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Soft Tissue Injury in Hoof - Updated Post #23 12/11/17

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  • Soft Tissue Injury in Hoof - Updated Post #23 12/11/17

    Got the bad news last week, my baby boy very likely has damage to one of the collateral ligaments in the foot, pending MRI to confirm and see how bad it is.

    The whole story is rather long but here goes. At the end of June Pizz came up lame on his right front after a gallop set done on good ground at slower speeds. He blocked to the pastern about 90%, ultrasound we clean higher up where there was a bit of filling below the knee. No digital pulse or heat in the foot. Vet figured it was a generalized strain to the right front, icing and rest for a week and reevaluate.

    After a week he was about 99% sound so we returned to light work while continuing to ice. He would start out off in his work but was amazingly light and willing to work. We had the best work he has ever done on the flat and never once did he finish worse than he started. Gradually over the month of July he got better and better and the lingering stiffness in warm up was attributed to a tight muscle in his shoulder. We even jumped, schooled XC, etc without any issues.

    Two weeks ago he got 3 days off (the most time off he had since the initial strain) while I was away and when I returned he was much worse. Not necessarily lame but incredibly difficult to the left, unwilling to reach through, esspecially in the left lead canter. Trainer saw him go and could see nothing really wrong, just that he wasn't going well. We assumed his shoulder had tightened up after the time off.

    I flatted two days with a little bit of improvement and then jumped him. Again I couldn't get him to go the bridle at the canter but he was jumping fairly well and my coach could not really see what I was feeling. After my last jumps I came back to the trot and he was lame on the right front again.

    Immediately back to icing. This time there was an elevated digital pulse and he was head bobbing lame at the trot (sound at the walk). Nothing on hoof testers. Vet wasn't able to get out for a week and his lameness did improve and by then he had no digital pulse. He was no worse with flexions unlike before.

    Blocked the coffin joint first, then heel, and then pastern. Each block gave some improvement (coffin joint showed the most improvement), but he was still taking the occasional funny step when being lunged on hard ground. Took X-rays to rule out anything bony. X-rays came back clean so the only thing left is soft tissue in the foot. Vet suspects a collateral ligament based on a slight change on an X-ray where it attaches to the pastern.

    MRI is scheduled for Tuesday and we will go from there but the general plan is to do restricted rest on flat ground and then once he is cleared for full turnout, move him to a pasture for the winter and let Dr Green work his magic until the spring when I will have the time to devote to bringing him back into work. Fingers crossed

    And sorry for the novel!

    Update post MRI: so interestingly, they found a couple of things. Damage to the lateral collateral ligament, small issue with the base of the deep digital flexor tendon, and some stuff on the pastern. The really interesting part is that the soft tissue injuries were older than expected, suggesting they were the cause of the original lameness rather than having been strained and then injuries fully two weeks ago like we had thought. Opted to inject with PRP (holy crap that stuff is expensive!) to reduce scar tissue formation. He is also going to have a special therapeutic shoe made (when I know exactly what it is I'll let you guys know).

    Game plan is 2 weeks of stall rest and wrapped for support then 1-2 months of very limited turnout (aka a stall with a little run out) and then we will increase from there.
    Last edited by Hawks Nest; Dec. 11, 2017, 06:56 PM.
    "I'm too sexy for my blanket, too sexy for my blanket, these mares-they should take it..." (J-Lu) - Featuring The Skypizzle Pony aka Classic Skyline

  • #2
    Sounds similar to mine except that my horse has been various degrees of lame for 31/2 mths. Blocked similarly and assumed soft tissue and in foot. Horse does not get an MRI. I'll be curious to hear what yours shows. Pretty much nothing makes him better or worse. You would think that tearing around his paddock would make it worse. Nope. Has been on small paddock turn out for 2 mths and will be going to pasture until spring for Dr Green. I am hopeful that 6 + mths of pasture time will fix him up.

    Comment

    • Original Poster

      #3
      Good luck with your boy silverdog. We are opting to do the MRI mostly because he is young and has a promising future ahead of him (and we can afford it) so we want to be sure of what is up, although it is unlikely that we would do any of the extra therapies because he will likely get an extra 3 months of rest.

      I plan to update this once I hear about the MRI
      "I'm too sexy for my blanket, too sexy for my blanket, these mares-they should take it..." (J-Lu) - Featuring The Skypizzle Pony aka Classic Skyline

      Comment


      • #4
        Mine is young too but does not seem to enjoy going to horse shows because of stomach issues (which have been managed aggressively) and a weird extreme sensitivity to loud noise (not hearing related, seems more the vibration in his head) - PA systems and diesel motors - so he will be retired from that. I hope to be able to enjoy doing the things he likes - trail riding and flat work at home. He may possibly be able to do some light jumping depending on how this whole thing turns out.

