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"Soft tissue" front leg lameness that improves with turn-out

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  • "Soft tissue" front leg lameness that improves with turn-out

    Hi. I am hoping that the experience / knowledge of the COTH might have some ideas about the cause of lameness that my horse is experiencing on his right front.

    As background:
    - He is a 17 yo OTTB gelding (raced through his 3-year-old season), and I have had him since he was 5-years old (did a little H/J, dressage, trail riding - i.e. light work).

    -He was born with bad front feet with very thin walls, and they are very asymmetrical - the left is somewhat flat and the right is very upright. The only way to keep shoes on him is with glue-on's, and he has been in those since I have owned him. The farrier is excellent.

    - Intermittently he has been off in the front. No swelling or heat. Multiple times we did the full work-up (veterinarian, farrier, radiographs, etc.) without any cause being identified. The lameness would resolve on its own in about a week with turn-out (no riding).

    - Last year, he developed a infection of his right hock, and after surgery, and 10 months of stall rest with hand grazing, he became pasture sound. (I was thrilled, as there were no guarantees of even that).

    Fast forward to now:
    - Over that last several weeks, he has developed rather persistent lameness on the right front, though it varies in its degree. No heat or swelling. He is out at night and in during the day (the barn's schedule). It is noticeably worse when he has been in the stall (which has mats), and significantly improved (though not completely resolved) after he has been turned-out all night (~16 hours).

    - Met with the veterinarian and farrier. No findings with hoof testers, physical exam, or a full set of radiographs. We have not (yet) done an ultrasound. At this point, the vet is thinking (really more from the process of elimination than any physical finding) that it may be due to a soft tissue issue. Maybe calcification or soreness of the deep flexor tendon. But the vet said that typically soft tissue issues do not improve with turn-out.

    So at this point, I am pretty puzzled. Any thoughts on what kind of "soft tissue" issue (that significantly improves with turn-out) might be going on? Or anything else that I should be considering.

    Thanks so much! WJ

  • #2
    Have you done blocks?


    • #3
      There are many soft tissue structures in the equine. Where did diagnostic blocks localize the lesion to? Hoof? Pastern? Fetlock? Higher up? If you know where the diagnostic blocks localized the lesion, then that will give you a list of possible structures involved and ultrasound would be the next step.
      Without this information, everyone will be throwing out structures at you: DDFT, SDFT, collateral ligaments, impar ligament, suspensory blah blah...


      • Original Poster

        Nope, we have not yet done the blocks.

        Regardless of which soft tissue structure it may be, I am wondering about a soft tissue issue that would get better with turn-out. Turn-out does help (though does not completely resolve) the front leg lameness that my horse is experiencing.

        My understanding (which well may be incorrect) is that you would not expect a soft tissue issue of any type or structure to improve with turn-out.

        Correct? Incorrect?

        Thanks! WJ


        • #5
          IME, soft tissue injury *does* improve initially w/very light movement. This is why so many lo-grade suspensory injuries are missed until they become major strains, tears or even avulsions.

          Think about yourself. You get out of the car and twist your ankle. You can walk on it all day, but those first few steps to the bathroom in the morning fresh out of bed are pretty painful. As you progress through your day, the pain is still there but with gentle movement, it subsides a bit.

          I'd recommend blocks, yes, with an eye on the DDF. Does the horse exhibit any classic laminit stance on particularly bad days? If so, I might take a look at that DDF, which is going to be hard w/out MRI. U/s can't reach deep enough to reveal issues into the hoof capsule.


          • #6
            Originally posted by Whistlejacket View Post
            Nope, we have not yet done the blocks.

            Regardless of which soft tissue structure it may be, I am wondering about a soft tissue issue that would get better with turn-out. Turn-out does help (though does not completely resolve) the front leg lameness that my horse is experiencing.

            My understanding (which well may be incorrect) is that you would not expect a soft tissue issue of any type or structure to improve with turn-out.

            Correct? Incorrect?

            Thanks! WJ
            Incorrect. Many soft tissue injuries will appear to improve with rest. I am curious as to how your veterinarian knew what to radiograph without doing blocks?