J. Vet. Med.

A 53, 364370 (2006) ` 2006 University of Liege, Belgium Journal compilation 2006 Blackwell Verlag, Berlin ISSN 0931184X

` Department of Large Animal Surgery, Faculty of Veterinary Medicine, University of Liege, Sart-Tilman, Belgium

Radiographic Evolution of the Forelimb Digit in Ardenner Horses from Weaning to 28 months of Age and its Clinical Signicance
J. P. Lejeune1,2,3, N. Schneider1,2, I. Caudron1,2, D. H. Duvivier1,2 and D. Serteyn1,2
` Addresses of authors: 1Department of Large Animal Surgery, Faculty of Veterinary Medicine, University of Liege, B41, 4000 Sart-Tilman; 2Centre Europeen du Cheval, Mont-le-Soie, 1 6690 Vielsalm, Belgium; 3Corresponding author: Tel./fax: +32 80216556; E-mail: jph.lejeune@student.ulg.ac.be With 4 gures and 1 table Received for publication February 24, 2005

Summary
Ossication of collateral cartilages is a common radiographic nding in draught horses and indication of a high frequency of interphalangeal osteo-arthropathy have been found in Ardenner horses. This study rst aimed at following the evolution of the digits of the forelimbs on radiographic images in a group of 32 Ardenner horses from weaning to 852 19 days and, secondly, at evaluating the clinical signicance of the observed radiographic changes. At 250 21 days, only 23% of the horses presented a small separate ossication centre of collateral cartilages above the level of the distal sesamoid bone or at the level of the proximal half of the middle phalanx. At 852 19 days, 100% of the horses presented an ossication of collateral cartilages but at dierent stages and grades. The presence and the extent of the ossication of the lateral cartilages were not signicantly associated with lameness. Phalanges changes appeared at the average age of 1 year and they were represented by entheseophytes on the dorsal surface of the middle and distal phalanges. The frequency of aected horses increased with age as well as the size of the entheseophytes. This may reect mechanical stresses applied to the interphalangeal joints. A signicant association with the presence of lameness was pointed out. The presence and the severity of phalanges changes could be of importance, in combination with a clinical examination, in improving the selection of horses able to assume work and/or leisure activities.

secondly, at evaluating the clinical signicance of the observed radiographic changes.

Materials and Methods

Horses Thirty-two Ardenner horses (14 llies and 18 colts), registered in the Belgian studbook, were selected and gathered together from weaning at the Centre Europeen du Cheval (Mont-leSoie, Belgium). This experimental group represented 9.3% of the births in Belgium in the year 2000. These animals were born between 17th April and 22nd August, principally during May and June. They were selected from among 70 foals (17 llies and 53 colts), originating from dierent stables, on the basis of a visit and a video lm, both carried out by the rst and the last authors, from 27th October to 15th November 2001. The video lm was used to compare all the foals after having completed the visit of the dierent stables. The video lm consisted of prole and face views of the foals so as to visualize the comments made concerning the foals and their standings during the visit. The selection was made to eliminate foals with obvious orthopaedic disorders such as angular and exural limb deformities. A subjective evaluation was carried out using the plumb line concept (Ross, 2003a). Foals with deviation in front, rear or lateral perspectives were eliminated. Mild bilateral carpal valgus and toed-out appearance could be considered normal in the foals (Parente, 2003). Foals presenting that deviation were not eliminated. Foals that presented joint distension were also eliminated. During the selection, 82% of the llies and 33% of the colts proposed by the breeders were selected in order to have a reasonable proportion of females/males. The horses arrived at the Centre in December 2001, at the approximate age of 6 months. Standardized conditions From their arrival at the centre, the horses lived in pastures and were fed a 12% protein mix during the winter and hay of good quality ad libitum. This mix was distributed at the rate of 1 kg/100 kg bodyweight divided into two meals. During the summer, pasture was sucient for feeding. Transitional periods were respected between seasons. Hoof trimming, according to rules for maintaining the biomechanical balance of the foot (Caudron, 1997) was regularly performed. Horses were divided into three groups raised in three dierent pastures www.blackwell-synergy.com

