1	Common Lameness of Older Horses Fernando A. Castro, V Resident, Large Animal Surgery UTCVM - LACS
2	Lameness “If your horse is lame in his shoulder, take off his shoes… Young and inexperienced practitioners are quite too apt to commit the error of overlooking the examination of the foot, looking upon it as a matter of secondary importance, and attending to it as a routine and formal affair only.” A. Liautard, 1888.
3	What is Lameness? Lame(adj.): crippled or physically disabled,as a person or animal,… in the foot or leg so as to limp or walk with difficulty. Lameness: incapable of normal locomotion, deviation from the normal gait. Claudication: limping or lameness.
4	What is Lameness? “Lameness is therefore not so much an original evil, a disease per se, as it is a symptom and manifestation of some antecedent vital physical lesion, either isolated or complicated, affecting one or several parts of the locomotive apparatus.” Liautard, 1888.
5	How to Diagnose Lameness? History, physical exam, manipulative tests, joint and nerve blocks, diagnostic imaging. Characteristic gait abnormalities (sweeny, fibrotic myopathy, upward fixation of patella, stringhalt, etc.).
6	Physical Exam
7	Physical Exam
8	Physical Exam
9	Lameness Exam Baseline x induced lameness Manipulative tests Coexistent lameness (compensatory or secondary).
10	Baseline x Induced Lameness
11	Baseline x Induced Lameness
12	Joint and Nerve Blocks
13	Diagnostic Imaging
14	Diagnostic Imaging
15	Diagnostic Imaging
16	Diagnostic Imaging Computed Assisted Tomography Magnetic Resonance Imaging
17	Common Problems of Older Horses Arthritis/arthrosis (degenerative joint disease, DJD). Navicular disease (caudal heel pain). Laminitis Severe soft tissue injuries.
18	Arthritis/arthrosis (DJD) Causes and predisposing factors: conformation, trauma (repetitive impact or acute trauma), overload, etc. Clinical signs: joint distension, pain, heat, reduced range of motion (stiffness). Affected joints: knee, fetlock, hock (bone spavin), pastern (ring bone), stifle, etc.
19	Conformation
20	Clinical Signs
21	DJD - Diagnosis Clinical signs Lameness exam Diagnostic imaging
22	DJD - Treatment Non-steroidal anti-inflammatories. Intra-articular corticosteroids and hyaluronic acid. Systemic hyaluronic acid and glucosaminoglycans (Legend, Adequan). Corrective trimming & shoeing. Exercise Nutraceuticals (glucosamine & chondroitin) Physical therapy and alternative therapies. Arthrodesis
23	Navicular Disease What is it? First reported 230 years ago. Responsible for approx. 1/3 of chronic lameness. Navicular apparatus. Cause(s): ???? Multifactorial: conformation, stress and non-adaptative remodeling, hereditary.
24	Navicular Apparatus
25	Navicular Apparatus
26	Navicular Apparatus
27	Navicular Disease – History & Clinical Signs Bilateral forelimb lameness (one side worse). Age: 7-9 years. Quarter Horse, Warmblood and Thoroughbred cross. “Choppy” gait (short stride). Worse on hard surfaces and when circling. Worse with rest. Hoof imbalances. “Pointing” of the feet. Hoof testers: +/-
28	Clinical Signs
29	Hoof Conformation and Navicular Disease
30	Navicular Disease – Diagnosis History and clinical signs. Lameness exam and nerve blocks (intra-articular and intra-bursal blocks). Diagnostic imaging (radiography, scintigraphy – “bone scan”, MRI). Response to treatment and trimming/shoeing changes.
31	Navicular Disease – Hoof Testing
32	Navicular Disease – Manipulative Tests
33	Navicular Disease - Anesthetic Blocks
34	Navicular Disease - Anesthetic Blocks
35	Navicular Disease - Radiography
36	Navicular Disease - Radiography
37	Navicular Disease- Radiography
38	Navicular Disease - Radiography
39	Navicular Disease – Changes
40	Navicular Disease – Treatment Corrective trimming and shoeing. (shorten toe, preserve heel, maintain balance of hoof, elevate heels, Non-steroidal anti-inflammatories + exercise. Intra-articular (coffin joint) or intra-bursal injections. Nutraceuticals. Isoxsuprine, pentoxyfiline, warfarin. Neurectomy (“nerving”).
41	Navicular Disease - Shoeing
42	Navicular Disease - Shoeing
43	Laminitis What is laminitis? Anatomy of the hoof: tough, flexible, connective tissue apparatus suspends the coffin bone inside the hoof wall.
44	Anatomy of the Foot
45	Anatomy of the Foot
46	Laminitis – Clinical Signs Pain (stiff gait, shifting weight to rear legs) of acute onset, usually on both front but can occur on all four or one limb only. Lameness accentuated as animal turns or on hard surface. Increase in digital pulses, warm hooves. Clinical signs are usually diagnostic. Usually secondary to a disease process (colic, retained placenta, Cushing’s disease, etc).
47	Laminitis – Clinical Signs
48	Laminitis – Radiography
49	Laminitis – Rotation of Coffin Bone
50	Laminitis – Rotation of Coffin Bone
51	Laminitis - Chronic
52	Laminitis - Treatment Treat primary problem (iv fluids, uterine lavage, pergolide – Cushing’s, etc). Anti-inflammatories, hoof support (Styrofoam, dental impression material, plaster of Paris, Lily pads). Cold therapy during developmental phase. Vasodilators (acepromazine, Isoxsuprine, glyceryl trinitrate patches) when clinical signs are evident.
53	Laminitis – Prognosis and Long Term Management Radiographic monitoring +/- venogram. Trimming & shoeing (very important!!!). Deep digital flexor tenotomy. Prognosis and management.
54	Trimming & Shoeing
55	Radiographic Monitoring and Venogram
56	Questions????