# Chronic Lameness - Cool to the Touch - Circulation Problems?



## bubba13 (Jan 6, 2007)

I'll try to make a very long story short. I have an 18-year-old who has been lame for years now, somewhat progressively worsening, but for the most part holding largely steady. Unrideable due to his problem. It's a lower leg lameness, but not true heel pain, and various vets have diagnosed it as "navicular," "low heels," "thin soles," "soft tissue damage," and a myriad of other problems, none of which actually fit his situation. Multiple visits to four different vets, with radiographs and ultrasounds, have proved inconclusive. All standard treatments have failed to bring him more than very minimal and short term relief: coffin bone injections, navicular bursa injections, mesotherapy and regular back injections (he has significant back pain as well, and I think it's a chicken-and-egg thing with his legs and back playing off each other and making each other worse), isoxsuprine, Tildren, joint supplements, magnesium supplement, daily bute, eggbar shoes, wedge shoes, soft pads, barefoot...even tried freezing his nerves but it didn't take. No one knows what he hell is wrong with him, and we've tried all the recommended treatments for things that *could* be wrong with him, to no avail.

I've noticed recently, though, that his legs are cool to the touch--cooler than the other horses'. Same with his ears. And maybe I'm grasping at straws, and maybe it's just within the realm of normal equine body temperature deviation, but I wonder if he could have some kind of circulation problem that all of the vets have missed, and that is at least contributing to his lamenes issues? He's never had thermography as a diagnostic; no one has ever recommended it. And I thought that isoxsuprine was used specifically to improve blood flow, and it didn't do a thing for him. But has anyone heard of such a thing as I just described--is it a tenable theory?


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## Indyhorse (Dec 3, 2009)

I have never heard of it, but it stands to reason that if his circulation is poor enough to make the the temperature difference that noticeable, it could well be a contributing factor to his lameness. Although it could also be another symptom. I have nothing intelligent to suggest, but am subbing so I can see what wiser people have to say.


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## bubba13 (Jan 6, 2007)

I've heard of something called "Sympathetic Nerve Dysfunction." Don't know much about it. 

Equine Infrared Imaging, Equine Thermography, Animal Thermography,

Southern Hills Equine Veterinary Clinic - Our Services

I don't know if it's generally just one limb, or one area that's affected...or if it could be body-wide...?


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## corinowalk (Apr 26, 2010)

I am on the same page as Indy. I can see how poor circulation could lead to undiagnosable lameness. You would think some sort of blockage would show up on an ultrasound though.


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## AlexS (Aug 9, 2010)

I have nothing of any use to offer either, but is his lameness always the same leg or does it switch between the legs?


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## bubba13 (Jan 6, 2007)

It's both front legs, for sure, but it seems to be worse in the right. And you have to nerve block him higher in the right to get pain relief and soundness--they he switches to being crippled on the left.

Dunno if he has back leg trouble or not. When they're so bad on one, it's hard to tell if the others are "fine," or just less affected.


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## corinowalk (Apr 26, 2010)

I have to say, those Thermographs are super cool...but probably hella expensive.


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## bubba13 (Jan 6, 2007)

Probably way cheaper than an MRI, I'd bet!


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## corinowalk (Apr 26, 2010)

True. Is that vet clinic close to you? I think if it were affordable, it would be worth the experience.


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## Indyhorse (Dec 3, 2009)

You know, (and this is so a tangent so, forgive me, but I do have a point) over my lifetime I have had some bizarre, hard to diagnose medical problems. I also suffer from chronically low blood pressure (runs in all the females of my family - I tend to have a resting bp of 65/40). The low blood pressure has caused some problems in otherwise diagnosing relatively simple things with me. Raised bp, for me, tends to still be well within the "healthy" range for normal people, so it often gets shrugged off. But I have wondered in the past, if all my problems could actually be tied TO my low BP. One of the problems I have is I tend to get very bad cramps in my legs that are difficult to get rid of with anything other than a warm bath. Because of the low BP, I also have a lot of trouble regulating my body heat and will get chilled on even a cool summer evening, and when I get badly overheated I have to put ice on my pulse points because my body can not readily cool.

I am just thinking, it stands to reason it could be the same with a horse. I have no proof that my OWN problems are linked to my low BP, I just suspect that to be the case, so I certainly have no proof or even guesses to offer up in terms of your boy. I think the infrared imaging is intriguing, though, and I think the theory is definitely worth following up on.


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## AlexS (Aug 9, 2010)

found one site that claims it is $300 for the entire horse. 
Other UK sites are in the 65 pounds sterling for pair of front legs - about double it for $ exchange rate, depending on the day. 

