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 Straight Shooter
Posts: 5725
   
Location: SW North Dakota | Last week I took two barrel horses to the regional vet clinic to have my regular (highly qualified) lameness vet examine them. The mare, who is 13 and has been running since she was 5, needs her hocks injected twice a year. Although this is her usual maintenance, I always do a lameness exam. This time, she exhibited caudal heel pain, which masked her normal hock soreness at first. After a DIP block on the front feet, she showed her "normal," twice-a-year hock soreness. We injected her hocks. For the first time ever, we also injected her coffin joints and will start shoing her in a 2* wedge. Because she is a teenaged competative barrel horse (my daughter's), I was comfortable with the course of treatment (TA/HA injection).
Here's the one I'm curious about, and want to learn more... The gelding, who is a big, racy-built horse, has shown heel pain in the past year. His x-rays were normal, but we haven't done any soft tissue imagery. He's been in a 2* wedge for about a year, but recently has started traveling with a shorter extention in his stride, which resolved completely with a DIP block again this time. The vet wanted to also inject his coffin joints, but I wanted to do a little more research before I went ahead with injections- he's only 8 and hasn't been used very hard. I'm wondering why the wedges, which were very effective for a year, aren't the silver bullet anymore? Same shoer, same shoes, same everything. He isn't lame per se, but recently has developed some acute issues in his performance, like pulling off the backside of his turns/not finishing (same thing he was doing when we found he had heel pain). Vet explained last year that due to his size, and slightly long pastern, he was probably experiencing pain in his distal deep flexor tendon.
Can anyone who has experienced something similar please share your thoughts or treatment plans?
I understand that any injection is risky. I understand that steriods are hard on a joint. I understand that some horses have conformational issues that aren't condusive to extreme sports. I'm not trying to be snarky here (AT ALL), would just like to hear of other experiences and treatment plans, preferably those that have case studies or scientific backing.
My horses are on pasture/grass hay, Woody's Sales Prep and OE Game Changer.
Thanks in advance!
Edited by ND3canAddict 2016-08-31 9:16 AM
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 Born not Made
Posts: 2931
Location: North Dakota | ND3canAddict - 2016-08-22 9:04 AM Last week I took two barrel horses to the regional vet clinic to have my regular (highly qualified) lameness vet examine them. The mare, who is 13 and has been running since she was 5, needs her hocks injected twice a year. Although this is her usual maintenance, I always do a lameness exam. This time, she exhibited caudal heel pain, which masked her normal hock soreness at first. After a DIP block on the front feet, she showed her "normal," twice-a-year hock soreness. We injected her hocks. For the first time ever, we also injected her coffin joints and will start shoing her in a 2* wedge. Because she is a teenaged competative barrel horse (my daughter's), I was comfortable with the course of treatment (TA/HA injection).
Here's the one I'm curious about, and want to learn more... The gelding, who is a big, racy-built horse, has shown heel pain in the past year. His x-rays were normal, but we haven't done any soft tissue imagery. He's been in a 2* wedge for about a year, but recently has started traveling with a shorter extention in his stride, which resolved completely with a DIP block again this time. The vet wanted to also inject his coffin joints, but I wanted to do a little more research before I went ahead with injections- he's only 8 and hasn't been used very hard. I'm wondering why the wedges, which were very effective for a year, aren't the silver bullet anymore? Same shoer, same shoes, same everything. He isn't lame per se, but recently has developed some acute issues in his performance, like pulling off the backside of his turns/not finishing (same thing he was doing when we found he had heel pain). Vet explained last year that due to his size, and slightly long pastern, he was probably experiencing pain in his distal deep flexor tendon.
Can anyone who has experienced something similar please share your thoughts or treatment plans?
I understand that any injection is risky. I understand that steriods are hard on a joint. I understand that some horses have conformational issues that aren't condusive to extreme sports. I'm not trying to be snarky here (AT ALL), would just like to hear of other experiences and treatment plans, preferably those that have case studies or scientific backing.
My horses are on pasture/grass hay, Woody's Sales Prep and OE Game Changer.
Thanks in advance!
Curious ... which vet did you go see? If you don't want to post publically, you can PM me. I am curious.
