The aim of the trot-up is to allow the observer a clear view of the horse moving in a straight line and in balance, so that the gait can be assessed.

Horses are trotted up primarily to check for soundness. The trot is an even gait, with legs moving in diagonal pairs, so it is the easiest in which to spot lameness or uneven loading of the limbs. A horse may also be trotted up in-hand as part of a sale, to show off his movement.

FEI competitions for all disciplines will include a trot-up (otherwise known as the horse inspection) to check the horses are fit to compete. At three-day events, an initial trot-up takes place prior to competition. A second trot-up the morning after cross-country then follows to check the horses have recovered and are fit to continue to the final showjumping phase.

A trot-up in a straight line as part of a lameness examination allows the vet to make an initial assessment of the horse’s soundness. Further tests, such as flexion tests, lungeing and a ridden exam, may be necessary for the vet to gain more information.

At a pre-purchase exam, the vet is making a full assessment of the horse on behalf of a client. A trot-up is part of the examination, to identify any lameness issues that may prevent the horse being suitable for the buyer’s needs.

In all cases, a good, level surface that is not too loose, slippery or stony will help the horse trot confidently and offer the truest indication of his soundness.

A closer look

It is useful to know what the vet is looking for in these different trot-up circumstances.

As a spectator at a competition trot-up, it may be puzzling as to why some horses pass the trot-up while others are sent to an area called the holding box and occasionally eliminated.

The ground jury and veterinary delegate will assess each horse visually as he stands in front of them, before seeing him trot to evaluate his soundness. Any horse they have concerns about will be sent to the holding box for further assessment.

The vet in the holding box will be able to do a more thorough examination, including palpation and assessment of the horse’s limbs, to help identify any injuries — such as tendon or ligament injuries — which would prevent him from continuing in the competition.

A horse who has sustained a small overreach during the cross-country, for example, or who has pulled a shoe off, may appear slightly unlevel. After veterinary assessment, however, he may be deemed fit to complete a round of showjumping.

There may be horses competing that are poor movers, without having any specific injury that would be exacerbated by competition. At the second trot-up, on the final day, the ground jury will have benefited from seeing competitors at the first trot-up and in the dressage, so will have a clearer view of how each horse normally moves.

Taking the lead

Trotting up a horse correctly is an important skill to learn. The horse should be wearing a bridle for control and be led from the left side. Start by standing him up square so the vet or ground jury can examine him from all sides.

At an event trot-up, you will be expected to walk the horse for a few steps before trotting him away and then back towards the vet and ground jury. When examining a lame horse, or a horse for purchase, I ask to see him walked away and back and then trotted away and back. There is value in seeing the horse moving away and back towards you in both gaits.

The horse needs to be able to move his head freely without being held on a tight rein. The aim is to keep him moving in a straight line and at an even pace.

Stay by his shoulder and walk in a straight line by looking ahead, not at the horse. In trot, it is best to set off at a steady run with an even rhythm — remaining at his shoulder. If you run ahead or turn around to look at him, he may well back off and drag behind you.

It is important to keep the horse’s head and neck straight. If he curls towards you, this can make the gait look uneven and the right hindquarter can swing out and appear to drop away.

Experienced riders will have different ways of presenting a horse well, but I advise people to hold the reins in the right hand, as if you were riding one-handed, with your palm downwards and the reins separated by your hand. You can then place your arm across the horse’s chest so your hand is central, directly below the base of the neck.

With the reins in this position, you can encourage the horse to relax and take a contact with the bridle. He should then drop his head and lift over his shoulders and back, trotting with an even, powerful hindlimb gait.

If you are holding the reins together, in a fist, it is difficult to have much influence on a horse who sticks his head in the air and swings about. You can only apply downward force and he may react against this by putting his head up and hollowing through his back and neck, compromising the way he uses his body and hindlegs.

The horse needs to be able to trot in his own balance and rhythm, so find the pace or speed that suits him — which may mean adjusting your running speed. Don’t worry about your footsteps being in time with his. It’s great if they do match, but you may trip if your legs aren’t the same length as the horse’s and you try too hard.

Return to walk a few strides before the end of the straight and turn the horse away from you by moving his shoulder. This avoids being trodden on or tripped up, which can happen if you turn him towards you.

It is worth practising at home so both horse and rider learn to trot correctly. A horse who is poorly presented may look uneven, even if he isn’t.

Ref Horse & Hound; 17 October 2019

A veterinary professional may want to see your horse trot up for a number of reasons, but what’s the best way to do it?

A good trot-up gives the observer a clear view of the horse moving in a straight line and in balance, so their gait can be assessed.

Primarily, vets use trot-ups to check for soundness. Because the trot is an even gait, with legs moving in diagonal pairs, it’s easier to spot lameness or uneven loading of the limbs than in walk or canter.

When are horses trotted up for vets?

Vets might wish to see horses trotted up as part of:

• a lameness examination, in which further tests, such as flexion tests, lungeing and a ridden exam might also be carried out
• a pre-purchase examination, in which a vet is employed to assess the horse’s physically suitablity for a buyer
• an FEI competition of any discipline to check the horses are fit to compete. At three-day events, there are two horse inspections: one before the dressage phase, and another following the cross-country phase. Horses have to pass both to be allowed to compete

The holding box

At an FEI event, the ground jury and veterinary delegate will pass a horse following a trot up or send him to a holding box for further examination.

The vet in the holding box performs a more thorough examination, including palpation and assessment of the horse’s limbs, to help identify any injuries — such as tendon injuries — that would prevent him from continuing in the competition.

A horse who has sustained a small overreach injury during the cross-country, for example, or who has pulled a shoe off, may appear slightly unlevel. After veterinary assessment, however, he may be deemed fit to complete a round of showjumping.

Some horses are then represented at the trot-up, while others might withdraw from competition at the holding box.

Equipment to use to trot your horse up for the vet

Be ready to trot your horse up with:

• a well-fitting bridle, headcollar or halter
• stout, appropriate footwear, such as yard boots
• a riding hat
• riding gloves
• a schooling whip, if needed

How to trot up a horse for the vet

Before considering how to trot up a horse, first select your surface. It should be level and not too loose, slippery or stony.

• Stand your horse square. This allows the vet to walk around and examine the horse’s posture from every angle. Hold the reins in your right hand as if you were riding one-handed.
• Trot the horse away as straight as you can, keeping an even rhythm and ensuring he has enough rein to move his head freely so the vet can see any abnormalities. Your horse should be active, but not too fast.
• The vet may signal when they want you to turn and trot towards them, or if you’re unsure you can ask them to call out.
• Ask your horse for a walk transition a few steps prior to turning. When you turn, your horse should always turn away from you to avoid being trodden on. Guide the horse towards you slightly before asking him to turn away. This will enable you to trot back on the same line.
• Keep the horse straight towards the vet, but ensure you have sufficient control so as not to run them over.

It is worth clarifying whether the vet wants to see your horse walk first. If so, use the steps above in walk.

Furthermore, it is good to clarify how to trot up for the vet in particular. Some want to see the transition from trot to walk in front of them. You should make this transition very obvious.

If you have a young or inexperienced horse, practise the routine of trotting up so that when you need to do so you can produce a good, straight trot for your vet without any hassle. If you’re preparing to trot up at a competition, it’s worth you and your horse learning to trot correctly as a horse who is poorly presented may look uneven, even if he isn’t.

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The lameness work-up: what it is and what it can achieve

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“Don’t ignore your horse’s ‘off days’” is a key message behind a new campaign aiming to bust lameness myths and help UK owners – and horses.

Educational resource Talk Lameness, launched by Hallmarq Veterinary Imaging, is aiming to help owners become more confident in spotting subtle signs of lameness, which can mean sooner identification and treatment of any issues.

“For any horse owner, noticing their horse is ‘just not quite right’ can be a worrying and confusing experience,” a Hallmarq spokesperson said. “Is it simply stiffness? A training blip? Or the first sign of a more serious issue?

“Talk Lameness’ aims to cut through the uncertainty by addressing the top misconceptions surrounding equine lameness, empowering owners with the knowledge they need to have better conversations with their vets.”

Talk Lameness features quizzes, webinars and other expert advice, all aimed at boosting owners’ understanding. The team has also been busting common lameness myths, the first of which is that a horse would be lame if he was in pain.

Take the quiz

“Horses are stoic animals and masters of compensation,” the spokesperson said.

“Some horses do not ‘limp’ in an obvious way. Instead, pain might manifest as a shorter stride, resistance in transitions, a change in rhythm or even a grumpy attitude under saddle. They can shift their weight or look better after warming up, effectively hiding a subtle problem.”

The second myth is “It’s probably just stiffness or a training problem”.

“While horses do get stiff, it’s easy to mistake lameness for a training issue,” the spokesperson said. “Lameness can look like a training problem, stiffness or a change in attitude. Signs like reluctance to work on one rein, uneven contact or a drop in performance can all be valuable clues pointing to an underlying physical discomfort.”

Myth three is that lameness is always visible in a straight line, when issues often show up more clearly under saddle, on one rein or on a certain surface.

“Observing your horse in different situations is key,” the spokesperson said.

The fourth myth concerns horses who are “fine” once they have warmed up.

“‘Warming out’ of a problem is a classic sign of some types of lameness,” the spokesperson said. “Horses are good at coping. This apparent improvement can be a deceptive trap for owners, as the underlying issue remains and can worsen over time.”

Lameness myths busted

The final myth is that owners can do nothing until the vet arrives.

“Owners are the most important eyes and ears when it comes to their horses’ health,” the spokesperson said. “The goal is to support a better vet conversation and a clearer plan. By carefully observing and noting when, where, and how their horse feels not right, owners gather crucial information that helps the vet decide on next steps.”

Hallmarq said the initiative is not designed to diagnose but to support owners.

“Getting answers starts with knowing what to look for,” says Carina Northern, Hallmarq equine sales director for the UK and Europe. “We want to move away from worry and confusion and towards clarity and confidence.

“By understanding these common myths and using the free resources available on our website, owners can become proactive partners in their horses’ health and wellbeing.

“It’s all about empowering owners to feel confident and, crucially, to seek appropriate vet treatment and imaging if their horse is suffering with an issue.”

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Only about half of owners can recognise equine forelimb lameness, and a third hindlimb issues – and confidence in spotting issues does not necessarily match ability.

These were the findings of a study presented at the British Equine Veterinary Association Congress (11-14 September), by final-year vet student Jade England.

Ms England explained that lameness is one of the most often reported conditions in horses, and that previous research has suggested a high prevalence of undiagnosed lameness. This project, to investigate owners’ ability and confidence in identifying lameness, involved an online questionnaire completed by 509 people.

Each was shown videos of a sound horse, those with fore- and hindlimb lameness and one with bilateral shifting forelimb lameness.

Of these, 50.6% identified the sound horse, 50.3% the forelimb lameness, 32.3% the hindlimb issue and 8.9% the bilateral lameness.

“Investigating owner confidence, we found that most owners rated their confidence four out of five for identifying forelimb lameness, three out of five for hindlimb lameness, and two out of five for bilateral lameness,” Ms England said. “There is a group of people who are quite confident, but actually have the lower lameness identification scores, and a group who are lacking in confidence, but it doesn’t really correlate with their score.”

When asked about clinical signs of lameness, most selected head nods or hip hikes but far fewer cited pain expressions or behaviour changes.

“It’s probably no surprise that horse owners struggle to identify lameness, particularly hindlimb and bilateral lamenesses,” Ms England said. “Signs such as behavioural changes and pain expressions could really help with this, but we’re finding that owners are rarely using these.

“The results from this study can really help us understand the knowledge gaps and barriers owners may face when identifying lameness in their horses. We can use this to develop evidence-based resources focused on helping owners to improve recognition and understanding of lameness, leading to earlier identification, earlier diagnosis and faster access to treatment.”

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

Are you searching for a complete guide to joint injections in horses? Equine surgeon Thijs de Bont MRCVS demystifies their contents, application and use in pain and performance management

Most horse owners are familiar with equine joint injections. “I get his hocks done every year,” is a phrase we’ve all heard, accepted, and just moved on. But what does this really mean? Is it right, or even necessary?

Joint injections are technically known as intra-articular injections and are often referred to as intrasynovial injections. Intrasynovial injections also include injections into other synovial structures that are not joints specifically but are closed synovial compartments, such as tendon sheaths or bursae.

Joint injections allow for localised, targeted treatment of a specific area, maximising the dose of medication at the target site and minimising any potential systemic effects. They are used to reduce inflammation and therefore pain, which results in an improvement and often resolution of lameness. They improve flexibility and the horse’s ability to train key muscle groups. In some cases they can even be disease-modifying.

Equine joint injections can be used both to improve comfort and consequently welfare, and to ultimately enhance performance levels in our equine athletes.

Equine joint essentials

Joints in horses are made up of cartilage, bone and soft tissue, all of which have injury potential. The different types of joint include:

• High-motion, such as the fetlock or stifle joints
• Low-motion, such as the lower hock (tarsometatarsal and centrodistal) joints
• Fibrocartilaginous, for example the sacroiliac joint

Injuries to any of these structures cause inflammation. Joints may appear puffy (joint effusion) due to increased production of joint (synovial) fluid. Further clinical signs may include heat, pain on flexion with a reduced range of motion and, of course, lameness.

Typically, there are two main scenarios where joint injections are used in horses:

Targeted treatment for a recognised lameness originating from a joint. This is when a horse presents with a pain-related gait asymmetry and has undergone a full orthopaedic evaluation. This typically includes diagnostic nerve and joint blocks in combination with imaging such as radiography, ultrasonography, CT or MRI, which in turn have provided a specific diagnosis.

A drop in performance with no obvious lameness detectable, but rather a number of more subtle symptoms including changes in rideability, resistance to performing certain movements or consistently landing to one side over a fence. In these cases, your vet will recognise certain patterns that can be associated with certain types of injury. Targeted joint treatments can then be used in the first instance both as a treatment and for diagnostic purposes.

Which medications are used in equine joint injections?

Medications used for joint injections in horses primarily have anti-inflammatory properties. None can repair cartilage, but by providing a healthier joint they can slow the progression of degenerative joint disease.

The main medications used by vets to reduce joint inflammation are corticosteroids. They are a very effective, consistent and relatively cheap medication. Many products are available, but triamcinolone and betamethasone are the two most commonly used, due to their consistent effects and relatively short detection times – the approximate period of time for which a drug (or its metabolite) remains in the horse’s system.

In general, corticosteroids will be used alone or in combination with hyaluronic acid, which can contribute to pain relief via a variety of mechanisms.

Biologicals are a group of treatments whereby the animal’s own cells are collected, processed and injected back into a specific region, such as a joint or soft tissue structure. These include products such as platelet-rich plasma and a variety of autologous-conditioned serum products that essentially concentrate a variety of the animal’s own natural anti-inflammatories and growth factors at various volumes, with or without incubation. One major advantage of biologics is that they have no detection times and certain types provide enough volume that they can be frozen and stored for multiple future use.

Mesenchymal stem cells have anti-inflammatory effects and the potential to promote healing. They can either be autologous cells, which are processed from the patient itself either from bone marrow or fat tissue, or allogeneic, meaning that the cells are processed and are available as an off-the-shelf product following collection from a donor animal.

Polyacramide hydrogels reportedly integrate into the lining of the joint capsule, improving elasticity and therefore joint flexibility. They also supplement the synovial fluid, which in turn protects the joint surface.

Management of joint problems in horses

In principle a joint should be injected as infrequently as possible, and there is little truth in the theory that once you start you can’t stop. Joint disease is often progressive and intra-articular medication can slow the progression of cartilage degeneration.

Repeated injection of the correct dosage does not make the injections less effective, nor do horses become immune. Rather the level of damage within the joint becomes progressively worse over time, necessitating more frequent injections to maintain the same level of soundness.

Incorrect use of medications can directly contribute to the process of cartilage degradation, by injecting too frequently at too high a dose for example. However, even when used correctly, by increasing comfort and therefore your horse’s exercise levels, the medication can indirectly contribute to further exercise-induced wear and tear of the joint surface.

Your vet will always discuss the options available and the reasoning behind using a particular medication type based on your horse’s needs. However, injections are only truly beneficial if all other parts of the horse’s management are optimised.

It is essential to use a team approach, whereby the rider, vet, farrier, equine nutritionist and physiotherapist work together to optimise every controllable factor. This includes clearly defining both long- and short-term goals and making the right decisions at the appropriate time.

Working to this level of detail allows the horse to train both more consistently and in a correct way, which in turn maximises performance.

Day-to-day considerations

● Tailor your exercise plan to your horse’s individual needs and give your horse the time to strengthen and increase fitness levels.

● Don’t expect your horse to jump higher or perform more complicated movements if not physically ready.

● Prioritise a good warm-up and warm-down.

● Make sure your horse is not standing still in a stable for long periods of time throughout the day.

● Make sure to have your tack fitted by a professional at regular intervals.

● Diversify your rides and the type of work you do, and exercise on multiple different surfaces.

● Work on your own fitness and arrange for a rider biomechanics assessment to optimise your positioning, to prevent asymmetry.

● Get to know the normal appearance of your horse’s joints. Be aware of how the joints look, how they feel and how flexible they are.

● If you feel your horse is lame, stop and first consult your vet, prior to continuing ridden exercise.

Equine joint injections can contribute to a horse’s soundness in a hugely positive way, but should not be used to try and mask a significant injury. The welfare of our animals should never be compromised, and the horse’s best interests must always remain at the forefront of our decision making process.

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Poor performance or lameness with no obvious cause may call for an examination known as a work-up. Gil Riley MRCVS explains what’s involved

A lameness work-up is an investigation of the horse’s movement to diagnose injury or damage that is causing pain. The more accurate the diagnosis, the more finely tuned the resulting treatment plan can be. This, in turn, maximises the likelihood of a successful outcome and a return to athletic work in the shortest possible period of time.

A work-up may be performed because a reason for lameness is not apparent, or because performance is below par. There are many causes of loss of performance, including gastric ulcers, respiratory issues and temperament problems. By far the most common problem is orthopaedic pain, resulting from an abnormality somewhere in the musculoskeletal system.The aim of the work-up is to determine the root of this pain, using a sequential series of steps.

Where is the best place for a lameness work-up?

With so many unavoidable variables due to the individuality of every horse, it is important to standardise the procedure wherever possible.

