9.1.1. Coffin joint disease with sprained collateral ligaments
1 Author
Breed - Czech warmblood
Sex: gelding
Age: 8 years
Color: dark bay
Working discipline: sport horse - show jumping
2. Data of the patient
Reason why the owner complains: Interminttent lameness on the front limbs, reluctance to move and jump
Duration of the problems: Approximately 8 months with a gradual deterioration towards the end of the season
Stabling conditions: Stall
Bedding: Straw in combination with shawings
Surface on which the horse predominantly moves: Sand arena
Frequency of the hoof care: Every 7 weeks
Type of shoeing: Equilibrium two-clip horseshoes with a rocker toe
Lameness and diagnosis: Intermittent lameness more on the left front limb caused by palmar pain
3. Anamnesis
Characterization of the problems:
After stable stiffness or more jumping the interminttent lameness on both front limbs is accentuated. The most pronounced manifestation of lameness is in turns on a hard surface, soft surfaces alleviate problems with lameness.
Conformation:
Fig. No. 1, March 2: Front limbs from the front.
The limbs are very slightly knock kneed (carpus valgus) and with offset cannon bones and outward rotation of the whole limbs. It has a very slight inward rotation of the digit on the left limb, which is not on the right limb. The biggest problem is at the sagittal level. From this point of view, the digits are very steep.
Hoof shape and pathological changes:
The left hoof is steeper and is generally narrower due to the large palmar angle of the coffin bone. The right hoof is a little wider, lower at the heels. It has a lower palmar angle of the coffin bone and the axis of the digit is broken back more.
Fig. No. 4 and 5: Left hoof from the side and from below before trim
Fig. No. 6 and 7 .: Right hoof from the side and from below before trim
Evaluation of the hoof care:
The examined horse was 6 weeks after the last shoeing. During the presentation, he loaded the entire bearing surface of the hooves, only in the lateromedial direction he loaded the outer bearing edge slightly earlier with the left hoof.
Evaluation of the type of shoeing:
When the horse was shown, the shoeing corresponded to the needs of the limb movement. Horseshoes equilibrium with a small rocker toes were significantly worn on the outer front after 6 weeks by the increased need for hoof breakover, caused by the steepness of the limbs and short deep digital flexor tendons.
Examination results:
1. Palpation of the tendon system of the limb and hooves using hoof testers did not yield any desicive results.
2. Demonstration of the horse in motion on straight lines and in a circle was further evaluated on slow motion videos and confirmed the findings from the previous examintaions, see videos 1 - 4 below.
Video No.1. and 2 .: Left - Walk and trot on a hard surface on a straight line before trim
Video No.3: From left - Walk on a hard surface on a circle before trim
Video No.4. and 5 .: Trot on a hard surface on a circle before trim on the right and left hand
An important part of the assessment of the regularity of the horse's gaits is demonstration on the circle on the lounge. If possible, this part of the lameness diagnosis test should never be omited. It is advantageous to assess the horse's movement on the lounge on both hard and soft to deep surfaces. When moving on the circle, the load on the ligaments located outside the circle is highlighted (when moving on the left hand, the inner ligaments of the left limbs and the outer lateral ligaments of the joints and tendons of the tendons of the right limbs are stressed). Simultaneously with the ligaments, the joint structures are loaded on the circle (when moving on the left hand, the outer edges of the joints of the left limbs and the inner edges of the joints of the right limbs are compressed).
4. Problem description
Examination results:
3. Another method of farrier diagnostics was examination using a digital extension device.
Giant. No. 8, 9, 10 .: Examination with a digital extension device
Video No. 6: Examination with a digital extension device
Dorsal extensions on both limbs had the same level of 29 ° on the verge of comfort.
Palmar extensions easily reached the limit of 25 ° without signs of pain.
Latero-medial extensions on the left forelimb both reached only 16 ° until the shoe branches were lifted from the device pad with signs of pain.
On the right forelimb, the medial elevation reached 20 ° without problems, the lateral elevation only 15 ° to lift the horseshoe from the device pad, and signs of pain were evident.
The results of this examination replaced the feĺexion tests and were reflected in the trim of the hooves, selection and fitting of the shoe.
