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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35 September 2015 THE HORSE TheHorse.com STEP BY STEP JENNIFER O. BRYANT TheHorse.com/Step-By-Step M y mare, Diamond, could be the poster child for the subject of this article. Two springs ago, she was coming along well in her dressage train- ing, and visions of fun outings to clinics and shows were dancing in my head … until the day I got on, and she was off. Left front foot. The ensuing weeks and months went by in a haze of diagnostic tests, treatment efforts, and veterinary bills. After exams using ultrasound and other, less- expensive modalities proved inconclusive, and time had not, in fact, healed all wounds, I was advised to take Diamond for the gold standard in diagnosing foot problems: MRI, or magnetic resonance imaging. The MRI revealed the cause of my mare's foot pain: a lesion in the deep digi- tal flexor tendon around one of her pas- tern bones. We embarked on a course of some of the latest and greatest treatments, which you'll read about in this article. High-tech intervention, plus months of stall rest, followed by months of pasture turnout, equal one happy mare who as of this writing is pasture-sound, but who may or may not be a riding horse again. Diamond's condition falls under the category of what is known as chronic foot pain—a foot-related lameness that persists for more than, say, a couple of months, in experts' estimation. Fortunately, diagnos- tic advances are helping veterinarians determine exactly what structures are affected—gone are the days when all foot pain was lumped together and labeled "navicular disease"—and newer therapies offer the promise of better, or even com- plete, rehabilitation. Let's take a look at where the science stands at the moment. "Chronic," Then and Now "The old definition of 'chronic' was that we couldn't control or manage the issue," says José M. García-López, VMD, Dipl. ACVS, ACVSMR, associate professor of equine sports medicine and surgery at Tufts University's Cummings School of Veterinary Medicine, in North Grafton, Massachusetts. But "that is changing with MRI, which gives us a better chance of identifying and putting a name to the condition." " 'Chronic' refers to a period of time," says Jack Snyder, DVM, PhD, Dipl. ACVS, professor emeritus after more than 30 years at the University of California, Davis, School of Veterinary Medicine and a five-time Olympic Games veterinarian who's now based at Circle Oak Equine, in Petaluma, California. "After two months, I'd start putting (a condition) in the 'chronic' category." Even a lameness that starts as an acute injury can wind up as a lingering issue, he says. "Chronic" also implies a condition that requires veterinary intervention. "If at 60 days the horse is still lame, I get worried that we will need to do more therapeu- tic intervention than just conservative therapy," such as stall rest, Snyder adds. Types of Chronic Foot Problems Radiographs (X rays) have long been able to show bone-related injuries, such as fractures. But soft tissues, such as ligaments and tendons, don't show up in radiographic imaging. Ultrasound, which can be useful for diagnosing soft-tissue injuries in the leg and elsewhere, can't always penetrate deep enough into the foot to offer a conclusive diagnosis. That's why the powerful MRI has been such a diagnostic asset. Thanks to MRI, veterinarians have dis- covered that equine foot pain has myriad causes. García-López and Snyder rattle off some of the more common: Tendon tears; adhesions in the navicular bone or navicular bursa (the sac cushioning the bone from the deep digital flexor tendon, or DDFT); collateral-ligament injury of the coffin joint; tears of the impar liga- ment, which attaches the navicular bone to the coffin bone; subchondral (located just under the cartilage surface within a joint) lesions in the pastern bones; and bone contusions (bruising). "It's important to put a diagnosis to the Advances in Managing Chronic Foot Pain MATHEA KELLEY Improved diagnostics and more promising treatments are putting many foot-sore horses back to work Our sources say shock wave therapy has been a game- changer in treating soft tissue injuries to the foot.