A work-up is ideally performed at a veterinary clinic, where the vet will be familiar with how horses respond to the environment, the handlers and the facilities. These facilities will have been designed to allow the most obvious demonstration of lameness in the horse in the safest way — a small gravel lungeing ring, for example, that enables the horse to be seen moving on a hard surface with minimal risk of slipping.

Typically, one vet will use their experience and the examination results to lead them to the source of pain. A good lameness clinician needs to ensure they remain sufficiently objective to pinpoint the diagnosis. An advantage of bringing a horse to an equine hospital is that there may be more than one specialist, along with gait analysis systems and different imaging techniques that may be unavailable at home.

In certain cases, variations to the procedure may be necessary. A horse that has recently had its shoes removed may not be lunged on a hard surface, to avoid making him footsore, while the riding part would be omitted, of course, for an unbroken or miniature horse.

If the answer is found with the initial, static examination, or on the straight-line trot, the process ends there. It would be inappropriate to put the horse through unnecessary discomfort that would provide no further information.

If a horse will not tolerate nerve-blocking injections, we may opt to introduce imaging earlier than usual to minimise distress caused. This is not ideal, as it will take more time to reach the correct diagnosis, but it is a better alternative to risking injury to the horse, vet or handler.

Unravelling issues

Lameness in the limbs is most common, but pain in other areas can result in poor performance — especially back issues, such as impingement of the dorsal spinous processes (kissing spines) or spondylosis of the vertebrae. Such horses often exhibit no lameness on the straight-line trot or on the lunge, but show profound discomfort during ridden exercise under the weight of tack and rider. They may also resent palpation of the back, alerting the vet to the possibility of a problem in this area.

A work-up can also help to unravel a primary source of pain from secondary complications or compensatory lameness. An example would be hind limb suspensory pain — a common cause of lameness in dressage and event horses. Because it can develop insidiously, and in both limbs simultaneously, the rider may not realise anything is wrong in the early stages. The horse may adapt his movement to minimise pressure on the painful suspensories by moving his pelvis more, causing sacroiliac pain. When his suspensory ligaments are blocked out (numbed), the clinic rider is likely to report that he now moves more freely — but with a stiffness “higher up”. A subsequent nerve block of the sacroiliac area will then lead to further improvement.

Pain relief, such as phenylbutazone, should not be given for at least two days before the exam. Anything that makes lameness less obvious will make obtaining an accurate diagnosis more difficult.

What’s the verdict?

Eliminating possibilities to reach the correct diagnosis can take money and time.

While a definitive diagnosis is obtained in most cases, some may still evade an absolute answer — although a logical and well-supported suggestion can usually be made. Lamenesses that remain undiagnosed are usually suspected as being neurological in origin, emanating from the spinal cord or the associated spinal nerves and plexuses.

The emergence of gait analysis systems has been an exciting development in lameness investigation, particularly for horses that are unbroken or have become unrideable, or where lameness is so subtle that it is difficult for the vet to identify. These systems, however, should be regarded as another tool available to the vet, and just part of the process in uncovering the source of some lamenesses.

A lameness work-up: the process in detail

Part 1: historyThe horse’s background is explored thoroughly, from specifics of ownership and use to any previous lameness issues or suspicions. Other health conditions are also noted, along with the horse’s shoeing regime, the nature and onset date of the current lameness, details of any treatment and subsequent response.

Part 2: static examEach limb is palpated for swellings, heat, bony lumps or signs of traumatic injury, along with response to pressure. The feet are inspected, with attention paid to shoe fitting, the presence of a pulse and any pain upon use of the hoof testers.

The back and neck are palpated for areas of sensitivity or exaggerated pain reaction, and baited (carrot) stretch tests performed to assess neck manoeuvrability.

Part 3: dynamic examA. Straight-line trot: Unless severe lameness is already evident at walk, the horse is trotted away and back on a hard, level surface. As a two-time gait, trot allows direct comparison between sides. All but the mildest cases of lameness are usually apparent. Flexion tests may be performed at this stage. Any change in gait in the trot-away may point to a problem in a joint or an associated structure.

b. Hard-surface lunge: lungeing on a tight circle can provide vital information. Lameness that is particularly obvious on a hard surface may stem from a foot. Noting whether it worsens when the affected limb is on the inside or outside can help to pinpoint the pain source to a certain area of the foot.

c. Soft-surface lunge: lameness that is worse on the soft indicates that the problem is unlikely to be in the foot and may instead be in a soft tissue structure, such as a ligament or tendon. Further clues can be gained if it worsens in one direction.

d. Ridden exercise: the majority of lameness work-ups are brought to us by owners not because a horse looks wrong, but because he feels wrong.

An experienced rider can be invaluable in helping the vet determine the source of this abnormal movement, or lameness, by reporting, for instance, that the horse feels choppy on both front limbs, is not tracking up with a hindleg or resents pressure on his back.

Part 4: nerve blocksPossibly the most important tool in lameness diagnosis and often the cornerstone of the investigation. While “pain” cannot be imaged, the vet can narrow down the problem by progressively blocking out regions of the affected limb, or spine, before re-assessing movement. If an area is no longer painful, a horse’s gait will improve significantly — indeed, he may become sound. Such a response will categorically regionalise the source of pain.

Part 5: imagingWith the source of pain localised, imaging can be employed to assess the specific area — commonly radiography, ultrasonography, MRI (magnetic resonance imaging) and nuclear scintigraphy. Using information about the damage found, along with knowledge and experience of dealing with lameness, the vet may reach a diagnosis and formulate a treatment plan.

This feature was first published in Horse & Hound magazine; 9 January 2020

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Graham Fletcher shares his thoughts on the rising cases of horse injuries – and treating humans

It seems to me that injuries to horses are more common today than they were three or four decades ago – which is bizarre when I think about how many rounds we used to jump back then. As for the going… We were always pleased when a show watered the ground, because many didn’t; and we also jumped on soft to heavy footing.

At what used to be England’s best show, the four-day Royal, for each main-ring class, they’d take the top 24 from a preliminary ring, where 60 to 80 horses had jumped – except the last day’s national championship, which was over three rounds. It was possible, therefore, to jump 13 rounds over four days – and the mindset of all riders then was not to give horses a day off.

Aachen – then and now regarded by many as the world’s best show – lasted 10 days. Qualifying for main classes required an awful lot of jumping. The grand prix on the Sunday is a wonderful class in front of 40,000 knowledgeable spectators. I was lucky enough to win it on Buttevant Boy over two full rounds followed by eight puissance-type fences, then four of us went into a speed jump-off. The horses certainly knew they’d had a class!

Thanks to improved horse welfare, they’ve never been better looked after, as they deserve to be. Poles are lighter and collapsible back cups have reduced falls.

All-weather arenas have taken the sting out of hard ground and well-drained grass arenas are underlaid with sand. I remember how, when it rained heavily at Hickstead, the Sussex clay was hard work for the horses. Now, with its state-of-the-art rings, it’s a totally different ball game.

So why so many injuries? Tendon injuries were rare in my day, despite all the jumping horses did.

Top horses are so hard to find nowadays that I can understand people erring on the under-jumping side. Yet that theory is confounded by one of the current top combinations, the great John Whitaker and Equine America Unick Du Francport. Despite doing more shows than most this year, “Frank” has kept his enthusiasm and freshness – a credit to how he’s been produced and managed.

So, what’s John’s secret? First, he likes to turn him out for a few hours, but being a sharp horse, Frank would never settle – until he got a donkey friend. Now he happily has a spell in the field. John’s second tip is another that means his yard has few soundness problems – and that’s doing roadwork. Sadly, traffic makes it difficult for some to do likewise, but getting horses out of the arena onto the fields or tracks has undoubted benefits.

As we adopt modern ideas, maybe we shouldn’t discard successful traditions – but instead take the best from both?

Funding healthcare

Few horse people haven’t been eternally grateful to our ambulance crews and the NHS after a bad fall. As Mr Jorrocks said: “A fall is an awful thing.” And that’s not changed nearly 200 years later.

It’s certainly awful if one of your children has a bad one; there’s no worse feeling than seeing them in terrible pain. Like all of you who’ve had that experience, I’d like to say from the bottom of my heart how much we all appreciate those doctors and nurses. It’s more at the everyday end of healthcare that we hear of lengthy waits for appointments; so it’s interesting to learn how other countries manage.

We’re just back from Vilamoura, where our boys Olli and Will had a successful tour. When your team is away for a month with staff, there’ll always be the odd health problem – and the chance to see how another system works.

Not long ago, Portugal was regarded as one of Europe’s poorer countries. But their health provision is top-class. If you need an emergency appointment, you’re seen within minutes at the doctor’s surgery – at a cost of £50.

I’m sure a big percentage of Brits would be pleased to pay that for a similar service. Then maybe our nurses and carers could be paid what they deserve.

● Do you agree with Graham? Write to us at hhletters@futurenet.com. Please include your name, nearest town and county for potential inclusion in the magazine.

• This exclusive column will also be available to read in Horse & Hound magazine, on sale Thursday 8 December 2022

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

Navicular in horses relates to problems associated with the navicular bone in the horse’s hoof and is a common diagnosis for lameness in the front foot. The label navicular disease is used to describe a variety of conditions, including a progressive degenerative condition involving the navicular bone (which is located behind the pedal bone inside the hoof capsule), the bursa (the joint capsule that sits around the bone) and the deep digital flexor tendon (which runs over the navicular bone before attaching to the pedal bone), of one or, more commonly, both front feet.

Navicular is not a single ‘disease’ – it is a syndrome of abnormalities. Although the term – along with ‘navicular syndrome’ or ‘palmar foot pain’ as it is sometimes known – was once widely used as a generic diagnosis of heel pain, thanks to advances in technology, vets now use the term ‘navicular disease’ to specifically refer to changes within the navicular bone structure itself, identified by MRI scanning.

Navicular in horses: Signs | Diagnosis | Causes | Treatment

Signs of navicular disease

Navicular disease typically affects both front feet, although one foot is often worse than the other, so your horse may initially appear lame on one front leg. However, on the lunge the horse may show lameness on the inside leg in both directions.

You may also notice that he lands with the toe of the hoof first, ahead of the heel. In addition, navicular generally worsens with hard work and lessens with rest. None of these signs add up to a definitive diagnosis of navicular, but are possible clues. There are navicular bones in all four feet, but associated lameness almost always occurs in the forelimbs.

Diagnosing navicular syndrome in horses

If you suspect your horse may be suffering from navicular disease, you should contact your vet. They are likely to review the whole clinical picture, assessing the feet and shoeing, together with the way in which the horse moves, a well as performing flexion tests and nerve blocks to assess the affected area to see if this reduces the lameness.

Historically the term navicular syndrome came into use 15 or so years ago to describe lameness confirmed as being within the foot and heel region. Diagnosis was reached using nerve and joint blocks and where irregular margins (edges) to the navicular bone were evident on radiographs (X-rays).

The use of MRI has enabled accurate diagnosis of damage to soft tissue structures, such as injuries to the deep digital flexor tendon, the impar ligament and collateral ligaments of the distal interphalangeal (coffin) joint. Vets can also see increased fluid in the navicular bursa and distal interphalangeal joint via MRI, which may indicate inflammation of these structures.

Furthermore, MRI can also detect changes in bone. As it creates images as ‘slices’ through the foot, rather than two-dimensional images where anatomical structures are imposed upon one another, it offers greater potential than radiographs alone to highlight mild or early navicular bone changes.

Now that vets can pinpoint issues in the navicular region by using MRI, they no longer have to lump everything under one umbrella term.

This ability to diagnose specific injuries within the foot much more accurately is one of the main reasons for the apparent decline in the number of horses diagnosed with navicular disease.

That said, many vets have now come full circle and are once again willing to diagnose navicular disease, particularly in those horses where MRI indicates predominantly bony changes with minimal soft tissue involvement.

Causes of navicular problems

The causes of navicular disease are many and varied, and are not solely down to the influence of genetics.

We know that bone adapts to stresses placed upon it; it is thought that excessive stresses may lead to inappropriate adaptation and degeneration of the navicular bone.

Skilled farriery can lessen these harmful stresses, which is perhaps another reason why fewer horses today suffer from foot pain.

Poor conformation or the development of a long toe and a low heel will only add to the stresses placed on the navicular region during exercise, so it is important that these shortcomings are addressed with appropriate farriery. Even the well put-together horse can suffer, however, if hooves are not kept properly trimmed and balanced.

Possible contributing factors include:

• Although it’s found in all breeds of horses, it’s most typically diagnosed in quarter horses, thoroughbreds and warmbloods
• Underrun heels, sheared heels, contracted heels, mismatched hoof angles, and disproportionally small feet may all be contributing factors in a predisposition towards navicular
• Affected horses are usually between the ages of 7 and 14.

Treatment for navicular in horses

The treatment for navicular is as varied as the possible causes so you will need to take veterinary advice regarding the various options appropriate for your horse.

If it is thought that foot conformation may be a factor, therapeutic shoeing may help a lot, especially in the early stages. There are many different approaches. One school of thought is that it is best to remove shoes to improve the blood flow to the feet, but others choose corrective shoeing, using a shoe that supports the heel and can reduce the load exerted on the navicular bone by the deep digital flexor tendon. Your vet and farrier can advise you on the best course of action for your horse.

Rest and controlled exercise can be useful, especially in the early stages, when it can help to reduce the stresses on the navicular bone, particularly in conjunction with an appropriate change in shoeing.

Many horses respond well to a combination of medication and effective farriery.

There are several different medical treatments available including painkillers that also have anti-inflammatory effects, to the newer bisphosphonates, which regulate bone metabolism. Some studies have suggested these bisphosphonates are useful, however it is unclear at what stage they work best.

Case series of navicular disease have shown a favourable prognosis, at least in the short term, with medication of the navicular bursa (the area around the bone itself) using corticosteroids and/or hyaluronic acid.

As navicular worsens with hard exercise, you may also need to look at reducing your horse’s workload. While riding avoid hard, concussive surfaces, surfaces with a camber and tight circles. This will reduce the concussion and uneven forces on the foot.

Surgery is sometimes considered as a last resort; there are different options reported, with the traditional surgical treatment, known as ‘nerving’ or ‘denerving’ being more common, when other treatment options have failed. This involves cutting the palmar digital nerves, so the horse loses sensation in the heel. As with any surgery, this is not without risk and may only mask the issue, causing more serious problems in the long term. There is a chance of the nerves re-growing and on average the procedure offers a mean of 20 months of successful performance. It will only work in cases where a nerve block to those specific palmar digital nerves has been positive.

While we still do not know exactly what causes degeneration of the navicular bone and its associated tendons and ligaments, in terms of imaging and awareness, at least, we have moved on in leaps and bounds in the last 15-20 years with the advent of MRI and improvements in equine foot care.

References

• https://www.ncbi.nlm.nih.gov/pubmed/25724857 – Is there an association between clinical features, response to diagnostic analgesia and radiological findings in horses with a magnetic resonance imaging diagnosis of navicular disease or other injuries of the podotrochlear apparatus? – Jan 2015

A study looking into the behaviours of a group of 60 ridden horses, considered sound by their owners, identified that 73% had low-grade lameness in one or more legs, using Dr Sue Dyson’s ridden horse pain ethogram. H&H finds out more about the research and its implications for the future...

More education is needed to better understand how horse behaviour can reflect underlying pain, a study indicates.

In the research, led by veterinary orthopaedic specialist Sue Dyson, 60 sports and riding school horses, considered sound by their owners, were assessed using a ridden horse pain ethogram (RHpE). The RHpE comprises 24 behaviours more likely to be seen in lame than sound horses; the presence of eight or more of these behaviours is likely to reflect pain.

Of the 60, 73% were found to be suffering with low-grade lameness on one or more legs, 47% had gait abnormalities in canter, and 47% had ill-fitting saddles with potential to adversely influence performance. Lame horses had higher RHpE scores than non-lame horses. The study was an extension of previous work that had shown that specific facial expressions and other behaviours are a reliable indicator of musculoskeletal pain.

Dr Dyson told H&H while she expected to find at least 50% of the horses to show lameness, a figure previously demonstrated by research, she was disappointed by the larger proportion – but added this work reinforced the value of the RHpE as a “signpost“ towards the presence of pain.

“Clearly there is ignorance about the fact behaviour can reflect underlying pain,” she said. “Education is required so owners, riders and trainers recognise behaviour, such as ears back and tail swishing, can reflect musculoskeletal pain, and vets know how best to investigate such horses.

“When an owner says, ‘My horse doesn’t like dressage,’ it may be because the horse is uncomfortable, and if the underlying problem was recognised and treated, the horse may be able to perform dressage quite well.”

The study found a larger proportion of the riding school horses compared with the sports horses showed lameness or gait abnormalities in canter.

“I think back to the riding school where I grew up and remember there being some grumpy or not very willing horses, and retrospectively they probably had some degree of musculoskeletal discomfort,” said Dr Dyson. “Horses are trying to communicate; we need to learn how to listen.”

Lucy Grieve, chair of the British Equestrian Veterinary Association’s ethics and welfare committee told H&H the study shows science can be applied to give riders, trainers and vets a framework to more reliably identify horses who need help and enable early detection.

“Horses are frequently presented to vets far too late after the injury started. Early detection not only means the horse should suffer for less time, but it can keep costs and recovery time down,” she said.

“A horse with a mild, short-lived injury is much more likely to return to full health than one with an injury that has grumbled on unnoticed and potentially resulted in a domino effect, leading to the development of further secondary injuries.”

Veterinary behaviour specialist Gemma Pearson told H&H this is an important study demonstrating the association between facial expressions and pain and lameness.

“Many people fail to recognise subtle signs of pain or stress in horses and assume any unwanted behaviours are due to the horse being naughty,” she said.

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After research has shown rider asymmetry can have a negative impact on a horse’s movement, riders are being encouraged to seek advice from expert practitioners working as a team to resolve any imbalance in their position. H&H speaks to biomechanics specialist Dr MacKechnie-Guire and coach Brigid Grant to find out more...

Research that found uneven stirrups can have a negative effect on equine movement emphasises the importance of teamwork in approaching rider asymmetry issues, its author believes.

Russell MacKechnie-Guire led a team looking at the effects of induced rider asymmetry, as part of a study published in the Journal of Equine Veterinary Science.

