can't ride much for a while for a number of reasons anyway. What I was wondering is if in the meantime there is more I can be doing to help my horse. I know that if he were a human athlete they'd probably recommend rest, maybe heat and massage. I've ordered an anti-inflammatory supplement with MSM and am considering contacting a massage therapist. I'd be happy to massage him myself but I know that if you don't know what you are doing you can cause more harm than good, and I don't know what I'm doing.

    Any other advice? Thanks in advance.
    Last edited by MelanieC; Jan. 30, 2011, 12:48 AM.
    MelanieC * Canis soloensis

  • #2
    Sorry to hear this.

    Ultrasound?
    Did vet do any blocks?

    Maybe post some details as to what work he has been doing, also turnout situation, stable conditions etc

    Comment


    • #3
      What is there, exactly, to discuss with the farrier about a "long range plan" for the feet? It sounds, based on your description, like a no-brainer for a competent farrier - trim the heels back, get the toe back. Shoes with wedge pads may be beneficial in the short run to correct the hoof angle nearly immediately while the trim is worked on to correct the actual foot (which may take many months).

      It's hard to mess up a horse's muscles by doing some massage work yourself if you're already going into it with some trepidation Worse case is usually that you don't do much/any good, but even then it probably still FEELS good (and makes you tired and maybe sore LOL!!). There are many good massage books out there if you want to learn some techniques.
      ______________________________
      The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

      Comment


      • #4
        You have a couple of hoof options, assuming your diagnostics are finished and you're not going to go with an MRI, etc.

        1. Start aggressive corrective shoeing, probably with some sort of wedge shoe or wedge pad.

        2. Pull the shoes, turn the horse out, and let it begin growing a better foot with frequent and thoughtful trimming.

        The horse I'm leasing had a DDFT/navicular bursa injury last summer and is rehabbing now after surgery. He has low heels and progress has been SLOW getting them to improve. Per the vet's recommendation he is in natural balance wedge shoes. Interestingly, the hind feet, currently unshod, have improved dramatically. I floated the idea of pulling the front shoes while he was in recovery but the vet didn't think that was a good idea at all and wanted those heels UP, which means, for now, doing it with shoes/wedges.

        He's doing well and will stay in the wedge shoes for as long as he needs to, but porbably if he cannot come sound and is eventually turned out for a long time, the shoes will probably come off and see what Mother Nature (and my farrier) can do.
        Click here before you buy.

        Comment


        • #5
          We just had a similar issue with my horse. Low heels and long toes lead to a tendon strain that's given him three months off.

          I got a new farrier who specializes in corrective shoeing. He did three shoeings using Morrison shoes--aluminum shoes with a wedge at the rear. He said it's important to reduce the pressure on the heel to restore good circulation and allow the heel to grow again. He also said that too many farriers will respond to this problem by simply chopping off the toes, which doesn't change the angle at all.

          After the Morrison shoes, we transitioned to a regular steel shoe and a slightly wedged plastic pad underneath. By next time, he may be back in regular shoes. His heels have grown and the angles are much more upright. He's also moving better than he ever has--in fact, he has a collected trot that we didn't even know was in there!

          Comment


          • #6
            Soft tissue injuries can take a long time to heal. Does the vet think it's in the hoof itself? Those can be hard to visualize without spending real $, although a good lameness vet can do more than you think with ultrasound.

            If you know what specific ligament/tendon you are dealing with, then, yes, there could be more you can do; shockwave, for example, can facilitate healing. Repeat ultrasounds can give you a good picture of how far along the process is, which in turn will give you some guidance for how much movement/exercise to reintroduce and on what time frame. There are other treatments that can be expensive if you don't have insurance, but first you need to know exactly what the injury is.

            The farrier is key for keeping him sound over time, but the injury has to heal.

            If it is not financially feasible to do the diagnostics on what the injury actually is, then I would take it VERY slowly indeed. If he is not sound, I would not do ANYTHING but handwalking if you don't know what is wrong. Only once he is sound would I very gradually introduce small area turnout and walking on good ground under saddle, and go slowly from there.
            The big man -- my lost prince

            The little brother, now my main man

            Comment


            • #7
              What are Morrison shoes, please?
              Click here before you buy.

              Comment


              • #8
                Originally posted by deltawave View Post
                What are Morrison shoes, please?
                Dr. Scott Morrison,DVM is a veterinarian at R&R in Lexington, Ky. He is also a farrier. He designed a series of aluminum horseshoes to treat a variety of hoof pathologies. When folks mention a Morrison shoe they are most generally referring to this one. http://www.grandcircuitinc.com/prodd...prod=MORSGCMOR

                Comment


                • #9
                  Originally posted by Rick Burten View Post
                  When folks mention a Morrison shoe they are most generally referring to this one. http://www.grandcircuitinc.com/prodd...prod=MORSGCMOR
                  Yes, those are the ones we used. Fantastic shoe--my horse moved unbelievably in them. Because they're aluminum, you can wedge the rear (that would make a steel shoe too heavy).