Examination results:
4. The limbs were subjected to X-ray examination before trimming and shoeing.
Fig. No. 11 and 12 .: X-ray from the left - left and right front limbs on 18.9.2019
Anteroposterior projections showed no deviation in the continuity of the articular surfaces, nor in the position of the coffin bones with respect to the bearing edge of the hooves.
Fig. No. 13. and 14 .: X-ray from the left - left and right front limbs on 18.9.2019
Lateral projections confirmed deviations in the position of the bones of both limbs. The steep position of the pastern bones reached 77 - 78 °.
Fig. No. 13 .: X-ray side projection left limb.
The left limb also had a steeper coffin bone position, which reached 61 °. The palmar angle of the coffin bone of 15.5 ° also corresponds to this position. The image also shows a slightly broken back axis of the finger and good anteroposterior balance of the hoof even after full shoeing interval.
Fig. No. 14 .: X-ray side projection right limb.
The right limb had a coffin bone position of 47 ° and a palmar angle of the coffin bone of 9.5 °. The axis of the finger is significantly broken back. Anteroposterior balance of the hoof was still adequate.
Fig. No. 13 and 14 .: X-ray side projection - frmo left: left and right limb
Fig. No. 15: and 16: X-ray oxpring projection from the left - left and right front limbs on 18.9.2019
Both images in the oxpring projection showed damage to the lower edge of the navicular bones at grade 2 - 3, which corresponded to a small dorsal extension and pain when examined on a digital extension device.
The results of the overall examination confirmed a set of problems manifesting as palmar pain of the hooves.
Chosen trim:
Fig. No. 17: and 18: From the left - front hooves from the side and from the back after adjustment
When trimming the hooves in the dorsopalmal direction, the heels were not reduced too much, as the dorsal extensions reached only 29 ° during the examination. The higher heels on steep foot slightly reduce their broken back axis, especially on the right limb. It reduces the tension of the deep flexor and thus its pressure on the damaged navicular bones. Slight rockers were rasped in the dorsal parts of the hooves and the weight bearing edge of the heels was gradually reduced by 5 mm in the length of 1.5 cm from the heel edges. In order to compensate for the irregular impact of the right hoof, the supporting edge on the outer half of the hoof was further reduced while maintaining the same height of the heels.
Shoe preparation and shoeing:
Front two-clip clasic roller size 2 horseshoes manufactured by Kerckhaert were chosen for shoeing. The shoe is 10 mm thick so that the chamfering of the outer edges has the strongest possible effect. The horseshoes were hot forged and slight rockers were created in the front parts of the bearing surface and the ends of the branches about 2 cm in length were slightly bent upwards so that the bearing edge of the horseshoe respects the shape of the hoof. This measure was chosen in order to maintain a regular impact of the hooves when the heels grow, see. right: Fig. No. 19 and 20.
Fig. No. 21. - 24 .: From the left - The left front hoof viewed from the lateral and medial side, from below and from the front.
Fig. No. 25. - 28 .: From the left - Right front hoof viewed from the lateral and medial side, from below and from the front.
Veterinary measures: Not specified.
Rules of the further care:
Monitor further development of limb movement and lameness. Ensure movement on soft surfaces and initially mainly on straight lines.
5. Chosen solutions
Effect of the first selected hoof treatment:
The horse's movement improved during the first week after shoeing and in the following weeks the horse was graduallly exersided On the fourth week the jumping lesson was followed by a partial loss of forward movement and signs of lameness. During the next two weeks, there was again alternating lameness on both front limbs. The horse was again examined radiologically and the results obtained were compared with the previous examination.
Fig. No. 29. and 30 .: X-ray - anteroposterior projection - left and right front limbs on 16.11.2019.
Fig. No. 31. and 32 .: X-ray - lateral projection - left and right front limbs on 16.11.2019.
X-rays showed decrease of the pastern angle by 10 ° and also a reduction in the angle of the dorsal wall of the coffin bones. The change in the size of the palmar angles of the coffin bones was insignificant.
Comparison of the results of radiological examinations from 18.9.2019 and 16.11.2019
Examination on a digital extension device revealed a greater sensitivity to lateral extensions on the left front limb, as the horse reacted painfully even at 12 - 14 °. The dorsal extension remained at 29 °. On the right limb, the results of lateral extensions were asymptomatic, but there was a painful reaction to dorsal extension at 20 °. From this examination it is possible to judge the sensitivity of collateral ligaments on the left limb and the coffin joint on the right limb.