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        • #5
          My gelding has had on/off lameness for over a year. Always blocked about 90-95% sound to pastern. I finally did the MRI and they found a very old/chronic tear in his DDFT. I feel terrible for not doing the MRI sooner as all the vets said this will not heal on rest alone. He has had all the therapies including surgery to deride and clean the area up.

          We are now 2 months post op and he has some great days where he walks well and soundly, then he has days that he plants his feet and won't walk.

          Due to my experience I highly recommend doing the MRI if you can afford it. It would of saved me a ton of money and him more pain/suffering.

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          • #6
            Definitely update after the MRI.

            Fingers and toes crossed for you and Pizz.

            Comment

            • Original Poster

              #7
              Updated the original post. The most amazing thing is that he was working so well in the month between the first lameness and the second and yet likely all the damage they found was sustained in the original injury and simply aggravated slightly two weeks ago when he went off again.
              "I'm too sexy for my blanket, too sexy for my blanket, these mares-they should take it..." (J-Lu) - Featuring The Skypizzle Pony aka Classic Skyline

              Comment


              • #8
                Thank you for the update! Definitely shows the need for MRI sometimes, because who would have expected that?

                Comment


                • #9
                  MRI's are an amazing tool to answer our questions. I am sorry for the diagnosis but yet glad you have some answers.

                  One of mine had an injury to the lateral collateral ligament and it was a very long layup. These ligaments take a very long time to heal more like 7 months to a year or more.

                  I had the IRAP done as well, shock wave and special shoeing. The shoe we used was this one -

                  http://www.grandcircuitinc.com/produ...ral-front-shoe

                  I had my horse on layup for 8 months then had the MRI redone and it was STILL HEALING.... it took over a year before he was sound enough to go back to work.
                  If you like the distance you see; continue forward. If you don't; stay still and the shorter distance works out. ~GM~

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                  • #10
                    Thanks for sharing and keeping up to date.

                    We just found a suspensory injury in the forelimb of my guy - similar story (kinda) but he is not quite young, 13/14 and has been lower level eventing.

                    We did a gallop set before I went on a trip for four days for a conference for work did my normal routine of icing and a light therapy pad afterward that evening. When I came home from the four day trip I found lameness and did very little under saddle work to see if it got better. He was always lame on the trot but not canter or walk. On the lunge he was lame on the outside leg only in one direction.

                    Took him to the vet after 2 weeks of non-riding turnout and still unsound. No heat, no swelling, etc.

                    After palpating found tenderness in the leg, closer to the pastern.
                    Ultrasound found a suspensory (lateral side) tear in the tendon.

                    I am not unfamiliar with a tendon/tendon sheath injury and I have to say one of the magical miracles from the one I had dealt with before was photon laser therapy and ultrasound therapy with a professional equine therapist. About a year and a half prior my horse came in one weekend after a show three legged lame. Took him to the vet and they found the sheath around his suspensory had calcification deposits which was rubbing against the tendons in the leg.

                    They wanted to try shockwave but I couldn't afford the treatments. Instead I turned to a long time friend who is a professional equine therapist to see if she could help. Her modalities broke up the calcifications into tiny deposits which then eventually disappeared. They were gone within a month and the tissue remained elasticized (the vet said it was incredible). But we still did the normal rehab program back into work (the whole 9 months) anyway. He was getting back into novice level when this new injury surfaced 8 months after being back in the tack. So maybe eventing is not the world for him as much as he loves it. But regardless I was considering biting the bullet and getting the PRP does this time as well as the therapy treatments.

                    Would love to know of other experiences with repeat injuries or PRP vs non-prp recovery. Thanks all for sharing!
                    DragonTea

                    Comment

                    • Original Poster

                      #11
                      doublesstables - yeah, the expectation is that his injury should heal fairly well time wise, I think because there is already signs of healing which made it hard to say what the extent of the original injury was. Since he was showing signs of healing while having been in full work on the injury for a month, things look good for healing now that he is being rested and having had the PRP. The vet at the clinic recommended shockwave starting in about 4 weeks but we are on the fence, mostly because we are in no hurry to speed things along and my normal vet is not of the opinion that it would change the quality of the healing. In the end it will be up to my mom who is absolutely amazing and paying for all of this (she is a horse person). I am already planning on not starting him back under saddle till late spring and likely no jumping for much longer. If he ever events again I'll be happy, but I will likely always worry about galloping and jumping on uneven ground, especially because there was no one specific incident where we can say that he took a bad step and hurt himself.