Introduction
Joint diseases are a major cause of lameness in horses. This trouble can have considerable negative economic consequences resulting from the reduced active lifespan of the concerned horses (Robert et al., 1995). Indications of a high frequency of interphalangeal osteo-arthropathy have been described in draught horses (Lejeune et al., 2002). A juvenile form of the pathology is suspected in this type of breed (Lejeune et al., 2002). In a previous study, a slight remodelling of the dorsal surfaces of the middle (P2) and the distal phalanges (P3) was observed in six of the 32 horses at 250 21 days of age (Lejeune et al., 2002). This study rst aimed at following the evolution of the radiographic images of the interphalangeal joints of the forelimbs of 32 young Ardenner horses from weaning to 852 19 days (approximately 2 years and 4 months) and,
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Radiographic Evolution of the Forelimb Digit each equipped with a shelter: two groups of nine males and one group of 14 females. Radiographic examination protocol One forelimb was held up to obtain a standardized position of the weight-bearing limb in order to perform lateromedial and dorsopalmar radiographic views of the corresponding digit. Holding up a limb helped the examiner have the same position and the same weight constraints on the digit at each evaluation and thus similar bearings. A mobile X-ray machine, Gierth HF 300 (Gierth International GmbH, Neu-Isenburg, Germany), and phosphor plates (cephalometric 8 12) for digital radiography were used. For the lateromedial radiographs, because of their small size, the plates were inclined in the sagittal plane in order to obtain the image of the entire digit. This can lead to a false interpretation of a very sloping axe of the digit when developed. The development was completed with a VetRay Combo 2000 scanner (VetRay GmbH, Pfaenhofen, Germany). The digital radiographs were analysed, by the same examiner, using the method of radiographic interpretation described by Denoix (1990a,b), by means of the Hipax imaging software, version 3 (Steinhart, Vorstetten, Germany). The intrinsic components of the joints were examined: the joint space, the subchondral bone, the insertion surfaces of the ligaments and the joint capsule, and the articular margins. The thickness of the joint space was evaluated in order to highlight a possible cartilage loss. The subchondral bone itself and its surface were also examined, paying close attention to their regularity and opacity. The opacity and the shape of the articular margins were also observed. Modications of the shape could be due to osteophytes and/or entheseophytes (Denoix, 1990a,b). The assessment of the entheseophytes was made according to their number, their size and their aspect. A regular and smooth bony prominence on P2, at the junction of the proximal twothirds and distal one-third, was regarded as a normal nding (Butler et al., 1993; Dyson, 2003). The radiographs of the digits were classied as normal or suspect (score ScP 0 for Score Phalanges changes 0), abnormal (slightmoderate severe) (scores ScP 1ScP 2ScP 3 respectively) principally taking into account the presence and severity of entheseophytes on the dorsal surface of P2, on the pyramidal process of P3 and on the dorsal surface of P3 distally to the pyramidal process, osteophytes and/or irregularity of articular margins (Lejeune et al., 2002). The horse was classied according to its most aected limb. With regard to the ossication of the cartilages of the foot, the dorsopalmar radiographs were characterized by three grades according to the classication of Ruohoniemi et al. (1993, 1997). First, the ossication originating from the base of the cartilage, at its attachment to P3, was graded from 0 to 5 and was called base grade. This grade was determined in relation to the most proximal point of ossication. At grade 0 no ossication was visible, at grade 1 a minimal ossication appeared at the base of the cartilage and at grade 2 a mild ossication extended to the palmar level of the distal interphalangeal joint. Grade 3 corresponded to a moderate ossication at the level of the proximal edge of the navicular bone. Grade 4 indicated an advanced ossication, extending above the navicular bone but remaining in the distal half of the P2. At grade 5, an ossication, extending to the level of the

