One of the most common problems in the equine athlete and pleasure horse is recurring lameness, which can be equally frustrating for owner, rider, and the veterinarian. At one moment, the issue may seem resolved, bringing relief, but then it may recur or maybe even a new problem develops. Being a veterinarian, horse owner and involved in the rehabilitation of horses, I understand the frustration but have come to realize that there is much to discover, learn and reveal when it comes to seeing the ‘entire’ horse in these situations. More often than not, the primary problem the horse is presented for is actually not the main issue, but in order to see the true problem, we need to step back and look at several factors. Despite us wanting to fix everything in one fail swoop, often the issue is more complex than we would like it to be.
The horse is a complex animal. They each have their own distinct personality and means of responding to their diet, environment, handler and rider. Just taking into consideration a variation in personalities creates challenges. We may have a horse that it more accident prone due to their playful or even dominant personality, which contributes to more lameness issues, injuries and higher veterinary costs. In other situations, again possibly due to personality, we have high stress levels in certain horses, which then contributes to more gastrointestinal problems, higher levels of cortisol and subsequently more tissue and joint weakness. Some horses also have conformational flaws, as no horse is perfect, which contribute to higher levels of strain on joints, ligaments and tendons.
Seeing the horse as an individual and taking all of this into consideration, we begin to understand that a lameness or health concern can be complex, but not impossible to remedy. In our rehabiliation program, my approach is different for each horse and no two horses are always managed the same, despite having similar conditions. Do we always have a 100% success rate? The answer is ‘no’, but often there are variables that are out of our control and more often than not, huge strides are made but limitations may still be present. One of the biggest problems we face is chronic damage done to a joint or tendon/ligament, that has resulted in scarrring or severe arthritis. Often, this degree of damage is irreversible and can contribute to long term lameness due to reduce range of motion. So, the take home point is to address a lameness in its early stage and as completely as possible, viewing all factors involved.
Here is my approach and thoughts on how we evaluate our horses. Keep in mind that the majority of horses that we are addressing are chronic in nature, having already had years of traditional therapies, injections and even surgical procedures applied with minimal to no impact on soundness. The cases are complex, but yet the majority of the horses improve dramatically with a high percent returning back to active work.
The Role of Inflammation in Horse Lameness and Soundness
Inflammation is the bottom line problem in most cases of lameness, irregardless of the presenting problem whether it be a joint, tendon, muscle or even hoof problem. This uncontrolled inflammatory response is what is responsible for pain, tissue deterioration, cartilage loss, tendon or ligament weakness and even blood circulation disturbances. The overall goal is to reduce this inflammation or reduce it to a more normal level. In our rehabilitation patients, we use our Cur-OST® Equine formulas to accomplish this, but we often need to dig deeper to resolve contributing factors. Each horse is different and thus our approach for the best outcome can vary from patient to patient, despite some horses having similar conditions. If we manage all contributing factors, then together with proper supplementation, the results are much better for the long term.
Factors to Consider in Horse Lameness and Soundness
Body Condition: One of the first things I do when presented a horse for evaluation is to break them down into one of two categories; easy keeper or not an easy keeper. Almost every horse is suffering the impact of excessive inflammation, but more often than not, in the easy keeper, the root of the inflammation stems from the gastrointestinal tract. Based on human research, an overweight body condition contributes to a higher level of inflammation in that individual. As the condition progresses, the gastrointestinal tract is impacted with altered bacterial flora, pH levels and changes within the lining of the bowel itself, which is termed ‘leaky gut syndrome’. In this situation, feed particles, additives, dyes and preservatives, not to mention bacteria, can actually cross over into the blood circulation where they should not be. Once in the general circulation, they can trigger a massive inflammatory response as they are perceived as being ‘foreign’, which then contributes to the overall level of inflammation and even alters the immune response. The immune system begins to react to almost everything, as it is on heightened alert, and thus it is common to develop allergies to antigens found in the everyday environment. In our patients, we take this into consideration and assume every ‘easy keeper’ is suspect for this situation and keep it in mind as the possible main underlying problem despite the presenting complaint of a joint, tendon or other condition. If the patient has a history of allergies, uveitis, poor hoof or coat conditioning, insulin resistance or Cushing’s disease, then the gut situation is confirmed in my opinion. Something as simple as poor hoof health or growth is justification for addressing the gut as it is often a sign that nutrients are not being absorbed or assimilated, likely due to poor gut health and not necessarily a poor diet.