Dr MacKechnie-Guire told H&H the team used experienced riders, who were assessed by a physio to ensure they had no inherent asymmetry, and saddle fit was checked.

Advanced technology was used to assess rider position and the horses’ locomotion, then one of each rider’s stirrups was shortened by 5cm (two holes) to induce rider asymmetry. After a period of acclimatisation, the measurements were taken again.

It was found that if the left stirrup was shortened, the rider’s hips moved to the right, and the upper body leaned left.

“In the horses, the equine spine altered its range of motion with the asymmetric rider,” Dr Mackechnie-Guire said. “We know from research that spinal stability is desirable, to transfer propulsive forces from the hind limb. Therefore, based on this data an asymmetric rider caused instability.”

Joint markers also showed that load increased on both of the horse’s front and hind limbs on the opposite side to the shortened stirrup.

“Horses will seek a locomotor strategy to compensate for discomfort or imbalance. This can lead to long-term asymmetry, that could then lead to loss of performance and possible injury over time,” Dr Mackechnie-Guire said.

He added that rider symmetry is “essential”, and riders need to be aware of the impact their position can have on equine locomotion. While people should not panic, he said, it is important to seek physio, therapy or biomechanics-based solutions assessing the whole body, preferably from a practitioner who understands a rider’s needs, as well as considering exercises to help improve symmetry.

He added that coaches are also important, as they see riders regularly and that if they notice asymmetry, they should refer the rider to a practitioner.

“Of course, horses can be asymmetrical too, which is why it’s essential to work as a team – coach, saddle-fitter, vet, rider and horse physios – to assess where the asymmetry is coming from,” he said. “If the rider has developed a strategy to cope with horse and/or saddle asymmetry, and the rider gets treated, after a short period of time, the asymmetry will recur –we must work together to evaluate the horse, saddle and rider interaction.”

Coach Brigid Grant, who has trained Olympic-level eventers, told H&H she recently had a client whose horse would not bend to the left, but worked well on the right rein.

“I looked at the rider and saw it was as if her whole body was twisted to the right, while she was asking the horse to bend left,” she said. “I advised her not to work the horse properly until she’d gone to a physio.

“I think it’s super-important for the rider to be as aware of incorrectness as possible. I liken it to standing up with someone on your shoulders; if they put all their weight on one side, or lean forward or back, it’s almost impossible to walk in a straight line, or go where you’re supposed to. That’s where I start from to help the rider be aware of the effect they have on what the horse is able to do.

“I think Pilates is best as it works on equalness – left-right and front-back – as an uneven person will greatly upset the horse’s balance.”

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Welcome to the third weekly episode of The Horse & Hound podcast, in which our news team discuss the key stories of the week, we interview para dressage sensation Natasha Baker and vet Ricky Farr talks about the use of lameness sensor systems...

Now live is episode three of The Horse & Hound Podcast, our exciting new audio service available every Thursday for subscribers to our H&H Plus service, for which a free trial is available.

Each week the podcast will be a hosted by a member of the H&H editorial team and include an interview with a top name and a panel discussion about the topics of the moment, plus expert advice from equine vet Ricky Farr MRCVS.

In our third episode of The Horse & Hound Podcast, our host H&H’s magazine editor Pippa Roome chats to H&H news editor Eleanor Jones and senior news writer Lucy Elder about this week’s top stories including increasing diversity in UK equestrian sport and how racing has negotiated its way through returning to action behind closed doors.

This week’s interview is hosted by H&H dressage editor Polly Bryan, who chats to multi-medal-winning para dressage rider Natasha Baker about coping with lockdown, how she got into commentating, her exciting new ride and her plans for Tokyo 2021.

We also hear from equine vet Ricky Farr MRCVS, who this week is talking about lameness and the benefits that lameness sensor systems can offer, while not replacing the need for an expert veterinary eye. We hope you will enjoy it.

H&H Plus podcast: episode three

We hope you enjoyed listening to our podcast. If you have any feedback on this new service, please email h&hmarketing@ti-media.com

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

Splints in horses are hard lumps, which are actually bony enlargements found on the side of the horse’s leg between the knee and the fetlock joint, located where the splint bone runs down on either side of the cannon bone.

What are the splint bones?

The medial and lateral splint bones are the remains of the second and fourth digit of the horse’s five-toed prehistoric ancestor. Digits one and five disappeared during evolution, while two and four become splint bones, with the middle digit forming the weight-bearing cannon bone.

The upper two thirds of each splint bone is attached to the cannon bone by dense fibrous tissue called the interosseous ligament. The lower section flares away from the cannon bone slightly and is connected to the surrounding structures by soft tissue. The lower end of the splint bone has a small pea-like “button” which can be felt through the horse’s skin.

In most horses the interosseous ligament gradually changes with age as the splint bones fuse to the cannon bone at around three to four years. This process is normal and has no clinical signs.

Splints in horses: Causes | False splints | Diagnosis and treatment | Complications

What causes splints in horses?

A true splint occurs when the interosseous ligament becomes damaged, leading to soft tissue inflammation and lameness with heat, pain and swelling in the area between the splint bone and cannon bones. As the acute inflammation settles and healing proceeds, new bone is laid down in this area, eventually forming a hard, non-painful lump, the size of which depends on the degree of original damage. This is the splint, which will reduce in size over time, but is unlikely to disappear. The new bone stabilises the source of irritation by forming a bridge between the digits.

These splints occur most typically on the inside of the forelimb, or on the outside of the hind limb in young, immature horses in work.

Poor conformation, mineral imbalance in the diet, excessive weight of horse or rider, concussion associated with work on hard and uneven going, and unbalanced hooves can all lead to splints forming.

False splints in horses

False splints occur as a result of direct external trauma to the splint bone itself, such as the striking of the inside forelimb with the opposite leg, or kicks to the outside splint bone during field trauma or injuries. A bony lump forms where there has been bruising and damage to the periosteum covering the bone.

Fractures of the splint bone, which are most common in young horses, can also lead to the formation of a splint. Kicks and infected wounds can also cause fractures along the splint bone. There are also some fractures of the distal or thinner lower end of the splint bone that are associated with excess bending of the fetlock, due to weakening of the suspensory ligament caused by desmitis.

Diagnosis and treatment of splints in horses

The diagnosis of a simple splint is usually achieved on clinical signs, but your vet may wish to X-ray, or much less commonly, use other imaging techniques, if complications, such as a fracture, are suspected.

A fractured splint should be suspected, if a horse has an open wound, often from a kick injury, on the side of the cannon bone , which is slow to heal.

In the majority of cases the main forms of treatment are rest and anti-inflammatory therapy, with hydrotherapy used in some chronic cases. Prolonged peroids of rest may be needed.

Once the splint has finished forming, most horses are able to return to work and suffer no on-going problems from a splint, although they can be unsightly and may be considered a significant blemish, particularly in show horses. If the swelling is reduced surgically, there is a high chance of recurrence in operated horses.

Complications

The main concern associated with fully formed splints is cosmetic, although a splint positioned close to the knee joints could lead to carpal arthritis or it has the potential to interfere with the soft tissues, although this would be unusual.

The usual complication with almost any splint is the amount of time off required, which can stretch into months and be particularly problematic in older competition horses.

With this in mind, it is worth following these simple steps to lessen the risk of a splint forming in the first place:

• Exercise: don’t do too much too soon, especially on hard ground
• Maintain proper foot trimming and shoeing
• Use exercise boots or bandages to reduce interference injuries
• Manage horses kept together to minimise kick injuries, as much as possible

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

Lameness in horses is well recognised, but interpreted differently by different people. It describes the horse’s gait being adversely affected by pain or a restriction in the normal range of movement and should never be ignored. This pain or restriction can originate in the hoof, in the leg or elsewhere in the horse’s body, such as the back or neck.

Lameness can range from a subtle change in gait, which is often missed by the untrained eye, to the horse being unable to carry any weight on the affected limb.

Lameness has been identified as the most common reason for older horses to be put down¹.

Lameness in horses: Causes | Diagnosis | Prognosis

Causes of lameness in horses

Causes of lameness in horses are wide ranging and include, but are not limited to, the following conditions:

• Laminitis
• Tendon injuries
• Ligament injuries
• Bruised soles or hoof abscesses
• Bone fractures
• Poor hoof balance
• Back and neck problems
• Degenerative joint disease

What is the most common cause of lameness in horses?

According to the 2015 edition of the National Equine Health Survey², lameness is three times more likely to be caused by conditions such as osteoarthritis, also known as degenerative joint disease, than problems in the foot.

When should you call the vet for lameness?

If your horse is showing signs of lameness it is important to involve your vet at the earliest possible stage. This may save you time, money and frustration by diagnosing and treating the problem early, as well as potentially preventing further damage from occurring. In this way you can help prevent small niggles from becoming major long-term problems.

It is important to appreciate that low-grade — even sub-clinical — lameness may significantly compromise a horse’s performance, so if a horse becomes unwilling to perform certain movements that it was previously willing to do, this may be the earliest signs of a lameness problem.

Diagnosing lameness in horses

Being able to identify the reason a horse is lame is an ongoing challenge for equine vets, particularly with subtle and intermittent problems. Lameness can affect more than one limb or area of the body.

A thorough physical examination of the limbs, feet, neck and back, trotting the horse up in a straight line and on a circle on soft and hard surfaces, flexion tests plus nerve blocks are all common ways to pinpoint the location of the problem. Vets may also use a range of diagnostic tools, such as X-rays, ultrasound and nuclear scintigraphy (bone scans), MRI scans, as part of a lameness work-up.

To support the vet’s eye, a number of computer systems that use wireless sensors to track the movement of the horse’s poll, pelvis and the flight of the horse’s limbs have been developed to help identify where there are gait abnormalities³.

Levels of lameness are normally graded on a sliding scale, which can run from zero to five or zero to 10, depending on your vet. These gradings tend to be subjective and so are best used to monitor improvement or deterioration in a horse’s lameness, rather than to compare lameness among different horses.

Dr Sue Dyson, former head of clinical orthopaedics at the Animal Health Trust (AHT), has undertaken extensive research to identify the external signs that a horse is in pain. As part of this work, 24 behavioural markers were consistently linked to lameness⁴, with the presence of eight or more being a likely indicator of musculoskeletal pain. Lame horses displayed an average of nine of the markers.

Previous research designed to investigate why saddles slip had shown that nearly half of sport horses thought to be sound by their owners were actually lame⁵. This work is enabling Dr Dyson to develop an ethogram [table of behaviours] to help identify lame horses with the intention of producing a functional guide for horse owners to use in the future.

How do you treat lameness in horses?

Treatment for lameness will depend on the cause of the pain the horse is experiencing, but for mild lameness is likely to include rest, cold therapy and nonsteroidal anti-inflammatories (NSAIDs), such as phenylbutazone. Your vet will be able to advise on the best steps.

Can a horse recover from being lame?

Very few horses will enjoy their working lives without taking a lame step, in the same way that few active people will live without the odd ache or pain. In many cases a minor lameness can be rectified reasonably simply and quickly, but as the causes of lameness are so varied, the prognosis will depend on the type of issue found.

Regular and effective farriery is important in avoiding lameness as well as overall fitness and good management for every horse. The old cliché of “no foot, no horse” still holds true.

References

1. Factors associated with mortality of geriatric horses in the United Kingdom – Sept 2011

2. Joint problems most likely to cause lameness – 10 September, 2015

3. Assessment of repeatability of a wireless, inertial sensor-based lameness evaluation system for horses – Sept 2011

4. Top vet identifies ‘naughty’ behaviours that might show your horse is lame – 24 November, 2017

5. Half of all sport horses are lame, survey finds – 28 April, 2014

Also: Practical uses of quantitative gait analysis in horses – October 2019

If you have ridden horses for long enough, it’s likely you’ll have experienced that terrifying feeling of a horse buckling underneath you as he trips. It’s a dangerous situation for both horse and rider and a risk we should look to minimise, even though horses are normally adept at rescuing themselves before they hit the ground.

Due to the work we ask our horses to perform, occasional tripping is unavoidable, but when does it become a concern?

Tripping can be considered abnormal if it occurs more than twice per ridden session or if the horse always stumbles on the same leg. An additional warning sign is when the problem can be reproduced consistently during a certain movement or situation, such as exercising up or down an incline or when the horse is asked for increased poll flexion.

A particularly poor or slow recovery from a stumble is also concerning. Horses usually snap back upright as fast as possible, almost embarrassed by their ineptitude, so a laboured return to their feet warrants investigation.

There are a variety of tripping causes that can be ruled out by an owner or through a simple veterinary examination. Tripping in a young, unfit, unbalanced or distracted horse should improve with age and/or training. An obese animal is likely to trip less with an appropriate diet and exercise programme. Partially sighted animals and those with exercise intolerance or advanced cardiac disease are all more likely to trip when exercised, but these conditions would be diagnosed swiftly by a vet due to signs other than tripping.

Further investigation will require a detailed veterinary history and clinical examination, as there is often more than one condition at play.

Assuming there are no immediately obvious causes, addressing any foot issues will be beneficial, whatever the cause of tripping, and is often the solution in simple cases. Long toes on front or hind feet will cause delayed “breakover”, meaning the foot is slower to move in front of the horse and down onto the ground to bear weight.

In addition, a longer toe is closer to the ground through the arc of flight, so is more likely to cause a stumble. And excessively long hind feet can interfere with the heels of the front feet.

Careful trimming, with input from both vet and farrier, can improve foot shape and balance dramatically to reduce stumbling. Rolling the toe — by rounding the front edge of any chosen shoe — or using bar or reverse shoes, will alter the action of the foot during motion and can improve the biomechanics of the limb.

Pinpointing pain

A horse who continues to trip should be assessed for the presence of orthopaedic disease causing pain or lameness, or a neurological condition affecting limb coordination.

Orthopaedic conditions can mean a horse adapts his movement to minimise the degree of pain, potentially causing tripping.

An examination — with flexion tests, lungeing on soft and hard surfaces and ridden exercise — will often demonstrate a lameness, which can then be investigated with nerve and joint blocks to isolate the source of pain. Diagnostic imaging such as X-rays, ultrasound scans, MRI or CT will follow to identify the severity of the problem.

Causes of lameness-induced tripping include navicular disease, coffin joint pain, ringbone and arthritis of the fetlock or knee. These are usually straightforward to diagnose and, depending upon severity, are often manageable with a combination of remedial shoeing, intra-articular medication and controlled exercise. Regular physiotherapy is beneficial, along with non steroidal anti-inflammatory medicines prescribed by your vet, such as phenylbutazone (bute), and a good-quality joint supplement.

Problems higher up the leg can also produce stumbling, as they will limit the degree of protraction (extension of the limb) during locomotion. Shoulder issues, such as arthritis or bicipital bursitis (inflammation of a fluid-filled joint bursa, or sac), can present in this manner.

Some horses may stumble due to an orthopaedic issue without appearing lame. The neck, back and pelvis are all on the shortlist in such cases, but identifying the source of pain can be challenging. Blocks of these regions are technically difficult and carry a risk of inadvertent anaesthesia of major nerves, which can cause the horse to become ataxic (wobbly).

Without obvious lameness, it can be tricky to assess improvements in a horse’s movement after local anaesthesia. If tripping is intermittent, it is hard to be sure of genuine improvement during a short assessment after nerve or joint blocks. Feedback from an experienced jockey who can ride the horse before and after any blocks is one of the most valuable aids to interpretation.

Suspect areas can be screened for injuries with diagnostic imaging, which may include nuclear scintigraphy (bone scanning). Arthritis in the neck, back or pelvic region can be treated with ultrasound-guided intra-articular corticosteroid injections.

“Kissing spine” lesions can be treated with local infiltrations of corticosteroids or may benefit from surgery, while sacroiliac disease can be managed with anti-inflammatories and shockwave therapy, among other options.

Physiotherapy and targeted rehabilitation programmes also help in improving the mobility of affected areas, maintaining flexibility and developing the horse’s core strength.

Tipping the balance

Neurological disease is the biggest worry, particularly with the horse who trips with his hindlimbs. This can be difficult to diagnose in subtle cases.

A common cause is “wobblers” syndrome, which occurs when incorrectly formed vertebrae in the neck pinch the spinal cord. Arthritis of the neck joints or the growth of new bone (callus) around a fracture site can also create pressure on the spinal cord and, in the early stages, cause hindlimb weakness, which can manifest itself as tripping.

If the condition worsens, neurological signs become more obvious and are characterised by difficulty turning in tight circles, dragging of hindlimb toes and sometimes even forelimb incoordination. Neck X-rays will often confirm the condition and dictate the appropriate therapy.

Treatment options range from aggressive nutritional and exercise management in young animals that have developed too rapidly, resulting in neck instability, through to local injections of corticosteroids into affected joints to reduce inflammation. Surgical stabilisation of the neck joints may be an option. Fusion of the vertebral bodies results in around 60% of patients resuming a good degree of athletic function.

There are a wide range of causes of tripping and stumbling. If the problem proves dangerous or becomes more regular, seek veterinary attention, so the horse can be fully assessed.

Ref Horse & Hound; 20 June 2019

Desensitising part of a limb with anaesthetic may be necessary to localise the source of pain, as Dr Liz Barr explains

When there is no obvious swelling, heat or discomfort in the leg of a lame horse, the best option to localise the pain causing the lameness is to use diagnostic analgesia — which are commonly described as nerve blocks in horses. Blocking is also useful when a horse has multiple areas of swelling, some of which may be old, to confirm whether a particular finding on clinical examination is significant.

A nerve block involves injecting local anaesthetic around nerves at specific points on the limb, to desensitise various regions.

Local anaesthetic stops nerve signals to the brain; while the horse cannot feel pain after a nerve is successfully blocked, he can feel some pressure or movement.

The aim is to deposit the anaesthetic solution without touching the nerve itself with the needle, as this can result in a very quick and dangerous reflex kick. The anaesthetic can also be injected directly into joints or tendon sheaths to abolish pain associated with these structures.

How nerve blocks in horses work

The procedure takes place under veterinary guidance, at home or at a clinic. The horse is first watched in action to determine the baseline level of lameness. Some horses may not be obviously lame when trotted up in hand, or may have more general poor performance issues or problems that affect certain movements only. These patients will also need to be seen working under saddle.

The predominantly lame leg is then identified, but bear in mind that some horses will be lame in multiple legs. Others may merely appear so as a result of compensatory lameness, which arises from altered loading of limbs due to pain in one of them.