I'd say the theory makes common sense and for the amount you have invested in the horse already to diagnose him, it's certainly worth it.


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## bubba13 (Jan 6, 2007)

Ha! Thanks for price-checking.

There's a vet near here, and I've heard in the past that he does it. Rebel has seen him, though, and he never once mentioned that it was worth a try. Instead he fixated on how thin his soles were, and though Rebel shows no tenderness or response to hoof testers, thought for sure we could fix him with wedge shoes and pads. Been there, done that, did it again--nope.

I wonder if his equipment is good, though? Guess I should probably call him. And this is a petty issue, now, when a horse's comfort/life is at stake, but after some "personal life" crap this vet has pulled, and after finding out what a total *** he is in his non-vet time, I don't exactly relish seeing him again...


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## Katze (Feb 21, 2011)

Bubba I read somewhere about equine thermography! (i'll try and find the site I found it on)

Pinched/blocked nerves reducing blood flow to the legs, and the legs feeling cooler then "normal". On the horse with the reduced blood flow the legs were blue in the thermagraph, and "normal" horses were red/orange.


Have you tried a chiro/acupuncture and/or massotherapist for your horse?

Found one site with info: http://www.theinnerpicture.com/

Here's info about pinched nerves (same site): http://www.theinnerpicture.com/equine_thermography.htm


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## bubba13 (Jan 6, 2007)

I don't know anyone around here who does accupuncture, and I've very wary of things like chiro and massage therapy, unless I know several folks (reputable, smart horsepeople) who have seen the individual's work and will vouch for its effectiveness. The couple of times I've tried chiro in the past, I saw no results. Though it's been years.

Thanks for the link--I'll check it out.


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## Katze (Feb 21, 2011)

Eh I heard it's hit and miss as well but worth a shot if the person doing it was reputable. Good luck with your horse, keep us posted *sends healing vibes* !


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## corinowalk (Apr 26, 2010)

I wonder if the lack of circulation could cause thin soles. A good hoof would need good nutrition...nutrients can't reach the hoof if the circulation is that crappy.


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## bubba13 (Jan 6, 2007)

See, and I don't even know that his soles are even all *that* thin. His radiographs just showed not much space between the coffin bone and the ground. But generally, his hooves seem hard and healthy.


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## Horseman56 (Jul 25, 2011)

Regarding concerns of improper flow through the vascular bed, have you had a digital venogram performed? The test removes much of the guess work around blood flow and provides more useful information than thermal analysis.

Can you post lateral and dorsal/palmar radiographs for review?

Cheers,
Mark


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## bubba13 (Jan 6, 2007)

Hey Mark! I knew if I put the right key words in the title I wouldn't have to crosspost, and I'd attract the attention of you farrier-types. :wink:

('Moz' here, with the brown white-faced horse.)

No venogram--is the average local equine vet equipped to perform that test, or is it more a hospital thing? I've heard a bit about it, but not much, and don't really know what it entails.

Radiographs....the last time I tried to find them, I failed miserably. I'll see if I can rustle them up again, but I'm not holding my breath.


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## bubba13 (Jan 6, 2007)

One more question while I look--if my wild hypothesis *is* correct, is this even a treatable condition?


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## corinowalk (Apr 26, 2010)

Both of the sites you posted seem to suggest that acupuncture made a major difference in blood flow.


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## Horseman56 (Jul 25, 2011)

bubba13 said:


> Hey Mark! I knew if I put the right key words in the title I wouldn't have to crosspost, and I'd attract the attention of you farrier-types. :wink:
> 
> ('Moz' here, with the brown white-faced horse.)


Hello Moz. Always good to hear from you.



> No venogram--is the average local equine vet equipped to perform that test, or is it more a hospital thing? I've heard a bit about it, but not much, and don't really know what it entails.


Are they equipped? It's more a matter of knowledge/skill than specific equipment. A venogram is basically a radiograph with focus on the vascular system. The vascular system is made radio-luminescent via injection of a contrast dye, typically Reno-60.

The process is well described here...

NANRIC INC - THE TIPPING POINT: HOW VENOGRAMS MAKE THE DIFFERENCE BETWEEN SUCCESS AND FAILURE WHEN TREATING LAMINITIS



> Radiographs....the last time I tried to find them, I failed miserably. I'll see if I can rustle them up again, but I'm not holding my breath.


I remember that. Yours is a tough case for anyone, vet or farrier, but you know me... I like a challenge. :wink:

Cheers,
Mark


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## bubba13 (Jan 6, 2007)

I'll have to look into the venogram. Maybe I can ask the other pretty good, but slightly less morally questionable, vet. And I can ask nicely about a new copy of the radiographs while I'm over there.... 