                  It's also important to rocker the toe to adjust the breakover. it took my horse a couple of days to get used to this. I think he wasn't used to his feet responding so quickly!

                  Comment


                  • #10
                    Any different than the wedged aluminum Natural Balance shoes? That's what my boy is wearing.
                    Click here before you buy.

                    Comment

                    • Original Poster

                      #11
                      Thank you for all the info. I apologize but it has been a very busy few days.

                      I have not had ultrasound done. The vet did block both front feet the first visit (which ameliorated but did not entirely eliminate the lameness) and the left (worse) front the second visit (same result although more drastic). X-rays look great.

                      My horse has been working about four days a week, a maximum of 45 minutes at a time, and pretty light work -- either lunging/groundwork or undersaddle but nothing hard core. He is new to dressage and learning to accept contact, etc. after training for Arab breed shows (hunter pleasure, saddle seat, etc.). Unfortunately right now there is no turnout at all as the pastures have standing water in them (common in the PNW) but the horses all get some arena time during the day (not mine as he is on stall rest/handwalking only).

                      The stable conditions are good -- clean and big (either 12 x 12 or 14 x 14 box stall) with mats over wood over dirt (I think). He can walk around in there. He has a number of toys but I am worried that he is very bored -- he is a rather busy horse and requires a lot of mental stimulation, although he is also very stable and not prone to anxiety behaviors. He has neighbors he can see and interact with through bars.

                      The vet suggested Natural Balance shoes and mentioned rockering the toe. From my research it appears that barefoot + frequent trims is also an option. I don't anticipate riding regularly for quite some time and am fine with him having time off if that's what he needs in the meantime. The barefoot + frequent trims sound like a good idea to me because my horse's feet appear to grow very fast in addition to growing forward, but at any rate we have a farrier appointment on Friday to make all these decisions.

                      I am not inclined to go crazy with diagnostics at this point if tincture of time is the most effective therapy in the long run. It is not critical that he be back in work quickly. I'd like to be riding, but it's not like I'm a professional or anything and I'm more concerned with his welfare. I will look into shockwave therapy.

                      I hadn't looked into insurance as I've only had my horse for a few months. Would there be a point in getting insurance now, or would any therapy be excluded under a new policy at this point since he's already been seen by a vet?

                      Thank you all VERY much, this discussion is very helpful.
                      MelanieC * Canis soloensis

                      Comment


                      • #12
                        Unless you lie (thereby committing insurance fraud) on the paperwork for insurance, the current lameness/injury/area will almost certainly be excluded from a major medical policy.
                        Click here before you buy.

                        Comment


                        • #13
                          Originally posted by MelanieC View Post
                          I am not inclined to go crazy with diagnostics at this point...I will look into shockwave therapy.
                          I don't know what the prices are like in your area, but around here, an ultrasound is WAY cheaper than a course Shockwave. I certainly wouldn't invest the $500+ for Shockwave without doing an ultrasound first.

                          Originally posted by MelanieC View Post
                          I hadn't looked into insurance as I've only had my horse for a few months.
                          It's too late now, since you'd be required to provide a vet report and the vet would be obliged to report the lameness. In the future, it's best to get insurance immediately. I contacted my insurance company before I signed the contract on my horse to get a quote, then used the pre-purchase exam as the vet report. My horse was insured before he set foot on the trailer to my place, and I saved the cost of an extra vet exam.

                          Comment


                          • #14
                            Any different than the wedged aluminum Natural Balance shoes? That's what my boy is wearing.
                            The wedge aluminum natural balance 'PLR' (Performance Leverage Reducer) is similar to the Morrison roller, but key to using either one (or any shoe for that matter) is the trim and shoe placement . Removing all that under run heel then placing the shoes accurately around the coffin joint is a key component.
                            Simply wedging up under run heels will only serve to crush them more.
                            Patty Stiller CNBBT,CNBF,CLS, CE
                            Natural Balance Certified Lameness Specialist ,instructor.
                            www.hoofcareonline.com

                            Comment


                            • #15
                              yes, my suggestion on shockwave was only if you get a proper diagnosis; you can't just randomly shockwave the area and hope it's going to the right place (I mean, you can, but it's not likely to be all that helpful).

                              You can certainly use time, but it is a gamble. You need to know that you might put your horse on stall rest, pay board, not ride or have him advance in his training, and have him still be lame in 3 months. Or 6.