Blocking generally starts with an injection at the bottom of the affected limb, after which the horse is viewed in motion again.

Sequential nerve blocks are performed, working upwards, until the horse becomes sound or shows a significant improvement in the level of lameness — indicating the origin of the pain.

The exact cause can then be identified by appropriate imaging such as X-ray, ultrasound, MRI or CT, to reach an accurate diagnosis and formulate a treatment plan.

A more targeted approach may be preferable when blocking a hind limb to avoid the need for excessive injections, particularly in a sharp horse or known kicker.

The bottom hock joints are a common site of pain and lameness, so I often start by blocking these in a middle-aged or older horse with no palpable abnormalities. If the lameness does not improve, I go back and start at the bottom of the limb. If it does improve, however, I’ve managed to avoid up to four of these lower blocks.

Risks and limitations of nerve blocks in horses

Putting a needle into a horse’s leg, particularly a hindleg, is risky for a vet. There’s the added danger that a sudden kick or a quick move can result in the needle breaking off under the horse’s skin. Experienced handling can reduce risk, along with measures such as fitting the horse with a twitch, lifting another of his limbs, distracting him with food or using short-acting sedation.

If there is any suspicion that lameness is caused by a non-displaced fracture of a limb, blocking should be avoided. Removing the pain and repeatedly trotting and lungeing the horse can result in a catastrophic displaced fracture.

Vet and owner must recognise the limitations of nerve and joint blocks, and confusing information that may be thrown up.

Joint blocks can abolish pain in adjacent areas, creating misleading results. A common occurrence is a “cross-over block”, such as an injection into the bottom hock joint that also removes pain from the proximal suspensory ligament region. For this reason, it is routine to scan the proximal suspensory ligaments as well as X-raying the hocks of horses that go sound after this block.

Another shortcoming is that joint blocks may not abolish all the pain, although the joint is the problem. An example is persistent lameness in the subchondral bone, directly below the cartilage surface of the joint, where the anaesthetic solution is inadequately absorbed. There can also be issues within complex joints such as the stifle, where various joint compartments may not “communicate” to let the anaesthetic permeate the whole area.

Nerves can also be blocked incompletely, resulting in continued transmission of some pain and a response that is not as expected. Conversely, the anaesthetic sometimes diffuses up the limb — it may appear from the results of the blocking pattern that the pain is coming from the foot, but the anaesthetic has risen and blocked out fetlock joint pain.

Procedure prep

An additional risk is infection, usually of a synovial structure (a fluid-filled joint cavity). This can be minimised by first scrubbing the injection site with an antiseptic solution before applying surgical spirit. Clipping hair or feathers will enable easier palpation of the anatomy and more accurate needle placement, although this can still be difficult in very thick-skinned cob types and heavy breeds.

No other preparation should be necessary. Where a leg has been subject to multiple injections, applying a stable bandage overnight is a good precaution against swelling.

How much do nerve blocks in horses cost?

A number of nerve or joint blocks may be needed to abolish lameness, each costing £45-90 depending upon on the level of complexity (price correct as of early 2019). Once the service fee for lameness evaluation is added, plus local anaesthetic solution costs of around £12 per 10ml bottle (with 5ml being required to block a foot and 60ml for a stifle joint), costs can soon escalate.

Despite the expense and the inherent risks, diagnostic analgesia is of utmost importance in lameness diagnosis. Without obvious clinical findings, it is the only way to identify the source of pain categorically, and accurately diagnose and treat the issue.

Nerve block case study: ‘it was worth persevering’

Dutch dressage mare Peaches first attended the Bell Equine Vet Clinic in May 2016, with right forelimb lameness. Nerve blocks of the lowest parts of the limb failed to alter the lameness, but she came sound after a below-the-knee nerve block.

Subsequent ultrasound scans revealed damage to the proximal suspensory ligament, so Peaches was rehabilitated accordingly and regained soundness. Repeat ultrasound scans looked encouraging, but the lameness returned when she started full work the following spring and the ultrasound appearance seemed to have deteriorated. After trying unsuccessfully to put her in foal, her owners gave her the rest of the year off.

Last April, Peaches was reassessed to see if she would be capable of some light hacking. She remained lame on the right fore, although ultrasound scans of the proximal suspensory ligament showed no real reason for this. However, the 14.2hh mare came sound after an abaxial sesamoid nerve block — an injection of local anaesthetic above the fetlock joint. This indicated that the previous suspensory injury was not the reason for the residual lameness.

More specific blocks were then performed. Diagnostic imaging of the lower limb then enabled diagnosis of a synovial ganglion cyst (a fluid-filled lesion) of the digital flexor tendon sheath, along with mild arthropathy (joint disease) of the distal interphalangeal (coffin) joint. Once the digital flexor tendon sheath was medicated with hyaluronic acid, Peaches, now 15, regained soundness.

“It was worth persevering,” says her owner Rosemarie Lovegrove. “My daughter Bryony is now at university, so Peaches is my ‘happy hacker’, which is all we really wanted.”

First published in Horse & Hound; 14 February 2019

You may also be interested in…

Lameness in horses: what every owner needs to know

The lameness work-up: what it is and what it can achieve

Degenerative Joint Disease (DJD) / arthritis in horses: all you need to know

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Flexion tests can offer clues about a horse’s soundness, so why are they so controversial? Andrea Oakes investigates

There’s a particular point in the pre-purchase examination (PPE) where both buyer and seller wait with bated breath. After a short period with one leg held aloft, will the horse trot away sound — or will he show any signs of lameness? The flexion test on horses has long had its critics, but it remains a valuable part of both the PPE and lameness investigations.

“This is a common procedure that can be carried out in both fore- and hindlimbs,” explains Hetty Hill MRCVS, who works alongside Dr Andre Buthe at his sport horse clinic in Marlborough, Wiltshire. “The process involves manually flexing a horse’s leg for a period of time before releasing it and watching him trot away immediately afterwards. The idea is to stress the joints and surrounding soft tissue structures (the ligaments and tendons), to assess the horse for any deterioration in soundness.

“The horse is trotted in a straight line before and after flexion is performed, and so the same surface must be used to allow for the most accurate comparison,” she adds.

The BEVA (British Equine Veterinary Association) and RCVS (Royal College of Veterinary Surgeons) PPE guidance notes state that flexion tests of all four limbs may be carried out if the examining veterinary surgeon considers it safe and appropriate to do so. While most vets elect to perform flexions on most horses to gain additional information to form an opinion on the suitability of a prospective purchase, there are occasions when the tests are shortened or abandoned.

“Flexion may not be possible with a young or poorly handled horse, or where there are no suitable facilities,” says Hetty. “We are obliged to record all relevant findings on the PPE certificate. If flexion tests are omitted, the vet should document why.”

Confusing the issue

“When the horse trots after flexion, the vet will assess any changes in gait before grading the response,” explains Hetty. “The first consideration is whether there is lameness, or, in the case of an investigation rather than a PPE, any worsening of previous lameness. The degree of lameness is then graded.”

A positive flexion test generally refers to lameness that persists for a number of strides — usually more than three to five. Confusion can arise among owners, however, for two reasons: the way tests are carried out and the interpretation of the results.

Can response differ depending on the force and angle used when flexing the leg, for example, or the duration?

“Research has shown that increased force applied and time spent in flexion amplifies the horse’s response, and that a horse’s age and workload may influence results,” says Hetty. “Although most vets will hold the limb for between 30 seconds and a minute, there is no agreed time for flexion. Neither are there any definitive guidelines as to how many strides of lameness represents a positive result. This is assessed subjectively by the vet.

“The interpretation of the response to flexion may vary slightly between vets, but this is not a problem provided each individual is consistent in his or her approach.”

Hetty explains that there have been various suggestions as to how the flexion test method can be regulated.

“A group of vets from Italy published a study in 2016 where they used a pressure-sensitive glove to standardise the force applied during lower limb flexions,” she says. “This has some potential to minimise one of the variables in performing the test, but it does not eliminate others — such as the subjective nature of the vet’s evaluation of a response to flexion.

“Equine gait analysis systems using motion sensors are also becoming more widely used in the UK,” adds Hetty. “If used appropriately, they can provide a means for evaluating lameness objectively and may be used in recording response to flexion or nerve blocks during a lameness work-up. These systems may be used more commonly in PPEs in the future.”

Flexion test on horses as part of the puzzle

While there is little evidence currently available to link a positive flexion test with future lameness, various studies have tried to bring science to this rather non-specific procedure.

Despite their shortcomings, the flexion test on horses can be a useful “red flag”. The fact that one forelimb responds differently to the opposite one, when tested in the same way, could indicate a problem — but where, exactly?

“When flexing the fetlock, for example, the joint itself is put under pressure — but so are numerous soft tissue structures including the suspensory ligament branches, the flexor tendons and the proximal sesamoidean ligaments,” says Hetty. “Issues with any of these areas may contribute to resulting changes in gait.

“It is not straightforward to isolate specific anatomical areas with accuracy when performing a flexion test. This is particularly true in the hind limb, where the reciprocal apparatus ensures that the stifle and hock move together.

“It is fair to say, however, that the flexion test on horses play an important part in a lameness evaluation — but only if interpreted alongside other findings,” she adds. “Flexion can be useful in exacerbating low-grade lameness to aid your vet in a lameness work-up, and may give an indication of where to start with diagnostic nerve blocks. But the test is just one piece of the puzzle, so the horse’s response must be interpreted in light of other findings.

“The way a horse moves or flexes may give your vet ideas about where the problem could be, but flexion tests alone cannot provide a diagnosis,” says Hetty. “They are not a substitute for other components of an orthopaedic exam, such as manual palpation of the limbs, dynamic gait analysis, nerve blocks and diagnostic imaging techniques.

“Flexion tests have a place in the PPE and in orthopaedic assessments, but their limitations must be understood and acknowledged,” she concludes.

“Don’t be afraid to ask your vet to explain their findings and to give their opinion of how relevant they think these are for you and your horse.”

Should you buy?

“Lameness following flexion does not necessarily mean that a horse is unsuitable for purchase,” explains Dr Andre Buthe. “The general expectation is that a young horse will be sound after a flexion test, while an older horse may show more reactivity — but this is not always the case.

“An older competition horse showing reactivity after flexion may still be suitable, especially if the vet performing the PPE is satisfied with the rest of the orthopaedic evaluation. If a horse has a consistent competition record and has proved his ability to withstand the current workload without needing time off for injury, then it may be worth taking this into consideration when making a decision regarding purchase.

“Instead of focusing purely on the positive flexion test, it is important to find out if the examining vet has any other concerns that may prejudice the horse’s chances of performing the job required. As a purchaser, it may be sensible to consider walking away from a horse that has several other major findings. If the flexion test is the primary problem, however, a thorough orthopaedic assessment may be worthwhile and could help the decision-making.

“Buying a horse is always a balance of risks. If you do go ahead with the purchase, be aware that any findings from the PPE may result in exclusions being placed by your insurance company. And you may well have the same problem with flexion tests in future PPEs — although this is less likely to be an issue if the horse in question gains an outstanding performance record by the time you come to sell.”

What are your views on flexion tests as part of the PPE? Let us know your thoughts by emailing hhletters@futurenet.com, including your name and location, for the chance to have your views published in a future issue of Horse & Hound magazine.

Ref Horse & Hound; 29 November 2018

You may also be interested in…

Understanding flexion tests on horses

H&H looks at the factors that affect the response to flexion tests

Study could lead to ‘unbiased’ flexion tests for horses

Can flexion tests ever be objective rather than subjective? Yes, say researchers involved in a new study that has trialled

The definitive guide to the pre-purchase equine vetting

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A project to develop a guide to help owners, trainers and vets identify lameness through a horse’s behaviour and facial expressions has successfully completed its third stage.

Led by Sue Dyson, head of clinical orthopaedics at the Animal Health Trust (AHT), the first and second stages of the study have already successfully demonstrated that a horse’s facial expressions are a reliable indicator of pain.

The project’s third stage looked at which behaviours could be consistently linked to lameness – with a view to creating a method for assessing a horse as a whole.

In all, 24 behavioural markers were identified, including head tossing, unwillingness to go forwards, hurrying, toe dragging, crookedness, changing gaits spontaneously and stumbling.

The presence of eight or more of these markers was found to be a likely indicator of musculoskeletal pain. Lame horses displayed an average of nine of these behaviours, while non-lame horses averaged just two.

The final stage of the study will assess how well the ethogram [table of behaviours] works in differentiating lame and sound horses. Once the final ethogram is complete and has met with scientific approval, a functional guide for owners will be produced.

The study evolved from Sue’s extensive clinical work, where she recognised that poor performance was often labelled as “naughty” behaviour. Often, when the problems were finally identified as pain-related and the horse referred for investigation, injuries had become chronic and the opportunity for recovery was compromised.

It’s hoped that by being able to detect pain with a visual guide, owners and trainers will be more likely to take a sympathetic approach to problem behaviour, rather than resort to punishment.

Continued below…

Riders struggling to spot lameness *H&H VIP*

Almost half of "sound" sport horses in a study were found to be lame

Half of all sport horses are lame, survey finds

A new study shows that nearly half of all sport horses that were assessed were found to be lame or

Sue is currently marking 35 years with the AHT, where she treats hundreds of patients each year in the clinic alongside her ongoing research.

“Our clinical cases are integral to our research. Without them and the willingness of their owners to contribute their data to our research projects, we would not be able to advance veterinary techniques as comprehensively as we do now,” she said.

“At the AHT we have developed a cycle, whereby our clinical patients feed into our research, and in turn our research results are fed back into the industry to develop veterinary and owner knowledge to support the care of horses worldwide.

“I have always had a thirst for new knowledge and quickly learnt that by documenting my clinical observations, certain patterns emerged which could be translated into recognising new conditions. I didn’t think of this as research – just learning on the job. There are many unanswered questions when it comes to horses, and the learning process proceeds endlessly – and excitingly!”

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This year the Animal Health Trust celebrates its 75th anniversary. To mark the occasion we meet Lula — one of the charity's recent success stories

The case

Suspensory ligament injuries, although manageable, can limit and even end a horse’s competitive career. Horses in all disciplines are at risk of overloading and causing repetitive strain injuries to this structure, but dressage will see a much higher prevalence due to the nature of the movements and training regimes.

In 2014 almost 60% of horses referred to the Animal Health Trust (AHT) equine clinic with mystery lameness or poor performance problems, were suffering from suspensory ligament injuries.

Lula is one of these patients. She was first referred to the equine clinic in October 2015 after displaying some very out of character behaviour. When competing at dressage in the spring Lula reared during the test, which she had never done before and this was Eleanor’s first sign that something wasn’t quite right.

Through the summer Lula’s behaviour became more unpredictable at competitions and at home and Eleanor lost her confidence in their partnership. After checking Lula’s teeth, tack and feet to see what was causing these outbursts, she was referred by their vet to the Animal Health Trust (AHT), suspecting that there was an underlying pain-related problem.

The treatment

At the AHT Lula was assessed on the lunge and ridden and showed a reluctance to go forwards and a low-grade lameness in both hindlimbs. She was nerve blocked in her hindlimbs to pin point where the pain causing lameness was originating from.

The AHT Head of Equine Orthopaedics, Dr Sue Dyson, found blocking just below the back of the hock substantially improved Lula’s gait. Having identified the problem area, further ultrasonographic investigation confirmed there was proximal suspensory desmopathy (damage to the suspensory ligament) in both hindlimbs.

This is a very common injury that AHT clinicians see in performance horses and treat on a regular basis.

Lula was recommended for a neurectomy and fasciotomy. This involves detaching the nerve that triggers movement of the ligament which is causing pain. It also involves an incision into the band of tissue (fascia) which effectively squashes the ligament between the back of the cannon bone and the splint bones.

Sue was confident in Lula being a good candidate for the surgery, which would potentially give Eleanor and Lula a much needed positive step towards a better competitive future. “Approximately 76% of horses with primary proximal suspensory desmopathy are able to return to full athletic function for a minimum of two years,” says Sue.

Continued below…

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The outcome

Lula made good post-operative progress and Eleanor had a strict rehabilitation plan to follow at home, giving the two of them time to build their relationship again.

Over a year on, and the pair have gone from strength to strength.

Eleanor’s mother Mary is thrilled. “We took her rehabilitation slowly and Eleanor spent nearly six months doing a lot of groundwork, re-building the trust she had lost when Lula had been reacting to her discomfort,” she says. “Our patience has paid off and Lula and Eleanor are enjoying their ridden work together again.

“They are now both at Hartpury College where Eleanor is studying equine science with a particular interest in rehabilitation and therapies. It has been an invaluable learning experience for Eleanor. She is so pleased to have persevered and to be able to trust and enjoy her horse again.”

The Animal Health Trust will be celebrating its 75th anniversary with a variety of events this year. Visit www.aht.org.uk to find out more

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When Karen Shepherd’s home-bred dressage gelding Pepperwood Mister Mole developed sudden and severe lameness, the very last thing she suspected was laminitis.

Yet the shock diagnosis for the 17.2hh Hanoverian was the start of a year-long battle to save Mole’s life and return him to soundness. It’s a reminder that this crippling disease can affect all shapes and sizes.

Mole’s story began in December 2010, when he was given antibiotics for the first time following an infection. In a lean and fit condition, having recently competed at medium level, Mole was stabled because there was snow on the ground. His groom had just lunged him gently when she noticed that he then wouldn’t walk.

“The vet knew it was laminitis after feeling his digital pulse and seeing his stance,” says Karen, who was abroad at the time and returned home immediately. “My farrier, Steve Fisher, was amazing, and to this day I think it’s thanks to him that Mole is still alive.

“Steve came out over Christmas to fit and refit Styrofoam pads under his hooves. I remember us sitting with our backs to the stable wall, on Boxing Day, just looking at Mole. We were desperate.”

Hitting a low

Mole was given a sedative and painkillers and confined to a stable with a padded floor, where he was trickle-fed well-soaked hay.

“The first X-rays showed no rotation of the pedal bones,” recalls Karen. “But we hit the lowest point when further X-rays four weeks later showed that the bone in one foot had rotated to within 2mm of the sole (pictured top). The vet went very quiet. I don’t think anyone believed that a 17.2hh horse could survive that.”

Karen called in remedial farrier Richard Lovejoy, of Liphook Equine Hospital, Hants.

