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Tell Me More About Fusing Hocks...

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  • Tell Me More About Fusing Hocks...

    Hi everyone!
    Well, I'd like to know more about fusing hocks.
    My 15yr. paint mare has both of her hocks fusing. A year ago she had been living full-time outside, and while occassionally I would feel she was a bit 'off', she was never lame.
    Then last Christmas the owner gave her to me, and we had to move her into a stable. Shortly before she was moved (a few months before) she had started to go 'off' in the back right.
    I was able to ride maybe 20 min before she'd slowly go lame, and then she would be fine the next day till I rode her for about 20 min.
    After awhile of that, she was moved to a stable with turnout (two months). She was still having problems, so we took her to the equine hospital.
    They did an exam, lots of x-rays, and then hock injections (uppers). The found that she had arthritis in her front legs (upper pastern, I believe), the back left was almost done fusing with no arthritis, and the back right was in the process of fusing with arthritis.
    That was about a year and a half ago. The vet said it would take 6 months to a year to fuse. Umm, the vet was wrong...
    So she had her hocks done (uppers again) a few weeks ago, because she had been lame for almost 2 weeks, and the left hock was beginning to swell like the right hock. (The right hock always has fluid in it. It looks like a thoroughpin, but I'm told it doesn't hurt her at all).
    The vet fit all the fluid into the right hock, but couldn't get it all in to the left hock. She said it was really tight and that she'd have to use more steriod next time.
    So, what can you tell me about hock fusing? I was told it wouldn't take more than a year to fuse, but it's been a year and a half for the right hock, and longer than that for the left hock, and apparently neither are done fusing. (I was told that the left hock was done fusing when I had x-rays done a year and a half ago, but that was not correct.)
    Also, will she get worse as the left hock gets closer to fusing completely? Usually I can keep her sound with aspirin everyday, and bute when I need it (FYI: BL Pellets don't do anything) but I don't think aspirin will cut it anymore, at least not at the moment. Bute isn't doing much either... Isn't there a new drug that works like bute but isn't as dangerous?
    Also, if the vet couldn't get all the HA or whatever into her hock, does that mean that part of the bone is already fused, and I shouldn't really see her get any worse in that leg?
    And the vet didn't see any arthritis (or whatever it's called when you can see bony (sp?) changes on an x-ray) in the left hock (x-rays from a year and a half ago) so wouldn't that suggest she wasn't fusing anymore, since isn't it arthritis (bony changes) that cause hock fusing in the first place? Although I didn't think arthritis just disappeared like that...
    Lol, I'm all confused.
    I'm considering dumping her in a giant pasture again for the summer to see if it will help her stay sounder, but I probably won't since the pasture is two hours away.

    And another thing: I think her tendons are slightly contracted, or something. From her registration foal photo, I can see that her legs are pretty normal (not hock/sickle-hocked like she usually looks), but even then she seems to be standing a teeny bit more on her toes than her heels.
    Is there anything I can do to stretch that out?

    (Sorry that this is long, but she/we have a lot of problems I'd like to discuss. )

    When her hocks were really bad, she stood with them way underneath her, and it made us all believe she was remarkably level for a QH. Sadly, I've discovered that since she's a bit more comfortable now, she stands with her legs farther back like a normal horse, and she's built downhill... Poor horse... That can't be helping her back, which is already really tight. (I haven't had a chiro out, but I think I'm starting to get her to loosen up more, because she's starting to swing her back side-to-side more at the walk and trot, instead of just forward-and-back.)

    Let me see, do I have anything else to add?

    Oh, her hooves are terrible. She gets bruises all the time although it's not bothering her a lot now. (Last year I couldn't alk her outside because she would go dead lame on the gravel). Iodine, turpentine, biotin, and a bit of hoof conditioner seems to be helping a ton, but I can still see the bright red bruises she gets, usually at least one a week. She hasn't been lame from a bruise in months now, which is really encouraging. I don't want to put shoes on, if I can help it, because she would need pads on all fours, and that would be SUPER expensive, along with all the problems and risks associated with pads.(and shoes.)

    Ok, I guess that does it for now. Again, I'm sorry about making this really long, but at least you have her whole life history.