                              I don't mean to be a downer, but I've dealt with lots of soft tissue injuries. The more clear and complete the diagnosis, the better I was able to rehab the horse. It's not that a diagnosis necessarily lead to costly interventions, but it led to more informed decisions on my part.

                              There is also his quality of life to be considered. Extended stall rest is tough on horses; it is worth it, if it leads to soundness. If it doesn't, they might as well get turned out sooner rather than later and at least have a better life. Impossible to know without a diagnosis.
                              The big man -- my lost prince

                              The little brother, now my main man

                              Comment


                              • #16
                                Originally posted by asterix View Post
                                yes, my suggestion on shockwave was only if you get a proper diagnosis; you can't just randomly shockwave the area and hope it's going to the right place (I mean, you can, but it's not likely to be all that helpful).

                                You can certainly use time, but it is a gamble. You need to know that you might put your horse on stall rest, pay board, not ride or have him advance in his training, and have him still be lame in 3 months. Or 6.

                                I don't mean to be a downer, but I've dealt with lots of soft tissue injuries. The more clear and complete the diagnosis, the better I was able to rehab the horse. It's not that a diagnosis necessarily lead to costly interventions, but it led to more informed decisions on my part.

                                There is also his quality of life to be considered. Extended stall rest is tough on horses; it is worth it, if it leads to soundness. If it doesn't, they might as well get turned out sooner rather than later and at least have a better life. Impossible to know without a diagnosis.
                                Ditto -

                                Comment

                                • Original Poster

                                  #17
                                  Thanks again. I would like to get him sound (as in really sound, not just able to work) as soon as possible. Asterix, you're right, I am concerned about his quality of life. I am not sure if the vet mentioned ultrasound during the last visit but I am battling a really bad cold so I may just be forgetting right now.

                                  My horse has a known OCD lesion in his left stifle (on a non-weight bearing surface) and I have been planning to get that ultrasounded so may as well do it all in one shebang I guess. The irony is that he has had zero problems in the back and remains fine back there.
                                  MelanieC * Canis soloensis

                                  Comment


                                  • #18
                                    It does really depend on location (which he can narrow down with blocks).
                                    If it is INSIDE the hoof, ultrasound is limited. I have had one very experienced lameness vet tell me (and show me on my horse) that he can see a fair chunk of the deep digital flexor tendon via ultrasound, but not ALL of it. And there are other things in the hoof as well.

                                    If it is above the hoof, then ultrasound may be a wise investment to give you both an actual diagnosis and a baseline for a recheck.

                                    Inside the hoof gets you more into MRI territory, which can be super expensive. For an uninsured horse this may mean going the slow and hopeful route. I had to do this with a horse who was chronically problematic up in front before MRI was available. He came sound, and then went lame again; this time we could MRI the foot and found a very big lesion on the DDFT. We were able then to properly rehab that and adjust his lifestyle (ie, retire him from competition), and he remained sound on that foot.

                                    Good luck!
                                    The big man -- my lost prince

                                    The little brother, now my main man

                                    Comment


                                    • #19
                                      Don't know if this would help, but a lot of people have taken their soft injury horse and just tossed him out in the field and left him there for a year. If the horse couldn't go b'foot, they really stayed super on top of the shoeing and trimming and all of that.

                                      Then, a gradual re-introduction to work. The turnout prevented the stall craziness, the hairy handwalking, and the very stressful early rides, as the horse was already moving around and mellow.

                                      Not sure if you have a diagnosis at this time? Anyhow, site of injury would help decide if the above approach would help or hinder...

                                      Comment

                                      • Original Poster

                                        #20
                                        The injury appears to be in his foot as the vet blocked his heels. I think. Then again, I am guessing you can't really block much farther up or else the horse is stumbling around due to total lack of proprioception. Please bear with me. This is totally new to me; this is my first horse. I'll have to talk to the vet again. It would make sense if he didn't mention ultrasound if the injury is somewhere that US wouldn't visualize. Honestly, the impression I got was that my horse just has some sort of sprain but like I said, this is all new to me. Also, the underrun heels are a longstanding problem that I was made to understand would take a long time to correct.

                                        If I turn him out I'll have to move him to a different barn. He's currently at a training barn and as I mentioned there's no turnout in the winter (which is pretty damn long here in Oregon) due to the pastures being underwater. He is a horse who would probably be pretty bored turned out -- he really likes human interaction -- but it probably wouldn't be worse than being stuck in a stall. Anyway, one step at a time. I'll talk to the vet and the farrier on Friday and try to get a better idea of what is going on.

                                        Thanks again everyone. Much appreciated.
                                        MelanieC * Canis soloensis

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