Cori, I've actually heard increasingly good things about acupuncture...just again, how do you find a reputable practitioner?


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## corinowalk (Apr 26, 2010)

Acupuncture, like the rest of them, are going carry a good reputation with them. I'm still trying to find out more on this disease. If massage can help, trust me, you can do massage. Its really really hard to screw up.


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## Deslumbrar (Jul 31, 2011)

Have you tested him for Lyme (Borrelia, Bartonella, Babesia, etc)? Im kind of grasping on this one (I was recently diagnosed so its on my mind alot) but it has a tendency to cause a lower body temp, can cause decreased circulation, joint issues, muscle/tendon pain. Among many, many other things. But having tried so many different things, you might consider looking into that.

Or even just putting him on a few weeks of antibiotics to see if the issues show any response, since testing can be so hit and miss.


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## bubba13 (Jan 6, 2007)

That's an interesting and valid thought, Deslumbrar, but I don't think it fits in this case.

Here's the update, if you can call it that....

Yesterday I spoke to a cattle vet, who does some horse work as well. He said that if it was a circulatory problem, either he'd warm up out of it or his foot would die and rot off. I don't know if that's entirely correct, but it certainly makes sense. I think that theory was kinda crap, anyway, the more I ponder it....his legs are even _consistently_ cooler--I just happened to notice it several days in a row. Back to the drawing board.

So here's the new thing. I've mentioned how in the past we've tried all different kinds of shoeing arrangements, including barefoot. Well, he was just as sound/lame barefoot as ever, and since his current wedge aluminum shoes didn't seem to be doing much good, the farrier and I decided we might as well pull them again. This was, what, a week or so ago? Before making the decision, he pulled the shoes and watched me trot the horse in hand--no change from being shod, so it seemed like the right decision, and neither of us expected anything horrible to happen.

Oh, but it has.

A few days ago I noticed that he was way, way off on his right front. Usually he's crippled on both, but slightly worse on the front. But this is beyond being "off." When standing, he appears to bear full, even weight on both legs. When walking, he's a little short-strided and choppier on the right, and when you turn him you can really seem him gimp and hobble. But now at the trot and lope, instead of being just toe-stabby and stumbly, he's almost seeming to try to keep all weight off the right front, and just hold it in the air. This makes him hunch his back horribly, and he also looks drastically lame in the hind--but I suspect that this is just compensation for the front end problem. It's hideous to watch. 

I thought I'd give him a few more days to see if he just needed to toughen his feet up or something, then call the farrier to put the shoes back on. But with no improvement, I did a close examination of his legs today....and was appalled at what I saw. On the right front, now, there is a new subtle (but now glaringly obvious) swelling around the fetlock. Two small bumps on each side. They are in the approximate location (and are about the same size and shape) of wind galls...but have the sinking feeling that they aren't wind galls. They are fairly soft, and moveable, but I can feel soft tissue of some sort "popping" around under the skin if I play with them. If there's heat, it's very minimal. I can't tell if they're painful or not, but at least they don't cause him excrutiating pain upon palpation.

I don't know what to make of it, but the potential scenarios don't seem great. Now I'm worried about that old bone spur the vets said he had, and how it seemed risky for rupturing the DDFT....now if it was ruptured currently, I assume he'd be completely non-weight bearing, and even lamer than he is. Now could he have torn it, or injured it in some way? Gah, I don't know. Makin' me sick.

The vet will be out tomorrow evening....


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## bubba13 (Jan 6, 2007)

So....that was a bust.

Vet comes out, looks at him, confirms fluid/swelling in the DDFT/SDFT sheath, says it's almost certainly "just a progression" of his navicular, and that was that. I was fully prepared for a several hundred dollar vet bill--I wanted to go all out, with radiographs, ultrasounds, and nerve blocks, if necessary. But the vet kept saying that she saw no benefit to pursuing further--"we can if you _want_ to, _but...._"

I asked about doing a venogram, but she said that's not much use (in her opinion) for much other than "telling you when it's time to give up on a foundered horse," and she didn't think it would show much in Reb's case, anyway.

She kept trying to discourage me from considering a neurectomy, due to the risk of neuromas or potential tendon rupture due to his "possible" bone spur (she and several other vets swear that it's there and dangerous, another very good lameness vet, looking at the same X-rays, thought they were all nuts and said he'd have no qualms with nerving this horse). So I wanted to take more radiographs to see what the bone is like now, to see if nerving is an option, but she kept balking and said to "wait until he's lame at a walk." Well, he's lame at a walk now, but I guess not lame enough for her?

So finally we just came to the very unsatisfactory decision to look at his old radiographs (I think they're from two years ago). She's going to give me a copy and review them tomorrow. 