    Thanks in advance to any comments or suggestions!
  • Original Poster

    #2
    BUMP...
    Well that's sad; I just deleted my post...
    Anyway, here's an update: She's returned to how she was 2 years ago. She's sound for the first five minutes (usually she's sound my whole ride, sometimes a bit off, but 2 years ago she was able to go 20min) before becoming dead lame.
    I think the hock injections made her worse, although maybe they're making her worse to speed up the fusing. I've read that the injections destroy the cartilige (sp sorry) which increases inflammation/irritation which speeds up fusion.
    Based on your experience, would any of you believe that to be correct?
    Also, I've also read that using bute (she's been on aspirin or bute for the past year and a half) decreases the inflammation which stops fusion, because the body doesn't have the inflammation/irritation to tell it to continue fusing.
    That also seems like it could be true; what do you think?
    I'm considering taking her off her pain killers. She was the worst she's ever been yesterday, only able to make it a lap around the arena. I don't think she had had any bute that day though, which might have been the reason.
    Is aspirin an anti-inflammitory drug?

    Comment


    • #3
      Hi. Sorry to hear about your horse. Joint fusion is very painful in some horses. It is important to keep the horse moving to assist in progression and rate of the fusing. In horses with mild arthritis it is recommended to keep them moving and not stabled to keep the joints mobile and lubricated. With joint fusing it is often recommended to keep the horse in work to speed up the process, even though it is very painful for some horses.

      Medicine is not exact, and there are no boundaries or exacts as to how long joint fusion will take. It depends on many factors.

      The efusion (fluid) in your horses hocks concerns me, as it sounds like your horse has excessive amounts of fluid. Is there something else wrong with your horse's hocks besides just fusing? You mention your horse is a QH - by chance does your horse have very straight or post legged hocks, and/or is she extremely sickle hocked? Very straight hind end conformation puts extra strain on the hocks.

      Regarding injections: by the time that a horse has arthritis, the inflamitory response has begun. Joint injections reduce inflamation within the joint, and hyalauronic acid added to the mix helps lubricated the joint. When joints fuse, extreme inflamation is involved. As the joint space continues to narrow, injections may or may not be effective, or for shorter and shorter amounts of time between injections.

      In terms of her feet, is she medial laterally balanced, or is she high on the inside? Horses with hock issues often swing their hind feet medially (towards their umbilicus) like they are tightrope walking. They also tend to grow high on the inside walls. Increasing speed of break over is important in horses with hock issues, as is lateral support (to the outside of the hoof). Proper support with shoes that speed up the break over and are set wide to the outside to offer lateral support is helpful with painful hocks. Why do you think your horse would need pads? The shoe alone will lift her soles off the ground, and that can be enough to make a horse comfortable and not bruise.

      Lastly, can you post pictures of her hind end conformation? How about her hocks from the side and from behind? Pictures of her feet would be helpful, too.

      Comment


      • #4
        You don't want articulating joints to fuse. There are joints in the lower part of the hock that are non-articulating and it is sometimes beneficial if they fuse. If she is fusing in the upper joints of the hock, I imagine she would need to be retired.

        And shoes behind often help horses with hock issues. You can do glue ons if you hate the idea of nails.

        There are all sorts of drugs to make her more comfortable- adequan, legend, lots of people feed things like cosequin,MSM, topical stuff like surpass. Lots of turn out, light work, no work, special shoeing....

        I think you need to sit down with your vet, tell her what you want to do with the horse, and get a maintenance plan in place to keep the horse sound enough for your plans (or indicate the need to retire her). You may just have a horse that will not be sound for riding.

        Comment


        • #5
          Disclaimer: I am not a vet (yet), so take this as you will:

          OK, just some background info. There are actually 4 joints that make up the hock. There is the upper joint (tarsocrural or tibiotarsal joint), which is responsible for most of the motion of the hock joint. There are the proximal and distal intertarsal joints, which are low motion joints and the ones that people are usually referring to when they talk about hocks fusing. And there's the tarsometatarsal joint, which is between the hock and the cannon bone. It's pretty low motion as well.

          When hocks fuse, it's because there is bony remodeling (arthritis) amongst the bones of the hock joint, which eventually becomes severe enough to bridge the joint completely, causing fusion. Before it fuses, there is still motion in the joint, and the extra bone in there causes pain. After it fuses, there is no motion anymore, thus no pain.

