The best joint supplements for older horses provide additional nutritional support for normal and healthy joint function to help keep them in good working order, comfortable and moving at their best, enabling your horse to live a full and active life. Throughout your horse’s life, his musculoskeletal system and joints will be put to the test – and there’s a lot for your horse’s joints to contend with throughout the year.

In the winter, the increased likelihood of restricted turnout means they’re likely to be moving less and when this is combined with colder temperatures, stiffness is a common result. If the ground’s not hard then it’s wet, which can lead to more roadwork and increased concussive forces on the joint, too. Whereas in the summer hard ground is also unavoidable if you’re not confined to a school. Even if your horse is retired and able to live out full time, his joints – and the rest of his body – will require more support to maintain a good condition.

Best joint supplements for older horses: what are your options?

Here is a selection of the best joint supplements for older horses that are currently available, including the manufacturers’ descriptions of their products…

NB: Cost per day has been calculated using the maintenance measure for a 500kg horse in light work (where there was variation) and the RRP of the smallest available tub. Some products require you to feed more with a higher workload, which will increase the cost per daily measure, while buying a larger tub will likely decrease it – these costs per day are a guide only.

NAF Five Star Superflex Senior

Form: Powder

Sizes: 660g, 1.98kg

RRP: £37.99 for 660g

Daily measure: 22g

Cost per day: £1.27

Five Star Superflex Senior is a unique formulation providing a high specification of key joint support nutrients as well as omega-3 fatty acids and naturally sourced antioxidants to support healthy, flexible joints in older horses that are still leading active lives.

YuMove Joint Care Plus

Form: Powder

Sizes: 1.8kg

RRP: £156.40

Daily measure: 40g

Cost per day: £3.47

This has 25% more MSM and glucosamine and 50% more green lipped mussel compared to the standard YuMove Horse formula, so it can offer extra joint support for stiffer, more senior horses.

BettaLife PharmaQuin Joint Complete HA Equine

Form: Powder

Sizes: 400g, 1kg, 2kg, 5kg

RRP: £42.50 for 400g

Daily measure: 30g

Cost per day: £3.19

Formulated from the highest grade active ingredients with no fillers or bulking agents, containing glucosamine HCI, MSM and chondroitin in a 10:10:4 ratio.

Equinutritive Alpha Gold

Form: Liquid

Sizes: 1l, 2.5l, 5l

RRP: £32.99 for 1l

Daily measure: 30ml

Cost per day: £0.99

A 100% natural, turmeric based joint supplement to support hard-working, compromised or ageing joint. Contains turmeric, coconut oil, aloe vera and linseed oil.

Nutriscience Arthri Aid HA Powder

Form: Powder

Sizes: 1.2kg, 3kg

RRP: £45.92 for 1.2kg

Daily measure: 15g

Cost per day: £0.57

This apple-flavoured powder includes glucosamine, MSM complex and hyaluronic acid for improved joint mobility. It’s a super-strength alternative to the regular Arthri Aid.

Equine America Buteless Super Strength

Form: Powder

Sizes: 1.5kg, 5.5kg

RRP: £65.50 for 1.5kg

Daily measure: 50g

Cost per day: £2.19

Described as the ultimate nutritional support for joints and muscles in older horses with significant wear and tear or needing help to maintain mobility. It includes powerful levels of natural plant-based ingredients including boswellia, yucca and turmeric, as well as MSM to help the horses’ own anti- inflammatory processes. It’s a low-sugar formulation, which makes it suitable for those prone to laminitis.

Cavalor ArtiTec

Form: Liquid

Sizes: 2l, 5l

RRP: £179 for 1l

Daily measure: 60–90ml

Cost per day: £5.37–8.05

Designed to provide horses what they need during periods of intense work and is the result of seven years of scientific research into nutritional supplements for healthy tendons and joints in top-class sport horses.

Aviform Suppleaze VS

Form: Powder

Sizes: 1kg, 2kg, 4kg

RRP: £84.95 for 1kg

Daily measure: 64g

Cost per day: £5.44

This is a combination of Aviform’s Suppleaze Gold and Suppleaze Progen for horses that require the highest specification of supplement. It contains full clinical levels of glucosamine HCL, chondroitin, MSM, HA, bioactive collagen peptides, curcumin, boswellia and vitamin C. Available in a 100% compostable pouch. BETA NOPS compliant.

How to choose the best joint supplement for older horses

Joint supplements that are formulated specifically for older horses will tend to have the highest specification in a manufacturer’s joint supplement range – higher than most in our guide to the best joint supplements for general use.

Joint supplements are available in liquid, powder, and pellet forms, and it’s important to choose a form that your horse will readily consume. Cost is another consideration, and it’s often more economical to purchase larger quantities. We’ve calculated the daily cost of all the supplements featured in this guide using the smallest tubs available to help you compare them easily.

The most common ingredients found in joint supplements typically include glucosamine, MSM (methyl sulphonyl methane), and HA (hyaluronic acid), which support cartilage, suggested anti-inflammatory properties, and aid lubrication.

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The best joint supplements for horses provide additional nutritional support for normal and healthy joint function to help keep them in good working order, comfortable and moving at their best.

There’s a lot for your horse’s joints to contend with throughout the year. In the winter, the increased likelihood of restricted turnout means they’re likely to be moving less and when this is combined with colder temperatures, stiffness is a common result. If the ground’s not hard then it’s wet, which can lead to more roadwork and increased concussive forces on the joint, too. Whereas in the summer hard ground is also unavoidable if you’re not confined to a school.

Joint supplements for horses: what are your options?

Here is a selection of the best joint supplements for horses that are currently available, including the manufacturers’ descriptions of their products…

NB: Cost per day has been calculated using the maintenance measure for a 500kg horse in light work (where there was variation) and the RRP of the smallest available tub. Some products require you to feed more with a higher workload, which will increase the cost per daily measure, while buying a larger tub will likely decrease it – these costs per day are a guide only.

NAF Five Star Superflex

Form: Powder

Sizes: 400g, 800g, 1.6kg, 3.2kg, 9.6kg

RRP: £26.50 for 400g

Daily measure: 13g

Cost per day: £0.86

A scientifically balanced ratio of readily absorbed glucosamine, chondroitin and the highest quality MSM, which support the cartilage — the first part of the joint to show wear and tear. It also contains a powerful anti-oxidant formula, which tackles excess free radical build-up around the joint. Superflex contains the right combination of key nutrients in the optimum ratios and is also available in liquid form.

BETA NOPS compliant.

YuMove Joint Care for Horses

Form: Powder

Sizes: 1.8kg

RRP: £97.15

Daily measure: 40g

Cost per day: £2.16

This new and improved formula has increased levels of high-strength Glucosamine, MSM and omega-3, providing even more support, encouraging joint health and muscle recovery.

Dodson & Horrell Joint Support

Form: Pellets

Sizes: 1.5kg, 3kg

RRP: £25.61 for 1.5kg

Daily measure: 30g

Cost per day: £0.51

A pelleted supplement that supports the nutritional maintenance of your horse’s musculoskeletal system, designed to support healthy joints, muscles, tendons and ligaments. Also contains herbs from Dodson & Horrell Mobility.

BETA NOPS compliant.

TopSpec 10:10 Joint Support

Form: Powder

Sizes: 1.5kg, 3kg, 9kg or 20kg

RRP: £39.75 for 1.5kg

Daily measure: 50g

Cost per day: £1.33

A caramel-flavoured additive that includes an excellent specification of nutrients to help maintain health in and around joints. It includes a generous combination of natural sources of glucosamine and MSM, as well as a blend of antioxidants.

BETA NOPS compliant.

Animalife Vetroflex Original

Form: Powder

Sizes: 600g, 1kg or 2kg

RRP: £59.99 for 500g

Daily measure: 20g

Cost per day: £2.40

This supplement is a pure peptide protein and works by protecting the cartilage and synovial fluid against deterioration. It also stimulates the cartilage cells to promote more collagen, which helps maintain movement and flexibility by protecting the joints from friction.

Aviform Suppleaze Gold

Form: Powder

Sizes: 600g, 1kg, 2kg or 4kg

RRP: £51.95 for 600g

Daily measure: 27g

Cost per day: £2.34

This supplement offers medium to high level joint support. It contains the optimum ratios of chondroitin, glucosamine HCl, MSM, and high levels of hyaluronic acid, plus added vitamin C and boswellia.

BETA NOPS compliant.

Equitop GLME

Form: Pellets

Sizes: 750g

RRP: £94.20

Daily measure: 25g

Cost per day: 3.14

Manufactured by the world’s largest equine veterinary health company, Equitop GLME contains high quality green-lipped mussel extract (GLME), which provides nutrients to support optimal joint health. It is tested free of prohibited substances and can be used confidently in competition.

Science Supplements FlexAbility Plus+

Form: Powder

Sizes: 1.7kg, 10kg

RRP: £69.99 for 1.7kg

Daily measure: 57g

Cost per day: £2.35

The only joint supplement in the UK with a published peer-reviewed paper in The Journal of Equine Veterinary Science, it contains optimum levels of scientifically proven ingredients, including glucosamine HCl, chondroitin sulphate, MSM and Hyaluronic Acid.

BETA NOPS compliant.

Global Herbs MoveFree Plus

Form: Powder

Sizes: 500g, 1kg or 5kg

RRP: £37.50 for 500g

Daily measure: 22g

Cost per day: £1.54

This supplement helps to maintain joints, tendons and ligaments. A highly concentrated herbal mix, it supports freedom of movement and helps maintain the natural production of joint fluid.

BETA NOPS compliant.

The Golden Paste Company TurmerAid

Form: Pellets

Sizes: 2kg or 15kg

RRP: £23.20 for 2kg

Daily measure: 50g

Cost per day: £0.58

This joint supplement also supports the body’s natural inflammation process, aids digestion and promotes a healthy skin and coat. It contains turmeric (5.1% curcumin), linseed oil, black pepper, apple cider vinegar and yucca.

BETA NOPS compliant.

Omega Flexology

Form: Pellet

Sizes: 930g, 3.72kg

RRP: £41.25 for 930kg

Daily measure: 15.5g

Cost per day: £0.69

This natural supplement supports and maintains all aspects of joint health, from maintaining the health of tendons, ligaments and tissues to supporting healthy cartilage, muscles and mobility. Ingredients include glucosamine, MSM, HA and boswellia for ultimate joint health.

H Bradshaws ColiFlex Gastro-Joint Care

Form: Powder

Sizes: 3kg

RRP: £96

Daily measure: 30–60g

Cost per day: £0.96–1.92

This formulation targets the joint and digestive system in one supplement to ensure maximum nutrition for your horse’s joints, through improved digestive function. It contains Coligone, which works throughout the digestive tract using active, natural ingredients to help combat compromised digestive health and support optimum digestion. Also contains glucosamine, chondroitin sulphate, MSM, HA, anti-oxidants, omega-3 and calcium.

How to choose the best joint supplement for horses

Look out for the most common ingredients found in joint supplements, which includes:

• glucosamine – this works as a building block for lots of different processes in the body, and is particularly important for maintaining the cartilage between joints, which assists in smooth movement and reducing concussion of joints. Studies suggest a 500kg horse needs 10g glucosamine a day.
• MSM (methyl sulphonyl methane) – it’s suggested this possesses anti-inflammatory properties and could have a protective effect against some forms of exercise-induced injuries. An effective equine dose of MSM is said to be at least 1,200mg per day.
• HA (hyaluronic acid) – this is widely used for reducing heat, pain and swelling, and is known to help with lubricating the joints as well as maintaining healthy cartilage and connective tissue. Recommended dosages vary greatly, but you should expect a joint supplement to deliver upwards of 100mg of HA a day.

Consider the form the supplement takes – joint supplements can come in liquid, powder and pellet forms. Your horse may have a preference to one over another, which could make all the difference as if he won’t eat it, your horse won’t receive the benefit.

Cost is another consideration – we’ve calculated the daily cost of all the supplements featured in this guide to help you compare them easily. To make it as comparable as possible, we’ve used the smallest tubs available, but if you’re better off buying a larger volume of supplement if you can as the daily cost can become significantly lower.

If you compete with your horse then it is important you make sure any supplements you use do not contain any prohibited substances.

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• This article has been edited and approved by Karen Coumbe MRCVS, H&H’s veterinary advisor since 1991.

Degenerative joint disease (DJD) is another name for osteoarthritis, which is the most common type of arthritis in horses. It is a chronic, (i.e. long-standing) disease in which the cartilage on the ends of bones wears down, resulting in loss of joint mobility, swelling, heat and pain.