On the only positive note I can find, at least Rebel is still enjoying life. He's bright-eyed, healthy, fat, and a total PITA. He does get around pretty well at a walk. I'd like to see him sound again....but I guess that's never going to even come close to happening. :-(


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## HollyBubbles (Jun 22, 2009)

Just subbing to see what comes of this... Wishing you luck in any remote signs of progress

But as for acupuntcure, I have it once a week because of my back and it's really helping. The first time I had it done I was really sore the day after, but ever since then I've been improving quite quickly. So if you can find an acupunturist then I would say it's worth a go (although keep in mind I'm human and he's a horse, so we have completely dirrerent bodies :lol: )


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## bubba13 (Jan 6, 2007)

Shiznit. I should have asked about acupuncture (though I suspect he's so far gone in the case that he's past the point of being helped). This vet doesn't do it acupuncture; but I think there is one in the area who practices it.


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## HollyBubbles (Jun 22, 2009)

bubba13 said:


> Shiznit. I should have asked about acupuncture (though I suspect he's so far gone in the case that he's past the point of being helped). This vet doesn't do it acupuncture; but I think there is one in the area who practices it.


You would be suprised, sure there's a possibility that he's too far gone or that he may not benefit from it, but you never know till you ask or try right? Before I started it I would come home from school in so much pain I could hardly move, couldnt breath very far in at all and was so exhausted from trying to fight the pain all day I would go straight to bed... at 3.30pm
Plus the amount of days I had off school and riding because of it was amazing.. Mum literally dragged me into the acupuncturist and now I'm glad she did


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## Horseman56 (Jul 25, 2011)

bubba13 said:


> So....that was a bust.
> 
> So finally we just came to the very unsatisfactory decision to look at his old radiographs (I think they're from two years ago). She's going to give me a copy and review them tomorrow.


If there have been significant changes, 2 year old xrays aren't likely to have a lot of value.



> On the only positive note I can find, at least Rebel is still enjoying life. He's bright-eyed, healthy, fat, and a total PITA. He does get around pretty well at a walk. I'd like to see him sound again....but I guess that's never going to even come close to happening. :-(


Sounds as though you're willing to invest in what he needs if there's any reasonable chance of the horse meeting your performance expectations.

If so, trailer him to Dr. Reddens facility in Kentucky. I won't say the guy does miracles. but he's more aggressive than most and has lameness experience matched by few in the field. 

Given the cost invested thus far and, if you can't see the return on investment in this horse, one might also consider another horse that can perform.

I know this has been a tough road for you. Wish I had better advice.

Cheers,
Mark


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## bubba13 (Jan 6, 2007)

Oh, he's not going to perform. I doubt he'd even be rideable beyond a pasture-amble. I'd just like Old Faithful to be comfortable in his final retirement years, however many he has left (this would be a lot easier to take if he were, say, 25, instead of his actual 17 or 18). Hence my desire to do a neurectomy, even if it might ultimately shorten his life--gotta look at quality more than quantity. But not if the vet's squawking about it being a horrible idea.

I know the old films won't tell us much of anything, but I'm curious to see if I/you/anyone can spot that old nefarious "bone spur" that's supposed to be lurking and waiting to strike. When we took some shots late last year, which admittedly were not the same view, the other vet could not see the problem spot, nor did he see significant damage/remodeling to the navicular bone, nor did he see the bone spur problem on the original films. So I dunno what the heck is up with that. 

If money was truly no object, I'd get him MRI'd. But truth is that he's a worthless, though much-loved, horse, and truth is also that, unless there's a significant probability of getting him some relief, I can't afford to be throwing even more money at his problem--I'm supposed to be saving money for grad school, living expenses, and all that fun "growing up" stuff. And then again we look at: Is this thing even treatable, no matter what it is? It's gone on long and bad enough that I imagine that even surgical intervention isn't possible, if that was even an option to begin with (my vet was talking about cutting accessory ligaments as a new procedure).

What do you know about shockwave for long term relief? When I've read about it in regards to navicular horses, the study seemed to say that it worsened the appearance of the radiographs, but the horses got sounder. Then again, I know that it has short-term numbing effects, so is it really doing any good in the long run? Have you heard anything one way or the other?

As for Dr. Redden, short of more X-rays, more ultrasounds, and more nerve blocks, is there anything novel he could even hope to try for diagnostics (and then we get back to: Even if we know what it is, can we do anything about it?)? I think I told you how my farrier was going to try a roller shoe with Reb, based on Dr. Redden's design, but ended up nixing that idea after having a really bad experience with the shoeing job, even with Dr. Redden's involvement and direction. Could certainly be a fluke, though. I did get in contact with Chris Gregory, and he too feels we have exhausted our shoeing options....said I'm welcome to haul over there, but there's not much different he could do.