“Mole was a true sinker,” says Richard, referring to the severity of rotation. “He had a great regular farrier in Steve, who had done some really good first aid to give the hooves essential padding and support, but the pedal bone was threatening to come through the sole. We decided to fit eurothane supports known as Steward Clogs.

“These create the same effect as the heart bar shoe but with additional benefits. You can nail, screw, glue or cast them to the foot, sculpting them to fit. They create a multi-directional ‘breakover’, reducing shear forces and leverage and aiding movement.

“You can’t push the pedal bone back into position, but clogs allow the foot to remodel and the sole to thicken,” adds Richard. “Different options exist to help laminitis cases, but Mole did well with clogs packed with impression material.”

Richard refitted the clogs three times at five-week intervals, before beginning the long, slow process of trimming the foot gradually to counteract the effect of bone rotation and sinking.

Things were finally looking up for the stoic Hanoverian.

“The bone didn’t penetrate and the hoof capsule remained attached at the coronary band, but both were knocking on the door,” says Richard.

Management methods

After lengthy rehab, including six months of walking in-hand, Mole was able to be ridden again. He returned to competition a year after initial diagnosis, later winning the advanced medium freestyle at the southern regional championships, and last month becoming a regional prix st georges runner-up.

Now 15, he is training at grand prix. Karen opened a bottle of champagne when he did 15 one-time changes.

“I’ve researched the subject to find the best possible ways to manage a post-laminitic,” she says. “Mole leads a fairly normal life now, but is only grazed in-hand or put in a round pen to roll and graze.

“He was on top-quality haylage but I never feed this now, sticking instead to good-quality meadow hay and soaking it if necessary,” she adds. “We’re careful not to turn the horses out with frost on the ground, or even later in the day when the weather is warmer but the sugar is still in the grass. And I’m particularly wary of steroids or antibiotics, or anything that can destabilise the natural balance of the gut flora.”

Karen believes that some warmbloods are genetically susceptible to laminitis and should be treated more like a Welsh cob than a thoroughbred in their diet.

“We’re more aware that many warmbloods slot into the ‘easy keeper’ category,” agrees Richard. “They often test positive for equine metabolic syndrome (EMS). Mole wasn’t a fat horse, but he obviously wasn’t dealing with the sugars well.”

Vets report that horses can get laminitis the way people have headaches; as in Mole’s case, the cause is often unclear. Whatever the reasons behind his laminitic episode, Mole’s recovery has been remarkable.

“You don’t think that laminitis will happen, but, if it does, don’t give up,” says Karen, who has the framed X-rays hanging on her tack room wall as a reminder of how close Mole was to losing the fight. “Every day I ride that horse, I feel blessed.”

Who is at risk?

Competition horses may have a higher risk of laminitis than we think, explains Victoria South MRCVS.

The majority of laminitis cases seen in the UK are due to hormone disorders — either equine metabolic syndrome (EMS) or equine Cushing’s disease (also known as PPID).

EMS is caused by genetics, obesity, and lack of fitness, which lead to problems with insulin regulation. Horses with EMS have inappropriately high insulin levels in response to sugars and starches in their diet.

We can all imagine an overweight, cresty pony grazing on plentiful grass in the spring and predict that he has a high risk of developing laminitis. He has the genes, obesity and management (diet/fitness), so he ticks all the boxes for EMS.

Owners often assume that competition horses cannot have EMS and are not at risk from laminitis because they are “sporty types”, not good-doers. But in reality, many will have good-doer genes that promote EMS and an exaggerated insulin response to dietary sugars and starches.

We are not as good as we think we are at assessing body condition — and therefore obesity — in horses. Studies show that owners tend to underestimate their horse’s bodyweight and condition.

As Richard Lovejoy says, this is especially hard to assess in warmblood breeds. These horses may have minor external fat deposits over the crest, shoulder and rump, but can carry substantial intra-abdominal fat deposits that are just as important in causing EMS as more obvious obesity in a native pony.

The final EMS risk factor is fitness. Studies have demonstrated that dressage horses do not work at the same cardiovascular intensity as racehorses and event horses. This becomes increasingly important if they are suddenly out of work for any reason.

If there are rapid changes to a competition horse’s management, then it is sensible to reduce his dietary intake to reduce the risk of developing EMS and laminitis.

Since we cannot rely on body condition scoring to estimate laminitis risk, and fitness varies, it’s great that there are reliable, objective blood tests to diagnose EMS.

If you are concerned about your horse’s laminitis risk, ask your vet to test for EMS and equine Cushing’s disease. A blood sample to measure insulin levels is taken after an overnight fast, or as a dynamic test (blood testing after feeding glucose). Equine Cushing’s disease is diagnosed by checking adrenocorticotropic hormone (ACTH) levels on a blood sample.

These tests are safe and are performed by equine vets every day.

Ref: Horse & Hound; 10 March 2016

Riders are struggling to tell when their horse is lame, a recent study has found.

Almost half of the 57 “sound” sport horses involved in the project were in fact lame when ridden, found Dr Sue Dyson and Line Greve of the Animal Health Trust.

Only horses in regular work and believed to be sound by their riders, trainers and owners were selected for last year’s study.

The sample of horses was chosen from a professional showjumping yard, a dressage competition yard, a dressage training centre and a private dressage yard.

The horses were assessed in hand, on the lunge on both soft and firm surfaces, and ridden. Flexion tests on all four limbs were carried out and lameness was graded between zero and eight. In total, only 14 horses were sound under all circumstances.

Dr Dyson told H&H she believes owners and riders need to have a better awareness of when their animals are lame.

Of those tested, 27 (47%) showed lameness while ridden and seven were unsound only when ridden. Six were sound in-hand, on the lunge and ridden, but showed a grade one or two lameness after a flexion test on a single limb. Sixteen were lame in-hand, 24 showed lameness on the lunge on a soft surface and 23 were unsound on the firm surface.

The sample included 47 warmbloods, seven ponies and three Arabians, who ranged from three to 13 years old. The showjumpers competed at 1m to 1.40m and dressage horses from novice to grand prix.

The study found that there was no significant relationship between age or work discipline and lameness.

The study concluded that a horse being sound on a straight line “is not a reliable indicator of soundness”, and that riders “may be poor judges of lameness”.

Related articles:

• Grading lameness: how it works *H&H VIP*
• How to trot up your horse for the vet
• 14 ways to keep your horse’s legs healthy

“Unless you see a horse ridden, you are going to miss lameness,” Dr Dyson added.

“Ridden exercise is standard practice in a five-stage vetting, but a lot of people only do it to listen to a horse’s breathing rather than watching the horse’s gait. In many cases it is not used as well as it might be to assess how the horse is moving.”

H&H vet Karen Coumbe suggested a possible explanation for the findings could be that riders become accustomed to the way their own horse moves, which may explain why they do not notice lameness.

She added that it makes sense to obtain an impartial expert view.

The findings of the study were published online in the Journal of Equine Veterinary Science on 4 January.

Ref: H&H 11 February, 2016

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It is common practice for vets to grade the degree of lameness exhibited by a horse to give an estimation of its severity. The original grade can then be documented, allowing semi-objective monitoring of improvement following treatment.

Your vet may have described your horse’s lameness as “low-grade”, or perhaps it has been assigned a fractional score. Knowing how to put these scores into context can help an owner understand the sometimes complex process of reaching a veterinary diagnosis.

Limiting factors

It is important to recognise that any scheme attempting to grade lameness will have its shortcomings. People vary in their ability to detect lameness, and grading it will always be a subjective assessment.

Additionally, whether a particular grading scale runs from zero to five, eight or 10, there are no strict definitions of what constitutes a specific grade.

The American Association of Equine Practitioners promotes a one to five scale. Each grade does have a specific definition, but this results in most horses with lameness evident when they move in straight lines having a grade three of five lameness — irrespective of the gait characteristics.

Other variables include:

•  Circumstances: the degree of lameness may vary hugely when on the lunge or under saddle, to the left or right, or on a soft or firm surface. Some schemes do not permit comparison between these factors, yet I believe it is important to record these variations.
•  Multi-limb lameness: grading is relatively straightforward if a horse is lame on only one limb. If more than one limb is involved, the grade becomes a less accurate reflection of the actual amount of pain the horse may be experiencing in each of the lame limbs.
• If lameness is similar in either both forelimbs or both hindlimbs, it may not be possible to detect a lamer limb. The severity of the lameness in each limb may only become apparent when the pain that is causing it is abolished by nerve blocks. For example, a horse with a symmetrical short-stepping forelimb gait may exhibit four-eighths right forelimb lameness once the left forelimb is free of pain.
•  Consistency: lameness may be intermittent. A horse with low-grade foot pain may take a few lame steps only on a turn, then appear sound. It would be misleading to say that he was two-eighths lame without qualifying that this was only sporadically apparent.
•  Compensation: horses adapt differently to lameness to try to reduce pain. Signs can be difficult to interpret, with compensatory movement sometimes mimicking lameness in a certain limb when the real source is elsewhere.
•  Adaptation: if a horse is assessed while ridden, there are many adaptations to his gait that may reflect lameness. Similar low-grade lameness in both hind limbs may result in lack of hind limb impulsion and engagement, leading the owner to complain that he lacks power. The horse may be on the forehand and have a tendency to become overbent, especially on 10m circles. These features are difficult to incorporate into a grading scale.
•  Gait alteration: abnormalities of gait may be most evident in canter, with the horse tending to become disunited on circles and turns, or break into trot. Other horses may show gait changes only under specific circumstances — perhaps preferring to land on a certain leg when jumping, or finding flying changes more difficult in one direction. These lamenesses are genuine, but cannot be graded.

Limitations aside, it is useful to grade lameness to provide some framework for measuring recovery.

It is perhaps most constructive when assessing lameness following nerve-blocking, so that before and after grades can be documented. Improvements are then less likely to be missed.

This can be vital in severe cases where it may not be possible to abolish lameness. Documenting progress from six-eighths to three-eighths, however, represents a significant clinical improvement.

The question that then arises is whether the residual lameness is the result of failure completely to abolish pain from a single source, or if there is a second source of pain.

Comparing grades after nerve-blocking various limbs in a multi-limb lameness can increase the likelihood of a more accurate diagnosis.

Pinpointing the problem

Is low-grade necessarily better than a higher-grade lameness? This is not straightforward to answer.

A low-grade — even sub-clinical — lameness may significantly compromise a horse’s performance in certain movements. It may be much more difficult to diagnose the source of pain.

A general practice vet may assess the horse in-hand and on the lunge and be unable to detect lameness, erroneously concluding that he does not have a pain-related problem. Yet a specialist lameness clinician would assess the horse being ridden before nerve-blocking him, using easier performance of the problematic movements as the outcome factor.

Low-grade lameness may not markedly compromise performance in some horses, especially if they are going well within their athletic capacity. A horse who loves jumping and has adequate scope to perform at a given level may cope, but may struggle nearer the limit of his athletic potential. If he continues to over-exert himself, the lameness may deteriorate.

Such a horse may have adapted to the lameness by stiffening his back. Physiotherapy treatment that relieves muscle tension may actually make the lameness more apparent.

The road to recovery

Once lameness is identified and treated, recovery will depend on the underlying cause.

Removal of a stone wedged between the frog and a shoe may result in immediate and complete resolution of lameness, for instance. With some lamenesses, it may take several weeks for normal neural pathways governing foot placement to be restored following relief of the primary source of pain. Subtle gait abnormalities may persist for several weeks, although these may not be discernible.

Ref: Horse & Hound; 12 November 2015

Lameness is three times more likely to be caused by conditions such as osteoarthritis, also known as degenerative joint disease, than problems in a foot, according to results from a recent survey.

The National Equine Health Survey (NEHS) is run each May, and this year the survey was completed by 35% more horse owners than in 2014, with nearly 15,000 entries.

Eighteen percent of horses were recorded as lame, with 13.5% of them suffering from the condition due to osteoarthritis. This was down from 13.9% in 2014 and 14.8% in 2013.

Meanwhile foot lameness was recorded in 4.5%, a similar figure to previous years. Vets are pleased that the survey is now producing solid results.

“NEHS is now providing important evidence that is replacing subjective opinion,” said Prof Josh Slater of the Royal Veterinary College.

“While the lameness figures were initially surprising, given that the foot has been generally regarded as the main problem area, that figures have remained consistent over the past three years gives constructive credibility to the data.

“Our findings will help owner vigilance with day-to- day healthcare as well as help prioritise on areas for future veterinary education and research.”

H&H vet Karen Coumbe added: “Possibly the reported reduction in foot lameness reflects good farriery and the awareness of the old cliché, no foot, no horse.”

Laminitis was down to 6.4% from 7.1% last year, although Cushing’s was on the rise from 6.4% up from 5.6% in 2014.

Other issues recorded included skin diseases, which accounted for 17.2% of responses, and recurrent airway obstruction, at 6.7% was the most recorded respiratory problem.

Weighty Issues

Equine obesity continues to be a problem as 23.2% of horses were reported as being overweight with a body condition score of 3.5-5, continuing the upward trend seen in the past (7.8% in 2013 and 16.9% in 2014).

Next year’s survey will explore links between obesity and the possible associated rise of diseases such as equine metabolic syndrome — which was reported in 2.4% of 2015 returns — and laminitis.

Ref: H&H 17 September, 2015

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Trotting your horse up for the vet for a lameness assessment can be an anxious time, so we asked Fizz Marshall, former manager of the Equine Therapy Centre at Hartpury College, to share her top tips for getting it right.

Standing the horse up

“First of all you want to get the horse to stand nice and square,” says Fizz. “This is so that the vet can walk around the horse and look at it from every angle, looking for asymmetries or any difference in muscles or posture.”

Walking the horse

“Next we move onto walking the horse up and down. You want to make sure you walk the horse away as straight as you can, keeping an even rhythm and allowing the horse to have its head so that the vet can see any abnormalities with the way it’s walking or moving,” says Fizz.

“When you come to turn the horse you should always turn the horse away from yourself. This is a safety thing apart from anything else as it is less likely to stand on your feet

“The trick is to pull the horse slightly towards you, swing it out and then turn it around. You then end up walking back in the same line that you started.

“When you’re walking back towards the vet, you want to keep the horse really nice and straight and aim for your target.”

How to trot up your horse

After walking away and back, the vet will usually ask to see the horse in trot.

“The same applies to the trot-up,” explains Fizz. “You need to keep a really nice, even pace and not go too fast when you’re trotting. If you go too fast the vet won’t be able to see enough and they’ll probably tell you to slow down.

“Again, give the horse its head so that you can see any head nods or tilts or anything that might give clues to how the horse is moving.

“When you come back up towards the vet, don’t run them over! Lots of vets will actually want to see the transition from trot back to walk, so make that very obvious.”

You may also be interested in…

14 ways to keep your horse’s legs healthy

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Much of what is known about the equine foot has its historical origins in the work of farriers and blacksmiths. Early veterinary texts discuss a number of conditions familiar to us today, such as navicular disease (grogginess), laminitis (fever in the foot), canker and corns.

Advances in veterinary science have deepened our understanding of the internal structures of the foot, revolutionising the way farriers approach hoof care. We now know that a good working relationship between vet and farrier is essential for soundness in the horse.

But what can the modern veterinary world teach farriers?

With the discovery of X-rays in the late 19th century, it wasn’t long before the X-ray tube was pointed at the horse’s foot. X-rays (radiographs) primarily diagnose bone-related conditions. A change of around 30% bone mineral density may be required, however, before signs are visible on a radiograph image.

Not only does this mean that early disease changes may not be detectable by the naked eye on radiographs, but also that clinical signs — namely lameness — do not always correlate with what the images show.

As well as assisting with a diagnosis, radiographs are useful for the farrier in the assessment of foot balance. Through the use of good medio-lateral (from the side) and horizontal dorso-palmar (front to back) radiographs, the farrier can appreciate how external “landmarks” in the hoof construction are related to internal structures.

Although radiography can inform on some conditions involving soft tissues of the foot, it is the availability of magnetic resonance imaging (MRI) that has completely opened up our ability to see inside the hoof.

MRI — the inside story

MRI should never take the place of a good clinical assessment and veterinary diagnostic work-up. Static and dynamic examination of the whole horse should be performed by vet and farrier (ideally both together). Evaluation of the horse’s conformation, as well as palpation and visual assessment, should be undertaken and related to the presenting signs.

The farrier will then check the feet and limbs for obvious problems or damage, and assess foot balance and shoeing in relation to movement. Assessment is performed at both walk and trot, with a lameness value often being assigned by the vet.

Seeing the horse walk is particularly important for the farrier, because how the foot lands — flat or laterally, for example, or toe or heel first — is related to foot balance. Heavy landing on one side or the other can eventually lead to foot-related lameness.

From the vet’s perspective, localisation and response to diagnostic analgesia (nerve blocks) should always be performed to confirm the source of lameness as within the foot.

Horses with forelimb lameness originating in the foot may look “shoulder lame”, as they generally pull up and away at the shoulder/neck region. It is important to be focusing on the right area from the start of the treatment.

Before rushing the horse into the MRI scanner, good-quality foot radiographs are essential. A number of conditions can be diagnosed without MRI and dealing with obvious foot imbalance may be necessary before progressing to advanced imaging techniques such as MRI.

That said, even in cases where a diagnosis has been reached by radiography (such as navicular disease), MRI can provide information that radiography simply cannot — not only about the soft tissues, such as tendons and ligaments, but also about what is going on inside the bones.

This additional information can inform vet, farrier and owner on treatment options as well as likely prognosis. Indeed, with conditions of the navicular apparatus, for example, radiographs often severely underplay the extent of changes present.

Collateral damage

One area where MRI has been instrumental is the recognition of the importance of injuries of the collateral ligaments of the distal interphalangeal (coffin) joint.

These injuries are often diagnosed in sport horses, possibly related to the demands of their competition workload on various surfaces. There may also be an association of foot balance and conformation, where medio-lateral imbalance and rotational abnormalities may lead to stress across the joint and hence the ligaments.

Collateral ligament injuries can present as an acute lameness, sometimes seen if a horse suddenly stops and twists at a fence or gate, for example. They commonly present as a chronic, insidious lameness, however, often made worse when the horse is worked — particularly when lunged on a circle.

Diagnosis may be made through ultrasound examination, although full evaluation of the ligament can only be obtained via MRI.