It is a common cause of lameness, reduced performance or stiffness, especially among older horses, that often improves with gentle exercise. It can affect a single joint or several joints simultaneously. In more severe cases it is a common cause for retirement of an older horse.

Bone spavin (arthritis of the lower hock joints) and ringbone (arthritis of the pastern or coffin joints) are two of the best-known examples, but any joints are at risk.

The causes of DJD are not clear and currently the condition cannot be prevented. Once established, it can only be managed, not cured. Management must aim to reduce pain and minimise progression of the condition by stimulating the cartilage and inhibiting further degradation.

Another serious type of arthritis found in horses is septic arthritis. This is an acute form of DJD caused by a bacterial infection inside a joint. It is typically seen in foals that have compromised immune systems or systemic disease, as well as in horses of any age that have suffered a traumatic injury near a joint. In all such cases, infection enters the joint cavity, which can be difficult to treat. Unless a septic joint is treated rapidly and aggressively, usually by flushing out the contamination, it can be career-ending.

Arthritis/DJD in horses: Signs | Diagnosis | Treatment | Prognosis

Signs of DJD

Typical signs of DJD include:

• Horse demonstrates stiffness that gradually reduces with gentle work
• Swelling of one or more joints in the leg; commonly the lower limb, such as the fetlock, pastern joints, knee and/or hock
• Lameness

Diagnosis

Diagnosis of DJD follows a thorough physical and lameness examination by your vet. X-rays can be used to assess the severity of the joint damage.

Treatment of DJD

Most arthritic conditions of ‘high motion’ joints (such as the fetlock) cope well if you can maintain active movement through low impact exercise, in addition to reducing the load and internal inflammation within the joint.

This can be achieved via a treatment plan focusing on both:

• Physical management — such as changes in diet, exercise, shoeing, stable/environment
• Pharmacological management — the use of drugs

Physical

As long as lameness does not increase, it is best to keep the horse active. Spend extra time warming up and avoid working the horse on hard, concussive surfaces at any pace faster than the walk.

It is important to keep the horse’s weight under control as excess weight can cause more pressure on the joints.

Talk to your vet and farrier to ensure there is a good hoof-pastern axis in order to equalise the weight distribution throughout the lower limb.

Monitor the progress of the condition and make changes to the levels of exercise as appropriate.

Pharmacological options

Oral non-steroidal anti-inflammatories — the use of oral pain killers/anti-inflammatories is common in the management of this chronic condition. A good way to help an arthritic horse is to use bute strategically — if you only ride once a week, then give bute the day before the horse is worked and the day after. By doing this you gain the maximum benefit without the body becoming used to the medication.

Steroids — There are several types of steroid available to inject into joints to reduce the ongoing inflammation, with different medication being required for different high and low motion joints. The individual advantages/disadvantages of each these need to be discussed with your vet. There are other newer options for intra-articular (i.e. into the joint) therapy, such as products derived from stem cells, see autologous products below.

Polysulphated Glycosaminoglycans — these products with the principle component chrondroitin sulphate can help to prevent cartilage degeneration.

Pentosan Polysulphate — these products have been suggested to help stimulate hyaluronic acid production within joints, which is essential for good joint function. These products include Cartrophen.

Bisphosphonates — these products are designed to affect the “turn over” of bone, which can be excessive during the arthritic process. Once again, these products have many advantages and disadvantages, which need to be individually discussed and evaluated with your vet.

Autologous products — these are products derived from the patient, quite often by extracting blood/bone marrow or fat and processing it prior to re-implantation back into the patient. This is a very specialised therapeutic avenue, but has very promising results.

Many of these treatment options are not permitted in competing racehorse and/or sports horses.

Alternative therapies

There is a range of alternative therapies that have some anecdotal evidence for use helping horses with DJD. However, very few, if any, have peer-reviewed, double-blinded studies demonstrating their effectiveness. That is not to say that they do not work, but vets require all treatments to have some form of proven safety record or, at least, should have peer-reviewed critiques of the product used.

This lack of research means few vets will recommend the use of alternative therapies to help manage DJD. However if you wish to try alternative therapies on your horse, those with anecdotal evidence to support their use include:

• Magnetic boots
• Acupuncture
• Massage
• Nutritional supplements

Under Veterinary Medicines Directorate (VMD) rules, nutritional supplements cannot claim to treat an established medical condition, but there are numerous joint supplements available that have been formulated purporting to help support joint health. They vary in their ingredients, with many containing chondroitin sulphate and glucosamine, others glucosamine alone, or a mixture of plants and herbs including meadowsweet, nettle and yucca, with devil’s claw. NB: If you are planning to compete, then you must check any supplements you are using do not contain banned substances under the rules of that governing body.

Prognosis

As with any degenerative disease, the prognosis is guarded, but in most cases a horse with DJD can be managed with a suitable exercise program, supported by appropriate medications.

The management of any degenerative condition is multifactorial and should be tailored to every individual patient with your vet, farrier, physiotherapist, nutritionist and trainer as it will vary greatly depending on the age of the horse and the work he is doing.

Further reading

Osteoarthritis: a common disease that should be avoided in the athletic horse’s life – Raquel Yvonne Arantes Baccarin et all, June 2022

Drug trial indicates significant benefits for horses with arthritis – Horse & Hound, July 2023

New gene therapy research could help treat arthritis in horses – and humans – Horse & Hound, May 2020

The horse as a model of naturally occurring osteoarthritis – C. W. McIlwraith, D. D. Frisbie & C. E. Kawcak, Nov 2012

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If a puffy lump appears on a hock joint, how worried should we be? Matt Smith MRCVS discusses the significance of swellings in this area...

Fluid-filled swellings around the hock are not uncommon. Some may be innocuous, but others represent a potentially significant injury that requires investigation and treatment.

It can be difficult for even the trained eye to discern whether a particular lump is worth worrying about, but it may be useful to ask yourself the following:

• Is it a new swelling?
• Has lameness developed alongside its appearance?
• Is it warm, or painful to touch?
• Is it large or tense?

If the answer to any point is yes, it would be prudent to consult your vet. Conversely, if it has been there as long as you can remember and doesn’t appear to be causing a problem, it may be sufficient to monitor the swelling but otherwise leave it alone unless changes occur.

A complex structure

Why do swellings arise?

The hock is complex, comprising at least six different bones, four major joints, various supporting ligaments and a number of tendons. As the muscles above the hock contract, they pull on the tendons and cause the leg to flex and extend.

To ensure a smooth, gliding action, the tendons are bathed in synovial fluid – a thick, lubricating substance found in capsules called tendon sheaths and bursae. The difference between these is purely anatomical: sheaths encircle one or more tendons, whereas bursae are interposed between two surfaces, such as tendon and bone or cartilage.

The swelling of a joint, tendon sheath or bursa occurs as a response to inflammation – spaces open up in the synovial membrane (the tissue lining the capsule), allowing more cells, protein and fluid to enter and causing visible swelling. This inflammation of the synovial membrane (known as synovitis) is a sign of an underlying problem, rather than being the problem itself.

Common causes of joint swelling include chip fractures, arthritis and the developmental condition osteochondritis dissecans (OCD), which results in loose fragments of bone or flaps of cartilage within the joint.

Tendon injuries usually cause swellings in tendon sheaths and bursae. At the milder end of the spectrum, synovitis with no underlying structural injury can occur following periods of hard work.

There is no known link with poor conformation – nor are these injuries more frequent in a particular discipline or type of horse. While most causes must be a result of over-stressing a tendon or the affected structure, their occurrence is sporadic. It’s a bit like twisting your ankle – there’s little you can do to reduce risk.

Rest and recovery

In the acute phase of injury, shortly after the swelling develops, allow the horse to rest.

Cold-hosing and anti-inflammatory treatments, such as phenylbutazone (commonly termed bute) or meloxicam, will help in the early stages, in consultation with your vet. Bandaging can bring swelling down, but the hock is a difficult area to bandage properly and skin sores are a risk.

After the acute phase has passed, typically 10 to 14 days later, the next step will depend on response to this initial treatment. A gradual return to work may be possible, but any persistence of significant swelling and lameness should be investigated further.

If the swelling has reduced significantly and the horse is comfortable, it may be appropriate to drain and medicate the remaining fluid. Most commonly this is done with a small dose of steroids, which are potent anti-inflammatory drugs. This can be successful with mild injuries, but with anything significant it is likely that the swelling will recur.

Further investigation commonly includes X-ray, to enable identification of injury to the bones, such as chip fractures, and ultrasound to examine the tendons, ligaments and other soft tissues that make up the tendon sheaths and bursae.

If these methods fail to identify the underlying cause, arthroscopic (keyhole) surgery may be appropriate. Termed tenoscopy for tendon sheaths and bursoscopy for bursae, its use in equine medicine has progressed rapidly over the past 15 years and has revealed a range of possible causes, from tears along the margin of tendons and damage to their appendages, to tearing of the outer wall of the tendon sheath or bursa.

Keyhole surgery also allows treatment, by debridement (cleaning) and removal of disrupted tissue, which has vastly improved the prognosis of injuries. Because so many more cases have now been treated this way, we also have a much better idea of the chances of obtaining a successful outcome.

Know your hock swellings

Thoroughpin: fluid swelling of the tarsal sheath, which lubricates the deep digital flexor tendon as it runs over the back of the hock on the inside. A more severe case may be caused by injury to the deep digital flexor tendon or the bone that the tendon runs over.

Action – if swelling causes a problem, draining the fluid and medication with anti-inflammatories may help. Significant lameness warrants further investigation.

Calcaneal bursitis: swelling of the deep calcaneal bursa, which acts to lubricate the superficial digital flexor tendon as it runs over the point of the hock. This usually indicates injury, typically of the superficial digital flexor tendon or its thick attachments to the point of the hock.

Action – the most severe injuries involve a slipped tendon, where one of the attachments has completely ruptured. Surgery may be necessary.

Curb: a characteristic bow-like swelling of the plantar ligament at the back of the hock, a curb is most easily viewed from the side. Other, “false” curbs include development of a bursa in the region or injury to the superficial digital flexor tendon.

Action – curbs often settle of their own accord, but leave a permanent thickening. You should consult your vet if swelling is accompanied by lameness.

Capped hock: a distinctive swelling at the point of the hock, caused by distension of the most superficial of the calcaneal bursae. A bursa at the point of the hock is variably present in horses. Swelling most commonly occurs following some kind of direct trauma, such as backing into a solid object.

Action – in most cases, nothing needs to be done. Swelling may be reduced by draining the bursa and injecting anti-inflammatories. A wound with obvious lameness indicates an infection, requiring more urgent treatment.

Bog spavin: distention of the main joint of the hock – the tarsocrural joint – appearing as excess fluid in the upper part of the hock. In young horses, and those just starting work, the most common cause is OCD. Others include injury to the soft tissues, such as the capsule or ligaments providing support on either side of the joint.

Action – mild, soft swelling of this joint in both limbs on its own is not a cause for concern. New or prominent swellings, or those with lameness, should be examined. Severe lameness may indicate a puncture wound – a veterinary emergency.

Synoviocoele: A large, fluid-filled swelling seen towards the back of the hock on both the inside and outside of the calcaneal tendon. This typically develops when fluid leaks out through a rent (tear) in the wall of the tarsal sheath and the swelling may be pushed from one side to the other.

Action – rest is required to allow inflammation to settle. If the swelling continues to enlarge, or fails to resolve, options include drainage and anti-inflammatories. Keyhole surgery allows enlargement of the rent to prevent it acting as a one-way valve.

The author: Matt Smith MRCVS is a surgeon and partner at Newmarket Equine Hospital. This referral hospital is one of the largest in Europe, treating a wide range of leisure and sport horses from throughout the UK. Matt is a Royal College of Veterinary Surgeons (RCVS) specialist in equine surgery and has a particular interest in orthopaedic problems. 01638 782020, newmarketequinehospital.com

Ref Horse & Hound; 14 May 2020

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• This article has been edited and approved by Karen Coumbe MRCVS, H&H’s veterinary advisor since 1991.

There are two different types of windgalls, which are a soft swelling located to the rear of and slightly above the fetlock joint on a horse’s leg. This swelling is either an enlargement of the fetlock joint capsule (an articular windgall) or more commonly a swelling of the protective digital flexor tendon sheath (a non-articular windgall).

Windgalls are often dismissed as an inevitable side effect of an active life. Many apparently normal horses in full work have slight windgalls due to digital flexor tendon sheath swelling, particularly in the hindlimbs. The amount of swelling may vary according to the environmental temperature, being less obvious in cold weather and larger in hot weather.