My horse Red also suffers from heel pain, slightly worse on his left front than the right front. X-rays have always been clean. I've not done soft tissue imaging, but of course, we know it's in the soft tissue. I was told the specific reason will not change his treatment protocol, so it was not worth it to me to haul and pay for an MRI. And he's being managed well with what we are doing. He blocks sound when the heel (lowest block) is performed. He was diagnosed with his heel pain when he was 7 years old.
We started off with 2 degree wedge pads that year (with normal rim shoes) and that worked really well. As I started hauling him more and getting more speed on his barrel pattern, the 2 degrees wasn't cutting it anymore. We did coffin joint injections (when he was 8) and WOW did that make an amazing difference!
His 9 year old year, we bumped up to a 3 degree wedge pad, did the coffin joint injections, and he has felt the BEST he has ever felt.
For him, his heel pain is better when he's had some rest (aka: his winter break). So I usually can get by only doing the coffin joint injections around mid-June of each year, as it doesn't start to bother him until then. And we're usually done by the end of September.
For really long weekends, I'll give him Previcox a week ahead of time. Or if he is getting a little sore by the end of the season, I'd rather supplement wtih Previcox than do the injections again. I want to inject as little as possible, for his long-term soundness.
With that said, if the injections and shoes ever stop working, I've been told he would be an excellent candidate for a neurectomy.
This year, he's had the entire year off due to me having a baby  so I am curious to see how he will feel when I get him legged up again next spring, havign a year of rest.
On a sidenote, the vet I used also said DO NOT inject directly into the bursa from behind. While I do not believe there is any scientific evidence to back it up, he had seen numerous cases over and over where doing so caused the horse to be LAME and done about 1 1/2 years after they did the injections. Even though there might not be studies to back it up, it is good enough for me to not want to risk that happening to my horse, since they have seen it first-hand. So we will stick to only coffin joint injections.
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 Elite Veteran
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| How far out were you on shoes when he came up sore? Mine will start getting sore aroung the 5 week mark and I never let him go past 6 weeks.
Just my first question, since he has been more sound up until now. | |
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 Veteran
Posts: 239
| What did the rads show?
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
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 Expert
Posts: 5290
| 2H~QH - 2016-08-22 9:31 AM
What did the rads show?Â
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
Â
And I was always taught that Coffin joints are HIGH MOTION joints and when you use steroid it will actually cause more problems down the line. SOmetimes you have no choice. As compared to hocks that can be injected over and over with no ill effects. | |
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Straight Shooter
Posts: 5725
Location: SW North Dakota | 2H~QH - 2016-08-22 10:31 AM What did the rads show?
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
The radiographs were completely clean (at least free of any bony changes), but did indicate the angle of the coffin bone could be causing stress on the DDFT. The 2* wedges helped significantly until this year. Up until about july 20, he was just cruising the pattern. I started noticing a change in his movement, then issues on the backside of the barrel a couple of weeks after I started adding "real" speed, so it makes sense that there is some relation there. It got bad enough to quit entering him about a week after a reset (new shoes). Same brand of shoes, same shoer and the foot looks balanced. Vet agreed that the shoe job looked good, angles and balance was appropriate. Coincidence? I've had the same shoer for 25 years. | |
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Veteran
Posts: 239
| FLITASTIC - 2016-08-22 10:38 AM 2H~QH - 2016-08-22 9:31 AM What did the rads show?
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
And I was always taught that Coffin joints are HIGH MOTION joints and when you use steroid it will actually cause more problems down the line. SOmetimes you have no choice. As compared to hocks that can be injected over and over with no ill effects.
You're correct - coffin joints are much higher motion than the individual hock joints - any and all joint injections definitely have the potential to create adverse effects though, coffin OR hock, despite the range of motion any time you introduce a needle into the joint it has the potential right.
For me personally, I know that the arthritis/bony change are causing pain in the joint and that an injection can ease that pain - so I was willing to inject. If the injections do not help to keep her comfortable on her forefeet, I will not hesitate to retire her from barrels and find a new job for her. That is the risk I was willing to take on this mare. You may not want to be willing to risk injecting coffin joints and that is totally fine too! As for the injections causing more issues in the coffin joint than hock I don't have the experience/research on that so I can't comment on that. Maybe somebody who is still in practice can respond to that, I have been out of the field for awhile now....just giving my opinion on the OP's question | |
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Straight Shooter
Posts: 5725
Location: SW North Dakota | FLITASTIC - 2016-08-22 10:38 AM 2H~QH - 2016-08-22 9:31 AM What did the rads show?