A treatment plan is then made in conjunction with vet, farrier and physiotherapist.

Agreement on best management varies and may include a period of rest and controlled exercise (usually over three to six months), pain relief (systemically or via medicating the coffin joint directly) and physiotherapy treatment (through the ligament at the coronary band or via the hoof wall).

It is agreed, however, that corrective farriery is essential to address any underlying foot imbalance and reduce abnormal stresses across the joint and through the collateral ligaments during the recovery period.

The take-home message here is that if your horse is diagnosed with a soft tissue injury to the foot, make sure that the farrier is involved as early as possible in the management of the case.

Ref: Horse & Hound; 25 June 2015

Having to withdraw your horse from a competition because he is lame is frustrating, so are you doing all that you can to keep all four limbs healthy? The following handy checklist will help:

1. A horse’s lower limb is comprised of bone, joint and tendon and has limited protective muscle, hence legs are susceptible to damage. It is important to understand this.

2. Warming up isn’t just about preparing your horse to perform at his best, but also to prepare his body to work so that it stays injury-free. The transition of a horse’s body from resting to active should be gradual.

3. The warm up increases the mobility and elasticity of the horse’s muscles. This in turn minimises the amount of strain placed on tendons and ligaments.

4. Your discipline and the ground conditions will influence your warm up, but the basic principle is that a regular and repetitive regime is best.

5. A horse’s heart rate must rise in a controlled way in order to increase the amount of oxygen in the blood that supplies muscles and vital organs.

6. Cooling down after work is fundamental to a horse’s wellbeing, too. By letting a horse stretch his neck and relax his body, lactic acid can be released from his muscles, which reduces the risk of post-exercise injury.

7. Any leg protection should be removed immediately after work to prevent excessive heat building up in the tendons and ligaments.

Continued below…

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8. The core temperature of the flexor tendons can increase between 6°C and 8°C after fast exercise, and repeated elevations in the temperature of the tendon may lead to breakdown of fibres.

9. A rise in tendon temperature is exacerbated when boots or bandages are applied, as the natural cooling system — ie air passing over the leg as the horse gallops — does not occur.

10. Studies show that cool running water is more effective than ice. After hard work — such as galloping, jumping or a very hot day— cold hose your horse’s legs for at least 5mins.

11. Then gently walk the horse around before returning him to his stable. A few hours’ turnout is ideal, so that he can stretch in a relaxed fashion.

12. If running water isn’t available — for example, if you’re at a competition — soak cool boots in a bucket of cold, preferably iced, water. Make sure they are completely submerged. Once applied check the boots regularly to ensure they have not reheated — hot cool boots will do more harm than good.

13. Not everyone likes them, but clay or gel-based leg-cooling products can be a useful alternative. Once applied to the leg the liquid evaporates, carrying heat away with them. However, clay also has an insulating quality, which can counteract the cooling action. This is why bandages shouldn’t be used on top and, once dried, the clay must be washed off with cold, running water.

14. Feel your horse’s legs every day, so that you become familiar with what is normal for him. It makes it much easier to identify when something is wrong, as you will spot the first signs of any heat, swelling or tenderness.

For more veterinary advice on how to keep legs healthy, don’t miss the latest issue of H&H Ask The Vet, on sale now

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Osteoarthritis is one of the major equine health challenges.

Indiscriminate in nature, this painful joint disorder can affect animals from all disciplines — from the elite racehorse to the treasured pet pony. Its onset can be progressive, as a result of general wear and tear, or may follow injury or trauma. At its worst, the condition can cause early retirement or even necessitate euthanasia.

With careful management, however, it is often possible to maintain your horse’s range of movement, control pain levels and slow the course of joint degeneration.

A long-term issue

Although it can develop at any age, osteoarthritis is most commonly seen in the ageing horse.

One of the major problems is that the disease has a prolonged course. It often starts to develop many years prior to the horse showing any apparent or recognisable signs, such as lameness. There may have been an injury in the horse’s distant past, or some issue with his conformation, which results in a chain of events ultimately leading to osteoarthritis.

Once the disease is clinically apparent, there may be significant — and often irreversible — damage and abnormalities within the affected joint or joints. By the time it becomes obvious that osteoarthritis is causing a problem, diagnosis is usually straightforward.

Prior to this, however, detecting its presence can be challenging. This delay in detection is why osteoarthritis can be difficult to treat and cure.

It would be a major clinical advance if diagnostic tests were developed to identify the condition at an early stage. This would enhance the likelihood of prescribing effective treatment of the disease, and allow appropriate management measures to be implemented to halt its progress.

The performance puzzle

For a horse to appear obviously lame, one leg must be hurting more than another.

Frequently, osteoarthritis simultaneously affects several joints on different legs.

While a horse with low-grade pain in different joints may not show an overt lameness, he may display either a loss of performance or behaviour changes. He may become less forward-going, or his ability to jump or compete may be impaired. This behaviour is often considered “difficult”, and is typically ascribed to general back pain or an attitude problem.

It is important that horses with poor performance or behavioural issues undergo a thorough veterinary orthopaedic examination, as low-grade multi-limb lameness is easily missed.

Modern imaging techniques include digital radiography (X-rays), which can detect subtle lesions, or scanning methods such as computerised tomography (CT) or magnetic resonance imaging (MRI).

These show some promise, but are yet to become practical clinical tools for the very earliest diagnosis, mainly due to their cost and lack of accessibility.

Blood or urine tests have the potential in the future to predict the risk of osteoarthritis by measuring levels of specific proteins. This is an area of research interest but, again, nothing has yet shown enough promise to be turned into a clinically applicable test.

Which treatments work?

There have been no major advances in the last few years in the medication available to treat osteoarthritis in the horse, and there is little in the way of new developments on the horizon.

The mainstays of our basic drug list remain non-steroidal anti-inflammatories (NSAIDs, examples of which are phenylbutazone, flunixin and meloxicam) and drugs such as corticosteroids, hyaluronan (hyaluronic acid) and Adequan® (polysulfated glycosaminoglycan), which are mainly given by injection.

While often very good at treating the signs of equine osteoarthritis, as they can reduce much of the pain associated with the disease, none of these drugs have been shown to have a major effect on returning a diseased joint to normal. They can improve matters, but rarely provide a complete cure.

As a result of the lack of conventional medicines effectively able to treat the condition, other approaches have been developed that are increasingly being used as therapies. These “biological” approaches use either cells or proteins from an individual horse to treat his own affected joints, with the aim of improving joint repair.

A number of treatments with a rational scientific reason as to why they may work are available. However, in contrast with a newly-developed drug, these do not undergo rigorous testing prior to use, and there is currently no clear proof of their efficacy.

These biological therapies are very attractive but can be quite costly and, as yet, lack robust evidence to indicate which cases are most likely to benefit from their use.

Numerous nutritional feed supplements are said to improve the condition, although again there is little scientific evidence to support these claims. But there is considerable anecdotal data to suggest that they may play a supportive role in certain cases.

A diagnosis of osteoarthritis is not necessarily a death sentence for a horse. While he might have to perform at a slightly lower level, he may be able to continue working with careful management.

Ref: Horse & Hound; 5 February 2015

Catherine Austen’s hunter is hurried to surgery for a joint flush after a blackthorn injury, and makes a speedy recovery

Tuesday, 18 November

After a great day’s hunting with the Cottesmore, my horse, Molly, doesn’t look 100% sound. She was fine when she came off the lorry, but within an hour is lame. There is nothing to see in the leg or hoof, and the hoof doesn’t respond to hoof testers. But I did pull a long blackthorn out of her knee when I was washing her off, and there is a small amount of heat in the left side of that knee.

I am in Leicestershire, 2½hr away from home in Gloucestershire. I’ve seen one blackthorn injury before — on this horse, four seasons earlier — and I just know it’s happened again. I ring my veterinary practice, Bourton Vale Equine Clinic. They say to bring her straight in. Rugged up and bandaged, Molly limps into the trailer in the dark, bless her. I worry all the way home and concentrate on giving her a smooth drive.

I arrive at Bourton Vale at 8pm, and am met by vet Peter Clements and two interns, Maureen Whyte and Karolina Radwanska. I unload Molly and we take her into the examination room.

Clipping is not her favourite thing, and we sedate her to clip her foreleg out and look for signs of penetration by a foreign body. The knee is scanned to make sure there are no thorns embedded in the skin.

Peter takes a sample of synovial fluid from the radiocarpal joint, and the fluid is tested to check the white blood cell (pus) count and protein levels. A high level

will indicate infection or contamination.Molly’s counts are far higher than is acceptable.

Peter tells me that Jeremy Swan, the surgeon on call, will operate on Molly that night to flush the joint. The nurses reclip and scrub Molly’s leg, and the team anaesthetise her. She is lifted up with a winch and put on an airbed.

Jeremy puts an arthroscope into the joint through a 4mm sleeve, and can see on a screen what is happening inside the joint. An egress cannula is put into the other side of the joint, and 10 litres of saline fluid is pumped through the joint. While that happens, the arthroscope is used to look for obvious signs of penetration and bits of blackthorn or grit.

That takes 45min to an hour, and after that Molly is lifted off into the recovery area. Her head and tail are supported by ropes and pulleys so that she gets up with assistance.

Peter phones me late that night to say that they are very happy with how the operation went.

Wednesday, 19 November

I visit Molly at Bourton Vale. She has a huge bandage on her foreleg, but looks pretty happy and is eating, which is great because she tends to stop eating whenever she’s unhappy. I ponder the subject of blackthorns. Hunters seem to have joint flushes all the time because of them now — Jeremy confirms this, yet any older member of the hunting field will tell you that they didn’t happen 25 years ago.

“We treat them much more aggressively now than we did 20 years ago,” says Jeremy. “And we didn’t have arthroscopes then, which give a much more accurate diagnosis.”

Thursday, 20 November

Bourton Vale ring and say that Molly trotted up sound this morning. I can take her home on Saturday when she has finished her course of intravenous antibiotics. I’ve been lucky; a single flush has worked.

“It’s common to have two or three flushes,” says Jeremy.

“On the second or third day after flushing you know whether or not it has been successful. The clinical signs — whether it is hot, or painful — will tell you.”

Saturday, 22 November

I pick Molly up from Bourton Vale. She’s perfectly sound and leaps up onto the lorry. Her discharge notes say that the stitches can come out in 10-14 days, and that she is not to move much until then. The bandage should be removed in two days.

Monday, 24 November

I decide to rebandage the leg because I am worried about exposing the site of the operation to any dirt. I’m probably being over-cautious, and the incisions are tiny, but there we go.

Monday, 1 December

We take the stitches out — it has healed beautifully. Molly goes on the horse walker for 10min, which can be upped by 10min on each of the next few days. The farrier comes out to put her shoes back on.

Friday, 5 December

I ride Molly for the first time since her injury.

Thursday, 11 December

Molly goes hunting for the first time since the Cottesmore day. Accompanied by a friend on a young, green horse, we go for just 2hr. It’s perfect: we jump and gallop without ever really getting a long hunt, and she feels a million dollars. In fact, it’s like she’s been to a health farm or to Barbados for three weeks, rather than had an operation under general anaesthetic and box rest to recover. I’m lucky — she’s a tough old girl and has had a textbook recovery.

This article was first published in Horse & Hound magazine (22 January 2015)

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A marked but unexplained foot lameness may well point to a broken pedal bone. Karen Coumbe MRCVS gets the facts about these small but significant fractures

1. Prognosis depends on the nature of the damage

Fractures of the pedal bone are fairly common and can occur in horses and ponies of all ages, types and breeds. Yet vets are unlikely to see many of exactly the same types, so sharing information is paramount if clinics are to select the best approach to treatment.

In a recent study published in The Veterinary Journal, 285 cases of different pedal bone fractures were collected by vets from five clinics in Austria, Netherlands, Switzerland and the UK. Horses with a fracture that did not involve the the distal interphalangeal (DIP, formerly known as the coffin joint) — like Jasper — had a better outcome, with nearly 92% returning to their original or an expected level of use.

This same study showed that horses with a hindlimb pedal bone fracture had a significantly greater chance of successful recovery. No significant association was noted between the success rate and the horse’s age or the stage at which treatment was initiated.

The outlook depends on how the pedal bone is damaged. Vets use a numbered system to classify the type of fracture (see box, left). Key factors are the position of the fracture line and the number of fragments. If the DIP is involved, the risk of osteoarthritis developing is greater.

2. Everyday incidents cause most fractures

The cause was determined in approximately half of the survey cases. Slipping or stepping on solid objects and kicking an unyielding object were the most common, followed by spontaneous occurrence during exercise, a kick and, surprisingly, road traffic accidents.

3. Vet-farrier consultation can enhance outcome

Immobilisation of the foot did not affect outcome, according to this survey. This is also surprising, because horses often seem more comfortable once the injured foot is supported.

On reviewing the outcomes of less severe fractures treated conservatively (without surgery), a significant link was found between treatment method and a return to previous performance level. Of the cases treated with box rest alone, 97% had a successful outcome — compared to 81% with hoof immobilisation.

This suggested that box rest alone, rather than additional immobilisation, had a better outcome. Any support given by a foot cast or special shoe may be less important than previously thought.

Instead, it seems that the hoof capsule itself may be capable of sufficiently immobilising the injured area. Some vets have suggested that a half-limb cast is fitted, which would more effectively immobilise the joint above the fracture.

If a bar shoe or cast is applied, this in turn can cause complications such as contraction to the heel. Distortion of the foot shape increases the potential for long-term lameness.

Overall, it seems that appropriate management must be selected carefully after discussion with vet and farrier.

4. Multiple imaging methods may be needed

Subtle fractures can be hard to pick up on radiographs. More than one image may be required to get just the right angle, where the X-ray beam is parallel to the fracture line so that the gap shows up sufficiently clearly. My record is 11 images to find such a fracture, even when I was pretty suspicious that it was there!

There are good reasons — economic and safety — to try to reduce the number of X-ray images, so vets may now use other sophisticated technology such as magnetic resonance imaging (MRI) or computed tomography (CT) to provide a more accurate answer.

X-rays alone may not be a guide to the severity of the damage, as not all fracture lines show up. If in doubt, your vet may do follow up X-rays 10-14 days later to see what is happening with a painful foot.

5. Convalescence should never be rushed

Another challenge is that X-ray appearance and clinical healing do not always correlate. Sometimes the fracture line will remain long after the horse is sound, so a return to work should be based on clinical rather than imaging appearance. Further investigations such as nerve blocks or even a bone scan are useful to test the significance of a fracture line.

This recent long-term survey suggested that horses should be rested for at least two months after a pedal bone injury. Even if the horse becomes sound before this time, a premature return to training might result in re-fracture or delayed union or repair (bone healing).

Read all our latest lameness advice

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Considerable attention is paid to the conformation of the limbs of young Flat-racing thoroughbreds in the belief that a pigeon-toed weanling or one with bandy legs will perform less well than one with perfect, straight legs.

But there is far less emphasis on limb conformation in warmblood sports horses, in which angular or rotational limb deformities are quite common.

Researchers in Sweden have looked at whether the wonky legs apparent in some adult Swedish warmbloods are inherited, and whether the received wisdom that they lead to lameness is correct.

The limb conformation, breeding and soundness of more than 8,000 Swedish warmbloods, presented as four- and five-year-olds for quality grading, was analysed.

Researchers found that freedom from lameness and good health were most strongly correlated with an intermediate overall size of horse, a well-positioned neck, a light front end and correct, straight legs.

Marked toe-in or toe-out conformation was associated with reduced soundness across the population and these abnormalities were quite strongly heritable. When hock conformation was analysed, very straight and sharply angled hocks were correlated with unsoundness.

The researchers concluded that their findings were encouraging, because they showed that careful, selective breeding based upon conformation and soundness could improve the overall health of the breed.

This article was first published in Horse & Hound magazine (18 September 2014)

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From foalhood to 4 years is when young horses develop the foundations for future health and soundness. Jane Nixon MRCVS explores the physical issues during these crucial early stages

Youngsters tend to be green and gangly, with their bodies developing in fits and starts. But early identification of any developmental abnormalities among these more usual growth spurts is important, as many such problems predispose sub-optimal performance in adulthood.

The aim for producers is to breed an adult horse who is as symmetrical as possible. Monitoring the foal’s limbs should begin at birth, as this is the time when problems may be identified and stand the biggest chance of correction.

Some elite sport horse producers ensure their foals undergo a physiotherapeutic examination at birth to reduce the effects of any laterality (one-sidedness) or torsion (twisting) that may have occurred during the birthing process.

Bumps and bones

Developmental limb deformities can show at varying ages and should be constantly monitored and corrected by way of foot balance, nutrition and controlled exercise. Signs of incorrect development include any dissimilarity between left and right limb angles, or other variations from the norm.

It is usual for the foetal bone cartilage growth plates to become progressively ossified. The limbs finish their lengthwise growth when all these plates have closed, usually by 3 years of age.

Bumps can occur due to inflammation of the growth plates, a condition called epiphysitis. The bumps tend to form just above the fetlocks or on the knees, appearing between the ages of 4 weeks and 18 months. They may self-correct over 4 to 6 weeks, but the main causes are excess weight and too much turnout on hard ground.

Careful management is required until the affected growth plates have closed.

While the neck and back are susceptible to similar problems, the signs are not so readily recognised. They may present as obscure lameness or loss of full control of movement (ataxia).

The interlocking skull bones may also show excessive bone formation, which can appear as bulges in facial and nasal areas. These are usually self-limiting and resolve themselves without treatment.

Conformation problems

As the youngster matures from foalhood and into the early stages of work, further problems can occur. These include:

➤ Bone outgrowing muscles, tendons and ligaments, with resultant twisting of the cartilage of the growth plates.

➤ Too great a weight gain, too early, with resultant excessive limb loading.

➤ Joint concussion caused by too much exercise on hard ground.

➤ An unprepared musculoskeletal system unable to cope with too demanding exercise.

Corrections are sometimes possible, provided the affected growth cartilage is still “open” and not fully developed. These are made by addressing possible causes and altering ground reaction torque forces by experienced farriery.

Attempts at such farriery techniques on closed growth plates are impossible, however, and may be counter-productive due to the resulting artificial pressures on other still “open” areas and on related joints.

The main cause of many problems is poor conformation. Culprits include foot asymmetry (fore or hind), toe-out conformation of the fore feet and straight or sickle hocks.

