Lameness in Horses

The old adage of ‘no foot no horse’ is well worth remembering when it comes to lameness. Most lameness statistically is found in the hoof but there are so many potential issues with the horse’s leg below the knee and hock that it is important not to rule out these structures either.

How to spot lameness

Lameness in a horse may be either obvious, subtle or anywhere between those two points. It may also fluctuate which is described as intermittent lameness and this can make it tricky to diagnose.

The first point of assessment is a visual inspection, is there a wound or any obvious swelling, any lumps either hard or soft. A visual inspection is followed by a physical examination so feeling the horse’s legs and feet for heat, pain, any swelling or filling which may not be obvious to see but which may be felt, and whether or not there is a raised digital pulse which can be a sign of inflammation in the hoof.

Pain is not always consistent with a serious issue, for example, a horse with a bad abscess may be described as ‘fracture lame’ due to the pain level, the build up of pressure and infection in the closed capsule of the hoof meaning he is almost unable to bear weight on it. However, once the abscess has burst, the horse will almost miraculously, become pretty much sound very quickly. It is essential therefore not to jump to conclusions and make premature judgements about what might be wrong with the horse because this can impact upon treatment and management, often with adverse consequences.

Trotting up

Following a visual and physical inspection, unless the horse is clearly unable or very reluctant to move, then he will be trotted up; it is important to have a level surface for this so either concrete or road surface.

The usual procedure is to walk the horse away, turn it and walk it back and then repeat this in trot, it may be necessary to go back and forth in trot several times. An experienced eye is looking for irregularity of gait, saving a leg so load bearing more on one leg than another. This trot up may be followed by turning the horse in either direction on a very tight circle, lungeing in trot on a small circle on the concrete or assessing the horse on a softer surface such as an arena. Different lameness issues perform in different ways on different surfaces so all this provides information to assist the picture of diagnosis. An experienced eye may be required to spot subtle lameness, however sometimes it may be easy to see and quite obvious.

Trotting up may assist an owner in assessing what is wrong with the horse, there may be a clear wound or the horse might have been playing in the field and knocked himself. But sometimes, apart from identifying the leg or legs in question – horses can be lame in more than leg at the same time – an owner may be no further forward as to the cause following a trot up.

When to call the vet

A competent horse owner will be able to manage some conditions themselves without veterinary intervention. For example, an abscess in the horse’s foot can be poulticed to encourage it to burst and then tubbed and poulticed after it has burst, the farrier removing the shoe if necessary. A bang or a knock in the field can be managed with anti-inflammatory medication, cold hosing, stable bandages and either rest or conservative turnout. However there are plenty of situations which do require veterinary intervention and these range from the serious, such as a tendon or ligament issue, to the undiagnosed.

Unless you know clearly what is wrong with the horse, it is almost impossible to manage without diagnosis. If a horse has a subtle lameness caused by a tendon or ligament strain then turning it out or continuing to work it could prove disastrous. Turning out a horse with an abscess which is hobbling about will make little difference to either the outcome or the horse’s comfort levels. Without a diagnosis, it remains pretty difficult to know what to do next.

An initial visit from the vet will take the history and follow the usual process of a visual and physical inspection and followed by a trot up. If it does not appear to be serious but remains unclear as to the cause then most vets will suggest seven days box rest and some anti-inflammatory medication and pain relief. A knock or a bang will resolve in these circumstances but anything serious is likely to remain, so this first line of treatment can provide very useful data and if it is something serious, then you know you will not have put the horse at further risk because he is confined to his stable. An experienced owner may not involve the vet at this point but may call them if the lameness remains the same or worse after a weeks’ rest.

If the lameness persists then the horse will probably be required to attend a clinic or veterinary hospital for further investigation. This is called a lameness work up. It is usually more efficient to transport the horse to a clinic because they have everything required there on site. There will be a concrete runway, usually with a slight incline at one end, an area to lunge on the hard, a surface to see the horse move on the soft, X ray facilities and MRI scanning. All of this information will give the vets a clue as to where the problem might be. They then have the option of X ray, MRI or nerve blocking out different joints so that they can pinpoint exactly where the issue is. Which route they take depends on what they suspect may be wrong with the horse. Nerve blocking is the injection of anaesthetic into one or more joints of the horse’s legs. This medication takes effect quickly and then the horse is trotted up again, soundness indicating that this is indeed the location of the problem.

X ray and MRI scanning are fantastic tools but they do not always clearly define the cause of lameness; an X ray may show arthritic changes within the horse’s hoof but this may not be the cause of lameness, an MRI scan could show several hot spots in a joint, but it remains for the vet to establish, taking into account all of the other information, which one is causing the problem.

Treatment

With diagnosis comes treatment and most owners hope that firstly, it is possible to make a diagnosis and secondly, it is something that is not too serious. Treatment varies hugely depending on what underlies the problem.

Prevention of lameness

Even with the best and most responsible ownership, horses will go lame, however there are some key points to always follow in order to minimise the potential of this happening:-

• Always make sure the horse is properly fit for its job
• If a horse comes up from a holiday, follow a proper fittening programme, do not be tempted to cut corners
• Always work a horse on a range of different surfaces
• Pick out your horse’s feet regularly and check both the foot and the lower legs for any unusual cuts, bumps, lumps or heat
• Ensure that you use a good reliable farrier who can recommend the most appropriate form of shoeing for your horse’s foot structure and job
• Protect your horse from unsuitable surfaces and work, so do not compete on hard ground or trot endlessly on the road. Likewise, beware deep and very muddy going in the winter months if you can
• Maintain good foot hygiene
• Know your horse, do not ignore small or subtle changes