                      DragonTea - this is (thankfully) my first time dealing with a serious soft tissue injury. I am sorry you are dealing with a suspensory but from what I understand as long as you are careful and take your time there is a good chance of recovery. Ligaments are generally harder to heal and rehab because they are less elastic so the scar tissue causes a bigger issue while a tendon can handle having some scar tissue in it (from what I understand). Good luck with your boy!
                      "I'm too sexy for my blanket, too sexy for my blanket, these mares-they should take it..." (J-Lu) - Featuring The Skypizzle Pony aka Classic Skyline

                      Comment


                      • #12
                        Interesting report from MRI. At least you have a plan now. Hoping he heals completely. Today my horse finally trotted sound. This is with his completely unorthodox rehab plan. Heading to luxury pasture turnout in 2 weeks for another 4 months of rest. If sound in December will then do Aquatred rehab prior to coming home.

                        Comment


                        • #13
                          I agree with doubleS - it takes a long time for soft tissue to heal. My mare had a fairly significant collateral medial ligament injury, and she got almost a year and a half of rehab, handwalking and stem cell before she started back to light work. She is now schooling 2nd/3rd level, has been going pretty steadily under saddle for about 2 years now.

                          I would be very conservative in rehab, rather then risk re-injuring...

                          Comment


                          • #14
                            How has the PRP worked? We did my guy's stifle Friday so not same injury but curious if you believe it's helped. My vet said healing is slower with PRP.

                            Comment

                            • Original Poster

                              #15
                              Originally posted by MysticOakRanch View Post
                              I agree with doubleS - it takes a long time for soft tissue to heal. My mare had a fairly significant collateral medial ligament injury, and she got almost a year and a half of rehab, handwalking and stem cell before she started back to light work. She is now schooling 2nd/3rd level, has been going pretty steadily under saddle for about 2 years now.

                              I would be very conservative in rehab, rather then risk re-injuring...
                              Yup, the plan is to give him all winter off. The good news is that we are already 2 months into this and the MRI was about a month in and showed signs of healing so we are optimistic about healing. And thankfully a good ultrasound can show progress so we will be able to monitor the healing in the next few months before he goes out to pasture.

                              The other good thing is that there is no clear tear so while there is significant fiber disruption he is at less risk for reinjury during the healing (not to mention he has worked hard for a month on the injury without a tear). Either way, we are optimistic about healing although we have no plans to jump him for another year.

                              Originally posted by TWH Girl View Post
                              How has the PRP worked? We did my guy's stifle Friday so not same injury but curious if you believe it's helped. My vet said healing is slower with PRP.
                              At this point it is too soon to tell. He got the injection two weeks ago, we will not reultrasound for several more weeks. However, we are not concerned about a bit slower of healing if it means that the quality of the new fibers is better.
                              "I'm too sexy for my blanket, too sexy for my blanket, these mares-they should take it..." (J-Lu) - Featuring The Skypizzle Pony aka Classic Skyline

                              Comment


                              • #16
                                Be aware that an old injury that has scar tissue may cause hardships when returning to work. We had a horse with an old surgical site in the check ligament and he was on stall rest for splint bone surgery in another limb. When returning to work the scar tissue from the old surgical site was very tight and that area had to be rehabbed with the help of shockwave/icing/surpass to keep it from being inflamed. The gradual rehabilitation and careful anti-inflammatory routine helped to stretch the scar tissue out slowly without causing additional scarring to form.

                                Wanted to give a help heads up bc we found out the hard way about this. Our horse was misdiagnosed when it was old scar tissue the whole time.

                                Comment

                                • Original Poster

                                  #17
                                  Originally posted by TPF Hunter View Post
                                  Be aware that an old injury that has scar tissue may cause hardships when returning to work. We had a horse with an old surgical site in the check ligament and he was on stall rest for splint bone surgery in another limb. When returning to work the scar tissue from the old surgical site was very tight and that area had to be rehabbed with the help of shockwave/icing/surpass to keep it from being inflamed. The gradual rehabilitation and careful anti-inflammatory routine helped to stretch the scar tissue out slowly without causing additional scarring to form.

                                  Wanted to give a help heads up bc we found out the hard way about this. Our horse was misdiagnosed when it was old scar tissue the whole time.
                                  Yup that is actually how we discovered the extent of the injury. After the first lameness in June he returned to work and besides a slight lameness that he warmed up out of, we thought he was fine. It wasn't until he had three days off that he was worse again.

                                  Either way, the plan before putting him back into work is to have him turned out on undulating terrain to get the mobility back first.
                                  "I'm too sexy for my blanket, too sexy for my blanket, these mares-they should take it..." (J-Lu) - Featuring The Skypizzle Pony aka Classic Skyline

                                  Comment

                                  • Original Poster

                                    #18
                                    UPDATE 10/25/16
                                    He got his second ultrasound post MRI today. He had one 4 weeks after the MRI (last month) which wasn't too great. There were signs of calcification on the ligament and the other collateral ligaments didn't look too great either (LF ones were much better than RF ones which was understandable).