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
And I was always taught that Coffin joints are HIGH MOTION joints and when you use steroid it will actually cause more problems down the line. SOmetimes you have no choice. As compared to hocks that can be injected over and over with no ill effects.
This was my understanding, too- which is why I held off for now. From what I've always thought, you'll need to inject them more and more frequently until you nerve them or retire them. Of course, every horse is different, and it would seem there are also different medical opinions and research. | |
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Veteran
Posts: 239
| ND3canAddict - 2016-08-22 10:46 AM 2H~QH - 2016-08-22 10:31 AM What did the rads show?
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
The radiographs were completely clean (at least free of any bony changes), but did indicate the angle of the coffin bone could be causing stress on the DDFT. The 2* wedges helped significantly until this year. Up until about july 20, he was just cruising the pattern. I started noticing a change in his movement, then issues on the backside of the barrel a couple of weeks after I started adding "real" speed, so it makes sense that there is some relation there. It got bad enough to quit entering him about a week after a reset (new shoes). Same brand of shoes, same shoer and the foot looks balanced. Vet agreed that the shoe job looked good, angles and balance was appropriate. Coincidence? I've had the same shoer for 25 years.
I don't know that I'd be injecting the joint if the rads are clean......
But I am a big chicken LOL.
I've never injected a joint that's not showing change. Just don't see a reason to take the risk. I know lots of people do, that is just my opinion.
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Straight Shooter
Posts: 5725
Location: SW North Dakota | 2H~QH - 2016-08-22 10:50 AM ND3canAddict - 2016-08-22 10:46 AM 2H~QH - 2016-08-22 10:31 AM What did the rads show?
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
The radiographs were completely clean (at least free of any bony changes), but did indicate the angle of the coffin bone could be causing stress on the DDFT. The 2* wedges helped significantly until this year. Up until about july 20, he was just cruising the pattern. I started noticing a change in his movement, then issues on the backside of the barrel a couple of weeks after I started adding "real" speed, so it makes sense that there is some relation there. It got bad enough to quit entering him about a week after a reset (new shoes). Same brand of shoes, same shoer and the foot looks balanced. Vet agreed that the shoe job looked good, angles and balance was appropriate. Coincidence? I've had the same shoer for 25 years.
But I am a big chicken LOL.
I've never injected a joint that's not showing change. Just don't see a reason to take the risk. I know lots of people do, that is just my opinion.
Agreed. The mare did show some slight changes, nothing too scary, but the beginning of OA, probably- we did inject her, she is still working an honest pattern, just has lost nearly .5 of her usual times.
The gelding was clean as a whistle, and has not yet been injected.
I really appreciate your feedback! | |
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 You get what you give
Posts: 13030
Location: Texas | 2H~QH - 2016-08-22 11:47 AM
FLITASTIC - 2016-08-22 10:38 AM 2H~QH - 2016-08-22 9:31 AM What did the rads show?Â
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
 And I was always taught that Coffin joints are HIGH MOTION joints and when you use steroid it will actually cause more problems down the line. SOmetimes you have no choice. As compared to hocks that can be injected over and over with no ill effects.
For me personally, I know that the arthritis/bony change are causing pain in the joint and that an injection can ease that pain - so I was willing to inject. If the injections do not help to keep her comfortable on her forefeet, I will not hesitate to retire her from barrels and find a new job for her. That is the risk I was willing to take on this mare. You may not want to be willing to risk injecting coffin joints and that is totally fine too! As for the injections causing more issues in the coffin joint than hock I don't have the experience/research on that so I can't comment on that.  Maybe somebody who is still in practice can respond to that, I have been out of the field for awhile now....just giving my opinion on the OP's question
I'm a 4VM! Where do you practice? | |
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Worlds Greatest Laugh
Location: North Dakota | There is an interesting article called "Diagnostic Analgesia of the Equine Forefoot" put out by the Kentucky Veterinary Medical Association. Also, for trials and scientific approaches I like to search the NCBI. The National Center for Biotechnology Information.
