When a healthy horse comes up lame, it is disturbing for everyone
-- the owner, veterinarian, farrier and trainers, instructors and other
riders. Whether it is a top-level show horse, local competitor or weekend
trail companion a sore horse is heartbreaking, especially since many
animals will continue with the same high effort, even though they are
in pain. Lameness may mean an end to a career, and extended lay-up or
time-consuming health care from the owner; all are situations every
horse owner wants to avoid. A savvy owner, though, knows the facts of
her horse's case, and armed with that knowledge, can make caring and
smart choices about the future.
The first step when lameness appears is to get a complete medical work-up,
regardless if it was a slow-developing problem or an acute onset of
pain. A veterinarian can give a much more intensive examination, and
will have the equipment necessary for diagnostic procedures. It is very
important that the owner is prepared to give information regarding the
animal's circumstance. How long has the lameness existed? What leg or
legs are affected, and can it be narrowed down to a rough location?
What are the symptoms -- an "off" feeling while under the rider; head-bobbing
at the walk, trot or canter? Or an unusual stance? Having this information
will often help the veterinarian pinpoint the area to observe and test,
although some vets may prefer to go into the examination blind, leaving
them with an open mind. Sometimes the source of the pain may be very
different from where the lameness indicates.
Diagnostic procedures may vary some from one veterinarian to another,
but will follow a general pattern. First is observation of the animal
at rest and in movement. The horse's attitude when standing unbothered
is very telling, as is his way of going when trotted on straight lines
and circles. While the horse is standing his conformation can be assessed,
and any correlations made between faults and potential problems. Certain
conformational abnormalities may predispose an individual horse to lameness.
A history can also be taken at this time, with the owner describing
the horse's training program, competition schedule and any training
or behavioral problems while under saddle (pain is often the reason
for these problems). This time can also be used to evaluate the horse's
symmetry and temperament. While the horse is standing firmly square,
observe the balance of bones and muscles, and any appearance of atrophy
or disuse. The horse's temperament has a very important influence on
pain indication; a highly-strung individual will usually show stronger
reactions to pain than a more stoic horse.
The horse's movement is watched while he is trotted on a hard, level
surface. On hard ground the footfalls can be both heard and seen. With
the horse's head unrestricted, the handler moves him off at a trot.
The vet will observe his movement from straight on and the side as the
horse moves toward and away from him. The foot of each limb should land
squarely and with equal intensity. Each stride should be balanced, rhythmic
and even. A short stride may indicate a problem with that diagonal.
Circles are also a useful tool for evaluating a lameness. This will
show the horse's flexibility and his ability to move each leg away from
the body or toward the opposite leg.
Next the veterinarian will perform a flexion test. A joint is held partly
flexed for about one minute and then the horse is immediately trotted
off. This process will usually accentuate any existing lameness in the
stressed joint. It is difficult to be specific about the sore joint
since it is impossible to flex only one joint at a time, but it can
still be very helpful.
At this stage, the lame leg should have been identified. To help pinpoint
the exact trouble, spot nerve blocks are used. Local anesthesia is injected
over a nerve, starting at the lowest point of the affected leg. The
nerve impulses are temporarily stopped, allowing the horse to move pain
free. If the pain persists, then further blocks need to be performed
farther up the leg. In the circumstance where the lameness is only eased,
not eliminated, then the problem most likely is not limited to only
one location. In order for this process to succeed, there must be significant
lameness to start with so that improvement can be evaluated.
Radiographs are used once the source of pain has been identified. This
provides a two-dimensional view of the bony structures of the leg. Many
views must be taken to get a complete picture. The radiographs do not
provide much information about soft-tissue injuries or problems within
a joint. Bony changes can be identified, though. Interpretation is a
large part of making a diagnosis with radiographs, and they are most
useful when considered with the other test results. Some very slight
lamenesses may show up as insignificant alterations in the bone -- enough,
though, to cause discomfort to the horse.
All these tests can be performed by a veterinarian in private practice,
either at the barn or at the clinic. If at this point results are still
inconclusive, it may be necessary to haul the horse to a teaching hospital
where more in-depth testing is available. One of the more advanced methods
of diagnosis is nuclear scintigraphy or bone scanning. A radioactively
labeled bone-seeking substance is injected into the jugular vein and
is distributed to the bones after several hours. The radioactive substance
accumulates in areas of increased bone activity or blood flow to the
bone, which is then detected by a gamma camera. This test is more accurate
for acute injuries than chronic problems. Nuclear scintigraphy is potentially
more descriptive than radiography, but cannot be used as a replacement.
The two techniques should be considered complimentary.
Soft-tissue damage can be evaluated using diagnostic ultrasound. The
ultrasound waves are reflected from the tissue and played back on a
monitor. The images must be of high quality to accurately assess the
damage. Enlargement of a tendon or poor definition of the structures
can be determined with this as well. Progress is also monitored with
ultrasound during periodic evaluations.
Once the veterinarian makes a diagnosis, the farrier can be a horse's
best friend. With his expertise, many options may be open to the horse
and owner. Therapeutic trimming and shoeing may make the horse more
comfortable, usable once again, or even return him to his former level
of activity. Many types of shoes exist that will relieve pain and allow
the horse to move more naturally. However, it requires a very knowledgeable
professional to perform this work, as well as one who can discuss the
case with the attending veterinarian. The vet may write a specific prescription
for the farrier or leave him to make the shoeing decisions. Either way,
it is essential that the veterinarian and farrier maintain a good working
relationship. The owner's patience is also an essential requirement
for the farrier's success. Often there is more than one way to address
a lameness; the farrier will usually choose the simplest and least expensive
method first. If that does not work, he will move up the scale to more
intensive methods. However, it will probably require several months
to find the best therapy, and the owner must show patience through this
process.
When a horse is diagnosed with a chronic lameness, the owner needs to
take serious stock of his/her horse's life. It may be possible for the
animal to remain at the same activity level with veterinary and farrier
assistance, but usually some adjustments will need to be made. If the
horse competes, it may be necessary to drop to a lower level or even
leave the show ring entirely. In this case is the owner willing to scale
back his/her own goals to fit with the horse's altered abilities? At
this point, selling the horse is often considered. It is unfair to expect
the horse to perform when burdened by lameness, and a more suitable
home should be found.
Many times a horse that has a manageable lameness problem but is well
trained with a kind disposition will make a good mount for someone learning
the ropes of a sport, looking for a school horse. However, be certain
to inform a prospective buyer of the problem and be sure that he or
she is prepared to provide the care necessary, Sometimes a change in
discipline is sufficient to keep a horse in work and useful. A show
jumper with a forelimb lameness may perform in the lower levels of dressage.
Or a performance competitor may find a niche as an equitation mount.
And, using care and caution, most horses can be suitable trail mounts.
Retirement is sometimes the only option for extreme cases, or with degenerative
conditions.
Living with lameness is possible when the owner knows the facts. That
is why a veterinary diagnosis is so crucial to the horse's well-being.
Neither the owner nor the farrier can make sound decisions without that
baseline. It is also essential that all three can work together in the
horse's therapy and maintenance. But it is ultimately the owner's responsibility
to keep the animal's best interests in the forefront and make the choices
that will benefit the horse.
