Lameness

Horses
 Lameness Evaluation: One horse affected with a common lameness
(eg, American Association of Equine Practitioners [AAEP] Grade 3/5).
Lameness must be detectable at a trot in a straight line.

You have 45 min!

1. Obtain a history from the client/examiner;

2. Observe the horse at a walk and trot to determine the lame limb;
3. Explain how he/she determined which limb was affected and discuss appropriate general principles
related to equine lameness (eg, how to differentiate forelimb vs hindlimb lameness and how to
determine left vs. right limb);
4. Systematically examine the affected limb in order to localize the problem.
a. characterization of digital pulses;
b. picking up and cleaning the foot;
c. examination with hoof testers;
d. detailed palpation of the limb;
e. manipulation of joints;
5. May perform appropriate flexion tests to localize the lameness and discuss associated principles;
6. Indicate what nerve and/or joint block(s) would be appropriate to assist in diagnosing the specific
lameness in the horse
7. Indicate what imaging studies are appropriate for the horse they are examining;
8. Interpret the film or digital images provide by the examiner;
9. Formulate a conclusion regarding the affected anatomical region leading to lameness;
10. Communicate the source of the lameness to the examiner;
11. State what the likely prognosis is for the condition;
12. During this station you need to locate 5 anatomical structures randomly assigned from the 20 listed
(check the other presentation).
85 Pts
 Lameness exam

1. No lameness exam is complete without a history, physical exam, hoof tester

exam, jogging or lunging, flexion tests and regional (perineural or
intra-articular) anesthesia. Ancillary diagnostics that may be indicated, based on the
results of the initial exam include radiography, ultrasonography, and nuclear
scintigraphy, among others.

2. Lameness is commonly indicated by a headnod, hip hike, decreased cranial

phase of stride or height of stride, reduction in range of motion, tendency to
veer to the left or right. Signs of neurologic disease must be distinguished from
lameness, if there is any doubt.

3. Once a limb has been identified as the source of lameness, regional anesthesia should
proceed from distal to proximal (in real-life, this is sometimes suspended based on
physical and historical findings like obvious middle carpal joint effusion).
 Question the 1. What is the primary complaint regarding this animal?
○ Which limb is thought to be affected?
client/examiner 2. What is the age, breed and sex of the horse?
to determine 3. What is the horse’s intended use?
○ Work purpose, competition, leisure, riding
the medical ○ Workout exercise routine, training regimen
4. How long have these signs been present?
history of the ○ Acute vs Chronic
5. Is there any deterioration or improvement in
patient lameness?
History taking for
6. Have you treated with anything?
horses with lameness ○ If yes, has your therapy shown any success?
7. Has this problem happened in the past?
○ Access the association with certain activity, season or changes in
husbandry or in activity.
8. Which circumstance the lameness worsens or
improves?
9. Is there any history of trauma or accident?
10. Has the animal been sick recently?
11. Are there any changes in husbandry and
management?
○ Changes in shoeing and related issues, changing in training or
performance intensity, changes in surface, changes in diet, changes in
housing
 Standing examination
Step back and observe the horse from the
distance (1). Evaluate at the distance the
back, front and the 2 sides of the horse.

● Observe the animal at rest.

○ Note any alterations in posture:
weight shifting, pointing
○ Observe for any swellings, injuries, 1
atrophies, angular deformities
Forelimb
Normal horse: the weight will be evenly
distribute in each the forelimb.
● Normally will NOT shift weight on front
limb. both limbs should bear the same
amount of weight
● Notice any pointing - may indicate a
problem in that limb (2) or both limbs
(3). 3
● Shifting weight may indicate bilateral
problems 2
● refusal to bear weight on a limb:
infection/fracture/severe pain (4)

Hindlimb
● normal to shift weight from one leg to
another (5)
● non-weight bearing in one limb -
problems with that specific limb
4 5
 Corformation
1. A line dropped from the point of the
shoulder joint should bisect the limb.

2. A line dropped from the tuber spinae of

the scapula should bisect the limb down
to the fetlock and end at the heel bulbs.

3. The angle of the shoulder usually

influences the angle of the pastern

4. Standing under in front.

1 2 3 4 5
5. Camped out in front.

6. A line dropped from the point of the

buttock (tuber ischii) should follow the
cannon bone.

7. A line dropped from the point of the

buttock (tuber ischii) should bisect the
limb.

8. Asymmetry between the peaks of the

croup, points of the hip, and points of
the buttock (arrows).

6 7 8
 Normal walk and normal trot

The walk is a slow, natural, flat footed, four beat The trot is a rapid two beat diagonal gait. The
gait. forefoot on one side and the opposite hind
foot take off and strike
Each foot takes off from and strikes the ground the ground at the same time. The horse works
independently from one pair of diagonals to the other pair.
of the other three feet. It is known as the
foundation gait. The sequence of hoof beats The weight of the horse is distributed first by
after the horse is in motion can one diagonal and then the opposite diagonal.
be described according to this pattern: right
fore, left rear, left fore, right rear.