The swelling may also be influenced by exercise. Work often results in some reduction in size, whereas stable rest may result in accumulation of fluid and greater swelling. However, repeated work on hard ground can lead to an increase in the size of the windgall.

Usually these swellings are similar in size between pairs of limbs, and symmetrical swellings are normally no cause for concern, provided they are cool to touch and not painful, and most importantly readily compressible with the fluid being moveable between different outpouchings of the tendon sheath. For example, if the top part of the tendon sheath is compressed by finger pressure, then increased bulging will be seen on the back of the pastern.

Windgalls in horses: Causes | Signs | Diagnosis | Treatment

It helps to understand the anatomy: The tendon sheath encloses the superficial and deep digital flexor tendons, together with their attachments to the sheath wall. The membranous synovial lining covers the internal surface of the sheath, producing synovial fluid that contributes to both the health and lubrication of the enclosed structures.

If the sheath is damaged, it becomes inflamed and, synovial fluid production increases. This accumulated fluid can protrude from the leg at points where the tendon sheath is not constrained by other structures, causing a pronounced bulge towards the back of the fetlock.

Why do horses get windgalls?

Tendinous windgalls most frequently appear in response to hard work – particularly on hard ground – or increased exercise levels. They’re termed ‘reactive’, due to their association with general wear and tear.

Horses with poor conformation may be predisposed to developing windgalls. Poor hoof balance can also be associated. Horses that are worked on hard ground or deep going can develop the swellings, particularly when they are young. Injuries to the ligaments, tendons and the fetlock joint capsule can lead to windgalls developing, as can injuries to the articular cartilage in the joint.

If heat and lameness are present, the enlarged windgall is most likely ‘inflammatory’ – a more worrying development indicating underlying injury.

An inflammatory tendinous windgall usually affects one leg more than the others and is likely to be accompanied by a degree of lameness, although this may be subtle at first. This is called tenosynovitis and is relatively common.

Signs of windgalls

With an inflammatory tendinous windgall, the swelling will feel tense or hard and sometimes warm. It may be asymmetric in shape, if the sheath wall has been torn.

In general terms, the larger, warmer and more painful these windgalls are – that is, the more marked the amount of inflammation – the greater the degree of concern. The synovial lining reacts in proportion to the severity of the damage that has occurred, and in turn this dictates the nature and amount of synovial fluid produced.

Tears of tendinous tissue cause a small amount of bleeding into the sheath. This, and the torn collagenous tissue, then further irritates the synovial cavity and causes more inflammation.

Infection

Infection is potentially catastrophic in a digital tendon sheath. The risk of this will be greatest if a foreign body such as a thorn or splinter has penetrated the sheath, which can rapidly produce an acute inflammatory response within hours. Since this tendon sheath lies just under the skin at the back of the pastern, it is easily damaged. There may an obvious, large wound, but penetration by something small and sharp may not be immediately noticed.

Once infection enters an enclosed, fluid-filled area, such as the digital flexor tendon sheath, the body’s local defence mechanisms are unable to cope. Bacteria flourish and the area becomes septic – that is, overwhelmed by infection.

Diagnosis

Early and accurate diagnosis with any tendinous windgall is the key to a successful outcome.

With the nature of the tissues involved, an ultrasound examination is critical. In experienced hands, this can reliably determine the nature of the fluid and the state of the soft tissues enclosed by and bordering the sheath.

Fluid with high levels of inflammatory cells and protein can be distinguished, identifying possible infection. Tears of the flexor tendons and their associated attachments can be identified, directing treatment and providing some degree of certainty about the likely outcome.

Ultrasound will also identify puncture wounds that can be impossible to find on clinical examination, and will highlight the presence of foreign material within the sheath. Foreign bodies appear as bright spots which reflect ultrasound. In some cases, as the waves cannot pass through them, they can create an underlying shadow.

Mineralisation of the soft tissues, which occurs with longstanding degeneration (usually over a period of years), creates a similar effect, but this is easily distinguished.

X-ray examination can be useful if there are concerns regarding bones adjacent to the sheath, most commonly the proximal sesamoid bones. It will also identify soft tissue mineralisation, although this will almost certainly have already been seen with ultrasound.

Taking a sample of synovial fluid from the sheath can confirm whether contamination or infection is present. In these cases, there will usually be marked increases in white blood cell numbers and protein content.

The presence of blood in the fluid can indicate tissue disruption or tearing. Blood clears from the synovial fluid very quickly, however, so this cannot be relied upon unless performed within a day or two of an injury.

Treatment options

Selecting the most appropriate treatment for any tendon sheath injury relies upon correct diagnosis. This is not always possible upon first examination, but it should always be the goal.

If the sheath wall is stretched (sprained), treatment should be directed toward reducing inflammation. As a general rule, inflammation aids healing by removing damaged cells and tissues. In this situation, however, it can cause further damage.

Persistent swelling may lead to a permanent increase in the amount of fluid produced or the pressure within the sheath. Development of scar tissue is another problem that can be detrimental to the eventual outcome.

Reducing tissue temperature by methods such as cold hosing or using ice boots can help. Counter-pressure bandages, controlled exercise and anti-inflammatory medication can also aid recovery, so treatment usually involves a combination of these.

Penetrating wounds and punctures resulting in infection require emergency surgical treatment to remove the foreign material and damaged tissue. Medical treatment such as antimicrobials are ineffective in eliminating infection inside a tendon sheath.

Medical treatments in the form of regenerative therapies are used in an attempt to repair the damaged tendon such as stem cells or platelet rich plasma (PRP), have been used anecdotally, although there is no scientific proof as yet of their effectiveness.

More conventional medications that can be injected into the sheath include hyaluronan (lubricating agent) and corticosteroid (anti-inflammatory treatment), which are commonly used in combination for some cases of non-infective inflammatory windgalls.

While this treatment may suppress some of the inflammatory changes, using it without an accurate diagnosis may actually lead to progression of the injury. There’s the additional risk, albeit remote, of introducing bacteria with the vet’s needle and causing a serious infection.

Vets have recognised for many years now that the healing of tendons within synovial cavities is even worse than in other areas of the body. This has been attributed to the synovial fluid. The sheath environment is selective, meaning that the cells and proteins necessary for the removal of damaged tissue and subsequent repair are effectively excluded. The torn tissue remains in the tendon sheath, where it causes on-going irritation and prevents healing.

From reviewing many cases, vets now have clinical evidence that the removal of this tissue through keyhole surgery, known as tenoscopy, can be very successful. The digital flexor tendon sheath is acknowledged as the most difficult structures in which perform this delicate operation, however, so extensive surgical experience is critical.

Articular windgalls

These are a different condition, where there is an increase in fluid within one or more fetlock joints. Somewhat similar to the more common windgalls involving the digital flexor tendon sheath, these may also be associated with the wear and tear of hard work. They are typically seen in stocky animals with upright confirmation.

Provided the fetlock joint swelling is not hot, tense, painful when squeezed or most importantly, not associated with lameness, they are usually acceptable. It might make sense to review the work load, check shoeing and hoof balance and continue to monitor, especially if only one joint is affected.

If a horse has a swollen fetlock joint and lameness, then your vet should be consulted. There are many possible cases, which include:

• Acute trauma, such as a joint strain
• Infection
• Osteroarthrtitis
• Osteochondrosis (OCD)
• A bone chip or some other fracture.

A detailed clinical examination from your vet would be advisable. It may be necessary to obtain X-ray images or do diagnostic ultrasound to establish the cause. Once there is a clear diagnosis, then appropriate treatment can be selected.

References:

https://onlinelibrary.wiley.com/doi/full/10.1111/evj.13166

Colloquially referred to as the knee, the equine “carpus” would be more accurately termed the wrist — as this is its equivalent structure in the human body. The horse’s fetlock then relates to our knuckle, his hoof to our fingernail and his pedal bone to the bone in the very tip of our finger.

The carpus consists of two rows of bones: the radial, intermediate and ulnar carpal bones at the top, and the second, third and fourth carpal bones beneath (some horses, but not all, have an additional first carpal bone). The pointy bit you can feel sticking out at the back is the accessory carpal bone.

These rows form two joints, the radiocarpal joint and the intercarpal joint. There is, in fact, another joint between the bottom row and the cannon bone, known as the carpometacarpal joint. Having no movement, however, this joint suffers from very few problems.

Two extensor tendons run over the front of the carpus, and two palmar carpal ligaments at the rear attach the rows of carpal bones.

Floating fragments

Injuries to the carpus fall into two categories: bone chips within the knee, or a combination of fracture, swelling and laceration as a direct result of trauma.

Chips to the bones inside the knee are most often seen in racehorses, forming a big part of the surgery list every week as the Flat season gets underway.

These fragments may be developmental in origin and part of the osteochondrosis dessicans (OCD) disease process, but more commonly occur as a result of overloading. Uneven distribution of weight could be a one-off, high-load impact, causing a small piece of bone to fracture and form a chip, or more repetitive in nature.

As bone adapts to race training, it can become harder and more brittle, making it more susceptible to fracture. Chips can vary in size and occur on the edges of the knobbly carpal bones, typically where the force of the weight comes through the joint.

While most of the horse’s weight is distributed down the inside of the leg, there is also a lot of pressure on the front of the leg at full gallop. If you imagine a photograph of a racehorse in action, the carpus of the foreleg on the ground can appear hyperextended — almost bending slightly backwards. This often leads to an associated stretch of the palmar carpal ligaments at the back of the knee, so we commonly find damage to these in the presence of bone chips.

Less frequently, the fracture can be much larger. Diagnosis of a “slab” fracture is made because the horse is lame, with a joint that is swollen and painful when flexed, and can be confirmed by radiographs.

Treatment is aimed at removing the chip, via arthroscopy (keyhole surgery). If the fractured piece of bone is big enough, repair with screws may be possible — a procedure that can be carried out via arthroscopy under general anaesthesia. As long as the damage to the joint and the articular cartilage is not too severe, the prognosis is good. Around 80% of these cases return to their athletic career.

Trauma to the carpus is common and can occur from a kick, for example, or repeated banging of the joint against a hard object such as a stable door.

A swelling known as a carpal hygroma can form over the carpus, as fluid pools under the skin. A hygroma is a cosmetic blemish and lameness is not usually present, although infection can develop after drainage or injection.

An injection of contrast material and subsequent radiographic examination will outline the extent of the hygroma, while fluid injection into the carpal joints will establish whether or not there is any communication between the joint and the hygroma.

Treatment in the early stages involves drainage, steroid injections and bandaging. If infection is present, surgical resection (removal) of the infected tissue is recommended.

Any swelling over the carpus should be carefully evaluated. If there is a wound — even a pinprick from a thorn — infection can occur in the inter- and radiocarpal joints, as well as the tendon sheaths that lie over the front of the carpus.

In these instances, infection must be ruled out or appropriate treatment started immediately if it is discovered. Surgery may be necessary, involving high-volume lavage (flushing out) of the tendon sheath or joint.

Any lump or bump as a result of suspected trauma that causes lameness will require further diagnostics, such as an ultrasound scan or radiography.

Open wounds

The term “broken knees” refers to the often horrific-looking cuts and grazes a horse sustains when falling on to his knees on a rough, hard surface.

The carpi are particularly susceptible to damage as they lack padding from muscle or soft tissue and will be flexed when the horse falls, meaning that the skin is taut and more easily cut. Injuries are likely to be full-thickness and abrasive in nature, resulting in significant tissue deficit and bruising.

Additionally, these wounds tend to be heavily contaminated. It may be impossible to suture the skin, so wounds are often managed as second-intention healing where the edges are left to close naturally. The carpus goes through a large range of motion, however, which places the area under tension and reduces the chances of satisfactory healing.

Knee lacerations often need careful dissection to debride (remove) any dead tissue and contamination, a procedure that may require general anaesthesia. When sufficiently clean, the wounds should be repaired as well as possible and the leg immobilised either with a heavy bandage or bandage cast.

Broken knees should always be evaluated for evidence of joint penetration, although the two extensor tendons running over the front of the carpus will offer some protection.

Ref Horse & Hound; 16 May 2019

Joint disease is a significant worry for horse owners, a study has found, with 66% of horses having suffered lameness as a result of joint problems.

The majority of owners — 76% — said they were concerned about their animals developing osteoarthritis, with 74% feeding their horse a joint supplement for support.

The survey of 1,339 horses, conducted by supplement brand Cavalor, revealed owners’ worries were justified, with a fifth of horses having been off work for a year or more because of joint problems.