*sigh*


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## bubba13 (Jan 6, 2007)

Finally got those X-rays. Of course, the vet wasn't there to talk about them, like we had planned....

The farrier is also coming tomorrow, probably to wedge him back up. Poor ol' Reb is deteriorating so rapidly I'm afraid I'll have to euthanize him quite soon, unless something drastic happens....I just don't know what drastic steps we could take, as this vet seems to vehemently against nerving him.

This first set was taken in March of '09.


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## bubba13 (Jan 6, 2007)

And these were taken in July of '09. There supposed to be some kind of horrible, awful, very bad bone spur on the RF navicular bone.


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## coffeegod (May 6, 2011)

Jeez, bubba. I wish I could offer more than sympathy. My only suggestion is email Dr. Redden and ask if he thinks there is any chance of diminishing the pain or upgrading Reb's quality of life. The worst the vet could say is fark off.


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## bubba13 (Jan 6, 2007)

The farrier did come out today. Put a set of 3* aluminum eggbars on him. We've had those on before, without the greatest of results. So I don't have my hopes up. But maybe we can at least get them back to where he was before. Regardless, the farrier said it would take some time--like weeks--before we see any results, even if it is going to work, as the DDFT has to relax, and the navicular bone must settle, and the inflammation has to go down.


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## AlexS (Aug 9, 2010)

I know nothing of any help at all Bubba - but if you have to wait for the bones to settle and inflammation to reduce is there a med that can help speed that up?


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## bubba13 (Jan 6, 2007)

The only thing I'm aware of would be some kind of NSAID for pain and inflammation, and he's already on a daily 1.5 grams of bute (thinking about bumping that up to 2, as vets in the past have told me that it's safe, though I know there's disagreement on that point).

I just brought the horses in as it's lightning really bad here. They didn't want to come up, so I had to drive them with the car. When motivated, Rebel can and will trot--it looks horrendous, and very slow and head-bobby, but he could have walked if he'd chosen, and he is, at least, able to get around. Bah.

Does anyone know how to read X-rays and want to take a stab at the bone spur thing?


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## coffeegod (May 6, 2011)

I am of no help with the x-rays. Wish I was.

I did find this site for herbs and horses: Herbal Index - Naturally Equine - herbs for horses and horse healing products

Dunno if it will offer any help but I do wish you the best of luck.


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## Horseman56 (Jul 25, 2011)

Okay, I'm not a vet nor a radiologist but I'll take a shot.

I can't see anything I'd refer to as a significant bone spur, but...

I wonder if the vet is referring to this....










That "_spur_" is the only thing I can imagine a person might think is a bone spur or remodeling of the navicular bone. It's not and I'm doubtful that an equine vet would think so either, but one should not presume, huh? 

Anyway, I happen to have a cadaver foot or two (or 3, or 4, etc) laying around, so let's take a look at the navicular bone, it's placement in the hoof capsule and the potential "spur".

Here's a distal limb presenting major bone placement and related structures. The navicular bone is labeled "4", just caudal the distal phalanx (coffin bone) and above the digital cushion. You can see the deep digital flexor tendon (painted yellow) as it crosses distal the navicular bone on it's way to it's insertion point at the solar margin of the coffin bone.










If we remove this "half" of the navicular bone and view it edge-on, we can see the bottom of the distal process where the bone articulates against the distal phalanx. If we hold it at the correct angle, you can see how it protrudes a bit. That's the "spur" you see in the radiograph of the right fore.










Let's look at another example.

this is a complete coffin/navicular bone, removed from the associated hoof capsule. This top view prevents you from seeing the distal (lower) portion of the articulating process, so we'll remove it and view the bone edge-on from the lateral side.










And here's that same bone viewed from the lateral side. See the "spur".











Here's a third example....










In this photo the coffin and navicular bones are turned upside down so we can see the distal surface. See the rise in the center of the bone process? Look to each side of that "rise". See how the bone models to a slight point just lateral/medial of that "rise". These "points" create that spur-like appearance in the radiograph.

Again, I'm neither vet nor radiologist; only a lowly farrier, but nonetheless, that's my take on what a person (vet?) may have interpreted as a significant spur on the navicular. Personally, I don't see any significant problems at the navicular of the right fore.

That said, I might express some concern about the sidebone in that foot. 

Cheers,
Mark


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## bubba13 (Jan 6, 2007)

I googled "sidebone radiograph" for comparison...holy cow!










