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Can someone look at these xrays?

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  • Can someone look at these xrays?

    Background: 6 months ago, my 8 year old horse came in lame, headbobbing, etc. Stumbling on the leg, and really shifting his weight up an down when he was standing. No swelling or heat. No pain when he was palpated. Thought it was a stone bruise, than an abcess. Waited a month, nothing happened. Blocked him and then went ahead and did xrays, found (I think) slight arthritis in the coffin joint on the right front, as well as slight navicular changes, although nothing significant.

    Horse was injected with HA (and had a geiser effect when the needle was stuck in), shoeing was changed to an onion shoe (which I had never even heard of LOL) upon consultation with the vet and farrier, and horse has been sound since.

    Brought him in yesterday, and he again displayed the same symptoms, so my best guess is that I waited too long between injections.

    But here's the question...the vet thought that he could easily go at least 10-12 months between injections because he didn't think the arthritis was much at all. And if he does in fact require injections every 6 months (already!), how does that bode for his future soundness if he's already crapping out at 8 years old? We are schooling all of 2nd level dressage and jumping once a week at about 2'3 and I had not even considered that he woudl be topping out already

    When you look at the xrays, do you see something different? Vet is coming out Friday to take a look...should I be asking something different?

    Thanks for looking
    In my opinion, a horse is the animal to have. 1300 pounds of raw muscle, power, grace, and sweat between your legs - it's something you just can't get from a pet hamster.

  • #2
    Don't know but you might want to ask your vet about IRAP.


    • #3
      If you guys are totally 100% sure it's the foot/feet then I wouldn't mess around. You are lucky in that they can MRI feet. I would go to a clinic for a full evaluation, one that has all the latest diagnostic equipment.
      On the Internet, nobody knows you're a dog


      • #4
        Ditto on the MRI. You may have something going on in the soft tissue in the foot. And, yes, irritation from a soft-tissue injury can give you the geyser effect.

        Can't see much in the radiographs except for the odd floating object in the first one and a lot of horse shoe.
        The Evil Chem Prof


        • Original Poster

          Thanks guys. Vet is out Friday, and I'll be doing another xray to see what's up, and then I'll ask about an MRI if it appears that the xray isn't showing much

          (i don't know what's worse...I really don't want to see that the arthritis had gotten significantly worse but nor do I want to hear "well...what else could it be then?")
          In my opinion, a horse is the animal to have. 1300 pounds of raw muscle, power, grace, and sweat between your legs - it's something you just can't get from a pet hamster.


          • #6
            Look at your shoeing cycles too -- is the horse at the end of the shoeing cycle and ready to be redone? Sometimes my horse with the coffin joint issues would get a little funny toward the end of the cycle as he grew foot and angles changed, then was back to okay after shoeing. But he wasn't lame, just a little uneven looking when that happened.

            But if you are going to go into further diagnostics, do consider MRI. See what your vet thinks -- but it might give you a definitive diagnosis and better treatment options. And while it costs $$$, you will be spending that on x-rays or ultrasounds, etc. if this goes on a while.


            • #7
              Wish they would turn the brightness down on those x-rays, quality is not the greatest... but anyway, I do not think they are that bad. I would be quite surprised if the arthritis was the cause of head bobbing lameness.
              I definitely see the narrowing and arthritis in the coffin joint, although I would be skeptical it is the cause of head bobbing lameness. In my experience, coffin joint arthritis (as well as arthritis in general, actually) is a slight or moderate lameness that the horse may work out of after warming up.

              The floating bone piece is the lateral cartilages starting to ossify, aka form sidebones. Sometimes the formation of sidebones can be painful for the horse, although they are not supposed to cause huge issues once formed.
              I would be interested to see if that has changed at all on the new x-ray.

              I put another vote in for MRI to look at soft tissue problems.

              Was the joint injection just HA or were steroids (Vetalog, Depo) added as well? Was just the coffin joint injected?

              When did the shoeing change take place? Was it before or after the injection? Were you able to observe the horse after the injection and before the shoeing (or visa versa) to see which one was more effective?
              When was the horse last shod? Is he about due or was it done recently?