Feedback showed the disease was not just an ailment of older horses, with 10 as the average age of onset and 36% of horses showing signs of joint issues by the time they were eight. Thirty per cent of respondents revealed they had retired a horse earlier than expected owing to joint disease.

As well as the welfare implications for horses, joint problems also hit owners in the pocket. They spent an average of £2,104 treating their horses’ joint conditions while 5% paid out more than £7,500.

More than two-thirds (69%) of horses required up to five vet visits for treatment, while 21% needed as many as ten appointments.

This was despite owners’ vigilance when it came to their horses’ well-being — two-thirds check their animals’ legs daily and 90% implement post-competition care.

Cavlor’s survey was carried out in three countries, showing remarkably consistent feedback.

“We already knew that joint health is very important to horse owners but we were surprised by the scale of the problem,” said Cavalor managing partner Lieselot Hamerlinck.

“Once we saw the results from the survey of UK horse owners, we repeated the research in Belgium and the Netherlands. The results from all three countries were very similar so we are confident that this survey provides an accurate insight into joint disease.”

She added that she believes joint disease is an area of equine health that requires “extra vigilance”.

Continues below…

Understanding joint pain

Current treatment of joint pain commonly includes the injection of a drug into the joint capsule to support the body's

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“Horses are suffering from joint disease from a relatively young age and it’s tragic that 30% are being retired early as a result of the problem. Horse owners need to look after their horses’ joints all year round, not just during competition or periods of heavy work,” she added.

“Although three-quarters of horse owners are using a joint supplement, it’s about giving the right product tailored to the horse’s individual needs and choosing one that is clinically proven to work.”

For all the latest news analysis, competition reports, interviews, features and much more, don’t miss Horse & Hound magazine, on sale every Thursday.

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Rick Farr of Farr & Pursey Equine Vets shares his expert advice on infected joints in horses, how they can be treated and what the prognosis is

Q: Infected joints: “I was wondering if anyone could tell me their experiences with an infection on a joint please? What was the outcome and how long did it take to find out it was in fact on the joint? What is the prognosis and recovery time too?”

A: In order to answer your questions I will give you a few generalisations:

All infected joints require a concerted effort and a degree of urgency.

Identifying an infected joint can be the first challenge — however most horses (irrespective of the joint involved) show a significant degree of lameness. If a joint is ever suspected of being infected your vet will perform a procedure called arthrocentesis. This is the process of placing a needle directly into the joint and aspirating some of the joint fluid. By examining the fluid for any bacteria, protein content and types of cells present your vet will be able to decide whether the joint has been compromised. All of this can be done in practice and you should have an answer the very same day.

Continued below…

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So what do you need to do if a joint is infected? In essence this usually involves surgery (whether it’s at your local practice or at a referral centre). Under general anaesthesia the joint is “flushed” with a copious amount of fluid through the joint to remove all contamination; at the same time it is locally infiltrated with antibiotics. During the surgical procedure the soft tissue around the joint can also be assessed to see whether any other damage or additional complications are possible. The question I get asked by clients in this scenario is usually “when do we need to go for surgery?”. It is often the case that many of these cases present themselves ‘out of normal office hours’ — historically we have always advised immediate referral for surgery, however recent data suggests that referral the following day/morning does not have a significant effect on the overall outcome.

If you leave an infected joint and try to manage it with pain killers/antibiotics, all cases will eventually result in a persistent lameness and a question as to the welfare of the horse. In my opinion all infected joints should result in either referral or euthanasia.

One of the first hesitant questions I get asked is “how much will it all cost?”. You have to take into account three factors:

• The cost of the initial visit of your vet
• The cost of any potential referral/surgical costs
• The cost of recovery from surgery

I advise owners to budget for between £3,000-4,000. This will cover most outcomes pending no significant complications. This can be quite a shock for many clients, however I do try to explain the vast majority of this cost is taken up by consumables — for example, drugs, anaesthetics and post-operative bandaging materials and visits. Actual surgical time and professional time is often a small fraction of the overall expenditure.

Is it all worth it? In my opinion, YES! All joint penetrations have a much better chance of success when dealt with efficiently and effectively. I have had many experiences of horses sadly having to ‘wait’ for owners to make a decision on referral, which have sadly resulted in euthanasia of a horse. I appreciate financial constraints are always an aspect, however practical experience shows us that doing the job correctly from the start can save money, time and, more importantly, improve the welfare of the horse.

Is it successful? This is always dependant on each case, however, prompt referral to a surgical facility can result in return to full exercise and, in most cases, competition performance; in fact, in the past four weeks, I made such a referral which has culminated in a return to soundness following a significant laceration to the back of the heel/pastern on a forelimb, initially presenting with a full non-weight bearing lameness.

If you suspect an infected joint get your vet out as soon as physically possible.

For all the latest equestrian news and reports, don’t miss Horse & Hound magazine, out every Thursday

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

How do you feel when you get up in the morning? Do you bounce out of bed, or does it take you halfway to the bathroom to lever yourself upright? The answer will depend chiefly on how old you are, but also on what you did the day before, your level of fitness and even how comfortable your bed is.

Horses aren’t that different from us when it comes to early-morning stiffness. As autumn arrives we bring them in from the field, shut them in a stable for 14 hours each night and then wonder why they pull out the next morning less than supple.

The stiffness we see in horses comes from both the muscles and joints, but the underlying cause of each is subtly different. Joint stiffness is more age-related, the result of wear and tear. This occurs first as thinning and then loss of the articular cartilage, the smooth covering to the ends of bones that allows joints to move easily. There can also be thickening of the ligaments, and eventually new bone laid down around the joint. The result is inflammation within the joint and a reduced range of movement.

Joint stiffness will be made worse by hard work, firm ground or cold weather, because these are extra stresses on top of underlying damage. Joints stiffen overnight because when they are not moving, the synovial fluid — the oil that lubricates them — soaks into the cartilage. As the horse starts moving again, fluid is released and the joint loosens up again.

Muscle stiffness is more directly a result of recent exercise than of increasing age. The theory that stiffness and pain are a result of lactic acid build-up in the muscles has now been largely disproved. Lactic acid (or more correctly, lactate), is the probable cause of the muscle fatigue and pain felt during bursts of very intense exercise, but the general stiffness and soreness felt the day after hard exercise is due to low-grade damage to the muscle fibres.

The medical term for this is delayed onset muscle stiffness (DOMS) and it is the result of trauma to the membrane around muscle cells, which allows chemicals to leak out and trigger pain receptors. When a horse stands for long periods after exercise, the damaged muscle fibres contract and the muscles become stiff.

There are more serious causes of muscle stiffness, such as tying-up — when the muscles over the quarters cramp up during exercise. Some horses are more susceptible, and the trigger is often exercise following a period of box rest.

Movement is medicine

While some horses go out for part of each day in winter, many only leave the stable for exercise.

For older horses and those in full work, prolonged stabling is a recipe for stiffness. Some common-sense steps can help keep this to a minimum. The most obvious requirement is a stable large enough for the horse to move about freely, with plenty of dry bedding to encourage lying down. There should be good ventilation, without draughts, and the horse needs to be kept sufficiently warm.

If you can turn out during the day then do. For those with plenty of dry, well-draining turnout, remember that older horses can do better when out full-time, provided they are well rugged and have access to shelter.

The best way of managing stiffness is by regular, controlled exercise. All exercise should start with a slow warm-up and end with a period of cooling down. Begin your warm-up in walk, with the horse in a relaxed frame that allows him to stretch down. Then ask for gentle flexion and do large circles, before moving into trot.

Some people like to do stretches with their horse before mounting, but a ridden warm-up is simpler and uses all the muscles in their natural range of action. The length of time needed for warm-up and cool-down varies, but each should be at least 10 minutes. Muscles need to be kept warm, so for clipped horses an exercise blanket can be helpful.

Treatment options

Massage and physiotherapy have a role, but these are usually one-offs and not a substitute for a sensible daily routine. The same is true of spas and laser treatments.

Massage rugs have grown in popularity, although how much actual massaging their gentle vibration can achieve is debatable. Nonetheless, horses seem to find them relaxing and they may keep muscles warm. Magnetic rugs will do the same, although that is all they will do. Repeated studies in humans have found such magnets to have no beneficial effect — and there is no valid scientific reason why they should.

For stiff joints, there are fewer treatment options. Joint supplements have some value but their effectiveness is probably limited. The most important ingredient in a supplement is glucosamine, which should be fed at a level of 10g per 500kg horse per day. MSM is probably helpful as well, as are vitamins A, C and E.

Devil’s claw is a plant extract available in a number of herbal products. Trials have shown that it can reduce joint inflammation, and for this reason it has been added to the FEI list of controlled substances. It is not as powerful as phenylbutazone (bute), however, and some older horses reach the stage where a daily dose of bute is necessary to keep them comfortable. Bute comes from the same family of drugs as aspirin and ibuprofen. It is safe even long term, if given at the correct level, and is very effective at reducing pain and inflammation. A comfortable horse will move more readily and so stiffen up less.

The most important message is that too much rest allows everything to “rust up”. The key to combating stiffness is to keep moving.

Ref Horse & Hound; 21 September 2017

Do joint injections show up on dope tests? Peter Green MRCVS finds out

The injection of very small doses of medication straight into a joint can achieve the same — or even better — results as giving the horse a larger dose by standard injection into a vein or muscle.

The theory is that joint injections target the medication at the precise place where the problem is. Joint injections are commonly used for arthritis or degenerative joint disease in performance horses. Not only does the joint injection get the medication straight to the problem, logic suggests that it also keeps the medication enclosed in the joint capsule. This means the drug is less easy to detect in samples.

Steroids are banned in racing and most serious competitions. But tiny steroid injections straight into a joint are considered less risky and harder to detect — or so some vets believed.

Italian researchers recently published the results of an experiment in which they injected very small therapeutic doses of steroid into 1 hock joint of standardbred trotters. They then measured the adrenal function of the horses.

The horses’ natural steroid, cortisol, was suppressed within 12hr of injecting the joint. This showed that the artificial steroid had leaked sufficiently from the joint to feed back and reduce production of the natural hormone. Moreover, the injected steroid was detectable in urine for up to 48hr.

This shows that joint injections have effects on the whole horse — and could cause a horse to fail a dope test.

Fascinating new research suggests there may be limited benefits in giving joint supplements to older horses. Peter Green MRCVS looks at the evidence

Older horses stiffen up — their joints become less flexible, their tendons and ligaments lose their elasticity and things begin to creak.

Alongside this, a massive market promotes joint supplements to keep the spring in the step of these ageing horses. Apart from herbal painkillers like devil’s claw, most of these supplements contain “neutraceuticals” such as chondroitin sulphate and glucosamine.

Millions of people take these daily as capsules or powder, and thousands give them to older horses in the hope or belief that they keep them flexible, reduce joint ageing and prolong working life.

Vets in the Netherlands assessed 24 horses in their late 20s for lameness. The horses were trained to walk and trot on a laboratory treadmill, so stride length and joint flexibility could be accurately measured. Any obviously lame horses were rejected from the study, but those with barely perceptible and intermittent lameness were admitted. This was thought to be acceptable for old, stiff horses.

The horses were divided into 2 groups balanced for size and type. 1 group was fed a commercial chondroitin sulphate and glucosamine joint supplement for 3 months; the other a placebo that looked and smelled identical. The grooms and vets did not know which horses had received the active supplement and which the dummy.

During the experiment, the horses were turned out to pasture by day and stabled by night. All 24 horses were analysed again after 3 months. If the true joint supplement was going to have any effect, the vets expected stride length and joint flexibility to be increased.

The results, published in the Equine Veterinary Journal (EVJ), revealed that the supplement had made no difference. There was no increase in stride length in treated horses. Individuals in both groups showed increased joint flexibility, which was simply a result of the limited treadmill exercise. In fact, the horses receiving the placebo actually had slightly better knee flexion than those given the supplement.

The conclusion? Exercise keeps old horses more supple than joint supplements.