Personality: The personality of the horse is helpful as it can help to confirm the presence of gastrointestinal problems. It is interesting to see that many horses that have poor attitudes, dominance and aggressive tendencies, headshaking or other problems are often ‘easy keepers’. This is not true in all situations, but more often than not it is. We do see bad behavior or vices in all horses, easy or not easy keepers, but often the problem stems from different locations. For instance, we may have a horse present with behavioral problems and a history of gastric ulcers, but the root cause is not always in the gut as we would be led to believe. Sure, we may have ulcers present, but is the cause the same? In my opinion, again discriminating between easy keeper and non-easy keeper, the origin is different. In the easy keeper, I believe the problem is more central to the gut while in the non-easy keeper, the problem is more an improper response to stress. I also find that attitude problems are often resolved more easily when we address the main issue, whether that be gut oriented or stress related. The one thing that we need to keep in mind is that each horse is unique with their own personality, but often the negative traits are accentuated due to underlying health or stress problems. We may not be able to completely make it go away, as it the horse’s unique personality, but we may be able to improve it greatly.
Conformation: No horse is perfect, or at least I have never seen a perfect horse in regards to conformation. There is inevitably a flaw somewhere and the question is whether or not that flaw contributes to our problem at hand. In the majority of our suspensory injuries that we rehabilitate, there is a conformational flaw that has contributed to the injury. More often than not, this flaw is what is also contributing to ongoing lameness and failure to fully recover. The biggest problem we see is either a toed in or toed out conformation, which then creates more strain on the lateral or medial suspensory branch, creating problems. In many of these horses, these same conformational problems are actually creating other areas of concern, that are contributing to the lameness, but are often unrecognized or given credance. For instance, in a toed in or toed out horse, we may also have excessive strain on the fetlock joint, which may be leading to increased stress and inflammation, then subsequent osteoarthritis. In other instances, we may have a horse with suspensory injuries but if we look closer, we are also straight in the hocks, which creates a tendency towards osteoarthritis in those joints. In actuality, many of these horses are lame, but the primary source of discomfort and lameness is NOT the suspensory but is actually a degenerating joint. We can’t fix the conformational flaw, but through recognition, we begin to see certain limitations for the future. In my experience, the flaw is a contributing factor, but what is occuring is that the farrier is trying to correct the flaw, making the foot travel more straight, which actually then creates more problems. If we just allow the foot to be what it is, toed in or toed out, but still keep it in balance, then often problems begin to self correct. For instance, if a horse is toed out and we trim or shoe the foot to be more straight forward, it may look good from a visual perspective, but we have to remember that we also just twisted the entire bony column going up the leg into a position it was not intended. This creates more strain, stress and contributes to the inflammatory response and joint deterioration.
Hoof Balance and Health: Again, no horse is perfect and each foot is different. I am not a proponent of maintaining specific angles in a foot in every horse, but more so look at each horse as an individual. Often, we are more concerned about the cosmetic look to a foot than functionality. On that same note and taking into consideration, many times we are shoeing or trimming in an attempt to ‘fix’ that flaw, instead of just letting be what it is. The feet are one of the first things that I evaluate and with that, shoes are the first thing that is removed, regardless of the situation. Many times, the feet are out of balance with different heel heights, toe lengths and sole thickness. We may have a 55 degree angle on the right front and a 40 degree angle on the left front, then wonder why a horse travels as he/she does or why they are bruising certain areas of the foot. Other times, we see elongated toes and under-run heels. Instead of fixing the problem through corrective trimming and allowing the foot to grow out in a more healthy manner, we often just resort to a quick fix being a sole pad or maybe wedged heels. In many cases, we have very thin soles which are contributing to the problem, which are a result of an over zealous use of the rasp, improper balance or simply poor nutrition. We may have a horse diagnosed with pedal osteitis, which is true, but the cause is thin soles or imbalance within the foot. It is not uncommon for us to have a rehab horse present with chronic foot pain and a life time of expensive shoes, but when those shoes are removed and the foot is balanced, lameness actually improves dramatically. Sometimes all of our efforts in regards to corrective shoeing are actually contributing to the problem by inhibiting hoof expansion during weight bearing or even predisposing to thrush and chronic frog infections. This is why, regardless of the presenting problem, we remove shoes and opt to go the balanced, barefoot route. It clears the slate for us and gives us a more true perspective for what is and what is not.