365 proximal half of P2, was observed. Secondly, the total ossication of each cartilage, described as global grade, took into account both the ossication at the base of the cartilage and the separate ossication centres. This Global grade was determined in the same way as for the base grade, from 0 to 5. Thirdly, the absence (0) or presence (1) of separate ossication centres was mentioned. This last value was called separate centres. Radiolucent lines in the middle or distal part of moderately to extensively ossied cartilages were considered as signs of separate ossication centres. The limb was graded according to the most ossied cartilage and the horse was classied according to its most aected limb (Ruohoniemi et al., 1997). An additional scoring method was used in order to synthesize the information. The horses were considered to have no or minor ossication (score ScC 1) up to a base grade 2 without separate ossication centre (0-0-0, 1-1-0, 2-2-0), moderate ossication (score ScC 2) if the ossication extended at the most to a base grade 2 with a small separate centre of ossication (grades 0-4-1, 1-4-1, 2-4-1, 1-5-1, 2-5-1) and major ossication (score ScC 3) from a base grade 3 with or without a separate ossication centre (grades 3-3-0, 3-4-1, 3-5-1, 4-4-0, 4-5-1, 5-5-0). These evaluations were repeated 11 times on the 32 horses during their growth at the following average ages: 250 21, 289 18, 335 21, 392 20, 452 18, 504 20, 558 18, 613 19, 675 19, 752 21 and 852 19 days. Each evaluation lasted several weeks. The horses were distributed in time and evaluated from the earliest born foal to the latest born foal in order to minimize the dierences of age at the time of evaluation. For each evaluation, the percentage of horses in each category of severity was calculated for the phalanges changes and the ossication of the collateral cartilages. Lateromedial and dorsopalmar radiographs of the metacarpo-phalangeal joint and of the carpal joint, respectively, were performed at 852 19 days. They were interpreted in the same way as described above. Clinical examination protocol The clinical evaluation was based on the classical method of diagnosis of lameness (Denoix, 1992a,b; Trotter and McIlwraith, 1996; Ross, 2003a,b,c,d,e) and was carried out by the rst author. A simplied clinical evaluation was performed at 250 21, 289 18, 335 21, 392 20, 452 18, 504 20, 558 18 and 613 19 days. It consisted of a static part and of a dynamic part. The static part consisted of inspection, palpation and passive manipulation (Denoix, 1992a,b). The dynamic part aimed at characterizing the gaits and the possible lameness on a hard surface, walking a straight line and a volt (at both leads) as well as trotting in a straight line. An additional clinical evaluation, which specifically focused on the forelimbs digits, was performed at 675 19, 752 21 and 852 19 days on 30 of the 32 horses. It consisted of three parts: the static part, the dynamic part and the functional tests. The static part was identical to the simplied clinical examination previously described and the dynamic part was completed by observing the horses trotting in a circle at both leads on a soft surface. The functional tests were performed on a hard surface. They consisted of the lower limb exion test and four wedge tests: the rst one to raise the toe, the second one the heel, the third

366 one the lateral part of the hoof and the fourth one the medial part of the hoof. A wedge of 22 was used for the two rst tests and a wedge of 15 was used for the two last ones. An overall grade of the clinical status of the horse was established after the three last clinical evaluations: each horse was classied as healthy or lame. A horse was considered lame when lameness was observed, at least once, consistently under all circumstances (without performing the functional tests). This corresponded to at least a grade 3/5 of the grading system of the American Association of Equine Practitioners (AAEP, 1999): lameness is consistently observable at a trot under all circumstances (such as weight bearing, circling, inclines and hard surfaces). A horse was also considered lame when the same functional tests revealed lameness at two of the three clinical evaluations. This situation could be compared with a grade 1/5 or 2/5 of the grading system of the AAEP: lameness dicult to observe and not consistently apparent regardless of circumstances or lameness dicult to observe at a walk or trotting a straight line but that is consistently apparent under circumstances. These circumstances (weight bearing, circling, incline and hard surfaces) could be compared with the dierent functional tests. Complete clinical data for 30 horses was available. Two others were injured at the moment of these clinical evaluations and were therefore excluded from the experimental group. The frequency of lame horses was calculated on the basis of the results of the last three clinical evaluations (675 19, 752 21 and 852 19 days). In lame horses, the proportion of left, right and bilateral lameness was calculated. The functional tests, carried out at 675 19, 752 21 and 852 19 days, represented 180 tests of each type (lower limb exion test and four wedge tests): three repeated tests of each type on each forelimb on 30 horses. All these functional tests of both limbs were taken into account to establish the distribution, within the positive tests, among the dierent kinds of tests as follows: ratio between the number of positive tests of a particular type and the total number of positive tests. Relation radiography clinical examination

