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Discussion on Dianosis of deep digital problem

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anne hada
New Member
Username: Lamepony

Post Number: 1
Registered: 5-2003
Posted on Saturday, May 17, 2003 - 11:15 am:   Edit PostPrint Post

My wonderful 9 year old paint went slightly lame on the front right (head bob) almost a month ago. xrays and nerve blocks show nothing. Now I am told it is most likely a deep digital flexor problem. Wouldn't that respond to nerve block of the hoof and fetlock area? Vet says "no". Two vets have looked. One says definitely the deep flexor, the other says "not that" but probably soft tissue injury. What is the best test to isolate the problem? Would ultra sound be the way to go? I am on a limited budget but should I just get him to a clinic or what? He does not seem in distress at all but he bobs all the time. He also has VERY thin soles on the xrays and was poorly shod (all toe). could this have contributed to the injury if it is a deep flexor)? Farrier is now changing angles of feet slowly and put pads on but he's not improving. Any advice would be appreciated.
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 8389
Registered: 1-1997
Posted on Sunday, May 18, 2003 - 8:19 am:   Edit PostPrint Post

The deep digital flexor muscle / tendon unit runs from the elbow to the bottom of the hoof. Whether a nerve block from the fetlock down would localize the lameness depends on where the DDF is injured, for more on this see Equine Diseases Lameness Diseases of the Lower Limb Flexor Tendinitis.

On the other hand without specific localizing signs, just saying it is the DDF ignores that it could be lots of other things too, some of which require different therapies. Since you have eliminated the lameness from the fetlock down it is time to eliminate the cannon as a area. For more on this see, Equine Diseases Lameness Diseases of the Lower Limb Overview of Cannon Lameness.

Proper hoof and pastern alignment is important for many resons, you will find information at, Care for Horses Hoof Care Trimming and Preparing the Feet for Shoes. What the relation between this and your current lameness must wait until a proper diagnosis is made.
DrO
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anne hada
Member
Username: Lamepony

Post Number: 2
Registered: 5-2003
Posted on Sunday, May 18, 2003 - 9:38 am:   Edit PostPrint Post

So far they nerve blocked up to the knee and xrayed the whole leg. Nerve blocking beyond that was not possible due to a lack of cooperation on the part of my equine friend. Would Ultrasound be the logical next step? And again, withour wanting to offend anyone, is one of the little portable machines adequate, or should I just drive to a big clinic or find someone with more high tech equipment? I just want a real answer and nobody who has come out can really give me anything beyond their best guess.
I plan to keep this guy for life regardless of how this turns out, so it is important to make him usable again if possible.
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Robert N. Oglesby DVM
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Username: Dro

Post Number: 8393
Registered: 1-1997
Posted on Monday, May 19, 2003 - 5:48 am:   Edit PostPrint Post

I am confused Anne. In your first post you say it was blocked to the fetlock and in the second you say it was to the knee, it makes a difference to the best next step. I think if you feel uncertain about where your lameness exam is going you get a referral. It's not the size of the machine so much as it is the ability to localize the lameness before dragging the diagnostic imaging out that is important.
DrO
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anne hada
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Username: Lamepony

Post Number: 3
Registered: 5-2003
Posted on Monday, May 19, 2003 - 8:06 am:   Edit PostPrint Post

Sorry if that was confusing...here is what happened...the vet came and did nerve blocking initially. She got as far as his knee and then had to stop. He never went sound. Then she xrayed to the knee. Nothing showed up. She came back and xrayed the hooves (which were only slightly responsive to anything she did with a hoof tester). Nothing on those xrays. She did feel that his soles were extrememly thin and his hooves were in need of work, so I called a new farrier who changed the angles of the feet and put on pads and shoes. A week later he was still limping so I asked a 2nd vet for an opinion. He examined the horse and said it was the ddf. He did not do anything but look though and I still do not have a definitive answer. Both vets say 6 months rest but how will I know if he is really healed if I am not sure where the damage was/is. So that is why I am wondering about a clinic or ultrasound or where to go next.
The ddf sounds to me like it might be the problem but I am still confused as to why that would not have blocked. Since the lameness could not be localized what would be the right thing to do?
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 8398
Registered: 1-1997
Posted on Monday, May 19, 2003 - 7:25 pm:   Edit PostPrint Post

I wish more facts helped us understand your case: if the horse does not block from a high cannon block (4 point high palmar with a ring around the front of the upper cannon), why in earth's name did they spend all that effort radiographing below the knee: the lameness was not there.

Why did they not do carpal articular blocks next? If a accurate diagnosis is what you want you continue up the leg as far as your skills allow you. If you cannot localize the problem with your skills you submit the case to someone with greater skills or more technology. There are points of dimishing financial return: do you spend 10,000 (or 100,000) dollars to diagnose a 5,000 (or 50,000) dollar horse. There are cases that go undiagnosed no matter what you do.