In the current issue of H&H (9 January) we bring together top riders, vets and other specialists to find out if joint problems are on the increase. Here are our experts' recommendations on how to keep your horse's joints healthy — buy the magazine to read the feature in full

• Be more responsible for your horse. Know what “normal” looks like for him. Check his legs, trot up and lunge him regularly, do all you can to understand his way of going.
• Learn some biomechanics. A basic understanding will help you spot early warning signs.
• It’s up to you to balance your horse. Persistent poor training/crookedness can actually cause joint problems.
• Check you yourself are not crooked.
• Work on different surfaces: don’t become an arena addict. Horses need variety, and hard surfaces and uneven ground are useful in moderation.
• Make sure you know what exercise your horse has done if you are not able to do it yourself.
• Act early if you detect swelling or heat — joint problems can be managed much more effectively if diagnosed earlier.
• Don’t overlook the value of rest. Even if you only have 1 horse to ride — he may need it.
• Communicate with your vet and farrier. They are vital team members in keeping your horse sound.
• Consider trimming foals’ feet from an earlier age. 
• Do not be obsessed about your horse having perfectly matching feet. A mature horse just needs the right feet for his shape and build.
• Try to “MOT” your horse regularly. Prevention costs less than cure.
• Don’t allow your horse to get fat. Excess weight is not good for joints
• Plentiful movement and turnout benefits horses. And don’t snub the horse-walker.
• Don’t write a horse off because it’s 1⁄10th lame — so are many people, but it does not stop them from living full, active lives.

Find out more about the latest advances in keyhole surgery from H&H's vet news expert, Peter Green MRCVS

Keyhole surgery, or arthroscopy, is now the method of choice for removing bone chips from joints, sorting out osteochondrosis problems with joint cartilage and looking inside tendon sheaths.

Although there have been a few brave attempts to perform keyhole joint surgery in standing horses under sedation, the vast majority is undertaken with the horse on the operating table under general anaesthesia.

Compared with old-fashioned joint surgery, in which the surgeon made an incision big enough to open up the joint and look inside with the naked eye, our contemporary keyhole techniques are a revolution. The current standard keyhole instruments are about 2-4mm in diameter, the thickness of a medium-sized knitting needle.

But even these are beginning to look dated as cameras and imaging equipment become smaller and smaller. Scientists have developed cameras small enough to stick on to tiny insects as they go about their daily life. Now, they have developed arthroscopy equipment no thicker than a hypodermic needle.

Vets in Colorado, USA, have reported on the use of 18-gauge keyhole surgery equipment for operating on the stifles of standing horses. This needle gauge is only just over 1mm in thickness, just like the needles we routinely use to perform joint blocks as part of the lameness work-ups.

The images obtained from this miniaturised equipment were just as good as those the standard 4mm camera could produce and the surgeons were able to operate on the stifles without sending the horses to the operating table.

The condition osteochondrosis dissecans in horses, also know as OCD in horses, is self-limiting in some cases and crippling for others, yet a series of uncertainties makes identifying the problem, deciding on treatment options and providing an accurate prognosis far from straightforward.

What is OCD in horses?

The developmental orthopaedic disease that is correctly termed osteochondrosis dissecans starts before a foal is a year old and can lead to several different bone and joint problems in later life.

Problems begin within the first 12 months of development, as the foal’s growing skeleton matures. Essentially soft cartilage cells are converted to more solid bone by a process known as endochondral ossification.

In OCD-affected animals, this natural process fails to function fully. Areas of damaged cartilage develop within the joint, leaving the underlying bone weak and prone to further injury.

Continuing cartilage and bone growth means that some defects may heal before the foal is a year old. Once a foal has matured to a yearling and beyond, however, the transformation from cartilage to bone stops and there is minimal scope for natural healing to occur.

Any loose flaps or fragments of cartilage that are not properly attached will cause irritation, inflammation and consequent swelling of the affected joint. The whole syndrome is called osteochondrosis, with dissecans referring to these fragments.

Signs of OCD in horses

The most obvious sign is an enlarged joint, swollen with extra joint fluid due to inflammation.

A bog spavin, which is a distended main hock joint, is most commonly recognised. While this may not necessarily be as bad as it looks, it’s best to have it checked out. Other less obviously swollen joints may be more of a potential problem, particularly the stifles and all four fetlocks.

Lameness may be present, but can vary in degree from day to day. Other signs include an awkward stance, reduced activity or unusual stiffness and poor impulsion. The horse may be reluctant or struggle to get up after lying down.

OCD in horses: diagnosis and treatment

Diagnosis can be made based on the clinical signs, but these may be subtle and X-rays are usually necessary to confirm the condition.

X-rays only show bone clearly, however, not cartilage. Keyhole surgery (arthroscopy) is sometimes required to assess the degree of damage within the joint and to enable removal of damaging fragments.

While such surgery can be very successful, it is debatable whether it is always necessary — especially if the horse is not actually lame.

In foals less than a year old, the disease has a relatively dynamic nature. Changes within a joint may develop or regress spontaneously. Some affected foals respond very well to a period of rest, together with an appropriately balanced diet.

One particularly challenging aspect of OCD is that it may be clinically “silent”. The condition may only be discovered in the older horse, for example, during a pre-purchase X-ray examination.

This can lead to some difficult decision-making. Electing to submit a sound horse to surgery can be tough but, if you do not, will it remain sound? Is it reasonable to complete the purchase?

As a vet, it is hard to provide accurate advice to enable purchasers to proceed with the least risk. The decision depends on many factors, particularly the horse’s performance record and the location of the OCD.

There is also an argument that lameness is a greater risk in the older horse with undiagnosed or ignored OCD problems, since long-term inflammation in joints can potentially cause arthritis.

The choice of treatment therefore depends on a variety of factors, including the degree of lameness and the location and severity of the OCD. The age of the horse and its intended use must also be considered.

There is no simple answer for many of these cases, so it makes sense to discuss all the options with an equine orthopaedic specialist. Surgical advances and joint medication have certainly helped manage OCD in individual horses.

The full veterinary article about OCD was first published in Horse & Hound magazine (16 May 2013)

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

Mysterious swellings can spring up on hocks for various reasons.

It is important to distinguish true bog spavins from other swellings in this region, which might include:

• Bone spavin. This is the traditional term for degenerative joint disease (osteoarthritis) of the lower hock joints. Sometimes a bone spavin can show up as a hard bony swelling on the inside of the hock, but often there is a little to see or feel, because the damage is on the inside.
• Blood spavin. Another odd term describing the normal saphenous vein. It can sometimes look quite large, as it runs down the front of the hock towards the inside, especially in thin-skinned thoroughbreds. It is nothing to worry about.
• Thoroughpin. This describes an entirely different fluid swelling that is found just in front of the Achilles tendon, above the point of the hock – higher up than a bog spavin and towards the back of the leg. A thoroughpin is inflammation of the tarsal sheath, which encloses the deep digital flexor tendon as it passes over the back of the hock. To confirm that a swelling is a thoroughpin – which is less serious than other types of inflammation – press on the fluid filled area. If it does not bulge out in a pouch at the front of the hock, it is not a cause for concern unless the horse is lame.
• A curb. This is a solid, soft tissue swelling at the back of the leg below the point of the hock. It is associated with a strain to the tendons and ligaments in that area, but rarely causes lameness. It is more frequently seen in horses with poor hock conformation, so is considered a significant blemish.
• Capped hocks. These are variably-sized, cold, painless, ball-like swellings that develop on the point of the hock. Often there is no known cause, but they are sometimes blamed on bandages that are too tight or repetitive trauma such as insufficient bedding causing repeated knocks.To read the full veterinary article about bog spavins see the current issue of H&H (23 August 2012)Read more about joint problemsAre you looking for an equine vet?

Equestrian health brand Equine America has added two new products to its range – So-Kalm Solution, to help keep horses calm, and Cortaflex HA Regular Solution, to support equine joint health.

And both products are currently available at a special introductory price of £19.99.

“The amino acids, premium grade magnesium and vitamin B1 in So-Kalm Solution will relax your horse without removing the edge required for competition,” said a spokesman for Equine America.

“Fortified with Hyaluronic Acid, Cortaflex HA Regular Solution economically and effectively supports and maintains healthy joints for each and every horse and pony throughout their life.”

So-Kalm can be fed as part of a daily diet to difficult horses, or when training young or nervous horses to help maintain a relaxed temperament.

Cortaflex HA Regular Solution can be introduced to a horse’s diet at anytime during a horse or pony’s life as part of their regular health care routine.

Both products are available in 946ml solutions, which equates to one month’s supply.

For more information visit www.equine-america.co.uk.

Like human athletes, the pounding and twisting that horses’ joints are subjected to, regardless of the type of activity they are doing, can leave them vulnerable to injury.

Joint injuries in competition horses are common. Different disciplines inflict varying stresses and strains on the horse’s vital hinges that give him the ability to gallop flat out, jump six foot and piaffe as if on air.

What problems are different horses prone to?

• Racehorses are particularly prone to fetlock and knee injuries because of the
  high-speed training they do on immature skeletons.
• Eventers are more at risk from sustaining traumatic injuries as a result of hitting fences – a fractured pedal bone or a chipped patella (in the front of the stifle) – for example.
• Dressage horses’ fetlock joints are put under enormous strain, especially in collected work.
• A showjumper’s coffin joints also have to tolerate substantial forces being put upon them.
• Even horses that don’t compete are not exempt from joint problems – arthritis of the hocks (bone spavin) is a common issue in older horses.

Read more about joint problems

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Complaints against Equine America (UK) Ltd have been partially upheld by the Advertising Standards Authority (ASA).

VetVits Ltd, who own EquiFlex, objected to two advertisements for Cortaflex that appeared in equestrian magazines.

In one of the advertisements Equine America (UK) Ltd said: “The following equine joint supplements have no objective clinical evidence of improving joint mobility – NAF Five Star Superflex, EquiFlex, PREMIERflex HA, ExtraFlex HA, STRIDE HA, My Joints, Athri Aid and New Market Joint Supplement.”

The advertisements continued to then detail objective research conducted upon their supplement, Cortaflex, with a link to the “outstanding results of the study”.

However the ASA found there to be “significant concerns about the robustness of the statistical analysis of the data … and there was a disparity between the data published” regarding this objective research.

Three claims were upheld:

• The research was found to have been conducted upon a formulation of the product not available in the UK.Equine America (UK) Ltd said that since 2002 they had added two new active ingredients to improve the products efficacy.The ASA decided that as the studies provided by Equine America (UK) Ltd concerned the effects of the substances in isolation, and not in conjunction with other active ingredients, that the advertisements were misleading.
• It was concluded by the ASA that the advertisements were misleading due to the claim that the there was “objective clinical evidence” in favour of Cortaflex.This was due to a small study group, (eight horses) short duration of the study, (two weeks) and a disparity between the data published in the Proceedings of the AAEP and the clinical paper on the website.Due to this they found that the trial upon which the claim was based not be sufficient enough to substantiate the advertisements by Equine America (UK) Ltd.
• VetVits Ltd had a claim upheld that the advertisements denigrated their company.Equine America (UK) Ltd claimed that the advertisements were “solely making a statement of admitted fact” however the ASA found that “the ads went beyond that.”This was due to the implication that EquiFlex was an inferior product compared to Cortaflex.Due to the ASA’s rejection of the Cortaflex study, details listed in the claims one and two, Equine America (UK) Ltd did not have objective clinical proof of its product either.The advertisements claim that EquiFlex did not have clinical proof of its efficacy was challenged by VetVits, however the ASA did not find Equine America (UK) Ltd to be in breach.The conclusion of this ruling is that the advertisements must not appear again in their current form.The ASA also told Equine America (UK) Ltd to ensure “they held robust substantiation for future claims” and “to ensure they did not discredit or denigrate other products or marketers in future”.

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A collagen product that claims to reduce recovery from injury time and damage to horses’ joints has been launched by proto-col.

proto-flex equine collagen is a natural supplement for horses and ponies offering nutritional support to help to maintain strong and healthy joints.

Collagen is the most common protein in mammals, making up approximately 35% of the whole-body protein content.

Wear and tear to the joints is normal and occurs naturally with age.

But, says pro-col, modern pressures placed on domestic horses, including confinement to the stable, wearing of metal horse shoes and roadwork increases the pressure onto the joints even further.

By feeding proto-flex equine collagen, the company says you may help to reduce the inflammation, pain and discomfort associated with natural ageing and excessive joint use.

proto-flex equine collagen costs £79.95 for 900g.

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A new supplement designed to ease joint problems has been launched by Equimins.

Inflam-E-Rase aims to help with the maintenance of healthy bones, joints and ligaments.

Equimins states the product contains a blend of anti oxidants, organic minerals, herbs and other ingredients known for their anti inflammatory qualities.

“Inflam-E-Rase is a powerful supplement that will be very useful for the horse or pony who is prone to discomfort from any condition concerning joints and the surrounding tissues,” said David Willey, managing director for Equimins.

“We’ve used ingredients such as devils claw and bromelain to help the horse in addition to vitamins B1, B2, B6 and B12 as well as 14 different herbs to create a really effective product.”

Inflam-E-Rase is available in 600g and 1.2kg tubs and prices start from £21.50.