OK, so "ossification of the collateral cartilages" of the coffin bone. Soft tissue turns to bone....why? Wikipedia says concussion. Trauma/inflammation/improper healing process? Based on comparison photos, Reb would be considered a fairly mild case, no? My understanding is that sidebone by itself does not generally cause lameness (unless fractured)....is this the case? My _impression_ is that the initial trauma that precipitated the formation of sidebone, or another issue, is what makes the horse limp. But I could be totally wrong. Surely the sidebone isn't what's making him so crippled, though....unless, can sidebone grate on non-ossified soft tissue, tendons or whatnot, in the way that the alleged navicular spur might? Does this happen? 

As for the navicular bone itself, yeah, I'm not a radiologist, vet, OR lowly farrier, just a biology student and horse owner. But I ain't seein' no spur, either. The vet who took the pictures saw it, then sent it off to Dr. Mike Major at Oakridge Equine in OK, who confirmed, as did another local vet--all were extremely cautious about neurectomy. Yet a fourth vet, who has quite a good reputation as a local lameness veterinarian, could not find the thing on the films. Yes, all had the advantage of playing with contrast and magnification when viewing the radiographs, but surely if this thing was as awful as they made it out to be, it'd be visible in the pictures I posted.

I _do_ see lollipop lesions, but according to the non-spur vet, those are to be expected with a late teenage performance horse. This same vet also raised concerned about potential pedal osteitis (looking at different films, I think).

I appreciate the explanation and images with cadaver legs. Hey, shortly I could probably supply you with four more.... :?

If I were your client, how would you advise me? Do you agree with my current plan, to shoe the most logical-seeming way possible (currently 3* wedge eggbar), watch the horse, and when it comes to salvage time (which to me is where we're currently at, but the vet seems to disagree) take some really good radiographs of the navicular, etc. to check for potentially-catastrophe changes, and then shoot for (high, based on nerve block results) neurectomy, praying there are no complications.


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## Darrin (Jul 11, 2011)

A few thoughts.

-Never tried acupuncture but my grandfather swore by it and I couldn't argue with the results. He went from having to crawl on hands and knees to walking again.

-Chiro, needed on one of my horses who obviously had a back issue after an accident. Chiro fixed it.

-Try calling your local and/or state vet college and explain everything you've done. I've seen some good things come out of our local vet college (Oregon State University) when it comes to helping people. Even if they can't help you might help them advance their understanding.


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## Horseman56 (Jul 25, 2011)

bubba13 said:


> I googled "sidebone radiograph" for comparison...holy cow!


That photo is a good example of serious sidebone. What I see on your horse's radiographs isn't that bad.



> OK, so "ossification of the collateral cartilages" of the coffin bone. Soft tissue turns to bone....why? Wikipedia says concussion. Trauma/inflammation/improper healing process?


All of those things are contributing factors and there are probably more. One might guess that continual stress on the cartilages would have a similar effect.



> Based on comparison photos, Reb would be considered a fairly mild case, no?


I'd say yes.



> My understanding is that sidebone by itself does not generally cause lameness (unless fractured)....is this the case?


Yes. I'll occasionally see one severe enough that presents discomfort. The discomfort typically presents when the horse is turning into the direction of the sidebone, not on the straight.



> My _impression_ is that the initial trauma that precipitated the formation of sidebone, or another issue, is what makes the horse limp. But I could be totally wrong.


No, you're not wrong, but severe cases could cause some problems.



> Surely the sidebone isn't what's making him so crippled, though....unless, can sidebone grate on non-ossified soft tissue, tendons or whatnot, in the way that the alleged navicular spur might? Does this happen?


Yes, it does happen. 



> As for the navicular bone itself, yeah, I'm not a radiologist, vet, OR lowly farrier, just a biology student and horse owner. But I ain't seein' no spur, either.


I don't see anything I'd call significant. I'd like to have a vet show me what they are seeing.



> The vet who took the pictures saw it, then sent it off to Dr. Mike Major at Oakridge Equine in OK, who confirmed, as did another local vet--all were extremely cautious about neurectomy.


Interesting chain of "yeah, I see it too". Made me think of the emperor's clothes. :wink:



> Yet a fourth vet, who has quite a good reputation as a local lameness veterinarian, could not find the thing on the films.


Maybe he's having the same trouble I am... or maybe he didn't see it because it isn't there. 



> Yes, all had the advantage of playing with contrast and magnification when viewing the radiographs, but surely if this thing was as awful as they made it out to be, it'd be visible in the pictures I posted.


Agreed.



> I _do_ see lollipop lesions, but according to the non-spur vet, those are to be expected with a late teenage performance horse. This same vet also raised concerned about potential pedal osteitis (looking at different films, I think).


