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TheHorse.com THE HORSE September 2015
Snyder calls ESWT "the biggest game-
changer" in soft-tissue injury treatment,
but notes that it works better in ligamen-
tous tissue than on tendons. Using ESWT
he has seen an "improved prognosis" of
injuries to the suspensory, collateral, and
distal sesamoidean ligaments, as well as
to other soft-tissue injuries. "It doesn't
work so well with injuries to the deep
digital flexor tendon," he says, and "some
people argue that you don't get a good
shock-wave effect in the foot.
Regenerative therapies can also be
used in conjunction with ESWT. "I do
more shock wave followed by PRP," says
Snyder. "If I feel there is a bigger hole in
the lesion, I'll use PRP and stem cells."
Another modality is high-intensity laser
therapy, which Snyder says has a "positive
effect on soft-tissue healing," as evidenced
by studies done in humans. It, too, can be
used with ESWT, PRP, stem cell therapy,
or a combination of all three, he says.
You have undoubtedly seen advertise-
ments for medications aimed at women
with osteoporosis, which is a decrease in
bone mass and density that can lead to
fractures and other problems. Horses can
develop a similar affliction in the bones
of their feet. In such cases, veterinarians
might prescribe medications that are in
the same class as those used in women.
These substances, known as bisphospho-
nates (brand names in the equine world:
Tildren and Osphos), work by regulating
the bone's metabolism, says García-
López. They "slow the progression of
osteoclastic activity," he says, referring to
the bone cells called osteoclasts that are
responsible for bone absorption, which
can lead to cysts (fluid-filled holes).
Snyder agrees that bisphosphonates
"do seem to have a positive effect." They
"work anywhere there is significant bone
remodeling that is painful."
Not all bone-related foot problems are
osteoclastic in nature, however. In cases
of sclerotic (abnormally dense) navicular
bones, bisphosphates are "not indicated,"
says García-López.
And don't dismiss one age-old, last-
ditch method of eliminating foot pain:
the neurectomy, in which a veterinary
surgeon severs the palmar and/or plantar
nerves so the horse no longer feels pain.
"People make a big argument against
neurectomy, but it still has a place in our
regimen," says Snyder. "It's not without
risk, but it's not that expensive, and it
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The neurectomy (severing the palmar/plantar
nerve) is a last-ditch effort for eliminating pain.
SHELLEY
PAULSON
Some chronic foot
pain conditions are
not necessarily a
lost cause—not
necessarily fixable, but
manageable."
DR. JOSE M. GARCIA-LOPEZ