          However, if there is significant arthritis in the upper hock joint, the horse may never be comfortable. Injections in the upper joints can be done (and I did them with my own horse until they stopped helping), but I've been told by one of the foremost lameness practices in the country that the tibiotarsal (upper) joint doesn't really like having stuff injected into it, so they try to avoid it if possible. This may be why your horse is worse and not better.

          Without repeat X-rays, you cannot tell if the lower joints are done fusing or not. I would not assume the vet was wrong unless you get repeat x-rays - your horse's problem may be in the upper joints, not the lower ones.

          If she were my horse, I would not take her off anti-inflammatories at this point. Honestly, if she is still this bad a month after hock injections, I'd be having the vet look at her again - you should have seen some improvement by now, not worsening. I might consider getting a second opinion as well. Unfortunately, they can reach a point where all the injections in the world are not going to make a difference. It happened with my mare. I would also add that typically horses with arthritis get better as they warm up and not worse - I think I'd make sure there's not something else going on in addition to the hocks.

          The drug you are thinking of is Equioxx - it's still an NSAID, but has fewer bad side effects on the GI tract and kidneys. Previcox is the canine version, which is much cheaper, but I know some people have had trouble getting their vet to prescribe the canine version. Aspirin is an anti-inflammatory drug, but can be very hard on the stomach in particular over long periods of time.

          As far as the injections destroying the cartilage, it depends entirely on what substance was injected. One of the most popular steroids, triamcinolone (Vetalog) actually protects the cartilage from further damage. Without knowing what they put in the joint, it's impossible to say whether or not it would cause cartilage damage. If they injected the upper joints (tibiotarsal joint), you do NOT want to damage the cartilage in there - that joint can't fuse, because the horse would not be able to bend the hock at all if it did.

          As far as the feet, I have had good luck with Keratex. It's expensive, but it really does help toughen up the feet. Also be aware that a good farrier can do some things with shoeing that can help with hock issues. I understand preferring to keep her barefoot if you can, though - I wish my horses could go without shoes!

          I hope this clears a few things up. I would be talking to my vet again ASAP since she is still having so much trouble a month after hock injections. Good luck - I hope you can get her comfortable!
          ~Nancy~

          Adams Equine Wellness

          Comment

          • Original Poster

            #6
            The efusion (fluid) in your horses hocks concerns me, as it sounds like your horse has excessive amounts of fluid.
            I've been worried too, but everyone I've talked to (and I've seen a lot of vets lol) says that it's just excess fluid and won't hurt her at all. I asked if it would weaken the joint or anything (like how prolonged swelling can weaken the skin) but was told that it was fine.
            I was told by one lady (her horse has trouble too, as she's also a nurse) that the fluid should drain when they went to inject her hocks. It did a little bit, but not much, and it filled up later back to it's normal size.
            The right hock always has swelling in it (a big bump on both sides filling up that indent in the hock), but the left one rarely does, but it seems to be small swelling in the left one most days too, now.
            I really haven't been able to find a connect between her soundness and the swelling, it's just a feeling I have...

            McVillesMom I'll get you pics today. I've never been able to tell what's up with her legs, but cause she wasn't standing normally till this year, when she was perfectly sound.
            Her back legs are still turn out slightly but she's not standing with them as far beneath her like she used to.
            I have copies of the x-rays from a year and a half ago, but I seem to have misplaced them once again. (That's about the eleventh time... )

            For a long time she would never bend her hocks all the way when she moved, but over time she slowly improved until she was fully sound and moving great. That has been about a year, and she's been great up until this past month or two. We noticed two days ago that she wasn't bending her right hock as much as she normally would, so she's acting just like she used to the beginning of last year.

            When joints fuse, extreme inflamation is involved. As the joint space continues to narrow, injections may or may not be effective, or for shorter and shorter amounts of time between injections.
            That's the part where I'm kind of concerned. According to the vet, this time the left hock was very narrow (they went through the outside, the normal way) and they couldn't inject everything they did in the right hock.
            The right hock was not narrow at all, according to the vet, because they fit everything in.
            So after a year and a half, can I assume that the hock is not fusing as fast as it should? It's been longer than that since the left hock started fusing (we didn't even know it was happening) and it's only now started getting tight.