A 600g tub of Inflam-E-Rase will last the average horse 30 days.

For more information visit: www.equimins.com.

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Many of today’s competition horses have less down time than they would have done 10 years ago.

As a result, there is an increasing trend to treat joints on a regular, so-called preventative, basis sometimes referred to as “joint maintenance”.

But what medications are typically used and what are their effects? H&H finds out

There are four principle types of medication used to treat equine joints:

• Hyaluronan (hyaluronic acid)

Hyaluronan is a normal constituent of joint fluid that is produced by the cells that line the outer membrane of the joint. As a natural product it cannot be detected on routine dope tests.

• Corticosteroids (including triamcinolone acetonide and methylprednisolone acetate)

Corticosteroids are potent anti-inflammatories. They act rapidly and have a valuable role in the management of joint inflammation.

But they they can increase the loss of important structural components from the joint cartilage, although this can be reduced by injecting hyaluronan at the same time. Another potential problem is the development of laminitis.

Corticosteroids are readily detected in routine drug tests.

• Polysulphated glycosaminoglycans (Adequan)

Polysulphated glycosaminoglycans are incorporated into the articular cartilage and are valuable in the management of osteoarthritis. These are also natural drugs so not detectable in a dope test.

There are, however, occasional severe, so-called flare responses after injection, which can be alarming and difficult to manage.

• Interleukin 1 receptor antagonist (IRAP)

Interleukin 1 receptor antagonist is produced by collecting blood from a horse in a specialised syringe.

It is then processed so that a fragment of the blood rich in IRAP is saved and either injected into the joints of the same horse then, or frozen and injected at a later date. IRAP is natural, so undetectable in a dope test.

For the full feature on equine joint medication, see the current issue of Horse & Hound (7 October, ’10)

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Mussels, glucosamine, apium seeds and rose hips are some of the natural, organic ingredients in the new Joint Power supplement from Forest Farmacy.

Hard ground, exercise and general wear and tear can lead to stress and strain on your horse’s joints, and keeping a horse sound and supple can be difficult.

But Joint Power — part of the company’s range of Organic Horse Power Powders — has been reformulated to support the strain on a horse’s body and increase movement and mobility.

The company says the natural ingredients help reduce pain and inflammation, ease muscular aches and stiffness, support the lymphatic system, cleanse toxins from an injury site, promote circulation, ensure optimum joint health and develop stronger, more supportive tendons and ligaments around joints.

Green lipped mussels contain natural fatty acids and chondroitin sulphate — an essential ingredient to help joints remain loose and flexible.

Glucosamine is a vital ingredient in the production, maintenance and repair of cartilage as well as helping to form ligaments and tendons.

Apium seed helps to break down crystal deposits around joints, encourage soft cartilage to protect the joints as well as acting as a natural anti-inflammatory to remove excess fluid from the body.

Joint Power can also help protect against future inevitable conditions such as arthritis, spavins and general loss of performance.

Joint Power is priced at £32 for a 40-day supply and does not require a loading dose.

For more information tel: 0800 970 9421 or visit: www.forestfarmacy.com

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Many cases of mystery lameness, that may once have been attributed to navicular syndrome, are now thought to be caused by injuries to the distal interphalangeal (DIP) or coffin joint.

What is the coffin joint?

The coffin joint comprises the middle phalanx (short pastern bone), the distal phalanx (coffin or pedal bone) and the navicular bone.

It has a voluminous joint capsule that extends upwards above the coronary band.

Identifying coffin joint problems

Identification of a coffin joint problem is dependent on localising pain to the joint using nerve blocks.

X-rays are required but it is important to recognise that the shape of the bones in this region of the foot varies from horse to horse.

In some animals, there is a small piece of bone known as a separate centre of ossification, which can be present quite innocuously and must be differentiated from a fracture fragment.

In heavier breeds, the bony protuberances on the middle phalanx can be large and must not be confused with new bone formation due to osteoarthritis.

Once it has been established that pain is originating in the coffin joint, it is then necessary to pinpoint the exact nature of the injury.

For the full article on coffin joint problems, see the current issue of Horse & Hound (29 October, ’09)

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A treatment has now become available with a completely novel approach to combatting the disease process of osteoarthritis (OA) in horses.

The product is known as an “autologous conditioned serum”. It is new because it uses factors taken from the horse itself to affect the joint. There is only one brand of serum (IRAP) on the market in the UK at present.

Despite the fact that further tests need to be done to assess why it works and what its long-term possibilities may be, it is finding favour with vets for a variety of cases.

It has raised interest where other current treatments, such as Bute and corticosteroids, may not be used due to rules of medication during competition.

Although its effects use “natural” proteins produced by the horse’s own cells, its use in competition, where doping rules exist, is currently unclear, although its use in such circumstances appears to be increasing.

As it uses the horse’s own cells, it is not technically classed as a medicine. As a result, there is a lack of hard data on either the benefits of its administration or when this therapy should be used.

How does it work?

Your vet will take a blood sample from the horse into a syringe that contains specially treated beads. These beads have an effect on white blood cells, causing them to release a range of natural proteins likely to be beneficial to a joint suffering from OA.

The blood sample is incubated for 24hr to ensure that as much of the relevant protein is produced as possible, then all the cells are removed by centrifugation and the liquid (serum) removed and stored.

This serum can be injected into affected joints as a treatment of OA. Generally, treatment is given at one- to two-week intervals, for a number of treatments. One blood sample yields enough serum for several treatments, hence it is possible for unused serum to be frozen and used in the future.

The benefit of this serum in the treatment of OA is still uncertain. The specific proteins produced by the cells is still unclear in the horse, although work in humans does suggest that those produced are likely to be beneficial if they are injected into a diseased joint.

In particular, these proteins should have an effect on the internal damage that is a feature of many joint diseases. A recent study performed in the USA identified that horses with OA treated with this product showed no adverse reactions and that lameness improved.

Furthermore, this study demonstrated some beneficial effects on the microscopic appearance of the joint.

Many questions remain. We do not know what types of OA may improve through this treatment, although it is true that the earlier it is started, the more likely it is to be beneficial. We also await good evidence of what is the actual effect of this treatment on horses’ joints in natural disease.

This text formed part of a veterinary feature about osteoarthritis, which was first published in Horse & Hound (5 April, ’07)

Lameness is probably the most common reason why horses are not able to work or fulfil their potential, and why horse owners seek veterinary advice.

No matter what the initial cause, any minor injury can lead to osteoarthritis (OA). OA is a major problem in horses, as well as in man and other animals, largely because, once the disease has reached the point where it is obvious to the horse and its owner, the damage is irreversible.

Current medical and surgical techniques do not allow a joint with OA to return to normal. Joints are fairly complex and are made up of a number of structures such as bones, ligaments and tendons, and the joint cartilage. Cartilage is vital to the function of the joint, as it provides the unique coating that allows one bone to move over another without causing pain.

In OA, this joint cartilage becomes damaged and lost. The body is then unable to repair or replace it, so the joint will never be entirely normal. It may be possible to manage a horse with some degree of OA to allow him to continue working using a variety of drugs, physiotherapy and structured training routines.

What is currently available?

Probably the most popular treatment for OA is a class of anti-inflammatory drugs called non-steroidal anti-inflammatories (NSAIDs). Bute is the commonly prescribed medication.

NSAIDs are extremely useful as painkillers and frequently make lame horses more comfortable. But they act at the level of relieving the signs of OA, rather than curing the underlying disease process in the joint.

The other main class of medication used is corticosteroids. These are extremely powerful anti-inflammatories that produce profound effects inside the joints, decreasing the amount of internal damage. They are almost invariably given as injections directly into the joint and can be extremely useful in managing lame horses.

But steroids do have their downside and, in some instances, can cause longer-term problems, despite being beneficial in the short-term. In rare cases, they have been associated with side effects such as laminitis and joint infection.

While most vets use corticosteroids regularly to treat OA, they accept that this is not always ideal. Other medical treatments that have been available for a long time include hyaluronan and polysulphated glycosaminoglycans (Adequan). These are injected into the bloodstream, joint or muscle. Both have some effect on the damaged joint and can help improve the articular cartilage.

There is also a multitude of nutritional supplements, not licensed as medical treatments, which may have beneficial effects on joint health.

This formed part of a veterinary feature about osteoarthritis in Horse & Hound (5 April, ’07)

A study that may help vets influence the natural repair response in horses’ damaged joints has won a prestigious industry award.

Equine sports science student Kate Scothorne won the Royal Agricultural Society of England’s (RASE) Eqvalan Duo Equine Thesis of the Year Award for her third-year dissertation: Identification of stem cell markers in an in-vitro model of intrinsic cartilage repair in horses.

Scothorne’s interest in the Nottingham Trent University course and research into joint repair originated from a horse she bought after leaving the Army six years ago.

“I began working in industry, but then decided it wasn’t for me, so I took a career break and went to study at Nottingham,” she said. “I wanted to know more about my horse — he’d had OCD as a youngster and was never right behind; always a bit stiff and with numerous things going on with him. I think that’s what sparked my interest.”

Having opted to study stem cells, she spent the 2004 summer conducting experiments during a placement at the Comparative Orthopaedic Research Group (CORG) at Cambridge University’s vet school. In September, for her final year, she returned to Nottingham to begin the analysis.

Scothorne said the most exciting area of her research was the fact age did not affect repair potential — older horses had as much chance of repair as very young animals.

“Stem cells are cells that aren’t mature and have not committed themselves to becoming any particular type of cell in the body — you can have stem cells in bone marrow that can become a range of tissues, including bone, cartilage, muscle or fat.

“We found stem cells in cartilage that had already committed themselves to becoming mature cartilage, called progenitor cells. This had implications because it was possible they’ll divide to produce more cells, which increases the possibility of repairing the cartilage. Mature horses had the same level of progenitor cells as younger horses.

“Surgical cuts may increase the activity of progenitor cells. My dissection cut had an effect on stem cells, not only where the cartilage has been cut, but quite a lot deeper.”

Dr Frances Henson, an equine surgeon with CORG, who devised and supervised Scothorne’s studies said: “It is very preliminary work but it’s incredibly groundbreaking. We are the first researchers to publish that there are stem/progenitor cells in equine cartilage — and this hasn’t been shown in any species.”

Scothorne is the second Nottingham Trent student to win the award and received £500 for her achievement. Her thesis has formed part of a report published in a human medical journal, and she now plans to study physiotherapy at Leeds.

Dr Henson has won a grant from the PetPlan Charitable Trust to continue the project.

This news story was first published in Horse & Hound (1 December, ’05)

Osteoarthritis of the lower hock joint, also known as bone spavin, is incurable, and the aim of treatment is to manage the pain.

It has been suggested that with time the lower hock joints will spontaneously fuse and subsequently become pain-free. In my experience this is very rare. Rest may result in temporary resolution, but generally lameness recurs when work starts.

In horses with minor X-ray changes or certain types of bone spurs around the joint, my preferred treatment is to inject medicines into the joints. Corticosteroids are often effective, but the degree of response and its duration vary hugely and is unpredictable.

Some horses become pain-free for up to six months, whereas in others improvement is only seen for two to three months. It is my impression that the best results come from combining corticosteroids with a joint lubricant (hyaluronan).

Although there is physical communication between the two lower joints in only about 35% of horses, a recent study showed that therapeutic concentrations of drugs can be achieved in both joints by injecting the lowermost joint only. This is good news because it is physically easier and safer to inject into this joint.

There is an alternative medication that can be injected into the lower joints called Adequan. This works differently to corticosteroids and may prevent further degenerative change within the joint. Despite spavin being quite common, there has been no good clinical trial to compare the efficacy of this with corticosteroids.

Shoeing

Corrective trimming and shoeing may help some horses, but should be used with care and with reference to each horse’s conformation and the way it both stands and moves.

A horse with a base-narrow conformation that overloads the outside of the limb, or one who twists the foot a lot during weight bearing may benefit from a small extension to the outside branch of the shoe (making the outside branch wider), or the use of a trailer (an outward projecting spur from the heel of the shoe). Keeping the toe short and rolling the toe may facilitate breakover and help to reduce pain.

Shockwaves

Recently, shockwave therapy has been introduced as an additional treatment, and there is some indication that it may help reduce pain. However, I think that it should be seen as an extra rather than primary means of treatment. Many horses with bone spurs can return to full function managed in this way.

Obviously, in a competition horse any medication has to be carefully timed so that it complies with rules. But horses with predominantly destructive X-ray changes respond poorly to these treatments and provide a much greater challenge.

