Living with Lameness
By Carla Huston
When a healthy horse comes up lame, it is disturbing for every one, the owner, veterinarian, farrier and trainers, instructors and other riders. Whether it is a top-level show horse, local competitor or weekend trail companion a sore horse is heartbreaking, especially since many animals will continue with the same high effort, even though they are in pain. Lameness may mean an end to a career, and extended lay-up or time-consuming health care from the owner; all are situations every horse owner wants to avoid. A savvy owner, though, knows the facts off her horse's case, and armed with that knowledge can make caring and smart choices about the future.
The first step when lameness appears is to get a complete medical work-up, regardless if it was a slow-developing problem or an acute onset of pain. A veterinarian can give a much more intensive examination than anyone else and will have the equipment necessary for diagnostic procedures. It is very important that the owner is prepared to give information regarding the animal's circumstance. How long has the lameness existed? What leg or legs are affected, and can it be narrowed down to a rough location? What are the symptoms - an off - feeling while under rider; head-bobbing at the walk, trot or canter; or an unusual stance? Having this information will often help the veterinarian pinpoint the area to observe and test, although some vets may prefer to go into the examination blind, leaving them with an open mind. Sometimes the source of the pain may be very different from where the lameness indicates.
Diagnostic procedures may vary some from one veterinarian to another, but will follow a general pattern. First is observation of the animal at rest and in movement. The horse's attitude when standing unbothered is very telling, as is his way of going when trotted on straight lines and circles. While the horse is standing his conformation can be assessed and any correlations made between faults and potential problems. Certain conformational abnormalities may predispose an individual to lameness. A history can also be taken at this time, with the owner describing the horse's training program, competition schedule and any training or behavioral problems while under saddle (pain is often the reason for these problems). This time can also be used to evaluate the horse's symmetry and temperament. While the horse is standing firmly square, observe the balance of bones and muscles, any appearance of atrophy or disuse. The horse's temperament has a very important influence on pain indication; a highly-strung individual will usually show stronger reactions to pain than a more stoic horse.
The horse's movement is watched while he is trotted on a hard, level surface. On hard ground the footfalls can be both heard and seen. With the horse's head unrestricted the handler moves him off at a trot. The vet will observe his movement from straight on and the side as the horse moves toward and away from him. The foot of each limb should land squarely and with equal intensity. Each stride should be balanced, rhythmic and even. A short stride may indicate a problem with that diagonal. Circles are also a useful tool for evaluating a lameness. This will show the horse's flexibility and his ability to move each leg away from the body or toward the opposite leg.
Next the veterinarian will perform a flexion test. A joint is held partly flexed for about one minute and then the horse is immediately trotted off. This process will usually accentuate any existing lameness in the stressed joint. It is difficult to be specific about the sore joint since it is impossible to flex only one joint at a time, but it can still be very helpful.
At this stage the lame leg of legs should have been identified. To help pinpoint the exact trouble spot nerve blocks are used. Local anesthesia is injected over a nerve, starting at the lowest point of the affected leg. The nerve impulses are temporarily stopped, allowing the horse to move pain free. If the pain persists then further blocks need to be performed, farther up the leg. In the circumstance where the lameness is only eased, not eliminated, then the problem most likely is not limited to only one location. In order for this process to succeed there must be significant lameness to start with so that improvement can be evaluated.
Radiographs are used once the source of pain has been identified. This provides a two-dimensional view of the bony structures of the leg. Many views must be taken to get a complete picture. The radiographs do not provide much information about soft-tissue injuries or problems within a joint. Bony changes can be identified, though. Interpretation is a large part of making a diagnosis with radiographs, and they are most useful when considered with the other test results. Some very slight lamenesses may show up as insignificant alterations in the bone, enough, though, to cause discomfort to the horse.
All these tests can be performed by a veterinarian in private practice, either at the barn or at the clinic. If at this point results are still inconclusive it may be necessary to haul the horse to a teaching hospital where more in-depth testing is available. One of the more advanced methods of diagnosis is nuclear scintigraphy or bone scanning. A radioactively labeled bone-seeking substance is injected into the jugular vein and is distributed to the bones after several hours. The radioactive substance accumulates in areas of increased bone activity or blood flow to the bone, which is then detected by a gamma camera. This test is more accurate for acute injuries rather than chronic problems. Nuclear scintigraphy is potentially more descriptive than radiography, but cannot be used as a replacement. The two techniques should be considered complimentary.
Soft-tissue damage can be evaluated using diagnostic ultrasound. The ultrasound waves are reflected from the tissue and played back on a monitor. The images must be high-quality to accurately assess the damage. Enlargement of a tendon or poor definition of the structures can be determined with this too. Progress is also monitored with ultrasound during periodic evaluations.
Once the veterinarian makes a diagnosis the farrier can be a horse's best friend. With his expertise many options may be open to the horse and owner. Therapeutic trimming and shoeing may make the horse more comfortable, usable once again, or even return him to his former level of activity. Many types of shoes exist that will relieve pain and allow the horse to move more naturally. However, it requires a very knowledgeable professional to perform this work, as well as one who can discuss the case with the attending veterinarian. The vet may write a specific prescription for the farrier or leave him to make the shoeing decisions. Either way it is essential that the veterinarian and farrier maintain a good working relationship. The owner's patience is also an essential requirement for the farrier's success. Often there is more than one way to address a lameness; the farrier will usually choose the simplest and least expensive method first. If that does not work he will move up the scale to more intensive work. However, it will probably require several months to find the best therapy, and the owner must show patience through this process.
When a horse is diagnosed with a chronic lameness the owner needs to take serious stock in her horse life. It may be possible for the animal to remain at the same activity level with veterinary and farrier assistance, but usually some adjustments will need to be made. If the horse competes, it may be necessary to drop to a lower level or even leave the show ring entirely. In this case is the owner willing to scale back her own goals to fit with the horse's altered abilities? At this point selling the horse is often considered. It is unfair to expect the horse to perform when burdened by lameness, and a more suitable home should be found.
Many times a horse that has a manageable lameness problem but is well-trained with a kind disposition will make a good mount for someone learning the ropes of a sport, looking for a school horse. However, be certain to inform a prospective buyer of the problem and that he is prepared to provide the care necessary. Sometimes a change in discipline is sufficient to keep a horse in work and useful. A show-jumper with a forelimb lameness may perform in the lower levels of dressage. Or a performance competitor may find a niche as an equitation mount. And using care and caution most horses can be suitable trail mounts. Retirement is sometimes the only option for extreme cases or with degenerative conditions.
Living with lameness is possible when the owner knows the facts. That is why a veterinary diagnosis is so crucial to the horse's well-being. Neither the owner nor the farrier can make sound decisions without that baseline. It is also essential that all three can work together in the horse's therapy and maintenance. But it is ultimately the owner's responsibility to keep the animal's best interests in the forefront and make the choices that will benefit the horse.
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Updated: October 2005.