            Why do you think your horse would need pads? The shoe alone will lift her soles off the ground, and that can be enough to make a horse comfortable and not bruise.
            I know that the shoes would help with the bruising some, but we still have huge rocks everywhere, rocks at least 2"+ tall, and it would still bruise even though the shoe would lift her up a quarter of an inch.

            You don't want articulating joints to fuse. There are joints in the lower part of the hock that are non-articulating and it is sometimes beneficial if they fuse. If she is fusing in the upper joints of the hock, I imagine she would need to be retired.
            Nope, unless she's suddenly started fusing the uppers, it's only the lowers that are fusing. Atleast, they're supposed to be fusing... They don't seem to be doing a very good job of that, lol. The vet assured me that she'd have full range of motion.

            There are all sorts of drugs to make her more comfortable- adequan, legend, lots of people feed things like cosequin,MSM, topical stuff like surpass. Lots of turn out, light work, no work, special shoeing....
            Right now she's on Adequan (for the past 2 months), MSM, biotin (smart hoof, to be exact), whatever painkiller she needs (aspirin if I have it, bute when she's bad (it doesn't help her anymore unless I give her three grams, which I don't like to do), and the BL pellets which don't do anything but make me feel better) and raspberry leaves that seem to help stock her from attacking other horses...
            The MSM actually works really well for her. She has no swelling, even when she should be stocking up somedays. Now I'm worried all the MSM is slowing down the hock fusing...

            There are actually 4 joints that make up the hock.
            I am quite certain it's the lower two bones, but I'll try and find the x-rays and/or the hospital recipt to make sure...

            but I've been told by one of the foremost lameness practices in the country that the tibiotarsal (upper) joint doesn't really like having stuff injected into it, so they try to avoid it if possible. This may be why your horse is worse and not better.
            I know that they injected the lowers, not the uppers. (One vet I looked at wanted to do the uppers, but I went to the hospital instead). Oh, I just remembered! I asked the vet about the swelling again, and she asked whether I thought the uppers might be swollen, and I said I didn't know, obviously, so she went over and checked her, and said she didn't think the uppers were swollen at all, so that's good news, right? Even if it's bad news, lie to me anyway. (joking... )

            I'd be having the vet look at her again - you should have seen some improvement by now, not worsening.
            After her first injections a year and a half ago, it took awhile for her to be sound again, but after that she went a year and a half without having any problems (other than soundness problems from bruising). It took a really long time for her to be comfortable enough to canter on the left lead without fighting. Actually, it was only a few months ago that she started to pick up the left lead without really fighting...

            From the x-rays it showed that the left hock should have been done/nearly done fusing, and the right hock was starting to with some arthritis. This time for injections (only her second ones) the left hock space was really tight, while the right hock was still open.

            As far as the injections destroying the cartilage, it depends entirely on what substance was injected.
            The vet said that next time she would use more steriod, which I didn't understand at the time, but if the steriod she uses would speed up the fusing, I think that makes sense now.

            As far as the feet, I have had good luck with Keratex. It's expensive, but it really does help toughen up the feet.
            Yeah, I've been wanting to try that. (The local tack store was out).
            Usually a good biotin supplement and iodine keeps her pretty sound, but I can use venice turpentine to help if I need to. It seems to help if I put it over a bruise too...

            I don't think I've mentioned this already, but her front legs have issues too. She has bone spurs on the pastern joint. (I don't remember for sure, but I think it has higher, like at the pastern/fetlock area).
            She doesn't seem to have a problem with that though.

            Recently I've noticed that she's cracking and clicking and popping all over the place, and she usually doesn't.

            Thanks for all the help everyone! I'll try and get pics up tonight, if I can find a ride to the barn...

            Comment

            • Original Poster

              #7
              Bump...
              These aren't the pics I promised (tonight! lol) but maybe you can get some idea of what I'm talking about from these:
              (totally sound and after a mini event): Walking
              Side view
              Click here for the full album (probably only on the first page)
              Put your mouse over a pick to see the description. I usually have the year in the title.
              There are some pics from a mini event we went to this year (June).
              I'll get up-to-date pics today.

              Comment

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