Equine Lameness for the Layman. G. Robert Grisel, DVM
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Also known as paddling.
Wrong Lead: Leading with the outside (rather than the inside) forelimb while turning or circling.
SECTION I
Our Responsibility to the Performance Horse
Biological tissue pathology does not come without cost. Even if the problem is mild, its persistence over an extended period of time can have permanent consequences with regard to an animal’s eventual comfort and performance. As time passes, our ability to successfully manage lameness becomes more challenging due to the natural progression of primary and secondary pathologies. Physiologic abnormalities that can be successfully treated (and in some cases reversed) early on may acquire varying degrees of permanence if left unaddressed for enough time. From this standpoint, the duration of lameness has an indirect relationship with the horse’s prognosis for future performance. Most veterinarians know this and would, therefore, prefer to treat acute severe inflammation (that recently developed) as opposed to chronic mild inflammation (that has been present for a long time).
The key to successful management lies in our ability to detect the problem during our “window of treatment opportunity”—that is, the phase when treatment will still be curative or at least highly effective. As many of us have learned the hard way, recognizing a problem after it has already reached the chronic phase makes successful management more difficult and, in some cases, impossible. We would all agree that management certainly gets more expensive as time goes on.
The key to maintaining long-term soundness in the horse entails proactive prevention (prophylaxis) as opposed to reactive treatment.
Once a problem has been recognized, we tend to be fairly proficient with regard to seeking professional consult, performing the necessary diagnostics, and implementing appropriate treatment. Veterinary research in the field of equine sports medicine has primarily been focused on improving diagnostic and treatment techniques that are implemented after the existence of a problem has already been confirmed. A major management dilemma, therefore, lies with the length of time between the onset of a problem and its recognition (fig. I.1).
I.1 Phases of Lameness Management
1. The onset of lameness. This represents the moment or period when the problem first occurs.
2. Local recognition of lameness. This represents the moment when the primary caretaker (owner, trainer, barn manager, friend, farrier) discovers the problem.
3. Veterinary confirmation of lameness. This represents the moment the veterinarian first becomes aware of the problem.
4. Clinical examination. This may be performed in the field or in a hospital setting. Physical assessment, passive and active soundness evaluations, palpation, flexion testing, and local anesthesia (blocks) are common techniques implemented during hands-on examination.
5. Diagnostic imaging and testing. Radiography, ultrasonography, thermography, nuclear scintigraphy, and magnetic resonance imaging (MRI) are imaging modalities commonly employed in modern work-ups of the lame horse. In some cases, clinical pathology (blood work) and histopathology (biopsy) are also performed to identify specific forms of disease.
6. Diagnosis. The results of clinical examination, diagnostic imaging, and other tests often enable the veterinarian to reach a diagnosis, which designates the specific cause of the horse’s lameness.
7. Treatment. Once a diagnosis is made, an appropriate treatment plan can be formulated for the horse. Corrective shoeing, systemic arthrotherapy (joint supplementation), local arthrotherapy (joint injections), extracorporeal shock wave therapy (ESWT), regenerative therapy (e.g. stem cells), and chiropractics are strategies frequently employed in the treatment of equine lameness.
We can shorten the length of time between the onset of lameness and its recognition by:
Improving the ability of the local caretakers (horse owner, trainer, farrier) to visually detect subtle lameness.
Improving dialogue between the local caretaker (horse owner) and veterinarian during the early stages of compromised performance.
I.2 Earlier Recognition of Lameness
Once the veterinarian is made aware of a performance issue, he or she can initiate the process of lameness confirmation, either through on-site evaluation or remote video review. The advent of telemedical (remote) evaluation allows the veterinarian to more quickly and easily become a part of the recognition process, a task previously restricted by time, distance, and expense. This concept typifies the foundation of equine sports wellness within the veterinary industry.
1 The Responsibility of the Horse Owner in Successful Management of Equine Lameness
Veterinary examinations are not performed on horses that are considered to be sound by their owners. It is the horse owner, not the veterinarian, who is best situated to initiate the processes of lameness diagnosis and treatment. Accordingly, observant horse owners make better horse owners. Unfortunately, most horse owners and trainers are not proficient at lameness recognition.2 Consequently only problems that are obvious, chronic, or advanced tend to receive medical attention.
The utilization of basic visual assessment techniques can help horse owners detect lameness more quickly, thereby starting the diagnostic process sooner and improving the horse’s prognosis for future soundness. Local trainers, farriers, and friends can also assist the owner in prompt lameness recognition. Remember, a veterinary degree is not required to formulate an opinion as to the existence, location, and possible cause(s) of a horse’s lameness.
At the end of the day, equestrians want to stay in the saddle as long as possible and spend as little money as possible doing it. But this relies on our ability to serve as the frontline “sensors” for lameness in our horses. The faster we’re able to recognize a problem, the faster the veterinarian can initiate the diagnostic, treatment, and recovery processes.
Horse owners who adopt a proactive approach to detecting lameness in their own horse tend to be more successful in whatever equine discipline they undertake. Those that can recognize subtle gait deficits will recognize small problems before they become big problems. The more timely problems are recognized and addressed, the less likelihood they have of becoming long-term or permanent issues. There is also less opportunity for other primary or secondary problems to develop. With fewer areas of the horse being affected, our visual depiction of asymmetry becomes appreciably less complicated.
Your ability to detect lameness will help you to:
Keep your horse in consistent work.
Save you money by staying ahead of problems that would otherwise incur increased diagnostic and treatment costs.
Improve your horse’s chances of performing better for longer.
The primary objective of this book is to shorten the time frame between the onset of your horse’s problem and your recognition of it.
The ability to localize the potential source of lameness is also very useful to the horse owner. The recognition of gait deficits consistent with a shoulder problem, for instance, tells the owner that the horse is not suffering from yet another foot bruise. With this knowledge, appropriate measures for further