At the walk a horse has never more than three

nor less than two feet bearing weight at the
same time, making up a triangular base of
support.
Sound - you
would hear a
less
pronounced
sound when
the lame leg
touches
ground
 Moving Examination
In addition to the sound, evaluate
how the horse is landing his feet:
straight, heel or toe

Look for smooth level and hard

surface (Easy to identify in a hard
surface)

1. Walking the horse in straight line

2. Trotting: Trote is easy to identify
the lameness in a horse, 2 beat
rhythm
3. Lunging (both directions)

Check for: 1
● Head nod
● Asymmetrical Pelvic Movement
● Change in stride
● Range of joint motion
● Shifting in tracking

2 3
 1. Head Nod
● Indicator sign of forelimb
lameness
● Head shift downs when the
non-lameness limb is in the
ground.
● Head is up when the lame limb is
in the ground. Shift weight

Remember: Down on sound

Up on the lame

https://www.youtube.com/watch?v=cQdPRR50E3c
 2. Asymmetrical Pelvic
Movement
aka hip hike or gluteal rise
● Indicator of the lameness in the
hindlimb
● Classic: hip rises when the
affected hindlimb touches the
ground. Hip Hike is not
consistent. So, check for total
vertical hip displacement
● To better visualize the
asymmetrical pelvic movement,
Place a tape markings on the
tuber coxae and evaluate the
movements of the markers

https://www.youtube.com/watch?v=PQ3iyoiZwA0
https://www.youtube.com/watch?v=EDodRfqhjuc&fb
clihttps://www.youtube.com/watch?v=EDodRfqhjuc&fbclid=I
wAR2hY75DjiHt6UoAsUARWTQEXEYZ0eq2n3xTxobpSC-o
QjB8t0pbr6hPpLg
 3. Change in length and
in height to the Stride

● Length: Stride of the affected

limb is always shorter
 3. Change in length and
in height to the Stride

● Height to the stride: Height

through which the affected limb
moves is lower

● The lame limb does not lift as

much!
 4. Range of Joint Motion
● In this example: patient is
reluctant to low its fetlock
 5. Alteration in tracking
● Normally the movement of
forelimbs and hindlimbs is
aligned.

● Alteration in tracking usually

indicated hindlimb lameness
 Lunging on a trot

● Horse needs to lunge in both

directions
● Ask for the assistance lunge the
horse and observe the horse trot
inside the circle.
● You see an increase in lameness
when the affected limb is inside the
circle
● Lameness associated with pain
during weight bearing
 Summary: Signs of lameness

● Head Nod: forelimb lameness

○ Down on sound
○ Up on the lame
● Asymmetrical Pelvic Movement: Hindlimb lameness
○ Increased vertical movement of tuber coxae of the side of the lame limb
● Change in length and in height to the stride: seen in any affected limb
● Range of joint motion
● Alteration in tracking: hindlimb lameness

https://www.lamenesstrainer.com/
 Exam the
Forelimb
1. Palpate along the scapula. Slide
your right through the the region of 1 2 3
the humerus
2. Reach and insert your finger in the
notch: greater tubercle
3. Slide your hand through the
Bicipital bursa
4. Run down both hands through the
forelimb to evaluate the temperature
and the presence of swellings.
5. Evaluate for presence of effusion in
the elbow joint.
6. Slide both hands and check for
lumps and bumps
7. Use fingers of both hands to
evaluate the Carpal joint. Check for 4 5 6 7
heat and swelling
8. Run down through the flexor
tendons and suspensory
9. Check the and end of splint bones
10. Evaluate if here is a strong pulse
that suggests inflammation. Normal
equine digital pulses can be very
hard to detect (see next slide)
11. Slide your hand to the coronary
band and check for effusion

Do not forget to check for hoof 8 9 10 11

cracks. https://www.wiley.com/WileyCDA/Section/id-831984.html
https://www.youtube.com/watch?v=zH4YySG1D_w&list=PL4xbDOZTIrbbDnOsx56FgAcrpxBixFWEG&index=6&t=0s
 Digital Pulse
1. Evaluate if here is a strong
pulse that suggests
inflammation. Normal equine
digital pulses can be very hard
to detect. 4 areas were the most popular for
finding the pulses

http://www.ironfreehoof.com/equine-digital-pulses.html

https://www.youtube.com/watch?v=3Qr7RiUegqI&list=PL4xbDOZTIrbbDnOsx56FgAcrpxBixFWEG&ind
ex=20&t=0s
 Exam the
Hindlimb
1. Grab the tail and make the horse 1 2 3 4
stand in the leg. Horse is not able
to kick out.
2. Hand in the hip and slide the other
hand. Look for swelling and pain
3. Palpate the medial side of the stifle
4. Run your finger in the patellar
ligaments, check for effusion of the
patellar joint
5. Slide both hands for evaluating
swellings and change in the
temperature
6. Palpate the calcaneus area
7. Check for effusion of tarsocrural 5 6 7 8
joint
8. Slide the hands through the splint
bone and suspensory ligament
9. Evaluate the flexor tendons
10. Effusion of the fetlock joint (cranial
to the suspensory ligament) and
tendon sheath effusion caudal to the
suspensory branch
11. Digital pulse
12. Check for effusion in the coffin-joint

Do not forget to check for hoof 9 10 12

cracks.
11

https://www.youtube.com/watch?v=n4B8yNJUn-U&list=PL4xbDOZTIrbbDnOsx56FgAcrpxBixFW
G&index=6
 Hoof testing

● Reaction to pain when the

hoof tester pressure the
area
● Heel, quarter, toe and frog
● Be careful: do not place
the hoof tester on the
coronary band
● Rear limb: rest the feet on
your knees

Picking up legs
https://www.youtube.com/watch?v=azCPvEstCR0

Do not forget to clean the sole

with a hoof pick
https://www.youtube.com/watch?v=howtUwnJQzg
https://thehorse.com/17545/how-to-pick-a-horses-h
oof/
 Lameness examination:
Flexion testing
● Accentuate and localize lameness
○ 2 more common:
■ Fetlock flexion test
■ Hock flexion test

● Fetlock Flexion test:

○ Flexion the digit at least for 30
seconds Up on the lame Down on sound
○ Ask for the assistant to track the
time. Tell the assistance to count
down the last 10 seconds, so
you can plan to put the limb
down on the floor and also to
take a safe distance from the
horse.
○ At the right time, release the limb
on the floor carefully and
observe the horse walk.
○ You observe the increase
lameness
○ This flexion test is sensitive for
lameness in the fetlock and digit
 Lameness examination:
Flexion testing

● Hock Flexion test:

○ Hold the hindlimb in the flexion
position for about 90 seconds
○ Ask for the assistant to track
the time. Tell the assistance to
count down the last 10
seconds, so you can plan to
put the limb down on the floor
and also to take a safe distance
from the horse.
○ At the right time, release the
limb on the floor carefully and
observe the horse walk.
○ The horse shows increased
lameness or stabbing on the
toe after the test when he/she
walks
○ It detects hindlimb lameness,
however, it is not specific for
lameness if the hock
 Nerve Block
Needle Volume of Location
anesthetic
Local anesthetics
Palmar Digital 25 g, 5/8″ 1–1.5 mL Just above
● 2% lidocaine hydrochloride collateral
(Xylocaine hydrochloride) lasts cartilages
only 60 minutes with the
maximum effect at 15 minutes.
Most Common! Abaxial 25 g, 5/8″ 1.5–2 mL Abaxial
sesamoid surface of
● 2% mepivacaine hydrochloride proximal
(Carbocaine). Longer lasting sesamoid
and less irritating than bone
lidocaine. The effect of the
block began to subside between
1 and 2 hours, but gait Low Palmar 22–25 g, 2–3 mL/site Distal
characteristics persisted Block (Low 5/8–1″ metacarpus
beyond 2 hours. For palmar 4-Point Block) (above
digital fully effective for 15 to 60 buttons of
minutes after splint bones)

● Bupivacaine hydrochloride
(marcaine) may be used if the High Palmar 25 g 5/8″ and 3–5 mL/site Proximal
goal is to provide a longer (High 4-Point 20–22 g 1.5″ metacarpus
duration of analgesia (4 to 6 Block)
hours), such as following
surgery.

http://cal.vet.upenn.edu/projects/field
If a SQ “bleb“ is seen
service/SPORTMED/DIAGANES/dia while injecting, you are
ganes.htm
too superficial!
 Nerve block:
Palmar digital nerve block (heel
block):
Medial and lateral palmar digital nerves

Landmarks
1. palpate the lateral and the medial
palmar/plantar digital neurovascular bundle http://cal.vet.upenn.edu/proj
(VAN - vein, artery, nerve) which is typically ects/fieldservice/SPORTME
palpable D/DIAGANES/dappdnb.htm
2. between the proximal sesamoid bones and
just proximal to the cartilages of the foot

Injection technique
1. Wear procedure gloves!!!!
2. Clean with alcohol the site of injection
3. With the limb held, insert the a small gauge
needle directly over the palmar aspect of the
palpable neurovascular bundle (1 cm above
the cartilage of the foot)
4. Attach the syringe, aspirate and inject the
local anesthetic across the vascular
bundle, onsent 10-20 min (lidocaine)
5. Do the same process for the lateral palmar
digital nerve This will not block the
lameness associated
Desensitized area with laminitis. Horses
1. 50-70% of the palmar/plantar aspect of the with navicular disease,
foot (navicular bone, navicular bursa,
digital cushion, distal aspect of Deep
septic navicular
Digital Flexor Tendon, sole, bars, heels, bursitis, or caudal
frog): including most of the interphalangeal subsolar abscess will
joint except proximo-dorsal region improve significantly.
 Nerve block:
Abaxia/ block (foot block)
Medial and lateral palmar digital nerves.

Landmarks
1. palpate the palmar digital nerves over the
sides of the proximal sesamoid bones (feel
“pop” them under your fingers). Just distal
to the proximal sesamoid bone

Injection technique
1. Wear procedure gloves!!!!
2. Clean with alcohol the site of injection
3. With the limb held, insert the a small gauge
needle directly over the palmar aspect of
the palpable neurovascular bundle (distal
to the proximal sesamoid)
4. Attach the syringe, aspirate and inject the
local anesthetic across the vascular bundle,
onsent 10-20 min (lidocaine).
5. Do the same process on the opposite side

Desensitized area
1. Skin over the palmar pastern and distal
dorsal pastern along with the foot and
Proximal interphalangeal joint are
desensitized.
2. Partial desensitization may also occur
Horses with septic or arthritic disease of
the coffin joint or navicular bursa, any
subsolar abscess, P3 fracture, or laminitis
will improve significantly
 Nerve block:
Low volar nerve block/ Low 4
point block
Medial and lateral palmar nerves and medial
and lateral palmar metacarpal nerves
Landmarks
1. The medial and lateral palmar nerve-
between the flexor tendon and the
suspensory ligament, 2 cm proximal to
the end of the 2th and 4th metacarpal
bone.
2. The medial and lateral palmar metacarpal
nerve runs parallel to the 2nd and 4th
metacarpal (splint) bones The site of
injection for the metacarpal nerves is just
distal to the end of the splint bones on
each (medial/lateral) side between the
suspensory ligament and the splint bones.
Injection technique
1. Wear procedure gloves!!!!
condylar fractures
2. Clean with alcohol the site of injection (distal cannon
3. Palmar: Insert the a small gauge needle bone/MCIII), Pl or
perpendicular to the limb between the P2 fracture,
tendons. Attach the syringe, aspirate and sesamoid
inject 2-3 mL of local anesthetic across the fractures,
vascular bundle. Do the same process on
osteochondral
the opposite side.
4. Metacarpal: Insert a small gauge needle fragments (chip
angled proximally toward the end of 4th fractures) of Pl.
metacarpal bone. Do the same process
described above. http://cal.vet.upenn
Desensitized area .edu/projects/fields
1. Entire metacarpophalangeal (fetlock) joint ervice/SPORTMED
and structures distal to this joint /DIAGANES/low4pt
.htm
 Nerve block:
High volar nerve block/ 4
point block
Medial and lateral palmar digital nerves and
medial and lateral palmar metacarpal nerves More proximal palmar
and palmar metacarpal
Landmarks nerves. Blocks most of
1. palmar nvs: on the sides of the flexor
the superficial and deep
tendons, below the deep fascia;
2. metacarpal nvs: in the junction between digital flexor tendons,
the canon bone and the splints, deep to distal check (accessory)
the suspensory ligament ligament, splint bones
(MC or MT II/IV). Horses
Injection technique with lameness from
1. Wear procedure gloves!!!! bowed tendons
2. Clean with alcohol the site of injection
(superficial digital flexor
3. Palmar nerves: insert a needle above the
communicating branch, through the deep desmitis), distal check
fascia to the palmar nerve located ligament desmitis, DDF
between the deep digital flexor and the tendon injury, splint bone
suspensory ligament. Inject 5 ml of local fracture, some
anesthetic and repeat on the other side. suspensory lesions will
4. Metacarpal nerves: insert needle distal
improve. Injury to the
to the carpus, between the splints
(metacarpal II and IV) and the origin of the suspensory
suspensory ligament down the cannon or proximal palmar
bone (metacarpal III) on both sides. Inject avulsion of the cannon
3-5 ml anesthetic bone (MCIII) will not
improve, if the lesion is
Desensitized area
proximal to the blocking
1. Metacarpal region along with the entire
metacarpophalangeal (fetlock) joint and site.
structures of the digit.
 Summary: Nerve Blocks

Palmar digital nerve block:

navicular bone, navicular bursa,
digital cushion, distal aspect of DDFT,
● Head Nod: forelimb lameness
sole, bars, heels, frog) including most
○ Down on sound of the distal interphalangeal = coffin
○ Up on the lame joint except proximo-dorsal region.
● Asymmetrical Pelvic Movement: Hindlimb lameness
○ Increased vertical movement of tuber co Abaxial sesamoid nerve block:
skin over palmar pastern and distal
Palmar Abaxial Low Palmar High Palmar dorsal pastern along with the foot and
digital nerve sesamoid nerve block nerve block distal and proximal interphalangeal
Block nerve block joint

Low Palmar nerve block:

entire metacarpophalangeal (fetlock)
joint and structures distal to this joint

High Palmar nerve block:

metacarpal region along with the
entire metacarpophalangeal (fetlock)
joint and structures of the digit
 Imaging:
1. Radiography
● useful in identifying damage or
changes to bony issues
● use on contralateral limb for
comparison

2. Ultrasound - best for soft-tissue

pathology: tendons, bursae, fluid
accumulation

3. Scintigraphy (nuclear
scanning) “bone scan”
● radioisotopes injected IV into the
horse are
● concentrated in areas of injury
● these are scanned with a gamma
camera, providing
● an image of the trouble site (horse
will need to be quarantined for
radioactivity after this procedure)

4. MRI/CT

● Scintigraphy/MRI/CT - less likely

needed
 Navicular bone: Palmaroproximal-Palmarodistal Oblique
Radiograph: (PaPR-PaDiO)

- Bones, joints, ask contralateral limb

for comparison
- Basic projections: Lateral, DP
- Upwards projections: P3 solar
margins, navicular, navicular skyline
- Oblique projections: DLPMO, P3: Dorsoproximal Palmarodistal Oblique
DMPLO
- Others: Flexed lateral and skyline
from carpus, Tarsus skyline, patellar
skyline

https://www.quia.com/files/quia/users/medicinehawk/
2407-Vet/Radiology-2.pdf

https://www.michvma.org/resources/Documents/MV Fetlock: Dorsolateral Palmaromedial Oblique (DLPMO)

C/2018%20Proceedings/santschi_03.pdf

https://aaep.org/sites/default/files/issues/Radiograph
Judy.pdf

https://www.slideshare.net/ShalynCrawfordGarman/e
quine-radiography-positioning-techniques-tips-for-ac
quiring-good-images
 Some conditions
The foot
-Some lameness types and prognosis Lateromedial
Dorsopalmar
- Navicular disease:
Dorsoproximal-palmarodistal (DPPD)(in 2 degrees)
- Sesamoiditis or fracture Palmaroproximal-palmarodistal (PPPD)(Skyline)
- Tenosynovitis/tendonitis
Fetlock
- Osteochondrosis
Lateromedial
- Osteoarthritis Dorsopalmar
- Bone spavin Dorsolateral-palmaromedial oblique (DLPMO)
Dorsomedial-palmarolateral oblique (DMPLO)
- Ring bone
Flexed lateromedial
- Suspensory ligament injury
- Patellar luxation Carpus
Lateromedial
- Spring halt (mechanic lameness, not
Dorsopalmar
painful), DLPMO
DMPLO
Flexed lateromedial
Dorsoproximal-dorsodistal (skyline)

Elbow
Mediolateral
Craniocaudal

Shoulder
Mediolateral
Craniomedial
Cranioproximal-craniodistal
 Some severe lameness conditions
Etiology: Treatment
● Sole abscess ● Sole abscess
○ Conditions soften sole & allow bacterial invasion (rain ○ Paring of infected area
and mud) ○ Poulticing of hoof (you can use baby diaper)
○ Sole bruises 🠞 infection ○ NSAIDS
● Septic joint or tendon sheath ○ Antimicrobials rarely indicated
○ Contamination of synovial structure iatrogenically or by ● Septic joint or tendon sheath
wound ○ Lavage +/- arthroscopy of structure
○ Hematogenous infection common in septic foals ○ Systemic & local antimicrobials
● Fracture/severe soft tissue injury ● Fracture/severe soft tissue injury
○ Trauma to limb ○ Immediate care: stabilization w/appropriately placed
splint
Presentation/classic case: ○ Fixation of fracture
● 4/5 to 5/5 on AAEP lameness scale Prognosis
● Sole abscess
DDx ○ Excellent
● Sole abscess ● Septic joint or tendon sheath
● Septic joint or tendon sheath ○ Fair to good
● Fracture/severe soft tissue injury
Test(s) of choice ○ Depends on location of fracture, whether open or
● Sole abscess closed, degree of soft tissue injury & displacement
○ Hoof testers Pearls
○ Evaluate digital pulses ● Sole abscess
● Septic joint or tendon sheath ○ Deep sole abscess 🠞 drainage at coronary (gravel);
○ Examine for joint/tendon sheath effusion take a little longer to resolve
○ Synoviocentesis ● Septic joint or tendon sheath
● Fracture/severe soft tissue injury ○ Emergency situation requiring immediate tx to avoid
○ Palpation of the limb for pain & stability life-threatening sequelae
○ Radiographs ● Fracture/severe soft tissue injury
○ Immediate splitting critical
 Some severe lameness conditions
Etiology: Fracture
● Sole abscess
○ Conditions soften sole & allow bacterial invasion (rain
and mud)
Type II
○ Sole bruises 🠞 infection
● Septic joint or tendon sheath articular
○ Contamination of synovial structure iatrogenically or by “wing”
wound fracture.
○ Hematogenous infection common in septic foals This is the
● Fracture/severe soft tissue injury
○ Trauma to limb
most
common
Presentation/classic case: type of P3
● 4/5 to 5/5 on AAEP lameness scale fracture.
DDx
● Sole abscess
● Septic joint or tendon sheath

Test(s) of choice
● Sole abscess
○ Hoof testers
○ Evaluate digital pulses
● Septic joint or tendon sheath
○ Examine for joint/tendon sheath effusion
○ Synoviocentesis
● Fracture/severe soft tissue injury
○ Palpation of the limb for pain & stability
○ Radiographs
 Conditions associated with the foot
1. Laminitis
Etiology: DDx
● Breakdown of hoof-lamellar interface ● Problems causing forefoot lameness & inflammation (ie sole
● Results in increased dorsal hoof wall thickness, rotation of P3 abscess)
w/in hoof capsule, decreased sole thickness, & “sinking of P3 ● Diseases causing reluctance to move or recumbency
w/in hoof capsule. (neurologic disease or myopathy)
● Endotoxemia (ie colitis, grain overload, or pleuropneumonia)
● Support limb (contralateral limb to primary lameness) Test(s) of choice
● Endocrinopathic (associated w/ hyperinsulinemia in equine ● Clinical examination (hoof testers)
metabolic syndrome and PPID) ● Radiographs (often acutely normal)
● Exogenous corticosteroid administration (anecdotal)
● Black walnut shaving used as bedding
Treatment
● Phases:
● Distal limb cryotherapy in acute phases
○ Acute:
● Sole support & stall rest in acute phases
■ Painful inflammation of the hoof lamellar
● Pain relief (NSAIDS, opioids)
interface
● Corrective trimming & shoeing during chronic phase
■ Not always externally obvious (ie no abnormal
hoof growth or radiographic abnormalities).
Prognosis
○ Cronic
● Guarded - hoof-lamellar interface is weakened by this
■ Abnormal hoof growth evident - ‘ringing”,
disease & recurrence is likely
depression of coronary band, “bunching” of
dorsal hoof wall growth
Pearls
■ Obvius radiographic changes
● The underlying cause must be identified & addressed
■ Can be intermittently painful
● i.e. horse's w/ PPID or EMS must be treated appropriately in
order to minimize recurrence & progression of laminitis.
Presentation/classic case:
● Horse walk w/ hind feet under them & forefoot extend (due to
forelimb pain); appear to “walk on eggshells” & reluctant to
move. It can happen on all feet.
● Weight shifting (treading)
● Recumbency in severe cases
● Prominent arterial digital pulses, warm feet
 Conditions associated with the foot
1. Laminitis

This horse had what was thought to be The distance between the dorsal distal parietal
a routine abscess at the toe (arrow) but surface of the distal phalanx and hoof capsule
a lateral radiograph revealed chronic increases (white double arrow) while it remains
laminitis close to normal proximally (black double arrow); i.e.
there is divergence of the surfaces (capsular
rotation). Also, the distance between the dorsal
margin of the distal phalanx and the sole and
ground is decreased (open arrow).
 Conditions associated with the foot
2. Foot Abscess
Etiology: Treatment
● Penetrating injury (eg. Nail in sole) ● Use hoof testers to locate site, and then pare with hoof knife,
● Disruption of hoof wall integrity- crack. to establish drainage.
● Types: ● Daily soaking and bandaging until drainage
○ Subsolar ● If unorganized abscess - Soak foot:
○ Gravel: Infection of the whiteline. ● Warm water; epsom salts.
○ Heel bulb: Breaks out in soft tissue around coronary ○ Epsom salt helps to draw out and organize abscess
band (2-3 days)
Presentation/classic case: ● Foot wrap with ichthammol (tarry) & epsom salts.
● Suddenly lame. ○ Place foot in diaper and duct tape it
● Increase digital pulses--throbbing ● Organized abscess:
● Increase warmth of hoof. ○ Decompress – cut hole in (pare) sole.
○ Flush abscess:
DDx ■ H2O2 + betadine
● P3 fracture ■ Remove exudate
● Sole bruise ○ Foot wrap with strong iodine.
● Laminitis usually bilateral bruising ■ Have farrier put shoe on foot after it’s dry and
then fill it!
Test(s) of choice Prognosis
● Hoof testers + ● Good
● Put pressure on hoof to see if it hurts Pearls
● Subsolar abscess ● Don’t forget to administer Tetanus toxoid
● Bulge of the coronary band will occur with Gravel and Heel bulb ● Do it if owner doesn’t know history of vaccine
 Conditions associated with the foot
3. Bruise
Etiology: Treatment
● Trauma
● Rest from heavy work
● Hard ground
● Change the environment, avoid rough ground
● Pressure from horseshoe on the bar area of foot (Corn).
● Sole Bruise:
● Usually from a poorly fitted shoe
○ Shoe and Pad—use silicone to seal pad
● Types:
○ NSAID
○ Sole Bruise: Rupture of blood vessels in the corium
● Corns:
beneath the sole
○ Set shoe off bar.
○ With time the blood spreads into the deeper layers of the
○ Reshoe more frequently (6-8 weeks).
epidermis and becomes visible as hoof grows.
○ Corn. A bruise that involves the tissues at the angle
Prognosis
formed by the wall and bar (heel)
● Very Good: a single traumatic episode and good
Presentation/classic case:
foot conormartion
● Variable. Most sole bruises occur at the toe or quarter regions
● Guarded: Poor hoof conformation and working in
and corns occur at the angle of the wall and bar. Occasionally
hard ground: recurrence is common.
the frog can be bruised as well.
○ The horse may show varying degrees of lameness
(usually mild to moderate) depending upon the severity
and type of the bruise or corn.
DDx
● Abscess
● Laminitis
● Navicular disease
● P3 or sesamoid fracture

Test(s) of choice
● HIstory and clinical signs.
○ Chronic bruises are usually visible
● Hoof testers +
● Put pressure on hoof to see if it hurts
● Subsolar abscess
● Bulge of the coronary band will occur with Gravel and Heel bulb
 Conditions associated with the foot
3. Thrush
Etiology: Treatment
● Presence of black necrotic exudate and a foul odor.
● Debridement of the affected tissue
● Results in an infection of the frog tissue, anaerobes thrive
● Topical application of an astringent agent +/- foot
● Hindlimbs are most frequently involved
bandages
● Contributing factors
○ copper sulfate, 2% iodine alone or mixed
○ Wet and unhygienic stable conditions,
with phenol, methiolate, and 10% formalin.
○ Neglect of daily foot care,
● Keep horse on clean dry footing—KEY!!
○ Lack of exercise.
○ Inadequate or improper trimming and shoeing,
Prognosis
● Early diagnosis: Good
Presentation/classic case:
● Malodorous thick black discharge in the sulci. (central and
lateral)
Pearls
● Lameness:
● Prevention: clean and dry bedding and routine
○ reaches deeper structures
foot care prevent most cases of thrush
○ loss of frog area

DDx
● Canker
● Abscess
● Laminitis
● Navicular disease
● P3 or sesamoid fracture

Test(s) of choice
● HIstory and clinical signs.
○ Presence of black, odiferous discharge in the sulci of the
frog together with the loss of the frog
 Conditions associated with the foot
4. Canker

Etiology: Treatment
● Chronic hypertrophic, moist pododermatitis of the ● Treatment is resection of proliferative tissue,
epidermal tissues of the foot. bandaging, maintenance in a dry environment.
● Common in draft breeds in moist environments, canker is ● Topical treatment: chloramphenicol; metronidazole
a proliferative disease of the frog and sole for which there powder; 2% metronidazole ointment; a mixture of
is no known cause (likely anaerobic or fungal etiology). ketoconazole
● It also affects horses with routine hoof care can still get
canker. Prognosis
● Early treatment: good
Presentation/classic case: ● Guarded to poor: Advanced cases (invasion of the sole,
● Lameness seen in advanced cases. bars, and hoof wall,) and seen in multiple limbs remain very
● Examination of the foot - a fetid odor and +/- intact frog
with a ragged proliferative filamentous appearance. Pearls

DDx ● Prevention: clean and dry bedding and routine foot care
● Thrush prevent most cases of thrush
● Abscess
● Neoplasia
Small, pale,
demarcated
Test(s) of choice growth along
the caudal
● Presumptive diagnosis can often be made based on the aspect of the
physical findings frog that can
○ Confirmation (biopsy) but is seldom performed be consistent
with early
canker
 Conditions associated with the foot
5. Navicular disease
Overview and Etiology: DDx
● Vascular compromise biomechanical abnormalities leading to ● Laminitis—acute, severe bilateral forelimb lameness.
tissue degeneration Hoof tester pain at the point of the
● Chronic forelimb lameness associated with pain arising from the ● frog in toe region
navicular bone and closely related structures including the ● Sheared heels—one heel higher than opposite heel on
collateral suspensory ligaments (CSLs) of the navicular bone, same foot
distal sesamoidean impar ligament (DSIL), navicular bursa, and ● Bruised feet especially in the heel region of the foot
the deep digital flexor tendon (DDFT). termed a “corn”
● Common causes of intermittent forelimb lameness in horses
between 4 and 15 years of age. One-third of all chronic forelimb Test(s) of choice
lameness in horse's ● PD block
● Increased Risk: Quarter horses, Thoroughbreds, and ● Radiograph
Warmbloods, particularly geldings ● US - soft tissue
● ● Scintigraphy, MRI recent years and is currently the
preferred diagnostic technique and CT scan
History and Presentation/classic case: Treatment
● History of progressive, chronic, unilateral or bilateral ● Rest for significant soft tissue injuries within the
forelimb lameness. Gradual loss of performance, stiffness, foot such as DDFT or CSL lesions
shortening of the stride, loss of action, unwillingness to ● Corrective trimming and shoeing is the basis for
turn, and increased lameness when worked on hard managing most horses with navicular syndrome.
surfaces.
● Most horses: bilateral forelimb lameness that switches to the Prognosis
opposite limb after a low PD block. ● difficult to predict because of the numerous bone and soft
● Rare in hindlimbs tissue abnormalities that can occur concurrently.
● Pain on hoof testers across the central or cranial aspect of the
frog, elicits pain in central frog region and across caudal third of Pearls
hoof. Long toe-low heel hoof conformation
● Increased heat in hoof capsule ● There is no cure for the disease and the preceding
● Increased digital pulses in affected foot treatments are probably more appropriately termed
● capsule at the medial and lateral aspect of navicular bone. management strategies because the disease/syndrome is
● Atrophied frog unlikely to resolve completely.
● Lameness, frequently bilateral, although predominates in one
limb
 Conditions associated with the foot
5. Navicular disease

Using egg-bar shoes is a common shoeing technique to

treat horses with navicular disease/syndrome.

Multiple abnormalities within the navicular bone as seen on

an oblique radiograph. Abnormalities present include
remodeling along the proximal border, multiple cystic lesions
along the distal border, and enthesiophytes on the wings of
the navicular bone.

Skyline radiograph of the same horse demonstrating sclerosis of

the medullary cavity of the navicular bone and erosions along the
flexor surface.
 Conditions associated with the foot
6. Sidebone: DO NOT confuse with Ringbone!
Etiology: Treatment
● Ossification of the collateral cartilages of the distal phalanx is
● If sidebone is suspected as the cause of
relatively common in certain breeds of horses, including most
lameness, conservative treatment with rest,
larger breeds such as Warmbloods and draft horses and
topical 1% diclofenac sodium cream (Surpass®),
Finnhorses and Brazilian jumpers.
and oral administration of NSAIDs is
recommended initially.
Presentation/classic case:
● Any contributing foot problems such as foot
● Apparent as an enlargement of the lateral and medial
imbalances should be addressed.
dimensions of the pastern region if the ossification is extensive.
● Surgical removal of suspected fractured
● Lameness resulting from sidebones is considered rare
sidebones is not recommended.
DDx

● Abscess Prognosis
● Neoplasia ● Difficult to predict because this condition is
thought to rarely cause lameness.

Test(s) of choice
Pearls
● Radiographic examination of the foot
● Rarely is pain elicited with digital pressure. If
present, the enlarged sidebone may contribute to
Standing dorsopalmar the lameness or may be associated with a
horse demonstrating a secondary fracture of the distal phalanx.
large uniaxial sidebone
that was thought to
contribute to lameness
 Conditions associated with the pastern
7. Ringbone
Etiology: Treatment
● Osteoarthritis
● Rest periods from weeks to several months
● High ringbone- distal aspect of P1 and proximal aspect of P2
● Reduction in workload and expectations for the
with or without proximal interphalangeal joint (PIP).
horse
● Low ringbone distal aspect of P2 and the proximal aspect of
● Arthroscopic removal of osteochondral
● the distal phalanx with or without distal interphalangeal (DIP)
fragmentation(s)
joint involvement
● Surgical arthrodesis (joint fusion surgery): chronic
● More common in middle-aged to older horses
or advanced
● Risk factors:
● NSAIDs—phenylbutazone for 7–10 days
Poor conformation, Hoof imbalance, Sports that require
● Intra-articular corticosteroids
repetitive quick turns and abrupt stops, e.g., Western
● Systemic chondroprotective drugs: polysulfated
performance, polo, jumping, articular fractures of first, second,
glycosaminoglycan or sodium hyaluronate
or third phalanx
● Oral chondroprotective
medications—glucosamine/chondrotin sulfate
Prognosis
Presentation/classic case:
● Early recognition: good- fair
● Focal or diffuse enlargement of the pastern region may be
● Chronic and advanced: candidate for retirement
evident visually as well as on palpation
● Palpable heat and pain with fi rm digital pressure
● most horses there is pain on flexion and rotation of the pastern
Pearls
● progressive and reduction in athletic soundness is
region
Lateral expected.
radiograph of the ● Intra-articular corticosteroids use is not
DDx
pastern region recommended in horses with a previous history of
with a laminitis.
● Laminitis
● Navicular disease marked
periosteal Typical enlargement
Test(s) of choice reaction around of the pastern that
may be
● Physical examination findings combined with the responses to visible in horses with
local anesthesia. OA of the PIP joint
● Radiographic examination of the foot : confirmation
 Conditions associated with the fetlock
8. Osselets
Etiology: Treatment
● Fetlock joint OA
● Rest periods from weeks to several months
● Most common in horses used for racing or other high-impact
● Reduction in workload and expectations for the
sports
horse
● Risk factors:
● Arthroscopic removal of osteochondral
Sports that require maximal speed, i.e., racing, Poor
fragmentation(s)
conformation, Specific diseases that may cause MTPJ
● Surgical arthrodesis (joint fusion surgery): chronic
(metacarpophalangeal joint) synovitis or arthritis
or advanced
● NSAIDs—phenylbutazone for 7–10 days
● Intra-articular corticosteroids
● Systemic chondroprotective drugs: polysulfated
Presentation/classic case:
glycosaminoglycan or sodium hyaluronate
● often bilateral with one limb affected more than the other.
● Oral chondroprotective
● Pain, heat, synovial distention of the JMTPJ
medications—glucosamine/chondrotin sulfate
● Stiff gait and shortened stride
Prognosis
● Resentment and decreased range of motion during MTPJ
● Early recognition: good- fair
flexion
● Chronic and advanced: candidate for retirement
DDx
Pearls
● In advanced MTPJ disease or traumatic rupture of
suspensory apparatus, surgical arthrodesis is
● Lower limb abnormalities needs to be ruled out
indicated.
● Chip fracture P1
● After arthrodesis, horses may be salvaged for
breeding purposes or retired to pasture.
Test(s) of choice
● Intra-articular corticosteroids use is not
recommended in horses with a previous history of
● Radiography: Chronic diseases
laminitis.
● Nuclear scintigraph
●
● MRI—Excellent imaging modality Lateral radiograph of the fetlock
demonstrating
a concave defect in the
metacarpus (arrow) at the
proximal aspect
of the joint consistent with
proliferative or villonodular
synovitis.
 Conditions associated with the fetlock
9. Osteochondral chip fractures P1
Etiology: Treatment
● Osteochondral fractures of the proximal end of the first phalanx
● Rest periods from weeks to several months
(P1) are relatively common in the forelimb of the horse,
● Reduction in workload and expectations for the
particularly the racehorse.
horse
● Trauma
● Arthroscopic removal of osteochondral
● +/- be history of acute lameness followed by dramatic relief
fragmentation(s)
when a chip that was caught in the joint is dislodged.
● NSAIDs—phenylbutazone for 7–10 days
● Intra-articular corticosteroids
● Systemic chondroprotective drugs: polysulfated
Presentation/classic case:
glycosaminoglycan or sodium hyaluronate
● lameness, which increases after exercise,
● Oral chondroprotective
● Synovitis of the fetlock joint indicated by distention of the joint
medications—glucosamine/chondrotin sulfate
capsule (between the suspensory ligament and the palmar or
plantar surface of the cannon bone) is commonly found
Prognosis
● Small acute, nondisplaced fetlock chip fractures
● usually have a good prognosis with conservative
DDx
treatment.
● Factors that lower the prognosis include extreme
● Lower limb abnormalities needs to be ruled out
large size of the fragment, chronicity, degree of
● Osselets
synovitis/capsulitis, and amount of OA present.
● Sesamoid fracture
Pearls
● Standardbred racehorses often have chronic joint
Test(s) of choice
changes associated with dorsal P1 fractures
● low 4-point nerve block
● Radiography: lateral
Lateral radiograph demonstrating
a typical palmar/plantar
osteochondral fragment
of the first phalanx
 Conditions associated with the metacarpus and metatarsus
10. Digital flexor tendon sheath (dfts) tenosynovitis
Etiology: Treatment
● aka (windpuffs) or be associated with lameness and disease
● Rest periods
conditions of the superficial or deep digital flexor tendons,
● Cold hydrotherapy, bandaging, and topical and
anular ligament, or sheath itself
systemic NSAIDs
● effusion within the sheath and possibly heat and tenderness of
● Systemic hyaluronan
the Digital flexor tendon sheath (DFTS)
● Injection hyaluronan,corticosteroids, or
●
autologous conditioned serum
● surgical drainage of the sheath should be
Presentation/classic case:
reserved for non responding septic tenosynovitis
● Effusion of the DFTS is visible and palpable.
● Fluctuant swelling palmar/plantar to the suspensory
Prognosis
● ligament and proximal to the sesamoids is present
● Fair: 68% returning to soundness and 54%
●
returning to levels of previous work
● guarded prognosis for athletic performance.
DDx

● Fractures of metacarpal or metatarsal bones

Pearls
● Chronic Recurring lameness can occur in horses
that are not rested long enough, which can be 5 to
Test(s) of choice
6 months.
● Ultrasonographic examination
● Surgery may speed up the return to athletic
● soundness and improve the cosmetic blemish.
This horse had diffuse
thickening of the plantar
aspect of the fetlock region
and effusion of the DFTS
that is
typical of horses with chronic
tenosynovitis.
 Conditions associated with the metacarpus and metatarsus
11. Splint (metacarpal/ metatarsal exocitosis)
Etiology: Treatment
● Young horses, most commonly affects the proximal medial
● Rest periods for the acute phase
aspect of the limb between the second and third metacarpal
● NSAIDs—phenylbutazone for 7–10 days
bones
● Intralesional corticosteroids
● Associated with training and subsequent injury between the
● Hypothermia: ice or ice/water packs
small metacarpals/ metatarsal (MC/MT) bones and cannon
● Acupuncture and massage.
bone, resulting in inflammation or tearing of the interosseous
● Surgery: If the proliferative bone is excessive
ligament.
● Most common in 2-year-old horses undergoing heavy training,
Prognosis
but cases occasionally occur among 3- or 4-year-olds.
● good to excellent for soundness except for those
in which the exostosis is large and encroaches on
Presentation/classic case:
the suspensory ligament or the carpal joint
● Heat, pain, and swelling over the affected region may occur
●
anywhere along the length of the splint bone.
● Splints most commonly occur about 3 inches below the carpal
joint
Pearls
● Chronic Recurring lameness can occur in horses
● Inflammation and swelling are the hallmark of this disease in
that are not rested long enough, which can be 5 to
the acute phase
6 months.
● Surgery may speed up the return to athletic
DDx
● soundness and improve the cosmetic blemish.
● Fractures of metacarpal or metatarsal bones
Visible enlargement
This large
of the medial splint
area just distal to exostosis of
Test(s) of choice the carpus typical of the medial
● Radiography horses with “splints. splint was
contributing to
● Ultrasonographic examination can demonstrate concomitant
lameness and
injury to the suspensory was removed
surgically.
 Conditions associated with the metacarpus and metatarsus
12. Fractures of the small metacarpal metatarsal (splint) bones

Etiology Treatment
● Fractures of the distal part of a small metacarpal or metatarsal
● Small distal fractures of the splint bones are
bone usually occur in older horses (5 to 7 years of age) and
traditionally treated by removing the distal
only rarely occur in horses under 2 years of age.
fragment (not universally recommended)
● Cases occasionally occur among 3- or 4-year-olds.
● Surgery is necessary
● Forelimbs are more frequently involved
in these cases or sequestration, osteomyelitis,
● Relationship between suspensory ligament desmitis,
and infectious arthritis may persist.
sesamoiditis, and fetlock OA or arthrosis
Prognosis
● For distal splint bone fractures, the prognosis for
Presentation/classic case:
● return to performance depends on the severity of
● On palpation, heat, pain, and swelling
suspensory desmitis, not on the radiographic
● more acute the fracture, the more swelling.
healing of the fracture.
● Open proximal fractures of the splint bones have
a more guarded prognosis,
DDx
● Splints
Pearls
● Chronic Recurring lameness can occur in horses
Test(s) of choice
that are not rested long enough, which can be 5 to
● Radiography
6 months.
● Surgery may speed up the return to athletic
● soundness and improve the cosmetic blemish.

Fractures of the distal splint

bones such as this
rarely heal and are usually
removed