Murrieta Equine Michael Hoge, DVM

"SUSPENSE" The suspense is whether or not a hind limb lameness is the hock or its kissing cousin, the upper suspensory. When the two lower hock joints are treated the medication also treats the upper suspensory. If the lameness or complaint improves after treatment, tract the time duration of improvement. If the complaint or lameness returns in less than 6 weeks consider the suspensory as a potential source. Repeating hock treatments at a frequency of every two months can compromise a suspensory injury.

Why is the Farrier Instrumental to the Prevention of Equine Lameness?

WHY IS THE FARRIER INSTRUMENTAL TO THE PREVENTION OF EQUINE LAMENESS? Horses have been domesticated for several centuries. We have selectively bred horses for speed, endurance, jumping and a variety of agility activities. Horse breeders have bred horses for these latter qualities, not for hoof conformation. For example, it is unlikely for a mustang to have a small hoof, sheered heels or a long-toed hoof conformation. Introduce the farrier: Since the domestication of the... horse, farriers have trimmed and applied a variety of materials to the horses hoof. Farrier skills and materials have evolved to allow the horse, with sub-optimal hoof conformation, to perform and reproduce. Gravity: In a canter, an average horse’s hoof lands with the force of three times the body weight (3,000 pounds), at 150 times the force of gravity. A well-balanced and well-conformed hoof can absorb these forces; however, issues such as a small, un-level, twisted, long toe (shallow heel), transfer these forces unequally through the hoof and up the limb. Introduce the veterinarian, who probably has limited to no farrier skills. Equine distal limb lameness is a combination of biomechanical stresses that are a function of: 1.Conformation 2.Shoeing 3.Ground surface 4.Speed 5.Exercise Prevention of lameness in an individual with abnormal hoof conformation can be addressed with distal limb radiographs and a consultation between your veterinarian and farrier. Properly positioned radiographs allow the visualization of the shape and position of the structures within the hoof capsule. This information is like a blue print to remodel your home. It allows positioning the center of the shoe to the center of weight coming down the limb, minimal breakover distance, level adjustments, etc. This inside information allows your farrier to make precise adjustments that would take several shoeing cycles to perform with a conservative approach. In the lame horse, it is important to identify the primary source of pain (accurate diagnosis), through a combination of anesthesia (blocking), and imaging. Armed with this specific information, a consultation between your veterinarian and farrier, the optimal biomechanical trim and shoe can be applied. For the prevention and treatment of equine distal limb lameness, a thorough understanding of anatomy and biomechanics is essential, coupled with a team effort between your veterinarian and farrier.

What is PRP? When stem cell therapy is not a viable, financial option, I’ve had positive response in my practice, using ultrasound guided PRP injections to treat acute tendon and ligament injuries. PRP (Platelet Rich Plasma) is one of the current regenerative medicines showing favorable results. Together with stem cells, bone marrow concentrate and bone marrow aspirate, they’re referred to as Natures Drug Store.... PRP is made by removing whole blood from the injured animal. Combining it with anticoagulant, it’s spun down on a machine, separating out the platelets. These are then injected into the injured tissue. This increases the net amount of growth factors which enhance the healing process. When an injury occurs, the injury releases compounds. These compounds send to the site messages to control the damage and begin the repairing process. The net effect of this process is healing. Applying PRP to the injury site improves this process. It’s like sending the healing factors rapidly, via email. It enhances the normal, snail mail delivery of the healing factors. By treating a tendon lesion with PRP, the injury is repaired with more normal tissue and less scar tissue. Depending on the size and severity of the injury, I’ve seen improvement by injecting PRP every two weeks. Chronic proximal suspensory desmitis with ultrasound guided PRP responded as well. In my opinion, selected joint pathologies respond better to PRP treatments than to injections of corticosteroids. With such positive results, the use and acceptance of regenerative medicine is increasing faster than the complete understanding of its complex mechanisms. PRP continues to prove itself as a viable therapy.

BACKACHE Reportedly in humans the most common complaint of pain is the headache, second is back pain. Horses with hind end issues are often considered to have hock, stifle, and suspensory problems. Often the palpable pain of the lower back is diagnosed as being secondary to hock lameness. In my practice when a client complains of their horse’s loss of performance, less power on a turn and unable or reluctant to change leads behind I always consider the lower back and pelvis... as a potential source. After I rule out myositis (tying up) in the horse with minimal or no hind limb lameness, the lower back and or pelvic regions are considered. Coupled with positive lower back and or pelvic palpations a complete ultrasound of the lower back and pelvis is an efficient way to rule this area as a source of the complaint. In cases of sacroiliac and lumbosacral disease, ultrasound guided injections offer a short term solution. Flexion and extension of the hindquarters is generated from the high motion lumbosacral joint and it is often underestimated as a source of decreasing performance. In other words a horse’s backache can give us humans a headache. See more

STIFLED? Most people, especially the over 40 crowd can relate to their own stifle (knee) problems. When a performance horse has decreased performance related to low-grade hind limb lameness the hock region is usually the first suspect. Case presentations are variable however individuals that present themselves with no swelling, no specific positive palpations are difficult at best to arrive at a specific diagnosis. In performance horses the tree highest probabilities with t...he latter scenario as to the lameness source are hock, proximal suspensory and stifle. Early stifle injuries in horses, like their human counterparts are usually soft tissue in origin. Like humans, horses have a high incidence of injury to the menisci, cartilage, joint capsule, supporting ligaments and tendons. Often, after normal stifle radiographs are obtained the diagnostic trail leads elsewhere. A complete diagnostic ultrasound examination comparing each stifle to one another is invaluable in order to assess the soft tissues. For example, a flexed stifle view allows visualization of the meniscal attachment and articular cartilage thickness, which is invaluable in diagnosing an early stifle injury. Personally I am less stifled if I include an ultrasound examination of not only the stifle but of the suspensory apparatus when diagnosing the subtle hind limb lameness of the performance horse.

Clincal Lameness Definitions Navicular syndrome: When you read the word "syndrome" attached to any noun one is instantly confused. Over the past decade the understanding of pain originating from the navicular apparatus has been more defined with the advances in ultrasound, scintigraphy(bone scan), and especially MRI imaging. A specific diagnosis of navicular bone edema(increased pressure and swelling within the medullary cavity of the navicular bone) often occurs in the young... horse beginning the training process. In the normal individual the bone adapts and the edema dissipates. In the maladaptive individual the swelling within the bone persists as well as the clinical presentation of heel pain. One of the most exciting treatments for bone edema is the administration of bisphosphonate drugs(Tildren). Bisphosphonates bind to cells(osteoclasts) that absorb bone, which indirectly can reverse the bone edema. Tildren is currently the most common biophosphonate used in horses in the United States and can be administered as a total dose IV or as a more economical peripheral limb perfusion. The promise of interrupting the navicular disease cycle before bone loss and permanent soft tissue injury is beyond exciting. See more

The objective of this page is to inform the horse owners of the relationship between lameness, conformational biomechanics, shoeing and athletic discipline. With the understanding of the latter one is able to construct a comprehensive plan involving treatments and rehabilitation.

The primary services provided at Murrieta Equine are lameness diagnositics with the application of regenerative medicine protocols when appropriate. General equine veterinary services are also provided with a full range of referrals for orthopedic and soft tissue surgeries, ophthalmology, etc.