J. P. Lejeune et al.

In order to study the relation between radiography and clinical examination, the frequency of positive functional tests of each kind was calculated in the dierent radiographic categories based on phalanges changes (entheseophytes and articular margins together) observed at 852 19 days as follows: number of positive tests of a particular type/number of performed tests of this particular type. The dierence between the radiographic categories was tested using the Fisher least signicant dierence test (P < 0.05). The radiographic categories concerning radiographic changes were: normal or suspect radiographs (ScP 0), slight abnormal (ScP 1), moderate abnormal (ScP 2) and severe abnormal (ScP 3) radiographs. The same frequency of the positive tests was calculated and tested in the same way in the three dierent categories: minor moderatemajor (ScC 1ScC 2ScC 3) based on the ossication of the collateral cartilages at 852 19 days. In order to obtain a unique and more accurate classication of the horses according to the articular pathology, the data from the radiographic and clinical examinations were combined. All the possible combinations between the clinical status and the radiographs concerning phalanges changes were envisaged to divide horses into six dierent categories: horses with normal or suspect radiographs (ScP 0), slight abnormal radiographs (ScP 1) and moderate abnormal radiographs (ScP 2), in each case sound or lame. The proportion of horses for each category was calculated. Regional anaesthesia (palmar digital analgesia) was performed on the horses with moderate abnormal radiographs and clinically lame.

Results
Table 1 shows the proportion of horses for each grade of ossication of the collateral cartilages according to their age. At the rst evaluation (250 21 days), most of the horses (77%) did not present any sign of ossication of the collateral

Table 1. Classication of the ossication of the collateral cartilages of the forefeet at each evaluation Average age (days) Grade of ossication ScC 1 000 110 220 ScC 2 041 141 151 241 251 ScC 3 330 341 351 440 451 550 250 21 289 18 335 21 392 20 452 18 504 20 558 18 613 19 675 19 752 21 852 19 19 16 0 13 42 3 0 3 0 0 0 3 0 0 6 16 0 3 56 9 3 3 0 0 0 3 0 0 3 16 3 3 47 13 0 3 0 0 0 9 0 3 3 19 3 3 44 9 0 6 0 0 0 9 0 3 3 13 9 0 44 6 3 3 0 0 0 9 0 9 3 6 0 0 39 16 1 6 0 0 0 1 0 1 0 0 3 0 28 31 3 6 0 0 0 0 0 28 0 3 6 0 16 13 6 23 0 3 3 0 0 26

77 0 0 19 3 0 0 0 0 0 0 0 0 0

77 3 0 13 6 0 0 0 0 0 0 0 0 0

69 6 0 6 16 0 0 0 0 0 0 3 0 0

The percentage in each grade is mentioned. The percentage of the main category is highlighted in bold for each age. The ossication is characterized by three grades: the base grade, the global grade and the presence or absence of separate ossication centre. These grades are grouped in three categories: minor, moderate and major ossication (ScC 123 respectively) (see text for explanation).

Radiographic Evolution of the Forelimb Digit cartilages (grade 0-0-0), while the others (23%) already showed a slight separate ossication centre above the level of the distal sesamoid bone (0-4-1) or the level of the proximal half of P2 (grade 0-5-1). As the horses grew, the severity of the ossication of the collateral cartilages increased and spread to them all. When only one ossication centre was present at the base of the cartilage, it expanded proximally. When separated ossication centres were observed, the progression tended to join them. The centre of the base expanded proximally while the proximal centre grew distally. A slight expansion of this centre was also observed proximally. Figure 1 shows the evolution, during the growth, of the ossication of the collateral cartilages through the percentage of horses with minor, moderate and major ossication. At the latest evaluation (852 19 days), 100% of the horses presented an ossication of the collateral cartilages, 9% showed a minor ossication only (ScC 1, until a grade 2-2-0); 32% had major ossication (ScC 3, from a base grade 3) among which 26% presented totally ossied collateral cartilages, following the proximal and distal ossication centres joined (4-4-0 and 5-5-0) and 58% had moderate ossication (ScC 2, until a base grade 2) and still presented two separate ossication centres. Figure 2 shows the evolution of the phalanges changes. Entheseophytes on P3 are illustrated in Fig. 3. At the third