I've seen horses with no lesions at all that present caudally lame. I've seen others with lesions that any vet would diagnose as severe and those horses walk off apparently sound. Using xrays to associate navicular lesions as relates lameness seems a very uncertain science.



> I appreciate the explanation and images with cadaver legs. Hey, shortly I could probably supply you with four more.... :?


Let's hope not.



> If I were your client, how would you advise me?


Since I'm not there, you need to work with and trust your farrier. He has a huge proximity advantage over me! 

If I were a speculating kind of guy (not second guessing your farrier at all)... I might try two things.... more of an inexpensive test than any real expectation of fixing anything.

1. I'd shoe him in a simple set of half rounds. Half-Rounds provide great ease of breakover in ALL directions and seem a low-level, general panacea for horses with various lameness issues. Again, I'm not expecting any dramatic change, but any improvement is a clue as to what may be going on.

2. Once shod and examined at the walk/trot/lope, I might consider casting the feet. I would want to know if completely stabilizing the hoof capsule made any difference in how this horse goes. Stop all/most expansion/contraction and reduce/remove forces that may act on any bone structures impinging on sensitive tissues. Again, not expecting anything dramatic, but looking for change to help me better understand what might be going on.

Your farrier could do the half-rounds comparatively inexpensively. With a bit of reading you could probably install the casting yourself. Check out the equicast website. It'll cost you $15 bucks per hoof to do it.

The last vets mention of pedal osteitis is interesting. Tough to diagnose in an 18 year old performance horse but still an intriguing possibility. 



> Do you agree with my current plan, to shoe the most logical-seeming way possible (currently 3* wedge eggbar), watch the horse, and when it comes to salvage time (which to me is where we're currently at, but the vet seems to disagree) take some really good radiographs of the navicular, etc. to check for potentially-catastrophe changes, and then shoot for (high, based on nerve block results) neurectomy, praying there are no complications.


Do I agree? I honestly don't know if it's a good protocol or not. My "gut" reaction is... we don't know what we're treating. Duct-tape the wedged eggbar on the horse and see how he goes before nailing up. If it doesn't help, you'll know you're on the wrong track. 

As to the appropriateness of a neurectomy in this case, that has to be the attending vets call to make. I gather since it's an option on the table that this horse must have blocked sound?

Cheers,
Mark


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## Horseman56 (Jul 25, 2011)

Almost forgot Moz (Bubba).... if I remember right, you are located in Missouri. Is that correct?

Only reason I mention it is... I'll be crossing Missouri in October on my way to Chris Gregory's place. 

Cheers,
Mark


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## bubba13 (Jan 6, 2007)

Horseman56 said:


> Interesting chain of "yeah, I see it too". Made me think of the emperor's clothes. :wink:


I want to think that, because it may spell better news for my horse (though he apparently didn't get the memo that he's actually perfectly fine, out there hobbling and all), but at the same time, I don't want the (highly-respected, well-reknowned) vets to have made such a heinous error, because there goes all my faith... 



> I've seen horses with no lesions at all that present caudally lame. I've seen others with lesions that any vet would diagnose as severe and those horses walk off apparently sound. Using xrays to associate navicular lesions as relates lameness seems a very uncertain science.


Frustrating, eh?



> Since I'm not there, you need to work with and trust your farrier. He has a huge proximity advantage over me!


I do. I think I've sung his praises before, but I'll do it again. He's great about owner education, he's open minded, he's willing to try anything, he's quick to respond to "thrown shoe" and "emergency" calls, and he'll take the initiative to make a phone call (to Chris, among others) if he's stumped about your horse.



> 1. I'd shoe him in a simple set of half rounds. Half-Rounds provide great ease of breakover in ALL directions and seem a low-level, general panacea for horses with various lameness issues. Again, I'm not expecting any dramatic change, but any improvement is a clue as to what may be going on.


The thing is, when a horse is so badly lame, I at least have difficulty noticing subtle changes. And we've tried just about every kind of shoe/pad on him...never with any changes, for better or worse. Even when he was barefoot the last time, his soundness level seemed to stay pretty constant, which is why we thought we'd be safe pulling his shoes this time. Nope. That said, I don't think half round were ever put on, so it's something to ask about.



> 2. Once shod and examined at the walk/trot/lope, I might consider casting the feet. I would want to know if completely stabilizing the hoof capsule made any difference in how this horse goes. Stop all/most expansion/contraction and reduce/remove forces that may act on any bone structures impinging on sensitive tissues. Again, not expecting anything dramatic, but looking for change to help me better understand what might be going on.


Better speak quietly now, or you're going to have all the barefooters screaming bloody murder. I'm not familiar with this process, so it's off to google....