I am currently dealing with this as well with one of my horses.
I recently read where Sasktoon is doing a trial on caudal heel pain in horses and is looking for candidates for their study...shall we go???? LOL I posted this then had to go look it up........
WCVM researchers, led by Dr. Kate Robinson, will test the efficacy of fESWT treatment in a randomized, controlled and double-blinded clinical trial using 32 client-owned horses that have been diagnosed with caudal heel pain. All horses will receive the conventional treatment for caudal heel pain — therapeutic hoof trimming by a farrier. However, half of the horses will also undergo shockwave therapy.
The team will rely on magnetic resonance images (MRIs) taken one week before treatment and three months after treatment to determine if the horses’ lesions improve. MRI is the gold standard for diagnosing caudal heel pain because it helps to detect soft tissue lesions not visible on X-rays. The team will also use Lameness Locator® technology throughout the trial to determine if lameness improves in these horses.
Edited by Runnincat 2016-08-22 12:41 PM
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Veteran
Posts: 239
| casualdust07 - 2016-08-22 11:33 AM 2H~QH - 2016-08-22 11:47 AM FLITASTIC - 2016-08-22 10:38 AM 2H~QH - 2016-08-22 9:31 AM What did the rads show?
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
And I was always taught that Coffin joints are HIGH MOTION joints and when you use steroid it will actually cause more problems down the line. SOmetimes you have no choice. As compared to hocks that can be injected over and over with no ill effects.
For me personally, I know that the arthritis/bony change are causing pain in the joint and that an injection can ease that pain - so I was willing to inject. If the injections do not help to keep her comfortable on her forefeet, I will not hesitate to retire her from barrels and find a new job for her. That is the risk I was willing to take on this mare. You may not want to be willing to risk injecting coffin joints and that is totally fine too! As for the injections causing more issues in the coffin joint than hock I don't have the experience/research on that so I can't comment on that. Maybe somebody who is still in practice can respond to that, I have been out of the field for awhile now....just giving my opinion on the OP's question I'm a 4VM! Where do you practice?
You go girl! You will probably be more knowledgeable on this subject than I am then :)
I am no longer practicing, but I was based out of Drumheller Alberta for a few years. I'm with the Canadian government now.
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Veteran
Posts: 239
| ND3canAddict - 2016-08-22 11:14 AM 2H~QH - 2016-08-22 10:50 AM ND3canAddict - 2016-08-22 10:46 AM 2H~QH - 2016-08-22 10:31 AM What did the rads show?
I am a veterinarian and I don't have a problem doing coffin joint injections for horses younger than their teens - age doesn't really matter - they can be any age and develop arthritis, bone spurs, and that will cause pain. I just did coffin joint injections on my 9yo as the rads were showing development of OA on the dorsal sides of her P1 and P2 for both feet. So don't let the age scare you off - just make sure that the rads are showing that this would be a beneficial injection. I never inject without rads!
That said, coffin joint injections won't help any strain on the DDFT - shoes and trimming will.
The radiographs were completely clean (at least free of any bony changes), but did indicate the angle of the coffin bone could be causing stress on the DDFT. The 2* wedges helped significantly until this year. Up until about july 20, he was just cruising the pattern. I started noticing a change in his movement, then issues on the backside of the barrel a couple of weeks after I started adding "real" speed, so it makes sense that there is some relation there. It got bad enough to quit entering him about a week after a reset (new shoes). Same brand of shoes, same shoer and the foot looks balanced. Vet agreed that the shoe job looked good, angles and balance was appropriate. Coincidence? I've had the same shoer for 25 years.
But I am a big chicken LOL.
I've never injected a joint that's not showing change. Just don't see a reason to take the risk. I know lots of people do, that is just my opinion.
The gelding was clean as a whistle, and has not yet been injected.
I really appreciate your feedback!
Good luck let us know what happens with him! | |
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Straight Shooter
Posts: 5725
Location: SW North Dakota | Runnincat - 2016-08-22 11:37 AM There is an interesting article called "Diagnostic Analgesia of the Equine Forefoot" put out by the Kentucky Veterinary Medical Association. Also, for trials and scientific approaches I like to search the NCBI. The National Center for Biotechnology Information.