367 evaluation (335 21 days), 6.12% of the horses had slightly abnormal radiographs (ScP 1) mostly due to the presence of entheseophytes on the dorsal surface of P2 and P3. The other abnormal signs, sporadically observed, were slight irregularity of the articular margins and/or the presence of small osteophytes. The frequency of injured horses as well as the severity of the entheseophytes, determined by their number, size and aspect, increased with age up to a frequency of 68.75% of the horses at the last evaluation (852 19 days). Among these 68.75%, 12.5% presented moderate abnormal radiographs (ScP 2). As far as the clinical examination is concerned, the simplied clinical evaluations did not reveal any lameness till the average age of 558 18 days. Slight forelimb lameness, visible without the use of functional tests and corresponding to a grade 3/5 of the AAEP was observed in two horses at 613 19 days of age. Analysing the data gathered from the clinical evaluations performed at 675 19, 752 21 and 852 19 days, 53.3% of the horses were considered lame. Within the positive functional tests, the distribution between the dierent tests occurred as follows: lower limb exion test 1.7%, toe wedge test 15.5%, heel wedge test 36.2%, lateral wedge test 39.7% and medial wedge test 6.9%. Lameness originated from the left forelimb in 52.9% of lame horses,

1 0.9 0.8

Fig. 1. Evolution of the presence and severity of the ossication of the collateral cartilages in a group of 32 Ardenner horses from weaning to approximately 2 years and 4 months of age. The y-axis represents the proportion of horses (one represents 100% of the horses) in the categories minor (ScC 1), moderate (ScC 2) and major (ScC 3) ossication (see text for explanation) while the x-axis mentions the average age (days) of the horse at the radiographic evaluation.

0.7 Proportion 0.6 0.5 0.4 0.3 0.2 0.1 0 250 289 335 392 452 504 Age 558 613 675 752 852 ScC 1 ScC 2 ScC 3

1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 250 289 335 392 452 504 Age 558 613 675 752 852

Proportion

ScP 0 ScP 1 ScP 2

Fig. 2. Evolution of the presence and severity of phalanges changes (entheseophytes on the dorsal edge of the middle and distal phalanges and modications of articular margins) in a group of 32 Ardenner horses from weaning to 2 years and 4 months of age. The y-axis represents the proportion (one represents 100% of the horses) of horses in the following categories of radiographic images: normal/suspect (ScP 0)slight abnormal (ScP 1)moderate abnormal (ScP 2) while the x-axis mentions the average age (days) of the horse at the radiographic evaluation.

368

J. P. Lejeune et al. radiographic lesions, made it possible to divide horses into four categories according to the radiographic data concerning phalanges changes at 852 19 days and to the clinical results. Category 0 concerned horses free of radiographic lesion and clinically sound; category 1, horses with slight radiographic lesions and clinically sound; category 2, horses with slight radiographic lesions and clinically lame and category 3, horses with moderate to severe radiographic lesions and clinically lame. The distribution of horses into four categories at 852 21 days occurred as follows: 12.9% in category 0, 35.5% in category 1, 38.7% in category 2 and 12.9% in category 3. Regional anaesthesia (palmar digital analgesia) was performed on the horses in the category 3 and a positive response was observed in all of them. There was neither abnormal radiographic image of the metacarpo-phalangeal joint nor carpal joint.

Fig. 3. Lateromedial radiograph of a horses left foot and pastern at the last evaluation. A markedly irregular entheseophyte on the dorsal edge of P3 is visible (full line arrow). The bony prominence on P2 (dotted arrow) is smooth and is regarded as normal but was not present at the rst evaluation. The radiograph is slightly underexposed in order to clearly illustrate the entheseophyte on P3. Some artefacts are visible (white dots) and should not be confused with lesions, notably proximo-dorsally to the pyramidal eminence of P3.

Discussion
At the rst evaluation (250 21 days), 23% of the horses already showed a small separate ossication centre above the level of the distal sesamoid bone or the level of the proximal half of P2. This early nding is consistent with a study by Verschooten et al. (1996), where the earliest ossication was observed in a 9-month-old foal. As the horses grew, the ossication of the collateral cartilages became more and more severe and spread to them all. The observation during this period of age corroborates the study by Ruohoniemi et al. (1997), which evaluated the Finn horse and pointed out a quick increase in the ossication during the period from 1 to 2 years of age. The way the ossication extended and the high frequency of separate ossication centres observed in this study have to be compared with a study on Brazilian mature jumper horses (Melo E Silva and Vulcano, 2002). Indeed, Melo e Silva and Vulcano found that 93% of the 163 horses studied presented an ossication of the collateral cartilages of the foot, but that only 6.6% showed separate ossication centres. These horses were older than 15 months of age (Melo E Silva and Vulcano, 2002). As observed in Ardenner horses, the progression of the ossication tends to join both separate centres. A late evaluation of the collateral cartilages of the foot may lead to the conclusion that there is only one single ossication centre. The frequency of separate ossication centres could therefore be underestimated. The terminology minor, moderate and major seemed to be more appropriate, in this study, to follow the evolution of the ossication with growth than the terms signicant and non-signicant of Ruohoniemi et al. (1997), who attributed the term signicant to the particular case of an ossication with a separate centre according to its proximal position and whatever its size. The extent of the ossication of the collateral cartilages was neither signicantly associated with lameness nor proportionally more positive functional tests. The moment of apparition of a bony prominence on the dorsal aspect of the middle phalanx at the junction of the proximal two-third and distal one-third was not described as such in the literature. This study pointed out that this bony prominence as well as the so-called entheseophytes (large and/ or irregular bony prominence on P2 and bony prominence on P3) were not present at 250 21 days of age and appeared progressively with growth. These bony prominences correspond to the insertions of the collateral ligament of the distal

from the right forelimb in 17.6% and from both forelimbs in 29.4%. The frequency of positive functional tests of each kind in relation to the radiographic data concerning phalanges changes was illustrated in Fig. 4. There were proportionally more positive toe wedge tests, heel wedge tests and medial wedge tests (P < 0.05) in horses with moderate abnormal radiographs (ScP 2) than in horses with normal or suspect radiographs (ScP 0) as well as in horses slight abnormal radiographs (ScP 1). In all horses with moderate abnormal radiographs (ScP 2), the lameness got worse after performing the heel wedge test. The extent of the ossication of the collateral cartilages was not signicantly associated with proportionally more positive functional tests. The absence of lame horses, free of radiographic lesions, as well as the absence of sound horses with, at least, moderate

1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

** * ** * * ** ** ** ScP 1 ScP 2 Radiographic grade * * *

Proportion

L. I. fl. Toe Heel Lat. Med.

ScP 0

Fig. 4. Proportions of positive functional tests of each kind in relation to the radiographic data relative to phalanges changes in a group of 30 Ardenner horses. Concerning the value of the y-axis, one represents 100% of the horses. L. l. ., lower limb exion test; toe, toe wedge test; heel, heel wedge test; Lat., lateral wedge test; Med., medial wedge test. The asterisks of each kind (* and **) indicates the signicant dierences (P < 0.05) between radiographic grades ScP 1 (slight abnormal)ScP 2 (moderate abnormal) and ScP 0 (normal or suspect) ScP 2 (moderate abnormal) respectively. No signicant dierence was observed between ScP 0 and ScP 1.

Radiographic Evolution of the Forelimb Digit interphalangeal joint (Butler et al., 1993), the digital extensor tendon (Collin, 1993; Breit, 1995) and the distal interphalangeal joint capsule, which dorsally unites the previously mentioned tendon. The frequency of injured horses as well as the severity of the phalanges changes, which were determined mostly by the size and irregular aspect of the entheseophytes, increased with age up to a frequency of 68.75% of the horses at the last evaluation (852 19 days). Entheseophytes may indicate that mechanical stress had been applied to the sites of attachment of a tendon, ligament or joint capsule to bone (Dyson, 2003). Such an observation does not necessarily reect degenerative joint disease (DJD), but it may reect slight joint instability, which may itself predispose to the development of DJD (Dyson, 2003). The lower limb exion test was seldom positive (1.7% of the positive tests) in this study. It can be that the force applied during the test was not sucient to inuence the locomotion after the manipulation. It is well known that thoroughbreds are more sensitive to exion tests than saddle horses (Denoix, 1992a,b) and a fortiori than heavy horses. On the contrary, for wedge tests, the weight carried by the tested limb allowed an important constraint. Even though these tests are not specic for a lameness originating from the foot, they could give some information regarding the most directly constrained anatomical structures. The heel wedge test stretched the digital extensor tendon, the dorsal part of the interphalangeal joint capsules, the collateral ligaments of the interphalangeal joints, the supercial digital exor tendon and the suspensory ligament (Denoix, 1987). The stretched structures include those whose insertions correspond to the observed entheseophytes on the dorsal surface of P2 and P3. Positive response to this test could also correspond to an increase in the intraarticular pressure in the distal interphalangeal joint induced by the elevation of the heel (Viitanen et al., 2003). The lateral wedge test induced an asymmetrical bearing and thus produced a rotation of the distal phalanx in the opposite direction compared with the raising of the foot and compressed the lateral part of the interphalangeal joints (Caudron et al., 1998; Viitanen et al., 2003) and therefore stretched the medial collateral interphalangeal ligaments. A lateral compression of the interphalangeal joints was previously pointed out in this group of horses at 250 21 days of age, by a radiographic assessment of interphalangeal bearings (Lejeune et al., 2002). With age, foals with the proportions of a saddle horse tended to the morphometry of a heavy horse, progressively heavier and more compact (J. P. Lejeune, unpublished data). Most of them tended to progressively present a conformation base narrow that may result in a compression of the lateral part of the interphalangeal joints. Even if ossication of collateral cartilages could cause transient and slight lameness (Verschooten et al., 1996), which could be responsible for a part of the positive lateral wedge tests (Goble, 2003) that mimics an examination on a small circle on hard surface, in this study, the ossication of the collateral cartilages was not signicantly associated (P > 0.05) with lameness. The combination of clinical information and radiographic data concerning phalanges changes should therefore be more accurate in order to establish a classication of horses. Regional anaesthesia (palmar digital analgesia) was performed on the horses with severe lesions of the digit that were clinically lame. A positive response was observed in all the horses conrming the localization of their lameness in the foot. The use of additional

369 imaging means, like magnetic resonance imaging, should be useful in diagnosing and eliminating other causes of foot pain (Dyson et al., 2003). The horses that were free of radiographic lesions were all clinically sound whereas horses with moderate lesions all presented an aected locomotion in one or both forelimbs. Their lameness got worse after performing the heel wedge test. The absence of lame horses free of radiographic lesions as well as the absence of sound horses with, at least, moderate radiographic lesions, made it possible to divide horses into four categories: category 0, elite horses; category 1, healthy horses; category 2, pathologic horses; category 3, very bad horses. In conclusion, the ossication of the collateral cartilages took place during the early growth period (23% of horses with a slight ossication at 250 21 days) and markedly increased to 2 years and 4 months of age where 100% of the horses had dierent severity stages. It was not clinically signicant. Phalanges changes slightly appeared at the average age of 1 year, mostly represented by entheseophytes on the dorsal surface of P2 and P3. The frequency of aected horses increased with age as well as the size and the irregular aspect of the entheseophytes. At 2 years and 4 months of age, 68.75% of the horses presented phalanges changes, mostly represented by these bone neoformations. These radiographic changes were mostly associated with lameness revealed or made worse by the heel wedge tests. The presence and the severity of phalanges changes could be of importance in combination with a clinical examination, especially in the case of slight radiographic lesions, in selecting healthy Ardenner horses able to assume work and/or leisure activities. Further studies should rst evaluate the evolution of the radiographic changes and determine if radiographic signs of severe osteoarthritis appear and, secondly, the long-term clinical signicance, notably at work.

Acknowledgements
This work was carried out thanks to the nancial support of the Ministry of Agriculture and Rural Aairs of the Walloon Region (Belgium).

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