Attention to hindlimb development is of paramount importance. The hindlimbs are attached to the pelvis and spine at the hips and the sacroiliac joint, and consequently any weakness will affect the development of back, core and neck musculature.

Incorrect muscle development can result in reduction of balanced performance in the adult horse. Unmanaged limb abnormalities will lead to osteoarthritis and consequently faults in action and lameness, due to restricted stride pattern as athletic requirement increases.

Such deformities can result in subclinical lameness by 8 years old and overt lameness by 10 years, requiring ongoing management.

The producer must decide at an early stage whether the animal is destined for the athleticism required by the sport horse industry or will solely be aimed at the showring, where youngsters frequently carry too much weight and are less likely to enjoy a subsequent athletic career.

Feeding for healthy growth

Nutrition management plays an important role in young horse development. Diet is also linked with increasingly well-recognised hormonal influences.

By 12-15 months old, the typical yearling should have achieved 90% of his mature height, 95% of his bone length and 75% of his adult weight.

As the youngster matures, a balanced diet remains an essential part of helping him to develop into a strong, healthy adult.

All but extremely experienced producers are strongly recommended to take nutritional advice from feed manufacturers, who have trained nutritionists at hand.

Laboratory testing for EMS (equine metabolic syndrome) and laminitis is now the norm, particularly in broodmares for the avoidance of laminitis and the consequent reduction of predisposition in offspring and subsequent generations.

Similarly, it is known that hormonal influences in fast-developing 2-year-old colts may predispose them to orthopaedic problems, including laminitis and/or limb overload in the older horse.

Producing a young horse to the point of his first outing under saddle as a 4-year-old — and for a successful adulthood — is a skilled task. It is important to remember that any painful incident at this stage may have a lifelong effect.

Every aspect of the young horse’s development should be monitored constantly and every unexplained change investigated.

Above all, under saddle a balanced, empathetic approach should be established and maintained to maximise the youngster’s potential.

How training affects tissue development

Different skeletal tissues develop at different times. Tendons, ligaments and possibly cartilage are most responsive to “loading” in the first year of life, while bone is more responsive during the yearling and 2-year-old period.

Research has shown that 2-year-old racehorses in light work are likely to have a longer, sounder working life than those not raced until later. For dressage horses, a small amount of balanced work under saddle as a 3- and4-year-old will encourage the correct adaptation of bone for future work requirements.

Once the skeleton has matured, at around 5 years of age, training should be directed at muscular, respiratory and cardiovascular fitness.

Young horse checklist

Manage your young horse with the following steps:

➤ VACCINATION: leading vet Dr Derek Knottenbelt has identified that the equine herpes virus can cause inflammation of the trigeminal nerve associated with headshaking. As such, both the in-foal mare and her offspring should be vaccinated against the herpes virus.

➤ NUTRITION: seek expert advice on the correct dietary requirements for these early years.

➤ TEETH: check there are no erupting milk teeth, tushes (canine teeth), wolf teeth or molar caps before you introduce the bridle. Ensure, too, that the lower jaw excursion (movement) is equal to the left and right — which is usually 1.5 incisors’ width each way. This will prevent asymmetrical loading and pain of the temporomandibular (jaw) joints, with ensuing imbalance under saddle.

➤ TACK: it’s crucial that the first saddle ever placed on the young horse’s back should fit. Otherwise, there’s the risk of local muscle spasm and development of scar tissue, which may never resolve, causing lifelong alteration of limb flight path.

➤ TRAINING: avoid movements that compromise development. Extended trot, for example, will overexert the undeveloped abdominal core muscles, causing back muscle soreness from which the youngster may never recover. Always do all exercises from both sides/on both reins.

The horse

Welsh part-bred Ystradmeadow Sancho (Alfie, born 2008) was bought by Gina Bruce for her daughter Isabella as a 3-year-old.

“He had a bit of a rough start — it turned out he was a rig,” says Gina.

However, after an operation at the Royal Veterinary College to remove both testicles from his abdomen, Alfie was soon broken and working well for his new owners, doing occasional unaffiliated showjumping, hacking and dressage, which is Isabella’s “true passion”.

He is now working at elementary and finished 7th in the novice restricted and 10th in the music freestyle at the 2014 Winter Championships.

The history

As his work progressed his owners noticed a slight intermittent lameness in the hindquarters on the right.

In March 2012 he was blocked and X-rayed and an inflamed cartilage was found in the stifle. Unfortunately, the treatment for this resulted in Alfie struggling with a far bigger problem — laminitis.

The treatment

The Bruces’ vet, Luisa Smith from House and Jackson, suggested they treated his stifle problem with a steroid injection, and a week’s box rest, after which Alfie should be able gradually to restart working.

The vet explained that there is a very small risk of such an injection triggering laminitis, which the Bruces understood and accepted.

“I understood that if it was going to happen, the laminitis was most likely to strike in the first 48hrs,” says Gina. “So when that passed without incident I felt more relaxed.”

However, when Alfie came towards the end of his week’s box rest, the Bruces noticed he wasn’t looking comfortable and found he had massive digital pulses in his front feet. He was shuffling badly and was clearly extremely sore. The vet came straight out.

Alfie was treated with ACP and given Danilon for pain relief and its anti-inflammatory effects. His feet were packed out with a plasticine-type material for support and taped up. He was then put on box rest on this regime for about 3 months.

“Alfie is quite feisty, a real biter, and not a very nice character in the stable. Box rest made him very depressed,” says Gina. “He just lay on the floor. It was soul destroying to see him.”

After this time his feet were X-rayed to reassure the vets nothing in the foot was moving (in some cases of laminitis the coffin bone — also known as the pedal bone — sinks or rotates within the hoof, leading to permanent damage to the foot). Alfie’s X-rays showed no sign of rotation which was very good news.

Around this time the vet also tested Alfie for Equine Metabolic Syndrome (EMS), which is a hormonal disorder that can cause laminitis.

The primary disorder in EMS is insulin resistance. Insulin enhances the uptake of glucose from the bloodstream into cells, and in conjunction with glucagon plays the major part in regulating blood sugar levels. Horses with EMS do not respond to insulin as they should, so glucose remains in the bloodstream, much as it does with human type II diabetes sufferers.

Alfie produced a borderline result, but the vet strongly believed he may be insulin resistant and suggested starting him on some Metformin tablets, which essentially lowers the sugars in the body. He began on 14 tablets twice a day as he returned to work.

“The improvement was terrific, right away,” says Gina, although persuading a feisty horse like Alfie to start work again sedately after so much enforced box rest was not easy — he was sedated initially to help keep him manageable. Gradually his medication was decreased and he was completely medication free by October 2012.

“It took months for him to overcome the laminitic stance,” Gina explained. “Horses become so used to their feet hurting them that the can retain this ‘braced’ position even when it no longer hurts. For some time he would walk very gingerly on hard ground once he was out of the school.”

The outcome

The Bruces persevered with his rehabilitiation and after the best part of 8 months largely confined to his box, Alfie was back on the road.

Isabella took him to an unaffiliated dressage competition in November 2012 and he won, first time out. He affiliated with British Dressage in March 2013 and has continued his success.

Ongoing management

Gina has read everything she can find about Alfie’s condition and management since a horse that has suffered laminitis is always at risk of getting it again.

As Alfie’s laminitis is related to EMS, the Bruces are very careful to minimize his glucose/ sugar intake.

Alfie is kept stabled, goes out for 3 hours or so to graze each day, but is now muzzled.

“And he is never turned out in snow, ice or frost as this can intensify the sugars in the grass that trigger the problem,” adds Gina.

His hay is soaked overnight and Alfie is fed Blue Chip Lami-Lite.

“Having had horses all my life it is still hard to have a horse with laminitis and not give them carrots and polos,” says Gina.

The future

The vet believes regular work is important, with time off best avoided so Gina says that if he is ever off with any other ailment, she will discuss with the vet whether to put him back on Metformin.

The costs

About £3,000 in veterinary fees.

Contacts

www.houseandjackson.co.uk in Essex

Tel 01277 823808/features/laminitis-in-horses-signs-treatment-57937

A new saddle study has shown an unexpectedly high degree of lameness in sport horses — with nearly half of those assessed being lame or stiff.

Dr Sue Dyson, head of clinical orthopaedics at the Animal Health Trust (AHT) and Line Greve, a PhD student, looked at 506 working sport horses. They were all assumed by their owners to be sound.

The horses were videoed in-hand and ridden, including in 20m circles in both trot and canter. The study showed 46% of horses were lame or had a stiff, stilted canter.

Dr Dyson said she was “shocked” by the results.

Saddle slip occurred in 12% of all the horses studied — mainly in those with hind limb (30%) as opposed to forelimb lameness (5%).

“The results showed that horses with hindlimb lameness and gait abnormalities are more than 50 times more likely to have saddle slip than other horses,”said Line Greve.

With nearly half of those studied being lame, Ms Greve said many horses with lameness “are clearly going unnoticed”.

She added that the study shows further education of riders and trainers is needed to help them identify saddle slip as an indicator of lameness.

The new study reinforces previous research published in 2012, which showed hindlimb lameness is often the cause of saddle slip (news, 25 October 2012 and vet, 13 December 2012).

That study, carried out on horses at the AHT, concluded the saddle consistently slipped to the side in 54% of horses with hindlimb lameness.

Anne Bondi, director of the Saddle Research Trust — which supported the AHT in both studies — says all riders should be aware their horses might not be as sound as they assume.

“Saddle slip can be an early warning of a problem with a horse,” she warned.

The full results of the study will be presented at the second Saddle Research Trust International Conference, held on 29 November at Anglia Ruskin University, Cambridge.

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The horse 

Nina Lady, a 16.1hh Irish sport horse (born 2002), used for all kinds of activities from low level eventing to riding club dressage and lots of hacking.

The mare has had mud fever in the past, particularly in her white hind socks where the underlying skin is pink.

“She had it even when we bought her 7 years ago,” says her owner Lucy. “But it cleared up, and we try to manage her carefully in wet weather. Nina Lady is mainly stabled, with daily turnout in spring, summer and autumn. We turn her out in mud wraps when it is wet to try to protect her, which are pretty effective.”

Since Nina Lady is kept on a livery yard in Berkshire that is on heavy clay, she did not get turned out for many weeks during the dreadfully wet winter of 2013/2014.

She had worn fairly rigid hind cross-country boots while being exercised on sandy tracks, after her softer Woof brushing boots went missing on the yard.

The problem

One day, having saddled up for a jumping lesson, Lucy was alarmed to find Nina Lady very lame in her off hind.

“My instructor removed her back boots, and she felt better, though still lame,” adds Lucy. Trotted in hand, the lameness was the same.

There were signs of some mud fever on the hind leg, as there was on a foreleg, and there was quite a bit of heat in the off hind pastern, though no obvious swelling.

“I went home that night really downcast, convinced there was some tendon or ligament problem, as the heat in the joint seemed quite intense and the mare had never been lame with mud fever before.”

Lucy’s yard manager was more hopeful, since the mare had done nothing out of the ordinary to trigger such an injury. He wondered if she had got an infection in her skin through a combination of the poor ground conditions and stiffer boots.

Diagnosis and treatment

The hind legs were bandaged and the vet saw her the following day. Once her bandages came off, the leg became quite swollen, but there was also some puss-like liquid oozing through the skin at the back of the pastern, which formed into a scab.

The treating vet, Rory O’Shea of Equine Sports Vets, in Sussex, was hopeful the problem was skin-related and nothing more sinister. But he needed the inflammation to come down first before he could scan the leg.

“Nina Lady appeared to have a minor focal area of dermatitis just above her ergot on her right hind which was ever so slightly weeping,” said Rory. “She received a course of antibiotics, anti-inflammatories and special eczema skin lotion was applied daily for 5 days (and bandaged overnight).”

Rory asked that the mare be box rested for a week, but walked in hand during the day. She also went on the walker for 15-20 minutes each day. By the week’s end Nina Lady was extremely full of herself and rather bored.

The outcome

When she was trotted up for Rory at the end of this time Nina Lady was sound, and ready to be brought back into work.

“It was a bit of a wake up call to realise that a fully stabled horse could still contract mud fever,” says Lucy. “Nina Lady is now exercised without boots. Afterwards I wash her legs off with some NAF ‘Love the skin you’re in’ wash, and towel them dry to try to minimize the chance of reinfection. So far, so good — but what we’d really like is some sunshine!”

Contacts

Equine Sport Vets, Tuckmans Farm, Bar Lane, Copsale, West Sussex, RH13 9AY

Tel: 01403 731 213

www.equinesportvets.co.uk

Can foot shape offer clues about a horse’s potential to stay sound? Dr Sue Dyson explains how research is attempting to quantify the link between poor foot conformation and lameness

Foot pain is the most common cause of lameness in horses from all work disciplines.

Some lameness is due to an obvious cause, such as a bruised sole or poor trimming and shoeing, and can be readily resolved. But a large number of horses have chronic foot pain because of more serious underlying injuries.

It is generally accepted that poor foot conformation and/or balance are associated with an increased risk of foot-related lameness. However, there is only limited factual scientific information to support this.

Since the advent of magnetic resonance imaging (MRI), we have become much better at making accurate diagnoses of these injuries, such as deep digital flexor tendon injury. Yet to determine if there are ways of predicting or preventing these injuries, we need a better understanding of why they occur.

What makes a ‘good’ foot?

In an ideally conformed horse, free from lameness, it is thought that the pastern-hoof axis should be straight and the front aspect of the hoof wall and the heel should be parallel.

The horn tubules — the thin, vertical “tubes” that make up the hoof wall — should be parallel with one another, as should the horizontal growth rings (which may have variable separation). The coronary band should be symmetrical, so that a line drawn between any two comparable points on the band is parallel to the ground.

While there is a lack of evidence-based information concerning foot conformation, some studies have revealed that deviation from this ideal conformation increases the likelihood of foot pain. A large-scale German study, for example, showed that horses with left and right front feet of different shape and size leave the sport horse population earlier than those with symmetrical feet.

To investigate further, researchers at the Animal Health Trust (AHT) in Newmarket performed a study in 2011. They documented photographically the foot shape and external hoof characteristics of approximately 350 lame and non-lame horses. The duration of the lameness was defined as acute (less than 3 months), intermittent (difficult to determine accurately), or chronic (more than 3 months).

All feet were photographed from the side and the photographs were assessed to determine the shape of the coronary band, which was described as straight or curved. The orientation of the horn tubules and the growth rings was also recorded.

The front of the hoof wall was described as straight, concave or convex, and abrupt changes in hoof wall alignment were recorded. Various length and angle measurements were made to describe the shape of the hoof capsule.

Causes of pain

Some of the results surprised us:

• Just half of the feet of “normal” (non-lame) horses had a straight wall — in a third of these, the wall was concave and in a fifth it was convex. In almost half of these curved walls, the angle changed abruptly part way down, usually coinciding with a prominent growth ring. This lack of straightness may reflect, at least in part, previous trimming techniques.
• Just half of the feet of normal horses had a straight coronary band — a third had an overall concave shape and a fifth had concavity in the back half of the foot. The incidence of curvature of the coronary band was significantly higher in lame horses. Moreover, a concave coronary band was associated with persistent lameness.
• One of the most unexpected observations was that a large proportion of non-lame feet had divergent growth rings at the heel and non-parallel horn tubules. Divergent growth rings have previously been considered to be a hallmark of laminitis, but it seems unlikely that such a high proportion of horses had previously suffered from it.
• The average angle of the front of the hoof wall was consistently greater than the average heel angle in both lame and non-lame feet, so the front aspect of the foot and heel were rarely parallel.
• Only the ratio of the height of the coronary band at the front and back was significantly different between lame and non-lame horses, being greater in lame horses. But there was no significant difference in the frequency of occurrence of a collapsed heel between the feet of non-lame and lame horses.
• Some 23% of lame horses had well conformed front feet. In 22% of those lame in one foot, the affected foot had a taller, more narrow and upright conformation. In 10% the lame foot had a long toe and a low, collapsed heel.
  A combination of a long toe and a low heel results in greater contact pressure on the navicular bone, increased strain in its supporting ligaments and the deep digital flexor tendon. This is subsequently associated with increased extension of the coffin joint.
  But chronic — long-standing — lameness may result in the development of an upright foot conformation over time, irrespective of injury type. This reflects lack of normal foot function and altered biomechanical loading.

What can we learn?

This study confirmed that asymmetry of foot shape may be present in foot-related lameness.

There is an overlap between the foot shape of normal horses and those with foot pain. But the presence of asymmetrically shaped feet, a curved coronary band, a low collapsed heel or non-parallel growth rings or horn tubules are potential indicators of a risk of foot-related lameness.

The presence of any of these at a pre-purchase examination should alert you that there may have been previous lameness.

Because this study focused on the foot from the side, however, there are other factors regarding conformation and foot trimming, which may be related to lameness, that were not investigated.

Markedly pigeon-toed conformation or obvious asymmetry of the foot from the inside to the outside are likely to result in asymmetrical loading of the bones and soft tissues of the foot, therefore predisposing the horse to injury.

All horses tend to land on the outside of each foot slightly in advance of the inside. If the foot is not symmetrically trimmed so that one side is higher than the other, the tendency to land on one side first may be accentuated.

The saying “no foot, no horse” holds ever true, and the importance of good trimming and shoeing cannot be overemphasised. Although there are clearly multiple causes of foot pain, good foot conformation, which is symmetrical between right and left limbs, may reduce the risks of the development of foot pain.

Foot pain: which horses are most at risk?

The large number of cases seen at the Animal Health Trust in Newmarket provides it with a significant database from which to identify lameness trends.

Some interesting facts emerged when the AHT reviewed all horses examined between 2001 and 2010 for investigation of lameness, poor performance or as part of a pre-purchase examination.

Advanced statistical analyses were performed on 4,618 horses, 1,132 of whom had foot pain. The results revealed:

1. There was increased risk of foot pain in horses aged from 6 to 9 and 10-15, compared with horses less than 6 years old. Horses older than 15 were protected, indicating a “healthy horse” effect (meaning that although one would expect older horses to have more degenerative-type injuries, some animals are simply less injury prone).

2. Showjumpers were more at risk of chronic foot pain compared with dressage horses. This is probably related to the higher forces transmitted through the foot when landing over fences, and the strains placed on the soft tissues of the foot when performing the quick turns that are very much part of showjumping.

