This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Hoof » Pedal Osteitis »
  Discussion on Club foot, contracted heels and pedal osteitis
Author Message

Posted on Monday, Feb 19, 2001 - 4:35 pm:

I have a 6 year old off-the-track TB who has been three-legged lame for 3 months. I purchased him sound 5 months ago, but he began stumbling on his club foot after 4 weeks or so of regular work and progressed to being acutely lame (grade 3 or 4 of 5) after the 6th week. He had been barefoot for at least a year prior and had only been in shoes for 2 or 3 months when I bought him. His hoof quality was poor (brittle, crumbly) and the hoof wall on the club foot is very thin. (He has been on supplements since... seems to have improved slightly). His frog is also quite elongated and the sulci are deep; while the farrier thinks the foot is certainly narrow and upright, he has hesitated to call it true contracture, but I'm not so sure.

Since the time of the most acute lameness there has been mild heat in the foot and a pulse. He has been guarding his use of the foot for so long that pain is referring into his knee (refuses to hold it up for cleaning, farriery, etc. and takes abbreviated strides with it) which allowed for a misdiagnosis previously. After HA injections in the knee failed, I got a second opinion and better radiographs. The new pictures show there to be no significant disease in the knee, and a subsequent PD block cleared-up the lameness immediately. The foot films show a 1-to-2 degree rotation of the coffin bone and significant pedal osteitis, not involving the joint.

It seems to me that his history of DDF contracture, combined with neglected hoof care, has caused a progression of disease: starting with the clubbing of the foot, leading to heel contracture and ending with coffin rotation, all causing chronic inflammation and hence pedal osteitis -- an unfortunate chain of events. My vet, who admittedly is conservative, thinks with heart-bar shoes we might be able to make him pasture sound at best. From your experience and research, what is a realistic prognosis and course of treatment for an animal with such a "kitchen sink" for a foot?

Posted on Monday, Feb 19, 2001 - 9:40 pm:

Jennifer,
what has been done to localize the pain to the foot? Though the foot certainly sounds suspicious none of the findings you list are absolute proof that the pain comes from there or that the knee has been effectively ruled out. See, Equine Diseases: Lameness: The Diagnosis of Lameness in the Horse for an in depth discussion of my points.
DrO

Posted on Tuesday, Feb 20, 2001 - 2:12 pm:

Dr. O,

I read your articles and we seem to have covered all of the diagnostic bases, outside of scintigraphy and thermography, but correct me if I'm wrong...

1. We started with inconclusive results with hoof testers.

2. We moved to a flexion test, which he failed when he first went acutely lame three months ago. But -- and this is the confusing part -- he passed the flexion the month before upon pre-purchase, and also passed the flexions we did last week while the PD block was in effect.

3. Carpal radiographs were relatively clean... slight evidence of arthritis beginning, but nothing out of the ordinary for a horse who had raced young, and certainly no chips or cartilige spurs which might explain his severe degree of lameness.

4. When the HA injections were done, the synovial fluid which we sampled was normal (clear, slightly yellow).

5. We performed a basic PD block with a dramatic return to soundness.

6. Subsequent films of the foot showed the pedal rotation, significant osteitis and air lines in the hoof wall, either from graveling/seedy toe or remnants of the 'laminitic episode' which caused the rotation.

Armed with these scientific results, we looked at the anectodal evidence:

1. Since all of this started, he has always looked markedly worse on hard ground than on soft arena footing.

2. The heat and pulse in his foot have remained constant, while in the knee there has been no swelling and only intermittent mild heat.

3. Before the PD block he was dead lame at the walk and quite reluctant to trot, while afterward he was completely sound at the walk and instantly willing to trot.

4. Although hoof testers never provided a clear-cut response, he seems tender when I'm cleaning certain areas of his very deep sulci with a pick. (I use thrush remedies on a regular, preventative basis because I know he is pre-disposed with those deep grooves... I don't think the "tenderness" is infection-related because I try to be hyper-vigilant about clean, dry feet).

5. His club foot is so upright that keeping his knees aligned is a challenge... it is inside the realm of possibility that because the club-footed leg's knee is higher than the normal leg's, that it could be causing the vague knee symptoms just because he is forced to stand crooked.

Admittedly, we've got a mixed bag of elements here. We're considering sending both the knee and foot films to Rochester for evaluation in case there's something there that my vet has missed... but it seems when you consider both the scientific and lay observations that the osteitis (paired with his hoof deformity) is the culprit. I'm just trying to get as much information as possible so I can make a decision about his future... obviously he's not going to be an open jumper, but if there's any chance at all of him being salvageable it's my responsibility to try.

Thanks so much for your time and consideration.

Posted on Wednesday, Feb 21, 2001 - 7:59 am:

That was what I wanted to see: We performed a basic PD block with a dramatic return to soundness. Now that I go back and reread the first post I see, it was there all the time.

Remember: pedal osteitis is not a disease but a description of a disease process, if you feel it is the problem then you need to determine the cause of the pedal osteitis to formulate a plan and prognosis. While working on your most likely diagnosis, I suggest you reevauate frequently, consider some unusual radiographic views (I like having the current set reviewed), and any suspicious areas should be carefully explored: do not rationalize away the cause for tenderness.

A 1 to 2 degree rotation is really a nonstarter as this falls below the accuracy with which you can measure these things in a typical field situation so I wonder about these air lines in the wall: that is a very significant finding.

Occasionally horses are difficult to examine with hoof testors because
1) they are just normally sensitive to the feel, 2) the whole bottom of the foot has become sore, 3) they have had a sore spot hit so often they really would rather not do it anymore
Sometimes a little bit of acepromazine and a knowledable handler (not an owner who insists on not paying attention to the horse but what you are doing) can turn a hoof exam around and produce useful information.

Hope I have hit something useful, I am just really rambling around blindly.
DrO

Posted on Wednesday, Feb 21, 2001 - 1:32 pm:

Thanks Dr. O...

We've tried the hoof testers in a bunch of combinations: with and without NSAID therapy, with and without tranquilization, etc. -- that's why the non-specific results have been a little puzzling... sometimes he flinches, sometimes he doesn't.

Considering all that you've suggested and advised, we're going on the assumption that past racing and training on the clubbed foot, paired with the subsequent year he spent jumping barefoot, have caused the progression of inflammation and deformity to the point of acute, possibly irreversible lameness. So I guess my real question is: do you think heart-bar shoes will alleviate his heel pain and allow his contracted heels to expand adequately, or should I be looking for other alternatives? I've had everything suggested from neurectomy to euthanasia... Obviously from where you are it's difficult for you to make predictions, but I'm just trying to gauge what's realistic for me to expect or even consider.

Yours appreciatively, JFD

Posted on Thursday, Feb 22, 2001 - 9:25 am:

All you can do is experiment JFD. I cannot find a rationale for a heart bar but since we are not sure where the pain is coming from....Why not just a regular bar shoe? to protect the sole?
DrO
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC