The Horse

JAN 2019

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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Page 43 of 51

44 January 2019 The Horse | pain cycle and control inflammation in throbbing feet. Yet other medications are helpful, particularly when the source of pain is coffin joint inflammation or osteo- arthritis. Veterinarians might administer the intramuscular (IM) joint injectable polysulfated glycosaminoglycan (Ad- equan) for chronic conditions and IV hy- aluronic acid (Legend) to manage acute joint inflammation. Vlahos says Adequan has been a mainstay therapy for the past 30 years for coffin joint arthritis. For stubborn joint ailments some veterinarians turn to IRAP ( interleukin-1 receptor-antagonist protein) treatment. In this process, the vet incubates a horse's blood with specialized beads, centrifuges it, and then injects the IRAP-protein- containing serum into the joint. The remainder can be frozen for subsequent treatments. Boswell says he's had success using IRAP and platelet-rich plasma together in coffin joints. PRP releases co-factors (bio- chemicals that initiate enzyme activity) from platelets, which he feels are reliable for pain control. Veterinarians can use extracorporeal shock wave therapy as an adjunct to PRP to stimulate platelets to release co-factors. He suggests treating the joint before soreness from chronic joint inflammation returns. Shock wave therapy might be useful for treating collateral ligament or suspensory ligament (of the navicular bone, which originates in the navicular bone and in- serts onto the short pastern) lesions. Though little published research exists on the efficacy of regenerative therapies for managing foot pain in horses, Boswell has also found through personal experi- ence that a combination of PRP and stem cell therapy helps heal the impar ligament when injected into the navicular bursa— the cushioning fluid-filled structure be- tween the navicular bone and the DDFT. Other medical treatments for painful hoof ailments include bisphosphonates (Tildren or Osphos) designed to prevent loss of bone mass (resorption). These medications are approved only for use with podotrochlosis in horses over 3 years of age. They're not approved for use in young horses due to possible effects on bone turnover, as well as potential com- promise to kidney function. Bisphosphonates have anti- inflammatory and analgesic (pain- relieving) properties, in addition to their anti-resorptive action on bone. Research- ers have demonstrated improvement in a week due to the short-term anti- inflammatory and pain-relieving effects. Neurectomy Historically, equine practitioners have cut the palmar digital nerves (at the low point of the pastern) to interrupt the pain cycle from the foot and improve comfort. Some veterinarians no longer recom- mend this procedure for equine athletes because a neurectomized horse can't feel the back third of his foot, and they believe it can continue to incur damage. Other veterinarians believe a neurectomy can be beneficial in certain cases and can return horses to athletic pursuits, says Ortved. Neurectomy can also make a horse pasture-sound that would otherwise be euthanized. Boswell says it should be a last resort, while other practitioners find it useful in the right population of horses. Take-Home Message The best management is prevention. It helps to start with well-balanced and trimmed feet. Radiology is a great tool to let both your veterinarian and farrier know what they are working with and to provide information and accurate mea- surements for vet-farrier collaboration. If problems develop, then a thorough diagnostic workup can help the veteri- narian identify the location and poten- tially the problem. Boswell stresses the importance of documenting all exam and diagnostic workup findings. "An effective response to therapy is best achieved with an accurate diagnosis," he says. h Handling the Thin-Soled Horse Thin soles commonly lead to painful hoof bruising and abscesses. "Thin-soled horses are a challenge," says Ted Vlahos, DVM, MS, Dipl. ABVP, Equine Regent ABVP, of Yellowstone Equine Hospital, in Cody, Wyoming. He emphasizes the importance of meeting nutritional needs to ensure good hoof growth in these horses. He says some hoof pads, sole packing, and/or impression materials can help horses to return to work. Rob Boswell, DVM, president of Equine Sports Medicine Group, in Wellington, Florida, rec- ommends trimming and shoeing these horses in a way that fosters normal physiologic foot reactions as the horse moves. The objective, he says, is to mimic ground reaction forces that the barefoot horse experiences and allow some normal pressure from the ground on the sole with weight-bearing to stimulate growth and toughness. He and Vlahos both find topical hoof-toughening products useful for thin-soled horses, as well.—Nancy Loving, DVM STEP BY STEP Veterinarians might administer joint injections for chronic conditions such as coffin joint arthritis. DUSTY PERIN

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