Clinical trials are now taking place to assess the efficacy of a currently unlicensed drug, Tildren, in the management of spavin. This may modify bone metabolism and stop further bone destruction, perhaps allowing repair to take place.

Joint fusion

For horses with major bone destruction, this leaves joint fusion as currently the most appropriate treatment. Joint fusion can be achieved surgically, by drilling into the joint spaces under X-ray control. The aim is to remove some of the cartilage and stimulate accelerated fusion of the joint.

The speed of response and the efficacy of fusion seem to vary hugely; some tend to develop a lot of bone around the surgical sites, which is probably not good. Generally, fusion takes six to nine months to develop and, at most, 65% of treated horses are able to return to some work.

An alternative means of fusion is to inject a chemical called sodium moniodoacetate (MIA) into the joints. This destroys the cartilage and probably local nerve endings as well. It is only feasible if the joint spaces are not already narrowed to such an extent that injection is not physically possible.

The treatment is often associated with quite severe pain within the first 15hr of treatment, but with appropriate painkillers this can usually be managed satisfactorily. Chemical fusion can be very effective and in my experience, if successful, tends to be quicker than surgical fusion.

However, if the horse has some communication between the lower and uppermost moving hock joints, it is not a suitable candidate for chemical fusion.

Whichever method of joint fusion is used, the biomechanics of the hock alter. Some horses that were successfully treated initially have gone on to develop recurrent lameness associated with osteoarthritis in the upper hock joints, or a fracture of the fused lower bone unit.

This veterinary feature was first published in Horse & Hound (8 September ’05)

Spavin is a term horse owners dread; it is the standard name for osteoarthritis of the lower hock joints. Bone spavin in horses may affect one or both of the lower hock joints, and frequently affects both legs.

The hock is a complex of several joints, with most movement occurring in the uppermost joint. There is relatively little movement of the two lowest joints, but a lot of force is transmitted through them.

Like osteoarthritis in people, the cause of spavin is not very well understood. There is a very high incidence of it in Icelandic ponies, suggesting that in this breed there is a genetic predisposition. Other factors, including trauma and conformation, may play a role. Although we tend to think of osteoarthritis as occurring in older individuals, the disease can affect horses of all ages.

For a pleasure horse, use of bute to provide long-term pain relief can be a very reasonable option. However, this depends on the degree of lameness and the response to medication. Some horses respond well, whereas others do not. This is generally related to the degree of lameness. But it has to be said that in some horses spavin is a career-ending disease.

Diagnosis of bone spavin in horses

The presence of X-ray abnormalities that are consistent with osteoarthritis does not always mean that a horse will suffer from lameness. A sound horse may have X-ray abnormalities and in many lame horses diagnosed with spavin, X-ray changes are fairly advanced when the diagnosis is first made. This means that the disease predated the onset of clinical signs.

However, once pain has been triggered it tends to be persistent. It’s therefore important to prove that the lameness is because of hock pain and not something else. This is achieved using nerve blocks. The entire hock region can be desensitised using tibial and fibular nerve blocks, or local anaesthetic solution can be placed into the lower hock joints — so-called intra-articular anaesthesia.

If the disease is advanced, intra-articular anaesthesia may give a false negative result — lameness may persist unchanged. This is because some of the pain comes from within the bones of the affected joints, which cannot be influenced by the local anaesthetic solution.

There are a variety of X-ray changes seen in horses with osteoarthritis, and recognition of these is important because it influences the likely response to treatment.

Some horses develop spurs of bone around the joints, called periarticular osteophytes. Others develop more destructive changes within the joints, with loss of cartilage resulting in joint space narrowing, with or without areas of adjacent bone loss. Such horses tend to be the lamest and most difficult to manage successfully.

Less commonly, lameness can be abolished by intra-articular anaesthesia, but the X-rays of the hock appear normal. Some of these respond very well to a single intra-articular treatment and probably had soft tissue inflammation.

However, there is a small group of horses without X-ray changes that responds very poorly to treatment. They don’t progress to develop X-ray changes and currently we don’t fully understand the mechanism of disease and pain in these. It is then important to rule out other problems, such as high suspensory injuries.

• This veterinary feature was first published in Horse & Hound (8 September ’05)

The correct diagnosis and treatment of orthopaedic infections (infections located anywhere inside or on the outer surface of the limbs) is challenging to any vet.

Long-standing infections involving vital structures such as bones, joints and tendon sheaths can be particularly difficult to treat, with less than 50% of infected equine fractures healing successfully.

Most commonly seen are infections of synovial cavities (joints, tendon sheaths and bursae) which can be career ending or even life threatening. Some long-standing synovial infections will be virtually untreatable and cause such severe pain that the horse has to be put down.

Do not delay in seeking veterinary advice with any injury, which might be infected. The longer the synovial infection is present, the more difficult and costly it will be to treat, and the more likely it is to result in permanent lameness.

It is always best to remember that what at first appears to be a minor injury can end up as the most serious. Any deep puncture wounds should be considered as much of an emergency as larger wounds. A puncture into a joint or tendon sheath can cripple a horse, as these structures cannot combat infection and require intensive treatment.

Diagnosis

If there is obvious lameness and a deep wound close to a joint, tendon sheath or bursa, a vet should be contacted urgently. The vet then has to decide if the injury is minor, or more serious and likely to develop into a serious orthopaedic infection.

It can be difficult to be certain because a wound that has penetrated a joint, tendon sheath or bursa is likely to look like any other injury. Most wounds that cause major infections appear minor and innocuous initially, apart from their position. The majority of horses are lame but the degree of lameness is variable.

If there is any serious concern that a joint or similar has been infected, the vet will do further special diagnostic tests to establish the seriousness of the condition.

Theses can include:

• taking a fluid sample from the joint or tendon sheath to look for signs of infection
• x-rays or scans to find out what is happening inside the joint
• laboratory tests on infected joint fluid to find out how severe the infection is

Treatment

If a joint or other delicate tissue is infected, the horse is likely to require a general anaesthetic and surgery to clean the affected area. For a joint or tendon sheath this will involve flushing litres of sterile saline through the damaged area to eliminate the infection.

It may be difficult to remove everything at once and to be successful the flushing has to be done before any permanent damage has occurred. Repeated flushes and intensive courses of antibiotics may be needed. With a survival rate of 90%, and 81% returning to their previous level of performance, the outlook is always guarded in these cases.

This article was first published in Horse & Hound (29 January 04 issue)

Joint pain, caused by inflammation of the soft tissues (synovitis), generalised joint trauma or osteoarthritis, can lead to lameness.

In some cases, obvious pain or swelling on manipulation of the joint, or lameness following flexion, suggests that the joint is painful and contributing to lameness.

In the absence of clinical signs, it is usually necessary to inject local anaesthetic into the joint. If a significant improvement is seen in the lameness or performance following the injection then the joint is likely to be the source of the problem.

Inflammation within a joint can result in the loss of important constituents of the joint cartilage. If the architecture of the joint cartilage is damaged, its role as a shock absorber will be compromised. Abnormal loads will be transmitted through to the underlying bone, which may respond by becoming stiffer.

This results in a potentially vicious circle of compromised function of a number of the structures of the joint, resulting in progressive osteoarthritis.

Joint inflammation also results in the production of an abnormal amount of joint (synovial) fluid. Although the fluid is important for joint lubrication and nutrition of the cartilage; an excessive amount may cause increased pressure within the joint and can cause pain.

Treatment

Once joint pain has been confirmed, treatment, which often includes injection of a drug into the joint, can begin. There are three main types of drug used for joint medication.

Hyaluronan (hyaluronic acid or “acid”) is a normal constituent of joint fluid. It is responsible for lubricating the soft tissue and has a role in nutrition of the joint cartilage. It may also have some anti-inflammatory role.

If a joint is inflamed, the amount and quality of natural hyaluronan is reduced and this has potentially damaging consequences. By injecting hyaluronan into the joint, it is thought that this encourages it to normalise its own production of hyaluronan.

Corticosteriods

These are strong anti-inflammatory drugs. Corticosteroids can suppress the inflammation and stop the vicious cycle described above if used judiciously. They act rapidly and have a potentially valuable role. However, they have disadvantages, because in the short term they can increase the loss of important structural components (proteoglycans) from the joint cartilage. Injecting hyaluronan at the same time can reduce this effect.

Corticosteriods, because of their potent anti-inflammatory effect, also reduce the joint’s ability to respond to infection and may mask the early signs of joint infection. When infection is then recognised it may be quite advanced and potentially extremely difficult to treat effectively.

One final, fortunately uncommon, problem associated with the use of corticosteroids is the development of laminitis, which can be rapidly progressive and possibly life threatening.

Polysulphated glycosaminoglycans (marked under names such as Adequan)

These are incorporated into the articular cartilage. Although osteoarthritic cartilage has limited ability to heal, these drugs can help stabilise the cartilage and are valuable in the management of osteoarthritis.

Sue Dyson examines the recent trend of injecting the joints of competition horses as a preventative treatment, and the concerns associated with it, in the 11 December issue of Horse & Hound. To purchase a back issue contact (tel: 020 8532 3628).

Healthy joints are of prime importance to the ridden horse, and lameness is the bane of riders’ lives. While there are many causes of lameness, maintaining healthy joints through a balanced diet can help ensure strong, healthy equine limbs.

Your horse’s basic diet should provide the necessary vitamins and minerals for optimum health and to sustain the level of work, but in some cases supplementation can help support joint condition.

Caring for cartilage

The first part of the joint to suffer under stress is the cartilage, so this is a critical area of joint health.

“Degradation of cartilage sparks a chain of events that leads to inflammation, stiffness and pain,” says nutritionist Kate Jones. “The use of compounds called chondroprotective agents to combat this is well established in both human and veterinary medicine.”

Chondroprotective agents are present in the structure of the horse’s joints. These agents have anti-inflammatory properties, enhance production of synovial fluid and also play a part in the prevention of osteoarthritis.

If the horse’s body cannot manufacture the required amounts of chondroprotective agents, then additional supplementation may be required in order to optimise health and performance.

“The most important chondroprotective agents are glucosamine, which helps synovial fluid, and chondroitin sulphate, which prevents cartilage degradation,” says Kate.

“Chondroprotective supplements can be fed both as a preventive measure and when existing problems are in evidence, and glucosamine and chondroitin sulphate should be given as a combination.”

The principle effects of glucosamine are threefold, as it works to:

• keep synovial joint fluid tough and elastic for strong joints
• assist synthesis of other chondroprotective agents
• regulate cartilage growth and repair

Joint cartilage is made up of two components — collagen, which is a protein, and a complex chain structure involving branches of chondroitin sulphate. The latter is an essential ingredient of cartilage, which works to hinder the action of enzymes that can break down the cartilage and stimulate the action of cartilage-building sites (chondrocytes).

Natural alternatives

There are also various natural products available that can nutritionally support an inflamed joint.

Devil’s Claw, a herbal derivative, is a popular choice for joint health and is reputedly very fast-acting. It does not actually contribute to joint repair, but it is useful for pain control.

MSM (methyl sulphonyl methane) is a natural product long associated with anti-inflammatory properties. It is a bio-available source of sulphur, vital for soft tissue growth, and is required in the synthesis of the bones to connective tissue.

Shark cartilage is still commercially available, despite all species of sharks being under threat. Kate adds: “Couple that with the inhumane method of ‘harvesting’, and shark cartilage becomes a controversial issue. Glucosamine can also be sourced from shellfish – these are sustainable, ethically produced, and just as effective.”

Supplements solely containing plant extracts can help the soft tissue damage associated with joint problems although they don’t provide the correct nutrients for optimum joint health

Oils are frequently chosen by horseowners to supplement their horse’s diet, and cod liver oil improves bone integrity for healthy joints, and is also useful to promote general health.

Kate recommends a high-quality product rich in vitamins and oligo-elements, which are easily broken down and utilised by the horse.

This feature was published in full in the September 2003 issue of HORSE magazine.

Types of injury

Bruising and haematomas

These are very common following kicks over muscular regions such as the rump (gluteal muscles), thigh muscles (quadriceps), or forearms. The overlying skin is often undamaged, but blood vessels are ruptured by the hoof’s impact.

Bleeding into the surrounding tissue may be mild, forming bruises, or in some cases more severe, resulting in large fluid swellings under the skin called haematomas. Mild bruising can be treated with cold hosing and compresses, but large haematomas deserve veterinary attention.

Skin lacerations

Trauma from kicks often only causes small skin wounds. However, these should be carefully examined as they often lead to pockets under the skin where the connective tissue has been separated by the blow, leaving atunnel into deeper tissue for bacteria to travel along.