There are very few resolvable lameness problems that are going to get well that won't with rest and time, but there appears to be a lot left to do diagnosically with your case: someone should have blocked out the knee joints. I would also want a repeat of the high cannon block first with testing to prove it has been done properly, call it cheap insurance before you get into more expensive diagnostics.
DrO
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anne hada
Member
Username: Lamepony

Post Number: 5
Registered: 5-2003
Posted on Wednesday, May 28, 2003 - 9:37 pm:   Edit PostPrint Post

Just to update you on how it is turning out... After much insisting, the vet finally came today to do more tests on my still bobbing horse. She did an ultrasound and found some tendon damage in the deep digital flexor. How the second opinion vet knew (or guessed) I don't know but the regular vet was actually very surprised because she kept saying he couldn't know that from just looking. Anyway, now that we know what it is, the rest period will continue. My new question is, what is the normal expected time for a horse with minor tearing to stop bobbing? I understand that he needs to rest well beyond then, I just want to know what to expect (within normal timeframes). Any ideas on what I should expect?
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 8475
Registered: 1-1997
Posted on Thursday, May 29, 2003 - 6:19 am:   Edit PostPrint Post

We have a schedule based on lesion severity to help explain some of the time frames and therapy see, Equine Diseases Lameness Rehabilitating Injuries to the Tendons and Ligaments.
DrO
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anne hada
Member
Username: Lamepony

Post Number: 6
Registered: 5-2003
Posted on Thursday, Jun 19, 2003 - 8:30 am:   Edit PostPrint Post

Updated info...my horse has had two corrective farrier visits since his initial lameness. This second shoeing, we added wedged pads and within 24 hours the horse stopped bobbing. Not that he is ready for work, of course, but we are delighted! The farrier explained that lifting the heels would likely take some of the stress off the tendon. Apparently it did. The wedges were not possible last time because the hooves were crooked.
We still have a long road to full healing and until my daughter can ride again, but when the vet comes back, we are hoping to start some mild rehab work as discussed in the articles.
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 8617
Registered: 1-1997
Posted on Thursday, Jun 19, 2003 - 6:58 pm:   Edit PostPrint Post

Great to hear things look better. I have a question about the wedge pads: did they return the foot and pastern to a normal alignment (did you start with low heels long toe) or are the heels high now?
DrO
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anne hada
Member
Username: Lamepony

Post Number: 7
Registered: 5-2003
Posted on Friday, Jun 20, 2003 - 11:46 pm:   Edit PostPrint Post

We started with a bad shoe job that basically sheered off the heels (leaving all toe)and one hoof was sort of crooked in that the the inside was longer than the outside. The heels are now where they should have been all along but with a wedge pad acting as the heel. The new farrier says that my horse may not be able to grow as much heel as would be ideal but that it is only the second shoeing so he will see what he can do to keep things in normal alignment. Unfortunately I guess now that he is feeling better, the horse decided to show off and ran around like a lunatic yesterday for a few minutes and today he seemed off again. It is very difficult to keep him resting. We used reserpine (sp?) a few weeks ago to try to take the edge off his desire to run since he broke out of his stall(took the door right down) to get away from stall rest and run and after the shot he seemed to be quieter, but he is a very active animal who hates to keep still. There seem to be so many factors at work. So far, I haven't asked anything so here goes...have you ever heard of Shrink-It astringent? I have had a number of people tell me to try it or a good astringent to try to increase circulation in the tendon area. Is this just something to do so you can feel like you are doing something? Or might it be a good thing to try?
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 8628
Registered: 1-1997
Posted on Saturday, Jun 21, 2003 - 9:08 am:   Edit PostPrint Post

No I have not heard of it, but many of these products induce folks to massage more which is good for circulation. Be careful with some of them under a bandage however: many can scurf a leg.
DrO
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anne hada
Member
Username: Lamepony

Post Number: 8
Registered: 5-2003
Posted on Sunday, Jun 29, 2003 - 9:21 am:   Edit PostPrint Post

I am sure it's in the literature somewhere, but I can't find the specific answer I am looking for...Some days Scout looks almost normal, like he is well on the road to healing, then he starts bobbing again. Is he reinjuring his leg? Is this normal?(one step forward, one step back?). I don't think he is running (much) in his little paddock, and I can't leave him in the stall because he breaks the door down after about 24 hours. I am geting alot of pressure to blister the leg but I read about that and would not consider it except I am so frustrated. Even at his worst, one bute tablet will make him sound again but mostly we haven't been using it on the theory if it doesn't hurt he will use it too much...
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 8677
Registered: 1-1997
Posted on Monday, Jun 30, 2003 - 6:42 am:   Edit PostPrint Post

It depends on why he is bobbing Anne. I was never very happy with the magical DDF diagnosis, even with US confirmation, and reading through the history above leaves me wondering if this is the DDF: a lesion large enough to be visible on US should have also caused swelling and lameness when it happened. I wonder if this was an old lesion or perhaps artifact. On the other hand a mild DDF tendenitis might behave this way.

You must get your veterinarian out to examine during one of the lame spells, recheck the lesions that they think are responsible and decide from this information if continued exercise is wise. In general if the horse is obviously trending toward more soundness the exercise is Ok, otherwise time to slow down.
DrO
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anne hada
Member
Username: lamepony

Post Number: 16
Registered: 5-2003
Posted on Tuesday, Dec 25, 2007 - 9:57 pm:   Edit PostPrint Post

looking back I rediscovered that I had posted this....as an update....Scout is now 13 years old. He has been completely sound and barefoot for the last few years. After many dollars spent on various "speciality" shoes I gave up and just let him go natural and let nature try to heal him. Within a few months he was sound and to this day has never been lame again (knock wood). We retired him from jumping and he is now just my trail and hacking around buddy but he is an awesome guy.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 19758
Registered: 1-1997
Posted on Wednesday, Dec 26, 2007 - 9:31 am:   Edit PostPrint Post

Great to hear he is doing so well Anne.
DrO
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