              Is this similar to the onion shoe you've been using? http://www.forgeandfarrier.co.uk/images/Onion-Shoe.jpg


              • #8
                There could be a soft tissue injury going on in there that an X-ray would not see. The MRI is your sure bet for knowing exactly what you are dealing with. Going from sound to head bobbing lame very suddenly does not sound like your typical arthritis progression.


                • #9
                  I agree that the x-rays don't look that bad. I'd probably account it to the sidebone but I'd inject the coffin joints again. I have some larger horses that are injected every 4-6 months. See how he is after the coffin injections and if not improved then either MRI or treat it like it's soft tissue.
                  "ronnie was the gifted one, victor was the brilliant intellect, and i [GM], well, i am the plodder."


                  • #10
                    You need a vet who is knowledgeable and concerned about the obvious coffin joint misalignment(it is "broken back") and the LONG toe and breakover point . Both will directly cause the coffin joint issues. In other words , some serious shoeing changes need to be made from what I see on that Xray . The onion shoes probably worked for a while because being wider at the back they held the heels of the foot up on the ground as the toe sunk in a little , thereby sort of "wedging" the foot ,But eventually as the foot grows forward more, the surface area of the long stretched toe will overcome the surface area of the wider heel shoe against the ground, and you again have a broken back misaligned joint. So the biggest problem I see is the shoeing. The stretched forward toe is like a Donald duck foot sticking out there, and the heels of the shoe look short. So there is more ground surface area in the front portion of the foot than the rear, and it should be exactly opposite. The stretched toe is also contributing to a thin sole as the sole gets stretched forward too. If these imbalances are not corrected you can inject till the cows come home but you will still have a periodically lame horse.
                    Patty Stiller CNBBT,CNBF,CLS, CE
                    Natural Balance Certified Lameness Specialist ,instructor.


                    • #11
                      What Patty said. Phew, so much less typing necessary now that Patty is on COTH
                      "Kindness is free" ~ Eurofoal
                      The CoTH CYA - please consult w/your veterinarian under any and all circumstances.


                      • #12
                        MRI, MRI, MRI. FIRST you need a solid anatomical diagnosis, THEN a treatment plan.
                        Click here before you buy.


                        • Original Poster

                          Thanks guys. Went out today, still same thing. He doesn't look too bad at the walk, but at the trot, he just lurches and stumbles around, equally on a circle as well as a straight line.

                          To answer questions, we had HA injected just into the coffin joint (and it was just HA, no additional stuff) and he was sound the next day, and I was riding him 5 days after that.

                          The onion shoe (and yes Tegan, that does look quite similar) was put on 3 weeks after the farrier consulted with the vet and agreed that the breakover point was wrong and he (still) had a freaking long toe (although to be fair, just looking at it, it really didn't look that long)

                          He is getting towards his 6 week cycle (incidentally, the first time he went lame was at the time that I had pushed it to 7 weeks and his toe was super long), so maybe that is part of his uncomfortableness.

                          I will post the newer xrays as soon as I get them, (I'm actually interested to see if the onion shoes helped anything) and will repost with what the vet says.

                          Now, last question...if it was a soft tissue injury, would injecting it have masked it for a while, to the point that he was quite comfortable showing first level and jumping? Or is it more likely that he has a soft tissue injury THIS time around and its aggrevating everything again.

                          I swear to God, soccer was never this complicated or heart tugging
                          In my opinion, a horse is the animal to have. 1300 pounds of raw muscle, power, grace, and sweat between your legs - it's something you just can't get from a pet hamster.


                          • #14
                            Originally posted by TropicalStorm View Post
                            He is getting towards his 6 week cycle (incidentally, the first time he went lame was at the time that I had pushed it to 7 weeks and his toe was super long), so maybe that is part of his uncomfortableness.
                            FWIW, the gelding I have with arthritis in his LF coffin joint seems to get way more relief from a regular trim cycle than he does from joint injections.
                            "In order to really enjoy a dog, one doesn’t merely train him to be semi-human. The point of it is to open oneself to the possibility of becoming part dog."
                            -Edward Hoagland


                            • #15
                              I will be curious as to what your vet says. I would ask him/her to be very honest with you about the trim/shoeing package. Personally I would not spend my money on a MRI on a foot that looks like that, certainly if you get the foot balanced and the horse is still unsound then it would be warranted. But thats me....
                              "Kindness is free" ~ Eurofoal
                              The CoTH CYA - please consult w/your veterinarian under any and all circumstances.