Small superficial wounds away from joints, which do not appear to be causing marked lameness, can be treated by poulticing, followed by twice-daily cleaning and application of a suitable wound ointment.

Deeper puncture-type wounds require veterinary attention, as the skin has been broken and bruised tissue is prone to infection. The wound will need flushing and the horse will require antibiotics and tetanus prophylaxis.

Large skin wounds may need stitching, and these must be seen straight away, as bacteria multiply rapidly and, after six hours, most wounds will be too infected to close.

Wounds that need stitching should be cleaned with saltwater (half a teaspoon of table salt into a litre of water) and bandaged to prevent contamination while waiting for the vet.

Infected or heavily contaminated wounds should not be stitched. Instead, they should be managed with antibiotics, bandaging and water-soluble wound ointments.

Kicks onto joints

Joints are particularly dangerous sites for a horse to sustain a kick. If the skin is broken there is a serious risk of joint-capsule penetration. Any puncture-type skin wound over a joint should receive veterinary care.

If infection gets into a joint, it will rapidly become septic. This is extremely serious and can lead to permanent lameness or even necessitate euthanasia.

Kicks onto bone

In many cases, the bone will just be bruised and will heal quickly, leaving only a splint-type bony swelling. These cases respond well to a week’s cold hosing and kaolin poulticing, combined with box rest.

Sometimes, however, the kick wound is deep or traumatic enough toaffect underlying bone, resulting in a ‘sequestrum’, a fragment of bone that has broken off with the initial impact or has become devitalized due to reduced blood supply as a result of infection.

The wound may heal initially, only to break open again. A chronic drainage tract will persist until the sequestrum is surgically removed.

Any kick wound which refuses to heal should be X-rayed to rule out bone chips, fractures or sequestra. Some kicks onto bone are so powerful they fracture the bone.

Many fractures can be repaired, though sadly some cannot, necessitating euthanasia.

Recognition of non-displaced ‘hairline’ fractures is essential for, as the horse gets sounder and starts to bear weight, the bone may suddenlygive way.

Any kick wound resulting in severe lameness deserves urgent veterinary attention.

Call the vet if:

• the wound is pouring or pumping blood
• the skin over a joint or tendon sheath has been penetrated
• the horse is lame
• a large haematoma has developed
• the wound is infected, highly contaminated or doesn’t show signs of healing
• your horse’s tetanus jab isn’t up-to-date
• the wound is deep or large enough to require stitching.

Alternative treatments

There are a number of alternative therapies that can be helpful with kick injuries and worth keeping in your first aid kit. Before using them, check with your vet that they won’t interfere with any other treatment your horse is receiving.

• Arnica: useful for treating bruises.
• Calendula lotion: used to flush out wounds, Calendula has antiseptic qualities and stimulates healing.
• Hypericum: eases pain – useful when an area is very painful but there’s not much damage.
• Hepar sulph: if a wound is infected and oozing pus, Hepar sulph will help stimulate healing.

In the early stages of either true ringbone or spavin, all that may be detectable is a slight stiffness that wears off with exercise, or a loss of action, where the horse does not move as well, particularly at a trot.

As the damage in the joint progresses, a more obvious and persistent lameness will become apparent. Early diagnosis improves the chance of managing the disease effectively.

Low ringbone is when the lower end of the pastern is affected. When this involves the coffin joint (between the pastern and foot bones) it may appear as obvious swelling around the front of the coronary band.

High ringbone (true ringbone) involves the pastern joint. To diagnose the condition in the early stages, vets may need to inject a local anaesthetic into the joint to see if the pain is there.

Ringbone can occur on any of a horse’s limbs, but is more common in the forelimb because greater weight and stresses are placed there as the horse moves. There are several possible causes:

• Direct blows to the bone, such as brushing or knocking a fence.
• Repeated tiny trauma associated with damage to the tendons and ligaments surrounding the joint, particularly with poor conformation.
• Poor or infrequent shoeing will distort the normal pastern position/conformation and increase the likelihood of ringbone.
• certain types of work, such as that of polo ponies and jumpers, which frequently turn sharply, are more likely to sprain the pastern joints resulting in an increased incidence of ringbone long-term.
• Other injuries, for example if a horse injures one leg, forcing it to put more weight on the opposite leg, there is an increased risk of ringbone developing in the leg which has had to cope with the stress of the extra weight.

Not all ringbone is serious as it depends on how close any bony damage is to the joints of the pastern. If the joint is not directly involved, it is described as non-articular and there may be lameness in the early stages, but this should settle and the horse become sound.

If it is articular (directly involving the joint) it is potentially more serious. Some horses have naturally knobbly pasterns, and what feels like an enormous lump may appear insignificant on an X-ray.

Q: My horse is being treated for degenerative joint disease (DJD) in both his front legs. However, I am thinking about treating him with magnotherapy or copper wraps. Can you advise?

Holistic vet Nick Thompson replies: In my experience, magnetic boots and rugs for horses are very useful.

We and our horses are electromagnetic beings and the principle is not as wacky it sounds. It is thought that the magnet affects the erythrocytes, which contain iron, and transport oxygen and carbon dioxide in the blood. It causes these erythrocytes to move towards the magnet, dilating the blood vessels.

Some companies offer a four- to eight-week trial on magnetic products, so shop around: you can’t tell in advance which horses will benefit. There is no harm in trying, and we have seen dramatic results using magnotherapy.

Copper bracelets or wraps can work for people with rheumatic-type pains. Copper may work on horses, too, but I suggest you try the magnets first and see how you get on.

For more about alternative therapies, and to locate your nearest homeopathic vet, contact the British Homeopathic Association, (tel 020) 7566 7800.

Q. My five-year-old cob is in foal for the first time. She has got a splint on one foreleg and fluid in both front knees and hind legs. She is stumbling a lot and recently actually fell on her knees. She’s been resting for a month now, yet the fluid is still there. Can you please help?

Jo Holmes MRCVS replies: Your horse may have a few minor problems which aren’t necessarily related. Moderate filling of the hind limbs can occur in horses when they stand in a stable for a long time, but it usually disappears with exercise.

Circulation can be compromised during pregnancy, making ‘peripheral oedema’ (swelling of the extremities) common near the end of term. Stable bandages and daily exercise will minimise this.

Check that your horse is sound behind and assess exactly where the swelling is. If it is at the back of the fetlocks, she may be forming windgalls (an enlargement of the tendon sheaths as the tendons pass over the back of the joints).

This is ‘wear and tear’, maybe due to the extra weight she is carrying. Her stumbling seems to have given her’swollen knees’ – the carpus (knee) may swell when it gets knocked, like when she fell recently.

It rarely causes lameness but can take months to go down.

There are several synovial tendon sheaths on the front of the carpus which smooth the passage of tendons connecting the distal limb to muscles higher up the leg, as they run over the knee joint.

Without such tendon sheaths – filled with the same synovial fluid as joints – friction across the knee would hamper the mechanicalaction of the tendons, designed to protract the limb forward.

Unfortunately, if damaged, carpal tendon sheaths tend to produce excess synovial fluid that results in a ‘big knee’.

Anti-inflammatories such as Phenylbutazone (bute) and coldhosing or ice packs will bring the swelling down initially but thereafter only time and exercise will reduce it.

The fact your mare is stumbling is more worrying, as she could become unsafe to ride. Regular shoeing is essential: get your farrier to check her feet carefully.

Poor or irregular shoeing can cause pedal osteitis (painful inflammation of the pedal bone in the foot). This is caused by a combination of concussion and shoes that put too much force through the sole. Thehorse may develop a shuffling forelimb gait, refusing to extend in trot and collapsing in front when ridden on hard ground.

Veterinary examination with hoof testers will elicit pain, usually in both front feet. Nerve blocks and X-rays will confirm diagnosis and heart bar or ‘seated out’ shoes and pads may help to spread force away from the sole and absorb concussion.

Although none of your problems are insurmountable, ask your vet to check your mare over if you’re worried at this point in her pregnancy.

The two small bones that lie at the back of the fetlock joint are called the sesamoid bones. These bones play an important role as part of the suspensory apparatus supporting the fetlock joint. This apparatus also includes ligaments that lie at the back of the cannon bone and pastern.

The suspensory apparatus acts like a sling on to which the fetlock joint sits and, as a result, much of the weight of the horse. This system allows the horse to bear weight without having to use much muscle effort.

Slow-motion videos of horses galloping demonstrate why the suspensory apparatus is vulnerable to injury. At high speeds the fetlock “drops” close to the ground because much of the horse’s weight is taken by the “sling” of the suspensory apparatus.

The forces on to the bones and ligaments of half-a-ton of horse galloping at 45mph are considerable, and it is not surprising that injuries commonly occur. They can occur anywhere along the length of the ligaments and bones of the suspensory apparatus.

Sesamoid injuries are common following trauma, such as kicks or strains, and are most common in horses regularly working at fast speeds, such as racehorses.

Q: Almost two years ago, my seven-year-old 14.2hh Arab X Welsh mare was diagnosed as having ringbone in her off foreleg due to conformation problems. Her stride has shortened and even on bute she is becoming more uneven in trot, uncomfortable in canter and finds walking downhill difficult.

Could you please tell me more about this condition. Is my mare likely to return to soundness?

Vet Harvey Carruthers replies: Ringbone is a common cause of lameness and often affects the pastern and coffin joints of each limb.

The condition could have beencaused by a direct blow to the joint, underlying bone disease, infection or concussion transmitted up through the limb.

If the area of the pastern joint is affected, it is classed as high ringbone, and if the coffin joint area is affected it is referred to as low ringbone. High ringbone is more common.

Articular or “true” ringbone occurs around a joint and is usually genetic in origin. Peri-articular, or “false” ringbone, occurs at a distance from the joint.

A horse with a very upright conformation is more susceptible to concussion transmitted up the limb. Ringbone can also result from exercising on hard work surfaces.

The symptoms of ringbone appear as inflammation around the collateral ligaments of the joints. The initial inflammation induces lameness and the degree of lameness gives an indication of the extent to which the inflammatory process has developed.

The inflammatory process leads to the deposition of bone around the affected joint and, if a horse has articular ringbone, the joint surfaces may become eroded.

While bute or other anti-inflammatory drugs may initially reduce the lameness, full recovery is not very common.

It is possible for affected joints to fuse, as bone deposition increases, and for lameness to resolve to various degrees. For this to happen horses require complete rest – field rest is acceptable.

Other treatments have included injections of steroids into the affected joints.

It is important to note that treatment has had very mixed success and, if the diagnosis is correct, be prepared for the fact that your mare may be unable to return to full work. I advise you seek further advice from your vet.

The fetlock is formed where the cannon bone and the long pastern bone meet. The joint includes two sesamoid bones at the back, which the flexor tendons pass over, and is strengthened by ligaments spanning the cannon and pastern bones.

When a horse is galloping or jumping the joint almost touches the ground when carrying the horse’s full weight. Routine stress combined with poor conformation and or a lack of fitness can result in fetlock injuries.

Before the vet can diagnose a swollen fetlock, it is important to identify the position of the swelling and whether the horse is lame.

Windgalls

Windgalls are soft swellings filled with synovial fluid towards the rear of the fetlock. They are seen in many horses and rarely cause a problem.

Articular windgalls are a swelling of the joint pouch between the suspensory ligament and the cannon bone. Horses commonly have small articular windgalls in all four fetlocks. If there is no pain on flexing the joint and no lameness, there is usually nothing to worry about.

Tendinous windgalls are a swelling of the tendon sheath seen between the suspensory ligament and the flexor tendons. Most horses have tendinous windgalls on the hind fetlocks. Treatment is of little value as they tend to refill with synovial fluid if they are drained.

Wear and tear

Arthritis or degenerative joint disease (DJD) is common in the athletic horse. They can result from an initial injury such as a kick, a chip fracture or wear and tear. The articular cartilage is damaged producing increased friction between the joint surfaces. The joint is painful when flexed, and slightly swollen.

The horse will appear intermittently lame, but the lameness may become more severe after heavy exercise and the vet must be called. Initial treatment is rest, followed by controlled exercise. The vet may inject drugs directly into the joint. However, DJD is incurable.

Joint infection

A septic joint will result in a greater level of lameness. Usually caused by a penetration wound from wire or a kick, it can happen when any foreign material enters the sterile area of the joint capsule.

The pain is so severe that the horse will hardly bear weight on its leg. The fetlock will be swollen, hot and painful, and a small cut is usually visible. If you suspect a septic joint call the vetimmmediately, as the joint will need flushing with saline solution.