> The last vets mention of pedal osteitis is interesting. Tough to diagnose in an 18 year old performance horse but still an intriguing possibility.


He just threw it out there as a possibility. He also took a few different pictures that time--I think we did a navicular bursa injection then, but maybe I'm wrong--and was appalled at the thinness of the sole. That's when he pretty much threw out the old navicular diagnoses and started calling this a horse with sole pain, since his coffin bones were "holey" and low to the ground. That's also when Reb was barefoot, and much sounder than now (though actually less than a year ago). His "treatment plan" was to do belly-scraping exercises to help with back pain and shoe the horse off the ground. And we can see how well that went.

One thing I forgot to mention earlier is that the horse was not at all responsive to hoof testers at that time, in any region. When the farrier was here the other day, Rebel was sensitive in the caudal region (though not immensely so), typical with the presentation of a navicular syndrome horse, as the farrier described.



> Do I agree? I honestly don't know if it's a good protocol or not. My "gut" reaction is... we don't know what we're treating.


Aye, there's the rub.



> Duct-tape the wedged eggbar on the horse and see how he goes before nailing up. If it doesn't help, you'll know you're on the wrong track.


Sounds reasonable, but after this acute onset of even worsened lameness and tendon sheath swelling, the farrier told me flat-out not to expect much improvement within a few weeks, due to the time it takes the inflammation to go down. Do you disagree?

On another note, in between writing my previous post and this one, I went out to the pasture to remove grazing muzzle. Reb was being an arsehole and trotting off away from me. Still a bad limp, blatantly obvious head-bob, short stride, stumbly, and pitiful lope...but am I kidding myself that he looked just a hair improved from a few days ago?



> As to the appropriateness of a neurectomy in this case, that has to be the attending vets call to make. I gather since it's an option on the table that this horse must have blocked sound?


I don't know the names of the nerve regions. Doing a regular navicular-type block on the right front, you get an improvement of symptoms. Move higher up the pastern (on the fetlock somewhere? it's been awhile) and he's suddenly lame on the left. Block the navicular region of the left and you've got a sound, happy, rambunctious horse.



Horseman56 said:


> Almost forgot Moz (Bubba).... if I remember right, you are located in Missouri. Is that correct?
> 
> Only reason I mention it is... I'll be crossing Missouri in October on my way to Chris Gregory's place.
> 
> ...


Yessir, I am, but perhaps a bit out of your way. I'll have to check, but I believe I'm south of him by an hour or two of travel. I would seriously love to have you come shower me with your wealth of knowledge wink, but I do wonder about farrier propriety....and how much I'd be in your debt. That's actually why I contacted Chris, as you know, to see if he'd have any use for me to bring my horses there as demo animals or whatever....spare you the trip, and possibly get the added benefit of education (and multiple opinions on the horse). But I guess that's not to be.


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## bntnail (Feb 3, 2011)

Ask your farrier about using an aluminim plate between the foot and shoe. Just like if using a pad.


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## bubba13 (Jan 6, 2007)

What does that do? I'm picturing a really thin slice of metal.


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## bntnail (Feb 3, 2011)

bubba13 said:


> I'm picturing a really thin slice of metal


Yes, 1/8th or 3/16ths will work. They also make a specialpad that is 2 thin alu plates w/ athin layer of rubber sandwiched in between.



> What does that do?.


Two things. Completely protect the bottom of the foot from external forces.
It will also restrict expansion/contraction to a degree. Similar to what Mark was suggesting w/ the casting.

I admit though that I'm a bit lost in this thread. Are the newest rads from 2 years ago?

I saw mention of sidebone but no DP rads, did I miss them? Hard to comment w/o them. If active, then hoof expansion is needed. Especially in the area of the sidebone.


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## bubba13 (Jan 6, 2007)

Yes, newest posted rads are two years old. And no, no DP view. But those are the ones that all the dire diagnoses are based off of. More recent films, from about 10 months ago, did not show substantial damage or horrific changes, according to the vet who took and reviewed them. We have had a fairly hard plastic pad in there before, I think, but I'll ask my farrier about the aluminum plate. He's got six weeks now to think about it....

Thanks!


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## bubba13 (Jan 6, 2007)

Thought I should update. Since the application of the new shoes (3* aluminum eggbars), we've seen gradual but consistent improvement. Rebel is by no means sound, but he's trotting, loping, bucking, and generally being a pain in the @$$ again. He has also been bumped up to two grams of bute twice a day, from one and a half, but I don't know whether that has any bearing on his bounce-back.


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## Deslumbrar (Jul 31, 2011)

Good that he's finally showing some improvement... Time will tell!


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