                              • #16
                                Originally posted by TropicalStorm View Post

                                Now, last question...if it was a soft tissue injury, would injecting it have masked it for a while, to the point that he was quite comfortable showing first level and jumping? Or is it more likely that he has a soft tissue injury THIS time around and its aggrevating everything again.

                                Based on my experience, yes the injection could have fixed it for a time. But they are complex systems…
                                The Evil Chem Prof


                                • #17
                                  Also remember that it could be two totally different problems. Maybe the coffin joint arthritis was the issue before, and injections helped, and this is something else, something new. Not saying it IS something different, just that you have to consider that possibility.

                                  If I understand correctly, this will be the first time the vet sees the horse since the recent lameness? So I think you will know more after the vet does the exam and can decide how to proceed.

                                  I don't think that IF (big if) there was a soft tissue injury the first time, an injection would have been able to mask it for that long a time, considering the work you did in between. Yes, I do think it can for a very short period, or so has been my experience, but not with the scenario you describe. But that's just me and I am certainly not qualified to say anything definitive on the subject. That will be something to discuss with your vet.


                                  • #18
                                    When lameness specialist thought my horse was developing arthritis in the pastern joint, he did a trail steroid HA injection. Horse was virtually sound for a couple week then head bobbing lame. Subsequently we did an MRI and diagnosed collateral ligament desmitis. The lameness specialist I know have told me that injections will only lesson tendon, ligament pain but not make the horse sound.

                                    Radiographic changes do not always correlate lameness. Sometimes horse with mild arthritic changes can be quite lame and other times horses with advanced arthritis can be sound.

                                    With my horse lameness specialist felt he would need injections approx. every six months. Sometimes mild changes on radiographs can actually be advanced cartilage degeneration on MRI or visa versa. Straight HA is great but your horse may need more than that to stay comfortable longer. Some have had great results with IRAP lasting longer than traditional joint injections. http://www.theequinecenter.com/IRAP.htm

                                    legend and adequan may also help prolong the effects of the injections and hoof care needs to be optimal.

                                    Best wishes!
                                    Last edited by Fharoah; Jan. 6, 2011, 03:30 PM.


                                    • #19
                                      Any updates?


                                      • Original Poster

                                        So little update:
                                        Vet came out on Friday. Horse was graded as a 1/5 out of lameness (he did look a heck of a lot better than monday!) on the RF. High and low flexions revealed no change. Palpated the tendons and ligaments and horse seemed fine with no response, and there was no heat present. Blocked the right front by the coffin joint, horse went sound, even while being ridden lightly.
                                        Opted to take xrays again for comparison purposes, and could find no major deterioration and the arthritis is still considered slight and mild. (I will post the xrays later when I get a copy and see what you all think about the new hoof angle)

                                        Opted not to MRI as vet didn't think that soft tissue was the issue (nor did he believe that it was possible for a soft tissue injury to have been masked for so long had that been the initial problem 6 months ago) however he said that it would be an option if horse was not sound in next few days.

                                        Vet wonders if the horse might have slipped and bumped the area on the ice and caused it to swell and get aggitated, as he came up so badly lame (instead of gradually, as would be typical with an arthritis issue)

                                        Anyways, we did reinject the coffin joint with HA, and added a little steroid to it as well this time, and it geisered up again (which makes me wonder if vet is right that he bumped it or aggitated it)

                                        Went out and briefly trotted the horse yesterday, and he was totally sound and is back out with his buddies this morning.

                                        Vet says that given that the arthritis is fairly mild (and really hoping that he in fact did aggrevate the area somehow instead of actually requiring injections every 6 months because he's a pansy) there should be no reason why we can't keep competing and riding as we are, so hopefully that's the case. I'm also looking in to starting Adequan with him (he's a big guy at 17.3hh, so I'm sure it would probably help him!)

                                        So we'll see. I'm cleared to start riding him lightly tomorrow, so here's hoping.
                                        In my opinion, a horse is the animal to have. 1300 pounds of raw muscle, power, grace, and sweat between your legs - it's something you just can't get from a pet hamster.