I am currently dealing with this as well with one of my horses.
I recently read where Sasktoon is doing a trial on caudal heel pain in horses and is looking for candidates for their study...shall we go???? LOL I posted this then had to go look it up........
WCVM researchers, led by Dr. Kate Robinson, will test the efficacy of fESWT treatment in a randomized, controlled and double-blinded clinical trial using 32 client-owned horses that have been diagnosed with caudal heel pain. All horses will receive the conventional treatment for caudal heel pain — therapeutic hoof trimming by a farrier. However, half of the horses will also undergo shockwave therapy.
The team will rely on magnetic resonance images (MRIs) taken one week before treatment and three months after treatment to determine if the horses’ lesions improve. MRI is the gold standard for diagnosing caudal heel pain because it helps to detect soft tissue lesions not visible on X-rays. The team will also use Lameness Locator® technology throughout the trial to determine if lameness improves in these horses.
SERIOUSLY, YESSSSSSSSSS | |
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 Just a Yankee
Posts: 1237
Location: Some where I haven't left yet | Once upon a Time in a Land Far, Far, Away. ..... When I actually rode horses and ran barrels. I had a big pretty mare, who... had the nicest X-Rays that anyone could want to see. This was before the MRI started making a big impact in equine medicine. She would flex about grade three lame during a lameness exam. I injected her coffin joints twice a year. She would be instantly comfortable. She stayed happy, competitive etc up until the day that she had what we suspect as a heartattack and she passed away. I have Zero issues injecting if needed, she was 6 years old when we started injecting as needed. Her feet were kept balanced. Man I miss her. | |
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Born not Made
Posts: 2931
Location: North Dakota | kboltwkreations - 2016-08-22 11:18 AM How far out were you on shoes when he came up sore? Mine will start getting sore aroung the 5 week mark and I never let him go past 6 weeks. Just my first question, since he has been more sound up until now.
Great point!!
My horse with issues gets reshod every 5 weeks on the nose as that is what my farrier said would be best for him, so that is what we do.
He doesn't really need a wedge pad with how good of a heel he has BUT it makes him more comfortable with his heel pain. In the grand scheme of things, 2 to 3 degrees isn't that much but of course you do change the dynamics when you add a wedge. | |
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Born not Made
Posts: 2931
Location: North Dakota | 2H~QH - 2016-08-22 11:50 AM
I don't know that I'd be injecting the joint if the rads are clean......
But I am a big chicken LOL.
I've never injected a joint that's not showing change. Just don't see a reason to take the risk. I know lots of people do, that is just my opinion.
Honest question then: If some sort of corrective shoeing does NOT help the horse that has heel pain, and the rads are clean .... what would you do? (If not inject.) | |
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Member
Posts: 32
| r_beau - 2016-08-22 3:12 PM
2H~QH - 2016-08-22 11:50 AM
 I don't know that I'd be injecting the joint if the rads are clean......
But I am a big chicken LOL.
I've never injected a joint that's not showing change. Just don't see a reason to take the risk. I know lots of people do, that is just my opinion.
Â
 Honest question then: If some sort of corrective shoeing does NOT help the horse that has heel pain, and the rads are clean .... what would you do? (If not inject.)
Pull the shoes and work with a farrier who specializes in barefoot trimming. Worked wonders on my gelding.
There are so many variables, but generally the horse will not go sound immediately. It takes time for them to begin using their foot properly - with a heel first landing. Definitely not a quick fix, but in the long run can cure a horse with chronic heel pain.
Edited by MPoloncic 2016-08-22 5:39 PM
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The Advice Guru
Posts: 6419
| Injecting with straight HA will reduce the inflammation in the joint. With injections you do not need to inject a steroid my vet refused to inject depomethasone, and betamethasone. He would only inject trimethisclione (actually has shown to protect cartilage even repair it in the studies)
For caudal heel pain, I would be leaning more towards contracted heels especially since you have two horses showing same pain.
I would find a different farrier.
Contracted heels if you continue to shoe is difficult to reverse.
Contracted heels if left without attention can cause navicular due to the decreased blood flow into the foot | |
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