3. Thoroughbred cross-breeds had a higher risk compared with warmbloods.

4. Horses with a high bodyweight to height ratio, indicating that they were overweight, were more at risk than horses in leaner bodily condition. This may reflect the relative loads transmitted through feet of similar size, with higher loads in the overweight horses.

H&H guide to spotting problems

A “normal” foot. The front of the hoof wall and the heel are approximately parallel and the coronary band is straight. The growth rings are parallel and so are the horn tubules.

Here, the front of the foot is more upright than the heel.

Notice here that the coronary band is not straight — it curves above the thin red line. Curvature of the coronary band is seen more in lame horses.

The outside aspect of the coronary band (the arrow on the right) on this fore foot is higher than the inside, reflecting different lengths of the hoof wall.

A low, collapsed heel rolling inwards under the back of the foot — the horn tubules (the vertical “tubes” that make up the hoof wall) are not parallel and are being crushed in the heel area.

A new study reveals some surprising facts about lameness, says Peter Green MRCVS

The old adage “no foot, no horse” came about because of the frequency and prevalence of foot-related lameness in working horses. Foot abscesses, bruises, corns, laminitis, not to mention the range of chronic low-grade internal foot problems like palmar foot pain and coffin joint disease — all figure highly in the clinical records of most working horse populations.

A study recently published in the Equine Veterinary Journal (EVJ) featured the lameness records of the horses of the Household Cavalry mounted regiment (pictured) over a 13-month period. Vets at the University of Nottingham studied the reasons for lameness and work absence, the proportion of horses that returned to full work and the time taken to recover.

The overall rate of lameness was much as expected — about 25% of horses had an episode of lameness at least once a year. But there were some surprises.

The most common cause of lameness was not foot trouble but cellulitis, an infection of the soft tissues of the lower leg similar to mud fever. Next came skin wounds, such as overreaches and speedy cuts. Foot-related lameness came third, which was not expected since these horses work on roads and other hard surfaces and need frequent shoeing.

The vets question whether the type of work influences these results and whether eventers, racehorses and hunters have different patterns of lameness from these military mounts. More research will no doubt answer the question.

Researchers at the University of Glasgow School of Veterinary Medicine are calling on horse owners to take part in a survey to investigate how lameness affects the country’s equines, and how it impacts upon their owners’ pockets and participation in sport.

The survey, which takes 10-15min to complete, is part of a Masters project supported by The Horse Trust and World Horse Welfare.

It aims to determine the annual prevalence of lameness and the number of days wasted for one horse in a 12-month period.

> To take part, visit https://www.surveymonkey.com/s/WeipersCentreEquineHospitalStudy

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Can flexion tests ever be objective rather than subjective? Yes, say researchers involved in a new study that has trialled a sensor-based system to measure a horse’s response.

For many years, opinions on the value of flexion tests — which involve bending a leg for a period of time and then trotting the horse up to reveal any subtle lameness — have been divided. They rely on the ability of the observer to identify and interpret changes in the horse’s gait.

The results can also vary, depending on how hard or high the limb is held.

But the recent research, conducted at the University of Glasgow’s School of Veterinary Medicine, seeks to abolish some of this subjectivity.

Prof Jim Moore of the Equine Veterinary Journal (EVJ), which published the study, said the new technique would help vets investigate lameness more accurately. It will also serve as “an unbiased method” of communicating findings.

Seventeen horses were fitted with sensors, which measured asymmetry.

They were first trotted up normally and then a hindlimb randomly selected and flexed for 60sec before they were trotted up again. Response to the flexion was assessed as negative or positive (lame) by an experienced observer.

The findings showed that a positive visual test correlated with changes picked up by the movement sensors.

H&H vet Karen Coumbe said: “Anything that makes analysing lameness more objective has to be worth serious consideration, as it can be hard to make comparisons. One person’s view of a mild lameness might be more severe than someone else’s.”

H&H reader Bev Green, whose 15-year-old thoroughbred-cross gelding failed a pre-purchase vetting six years ago on a flexion test, said she would welcome a more objective assessment.

“I was told that my potential purchase was 2⁄10 lame, but neither I nor the vendor could see even the tiniest nod,” she said. “I went through with the sale against my vet’s advice and [the horse] has not had a day off work since.”

This news story was first published in Horse & Hound magazine (6 June 2013)

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Research and clinical experience have shown that suspensory ligament injuries, particularly in the hindlimbs, are the highest injury risk in horses doing dressage — at all levels.

The exact cause of injury is not totally clear, but it is likely that a number of things contribute.

Dressage-specific paces or movements could be risk factors, as could the type of horse used.

The repetitive nature of dressage training might mean that the influence of these risk factors is exacerbated — just as human athletes specialising in a particular sport are prone to repetitive strain injury.

Factors that increase the strain placed on the suspensory ligaments are generally associated with an increase in fetlock extension or hyperextension (beyond the normal range of motion).

Excessive exposure to these factors is likely to result in ligament overstrain and injury.

Clinical review suggests that conformation could play a part. Injury is more likely to occur if the horse has a straight hock and a dropped fetlock, probably because he is more likely to hyperextend the fetlock during normal locomotion.

Increasingly, we’re selecting dressage horses with extravagant, uphill movement to get higher scores in competition. Desirable as these qualities may be in the arena, they’ve been identified as factors that increase strain placed on the suspensory ligaments.

How can you minimise the risk of injury?

• Take care not to overpush or overproduce paces. This is particularly the case with an extravagant, uphill mover or a young horse with poor core muscle strength
• Build cross-training and core muscle development into the training programme — but avoid overrepetition of exercises when a horse is tired
• Be vigilant for signs of back pain and schedule frequent and correct evaluation of saddle fit
• Never overtrain on an inferior surface or one that the horse is not used to — and be aware of the risk posed by hard, high-traction surfaces
• If a training problem arises, eliminate the possibility that ligament injury is a reason for resistance. Early detection improves chances of recovery
• For subtle injuries, arrange evaluation by a vet experienced with dressage horses who can assess the horse fully

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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)

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Hallmarq Standing Equine MRI, manufacturers of MRI (Magnetic Resonance Imaging) systems, has held a successful conference that discussed the diagnosis of equine lameness.

Leading equine vets travelled to the event in France to share their knowledge and discuss the latest developments when diagnosing horses lame.

The presentations highlighted the clear and rapid information that MRIs reveal. There were detailed images “illustrating how anatomical structures that could barely be seen a few years ago can be responsible for performance problems in highly competitive equines.”

Nick Bolas of Hallmarq MRI said: “The conference was the best yet and the number of delegates continues to grow every year. There was some very lively debate throughout.”

Sixty-one delegates attended the conference that was held in January in Chamonix, France.

For more information visit www.hallmarq.net.

More than half of the UK’s horse population could be slightly lame, according to the initial results of research by the University of Sunderland and the Saddle Research Trust (SRT).

Anne Bondi of the SRT told H&H: “Our project needs a lot more enquiry but we have been looking at every sort of horse, from riding school, to advanced and elite horses and our preliminary suggestions show that the majority of horses presented for the study show some asymmetry.”

Over the past two years 30 supposedly sound horses, that were volunteered for the research into synchronicity between horse and rider, were assessed.

Researchers found that the majority showed asymmetry in their gait.

Much of the asymmetry was subtle but could affect the horse’s performance, said Mrs Bondi.

“These are horses that are not particularly lame. When they move they just feel stiff or restricted. It’s not something that can be easily seen,” she said.

These suspected high levels of lameness do not surprise Dr Sue Dyson, specialist in equine orthopaedics at the Animal Health Trust.

“I am amazed by the number of horses that are presented to me day after day that clearly have been wrong for a while but people have not noticed,” she said.

“You only have to look at the number of horses that are put forward for pre-purchase exams [vettings] but not recommended as they are lame. Many have been put up for sale in good faith.”

She said the AHT is about to embark on a national survey of lameness and the results will be available in 18 months.

For more on this story, see this week’s issue Horse & Hound (1 November)

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A slipping saddle may be an early sign that your horse is suffering from hindlimb lameness, research by the Animal Health Trust (AHT) has found.

Working with the Saddle Research Trust (SRT), Sue Dyson and Line Greve of the AHT assessed 128 horses of varying age, size and type.

The study, which was released last month, concluded that the saddle consistently slipped to the side in 54% of horses with hindlimb lameness.

Dr Dyson said: “Detection of saddle slip provides an opportunity for the owner, rider and trainer to detect low-grade and sub-clinical lameness, with important consequences for welfare.”

Further analysis of the subject will include work to determine how much the equine back changes shape and how often saddles should be refitted.

“We all imagine our horse is 100% sound, but our study so far has shown the majority of horses show a level of asymmetry,” said Anne Bondi of the SRT.

“This AHT research is a tremendous step forward.

For the first time, owners have an early indicator that there may be something wrong.

“Previously we would have blamed saddle slip on the rider’s position or the saddle itself.”

The SRT is working on a number of studies researching lameness and saddlery.

Another, in conjunction with the University of Sunderland, aims to create an easy video analysis tool to detect asymmetry in the horse.

This news story was first published in the current issue of H&H (25 October 2012)

Look out for our veterinary special in H&H 13 December for more on this subject.

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Most horse owners will be familiar with the flexion test. It involves bending all the joints in a horse’s leg, holding the leg fixed in this flexed position for a period of time and then trotting the horse away.

The idea is that any trouble brewing in the joints, while not causing lameness during an ordinary trot-up, will be revealed by the flexion test. For this reason it is often part of the pre-purchase (vetting) examination on horses for sale.

But there is no real agreement about how long the limb should be held up, nor about whether it is the action of forcibly bending the leg, or of holding it bent, that reveals the lameness.

Vets in Kansas tried to shed some light on this. They devised a method of scoring the response to flexion tests using video footage of a horse trotting away from the camera.

They filmed the flexion tests performed on 34 horses presented for lameness investigation. For each horse, they carried out the flexion test for a 60-second hold-up time and for a five-second hold-up time.

The horses were randomly assigned to two groups: those in which the five-second test was performed first and those which had the full 60-second test first.

The assessments were made by experienced vets, but they did not know how long the leg had been elevated before the horse trotted away.

When the results were analysed, it was clear that two factors were significantly affecting the response to the flexion tests.

First, the 60-second test resulted in more positive responses than the five-second test, showing that it is not simply the bending of the leg that elicits the response, but the time which is an important factor.

Second, irrespective of the duration of the test, the responses were reduced on the second test compared with the first. In other words, the response to a flexion test is likely to reduce if it is repeated. This is important in lameness examinations when such tests may be used repeatedly on the same horse.

This veterinary article was first published in 16 August 2012 issue of H&H

Find an equine vet

Mention the word neurectomy – or denerving, as the procedure is often referred to – and you will immediately find yourself in contentious territory.

Deliberately cutting a troublesome nerve to induce lower limb numbness and therefore promote soundness is – and always has been – controversial.

Intervening to extend a horse’s life by giving it relief from pain is one thing, expecting it to continue to perform to the best of its ability is another.

Pros

• If the surgery is successful the horse will be pain free
• A horse can usually return to regular work
• Technological, surgical and anaesthesia advances mean that success rates are improvingCons
• The effects of the surgery may only last a few years in the forelimbs – the nerve can regrow
• Careful management and a strict shoeing routine are required to protect horses’ feet for palmar digital neurectomies
• The procedure is often undetectable, which may have implications for horses that change handsFor the full veterinary article on neurectomies, see the current issue of H&H (24 November 2011)Do you need to find an equine vet?

Read more about lameness in horses

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It is often assumed that it is possible to determine the source of pain-causing lameness by evaluating gait characteristics.

Unfortunately this is not always the case, because there are many ways in which a horse’s gait may be modified.

Often lameness is only apparent on a circle – sometimes the affected limb is on the inside of the circle and sometimes the outside.

A horse may be bi-laterally lame (lame in more than one leg), or unlevelness may only be apparent under saddle.

Some horses may seem completely sound in-hand and on the lunge, even to a lameness expert, but appear lame when ridden.

This sort of lameness may only become apparent in specific circumstances, for example, in left half-pass or on a 10m-circle right, or the problem may manifest as a four-time rather than a three-time canter. Perhaps the saddle has developed a tendency to slip to one side.

Such subtle lameness can have a major impact on performance.

More complicated still is a horse that does not appear overtly lame either in-hand or under saddle but feels lame to ride. Such horses are described as “bridle lame”.

The inference is that the way in which the horse is being ridden induces lameness. While I think a rider can have this effect, I also believe that any lameness that can be felt but not seen usually reflects an underlying source of pain.

A skilled rider may be able to mask such lameness – but that does not necessarily mean that the horse does not have a pain-related gait abnormality.

The development of technological gait analysis provides potentially interesting and useful information, but I do not believe that currently any such techniques can replace a skilled lameness diagnostician.

For the full veterinary article on assessing lameness, see the current issue of Horse & Hound (3 November, 2011)

Find out more about lameness in horses

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Lameness is the most common reason for older horses to be put down, according to new research funded by The Horse Trust.

Of 118 horses – aged 15 or over – whose deaths were reported during an 18-month period, 111 were euthanased.

Some 24% were euthanased due to lameness, while an additional 12% were put down through laminitis – a common cause of lameness.

The research, the first in the UK to provide data on the causes of death in geriatric horses, was carried out by the University of Liverpool.

This news story was first published in the current issue of Horse & Hound (27 October, 2011)

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Read more about lameness in horses

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Direct trauma injuries

The most common cause of shoulder lameness in adult horses is a traumatic accident — a fall or a collision, for example.

The front of the lower end of the scapula, called the supraglenoid tubercle, is at particular risk of fracturing because it is relatively poorly protected by overlying soft tissues.

Moreover, the scapula develops from several pieces of bone which fuse together early in the horse’s life, but the fusion lines remain weak points and fractures of the supraglenoid tubercle usually occur here.

The strong biceps brachii muscle, which attaches to the supraglenoid tubercle via its tendon and pulls downwards and forwards, can often displace the fracture as a result of its action.

Although initial lameness is often severe, it normally improves quite quickly, which can lead horse owners to think — wrongly — that the injury is less severe than first thought.

On the inside of the shoulder is a web of nerves, called the brachial plexus. These nerves are responsible for supplying all the muscles of the forelimb.

Damage to specific nerves can alter a horse’s ability to control the movement of the shoulder. This can occur if a horse collides with either a solid object or with another horse, resulting in the nerves being stretched.

If the muscles on the inside of the shoulder do not function properly due to nerve damage

as the horse bears weight on the limb, the shoulder will bulge outwards.

This is called shoulder slip and is best appreciated by seeing the horse walking towards you. The foot of the affected limb will often rotate, causing the toe to point inwards and the heel outwards.

This is not a pain-related condition, although at the time of acute injury, bruising and pain may contribute to lameness.

This gait abnormality reflects a lack of normal muscular control. If the nerve damage is not severe the horse may make a progressive and complete recovery, but if it’s more serious the clinical signs may persist long term.

For the full veterinary article on shoulder lameness, see the current issue of Horse & Hound (26 May, 2011)

Find out more about lameness in horses

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More articles on lameness

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Injuries that cause a horse to go suddenly lame with no obvious explanation can occur at any time, but are more likely to happen when jumping at speed is involved, such as eventing, racing or team chasing.

“Generally, the faster you go, the harder the ground and the bigger the fences, the greater the likelihood of injury,” says Bob Baskerville MRCVS. “The exception is when a horse is not adequately prepared.”

First, it is important to identify the region of the injury.

“The most common cause of sudden lameness is a problem with the foot,” adds Bob. “A stone could have become wedged, or more seriously, the horse may have a nail in the sole of its hoof.”

It is important to keep the horse as still as possible.

“When veterinary assistance is not immediately on hand, you should phone for help straight away; do no attempt to move the horse or you could cause more damage,” adds Bob.

Three tips for preventing injury

1. Ensure your horse is fit for the job:

Bob says: “I see a lot of injuries occur during low-grade sponsored rides where the horses are, generally, older and not fit enough.”

So, although it may seem obvious, ensure your horse is up to the task you are asking of him and that his fitness training has been tailored to his discipline.

2. Use appropriate leg protection:

It is better to go barelegged at an event than to use inappropriate boots and bandages. If the boots are too rigid or have too much elasticity, they can cause more harm than good.

Good leg protection serves a purpose, but it is crucial that all protection fits correctly and doesn’t hinder your horse’s action.

3. Shoe competition horses according to the job they do:

You will hinder a fit thoroughbred going at speed across country if you put weighty shoes designed for warmbloods on it.

A lot of farriers now follow the principal of keeping the toe short and the heel higher. This is fine for horses needing remedial shoeing and for those not expected to perform at speed, but if a galloping horse has its heels too high, it has the potential to overload the superficial flexor tendon.

For the full article on sudden lameness, see the current issue of Horse & Hound (25 February, ’10)

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Back problems are sometimes blamed for low-grade lameness in horses when in fact the back pain develops secondary to the lameness.

British Equestrian Federation (BEF) physiotherapist Vicky Spalding explains: “When a horse is lame in one leg, he attempts to reduce the loading on this limb by lifting the trunk of his body when the affected leg hits the ground. Back pain can occur when the lumbar and pelvic muscles are overused as a result of this.”

It is always worth looking to the foot as the cause of lameness until proven otherwise.

Horses with chronic foot pain will rapidly develop secondary back problems as a consequence of their bilateral and short-striding shuffling action.

Hock lameness can also cause discomfort along the back muscles, which usually vanishes when the hocks are pain-free.

It can be hard to believe that a single nerve-block in a hock joint will cure back pain, but if the primary lameness can be resolved, then the compensatory pain should reduce too.

“This is one reason why it is so important that a qualified practitioner is used to treat your horse’s back — it is essential that underlying lameness is not missed,” explains Vicky.

But even when the underlying injury and the associated back pain have been identified and treated, the story may not be over.

“Studies show that in the human spine, when back pain resolves, the core stabilising muscles may not regenerate fully unless stimulated to do so by specific rehabilitation exercises,” Vicky says.

“This may be significant in horses with compensatory back pain and it indicates a need for rehabilitation and re-education of movement following an episode of lameness.”

But remember, back pain can be a problem of its own, for instance in a horse with kissing spines.

For the full article on compensatory injuries, see Horse & Hound (10 December, ’09)