Diet: The diet is very important for overall health and plays a major role in lameness recovery and prevention, as well as behavioral problems. I believe in many cases, especially with behavioral problems and gastric ulcers, that diet is a major contributing factor. Going back to our discussion above regarding easy keeper horses, the diet can actually contribute to the inflammatory process and leaky gut syndrome through added sugars, dyes, preservatives and other additives. In other instances, I do get concerned with some low starch feed programs in which a lack of nutrients is present and contributing therefore to poor hoof, tendon and skin conditioning. In our program, we opt to feed whole cereal grains which are not processed but in their natural form with no additives. It is interesting to note that many conditions respond nicely to just this simple change, but often we do run into a problem transitioning a horse to that regimen as there are no added sugars, which they have become accustomed to in their normal diet. In this situation, we simply add a very small amount of pure Stevia powder, which sweetens the situation without the worries of excessive sugars. We don’t continue this for the indefinite, but usually it just takes a few days and they have been moved over successfully. The bottom line here is that we or they are what they eat. We rely almost 100% on the diet to provide macro and miconutrients in their natural form to aid in restoring health and helping to heal tissues. The diet can be used as a tool to enhance or repair the situation, but on that same coin, it can negatively impact their health, performance and soundness if not applied properly.
Mental Health: In many cases, the horse is protected out of fear by the owner that they may injure themselves if turned out in pasture or with other horses. Sometimes, the facility just does not have the space to provide adequate turnout for every horse. Other times, we have a horse that is being stall rested due to an injury for a prolonged period of time. The bottom line is that a horse is meant to be outdoors, grazing and enjoying life. When we alter this normal pattern, for what ever reason, we create an imbalance which results often in behavioral problems, increased stress and higher levels of cortisol. I am not against stall rest if needed, but most of the injuries we contend with are chronic in nature and have been present for many months or even years. When the horses are presented, they often have behavioral or health problems that are directly linked back to the stall rest, confinement and lack of ability to interact with other horses. Their personality is changed, mentation is altered and health is impacted. We do provide turnout for our patients as I feel the daily exercise is good not only for the body but also the mind as well.
Saddle Fit: This is an interesting area to me and one that has not been fully explored on my end as I am continually learning with each horse. Being in the realm of veterinary medicine, I honestly have never taken saddle fit into consideration up until we actually began to rehabiliate horses. As we would evaluate these patients and address the concerns, gaining ground on soundness, then returning them to light work, in many cases the problem would start to recur or another develop. After working with various individuals and gaining more knowledge, it has become apparent that proper saddle fitting is a major factor in some cases, which many have been advocating for several years. For this, I apologize for my own ignorance. The underlying factor in many cases of lameness is inflammation, which creates pain, muscle aches and contributes to joint and even vertebral deterioration. However, many factors contribute to that inflammation and poor saddle fit and even rider balance is one of them. We have had fairly large horses, body condition wise, come in for rehabiliation in which the prior riders were using too small of a gullet saddle, which was creating pain but it was unrecognized. When moved to a larger gullet and positioned properly so as not to bind or inhibit shoulder movement, the horse would become more comfortable and more willing to flow smoothly. Again, this is not an area that I am completely versed in, but I do recognize it as a major factor and seek outside help when it becomes a concern.
Overall, one can see the complexity in any one situation. As much as we would like a lameness to be resolved with one joint injection or other therapy, it just isn’t that simple. Inflammation is at the root of every case that we assist, but we can’t just stop there. The whole horse needs to be evaluated and even the rider in some situations, as every factor can contribute to the problem.
In cases of joint conditions and tendon concerns, we address the inflammation, but seek out contributing factors, including balance, trying to correct them. Helping to manage the inflammation through supplementation is implemented in every case and may be enough in many instances, but in others we need to enhance repair of the tissue through specific nutrient provision, even just for the short term. Every case is unique and with this, there is often not just one solution. We may have two horses with identical problems, but if treated the same, they may not each respond favorably. This is due to variation from horse to horse, including other contributing factors as mentioned above. If we can see the problems for what they are, addressing each for what they are, then our results are much better. That being said, results are optimal when the conditions are addressed properly in their earlier stages. Unfortunately, in the cases that have progressed for many months or even years, joint remodeling and even scar tissue have formed, which limit range of motion and impact soundness, which cannot be reversed. Thus…ideally we make every attempt to prevent these conditions or when they arise, evaluate the entire situation instead of just seeking that one pill or one injection fix.
I believe there is a means for improving almost every problem, but not every situation is identical. Step back. Evaluate completely, then make the necessary changes. If done properly, the improvements will be better and more complete, resulting in a not only sounder horse, but a more healthy one overall.
At Nouvelle Research, Inc., we are here to put our years of experience forward to assist you in any way. Have questions? We are here to help!
All my best,
Tom Schell, D.V.M.
Nouvelle Research, Inc.