Before shoeing, the horse was examined with a Lameness locator , which confirmed the greatest intensity of lameness on the left limb on a circle on a hard surface.
Fig. No. 33 .: Result of examination with a Lameness locator on a hard surface (on asphalt) on a straight line in trot before shoeing.
Fig. No. 34 .: Result of examination with a Lameness locator on a soft surface (in sand) on a straight line in trot before shoeing.
Fig. No. 35 .: Result of the examination Lameness locator on a soft surface (on sand) on a circle to the left in a trot on a lounge before shoeing.
Fig. No. 37 .: Result of examination with a Lameness locator on a hard surface (on asphalt) on a circle to the left in a trot on a lounge before shoeing.
Fig. No. 36 .: Result of examination with a Lameness locator on a soft surface (on sand) on a circle on the right in a trot on a lounge before shoeing.
Fig. No. 38 .: Result of examination with a Lameness locator on a hard surface (on asphalt) on a circle on the right in a trot on a lounge before shoeing.
Video No. 7 .: Examination of the horse in motion before shoeing
6. Follow up – Development of changes
Changes in the choice of horseshoes and shoeing:
Due to the results of previous examinations, it was necessary to choose a horseshoe with an intense lateral breakover on the left foot and a good relief of the deep digital flexor tendon in the anteroposterior direction on the right hoof.
Fig. No. 39 and 40 .: Left hoof after shoeing on November 16, 2019 when viewed from the side and from below
An iron rock & roll type horseshoe was chosen for the left hoof, made of an Equilibrium size 0 horseshoe with a slight rocker and a size 2 racing horseshoe welded on the inner edge.
Fig. No. 41 and 42 .: Right hoof after shoeing seen from the side and from below
A horseshoe Equilibrium size 0 was fitted on the right hoof and a bar made from a racing horseshoe was welded on the ends of the branches.
Effect of chosen farriery measures:
The horseshoe made for the left hoof significantly reduces the bearing surface of the hoof and allows very good lateral breakover. In addition, it helps the left shorter and steeper limb by raising the bearing surface of the hoof by 6 - 8 mm and compensating for the difference in the limbs. A large sledge bend was forged on the right horseshoe to move the tipping point as far back as possible. The welded lock on the tread surface of the horseshoe prevents the palm part of the hoof from falling into the soft surface, balances the height of the feet on both hooves and reduces the pressure of the deep bender on the hoof joint.
Result of the care:
Immediately after shoeing, the horse was re-examined with a Lameness locator, which confirmed the relatively positive immediate effect of the selected measures. Below is a comparison of the test results before and after shoeing.
Fig. No. 43 .: Result of examination with a Lameness locator on a straight line on an asphalt surface after shoeing.
Fig. No. 45 .: Result of the Lameness locator examination on a straight line on a sandy surface after shoeing.
Fig. No. 47 .: Result of the Lameness locator examination on the circle on the right on the lounge on the sand surface after shoeing.
Fig. No. 44 .: Result of examination with a Lameness locator on a straight line on an asphalt surface before shoeing.
Fig. No. 46 .: Result of the Lameness locator examination on a straight line on a sandy surface before shoeing.
Fig. No. 48 .: Result of the Lameness locator examination on the circle on the right of the lounge on a sandy surface before shoeing.
Fig. No. 49 .: Result of Lameness locator examination on the circle to the left on the lounge on a sandy surface after shoeing.
Fig. No. 50 .: Result of the Lameness locator examination on the circle on the left on the lounge on a sandy surface before shoeing.
Fig. No. 51 .: Result of the Lameness locator examination on the right circle on the lounge on the asphalt surface after shoeing.
Fig. No. Result of the Lameness locator examination on the right circle on the lounge on the asphalt surface before shoeing.
Fig. No. 53 .: Result of the Lameness locator examination on the left circle on the lunge on the asphalt surface after shoeing.
Fig. No. 54 .: Result of the Lameness locator examination on the left circle on the lounge on the asphalt surface before shoeing.
For 7 weeks, the horse was gradually exercised again in jumping gymnastics. During the next shoeing, the shoe on the left hoof was changed to Equilibrium with a significant rocker and forged edges of the branches for better lateral breakover. The type of shoeing was not changed on the right hoof. At present, the horse is in full sport work load.
7. Conclusion (take home message):