Common Lameness of Older Horses

Fernando A. Castro, V

Resident, Large Animal Surgery

UTCVM - LACS

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.

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.

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.

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.).

Physical Exam

Lameness Exam

Baseline x induced lameness

Manipulative tests

Coexistent lameness (compensatory or secondary).

Baseline x Induced Lameness

Joint and Nerve Blocks

Diagnostic Imaging

Diagnostic Imaging

Computed Assisted Tomography

Magnetic Resonance Imaging

Common Problems of Older Horses

Arthritis/arthrosis (degenerative joint disease, DJD).

Navicular disease (caudal heel pain).

Laminitis

Severe soft tissue injuries.

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.

Conformation

Clinical Signs

DJD - Diagnosis

Clinical signs

Lameness exam

Diagnostic imaging

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

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.

Navicular Apparatus

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: +/-

Clinical Signs

Hoof Conformation and Navicular Disease

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.

Navicular Disease – Hoof Testing

Navicular Disease – Manipulative Tests

Navicular Disease - Anesthetic Blocks

Navicular Disease - Radiography

Navicular Disease- Radiography

Navicular Disease - Radiography

Navicular Disease – Changes

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”).

Navicular Disease - Shoeing

Laminitis

What is laminitis?

Anatomy of the hoof: tough, flexible, connective tissue apparatus suspends the coffin bone inside the hoof wall.

Anatomy of the Foot

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).

Laminitis – Clinical Signs

Laminitis – Radiography

Laminitis – Rotation of Coffin Bone

Laminitis - Chronic

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.

Laminitis – Prognosis and Long Term Management

Radiographic monitoring +/- venogram.

Trimming & shoeing (very important!!!).

Deep digital flexor tenotomy.

Prognosis and management.

Trimming & Shoeing

Radiographic Monitoring and Venogram

Questions????


	Fernando A. Castro, V
	Resident, Large Animal Surgery
	UTCVM - LACS


	“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.


	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.


	“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.


	History, physical exam, manipulative tests, joint and nerve blocks, diagnostic imaging.
	Characteristic gait abnormalities (sweeny, fibrotic myopathy, upward fixation of patella, stringhalt, etc.).


	Baseline x induced lameness
	Manipulative tests
	Coexistent lameness (compensatory or secondary).


	Arthritis/arthrosis (degenerative joint disease, DJD).
	Navicular disease (caudal heel pain).
	Laminitis
	Severe soft tissue injuries.


	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.


	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


	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.


	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: +/-


	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.


	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”).


	What is laminitis?
	Anatomy of the hoof: tough, flexible, connective tissue apparatus suspends the coffin bone inside the hoof wall.


	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).


	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.


	Radiographic monitoring +/- venogram.
	Trimming & shoeing (very important!!!).
	Deep digital flexor tenotomy.
	Prognosis and management.