                                    Anyhow, today's ultrasound was much better! The vet was surprised at the progress in just a month and he has been cleared to have his shoes pulled and be moved to his winter pasture. He had already been in a decent sized turnout and was reportedly pretty wild with the lower temps so the improvement is really remarkable. Thursday his shoes will be pulled and in a week he will be moved up to VT (from our home farm in NH) to be turned out with a buddy in a 9 acre pasture (he'll start out restricted to a smaller portion at first and then gradually allowed out into the big pasture). While there is some risk of reinjury during this transition, he will have all winter to finish healing and in the end the goal is to just have some very elastic scar tissue come spring when I start him back.
                                    "I'm too sexy for my blanket, too sexy for my blanket, these mares-they should take it..." (J-Lu) - Featuring The Skypizzle Pony aka Classic Skyline

                                    Comment


                                    • #19
                                      I've been poking around these soft tissue threads mostly to see what people have done for rehab. I have an original thread on my guy's situation elsewhere on coth, but just find this thread interesting because the OP did opt for the MRI which showed the extent of the damage but did not change the healing protocol versus, say, what we are doing without an MRI.

                                      I like diagnostic imaging when the imaging will produce a particular protocol or the horse is not improving with rest, but just want to contribute our progress here for a horse that did not go the MRI route (yet) and did different supportive therapies.

                                      14yo gelding, bowed as a 2 year old race training, healed, went on to jump 3' consistently, 3'9" occasionally, sound for 10 years, bowed a 75% lesion on a bad step May 2015. Came NQR in May 2016 after full recovery from bowed tendon, new lameness difficult to diagnose as it was mild at first. Then blocked 100% sound in the foot. Assumed soft tissue injury in foot, probably collateral ligament given increased difficulty with turns. 2-degree wedge in shoes, 3 months on pasture, out of work, did cold laser and magnetic therapy every other day. 99% sound after 3 months of laser, magnetic therapy and rest. Started back under saddle walking on firm footing with good results, bucked and played in small pasture alone one morning 2 months ago, re-injured--lamer than before--lame at the walk. Did x-rays given degree of lameness, no bony changes or concerns.

                                      If no improvement, MRI planned, however, improved quickly over the course of the following week (also changed shoes 2 days after re-injury from full pads to pads only under the metal of the shoes as the pressure on the frog from detritus under pad may have been contributing to lameness). Magnetic and laser therapy continued during this time. 2 months later, horse is back to being 100% sound at the walk and 99% at the jog.

                                      General plan was to give him the winter off (resulting in basically a year off) and continue therapies--he is on 24-7 turnout in a small paddock for the winter with a buddy and he stays mostly quiet. Will revisit with vet, but am starting to think he should start his walking under saddle rehab if he can remain sound through it. Mostly to keep his brain and body moderately sane and fit, respectively, so that coming back into fitness is not a huge effort for him as he is more likely to hurt himself and/or his rider left to his own devices for that long.

                                      He was not really getting ridden while being NQR, but as far as true rest, he has had 6 months off, though he had 3 U/S walks on firm, level ground, lasting about 10-15 minutes each when cleared to return to work prior to tweaking the foot 2 months ago.

                                      Wondering if anyone caring for this similar injury had returned to under saddle rehab by this point. Obviously every horse is an individual and the protocols are all different and only your vet can say for sure, etc, but he remained sound after his last day of antics in the pasture (nearly 1 week ago) which is a dramatic improvement from being lame after the antics 2 months ago, so I'm thinking it might be beneficial to him to cover some ground with a rider up. I will confirm with my vet, but I do believe he would say the same. Of course, we would find out soon enough if we are wrong.

                                      Just wanted to add our story as folks who did not do PRP but did cold laser and magnets instead. Massage as well, to help with overall soreness from compensation, and reduce overall inflammation. Horse has been consistently improving with good ability to maintain soundness when challenged (by playing, etc).

                                      Comment


                                      • #20
                                        Great posts. Love the variety of rehab plans and that it seems no one was locked in a stall for months. My horse is now 7 mths post right foot injury and 5mths post avulsion fracture same leg. He is occasionally a little foot sore from being barefoot but generally looks pretty darn sound. He finally got turned out with the herd a week ago and is doing lots of slow easy walking. No one out there goes fast. Has US scheduled to look at everything in a couple of weeks. My vet friend recommended a total of 16mths turnout with no work. I may tack walk over the winter if his regular vet says OK. Hoping he starts back to fitness rehab next summer. He may never jump again but I am very hopeful for just doing flatwork.

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