Case Study – Gerbrant – EquiproVet SA

Gerbrant - 9 Year Old Friesian Gelding

Adult Horse Contracted foot mild Osteoarthritis and Sidebone.

This case is a 9-year-old Friesian gelding, who in February 2019 suddenly went more upright on his off fore than was normal for him.

To read O’Grady’s – Hoof Capsule Distortions and how they can be managed, click here.

The hoof appeared to vary over a few months in severity of uprightness and did seem to be linked to rainfall and quality of grazing (owner’s thought was sugar content and potential laminitis), food was cut as a result to avoid a potential laminitic episode.

The gelding also experienced irregular shoeing intervals due to scheduling issues on the farrier’s part.

The owner attempted unsuccessfully to deal with the undesirable hoof angles with the farrier and eventually obtained the services of a new farrier. The decision was made to take the horse to the vet for x-rays on the 18^th December 2019. This would allow the new farrier to know exactly what he was working with and for the owner to make an informed decision about the horse’s training and level of work.

It must be noted that, at no point was he noticeably unsound or battling with his work. It was concern for his soundness and long term well-being that prompted the actions taken.

You will see from the radiographs that his off fore and near hind are significantly worse than near for and off hind.

Joint Maintenance

The gelding has been on Equaan 1000, weekly since mid-2018 until early 2019 and then was maintained on a twice monthly dose (every second week) for the last year.

Vet Report: (18/12/2019)

The prognosis is guarded as improving the angles and size of a contracted foot in an adult horse is next to impossible. The owner is realistic about her horse and the outcome, she wants him sound and happy and getting him back to competing without pressure would be a bonus. Having him sound to hack and do some light schooling is the ultimate goal.

He has sidebone in both front feet, the off fore is significantly worse. He also has some arthritis on the front of the joint between P1 and P2. His pedal bones, off fore and near hind are too vertical and require management through remedial farriery. The off fore is by far the worst and requires the most attention.

The recommendation from the vet was to trim the front feet to what their normal angle should be (just before the horse gets sensitive), in order to put the bones back in the best alignment possible. Then because you can’t drop a horse’s heels by 2 cm without causing compensatory issues with tendons and ligaments, providing a wedge pad for the last quarter of the hoof to reduce strain on tendons and ligaments.

Re assess and x ray 4 weeks after initial assessment

Farrier’s Report:(18/12/2019)

After speaking to the Vet and looking at the x-rays, the farrier was in complete agreement with the Vet. He also gives the horse a very guarded prognosis and will have to manage shoeing schedules very carefully. Apart from using a wedge pad to alleviate tendon strain, he rolled the front of the shoe to encourage break over and created a rocker effect to assist the gelding to drop back onto his heels as he felt more comfortable to do so. Ideally landing was encouraged for mid foot with a gentle rock back to the heels and a rapid break over to avoid strain.

Additional Therapies:

The owner had him checked by the chiropractor to ensure that he hadn’t compensated and was at risk of further complications.

As part of his routine maintenance he is treated every two weeks by Caty Greve of Caty Greve Equine Therapy. Caty uses the Winks Green Transeva Farradic Pulse Machine with great sensitivity and knowledge. Caty was kept informed of the vet’s findings and agreed to pay particular attention to the comfort of his muscles and tendons particularly of the O Fore and N Hind. A serious concern was how tight his tendons and ligaments were with the change in shoeing. Caty worked to relax and ease tight muscles and “wake up” muscles that were possibly a little inactive and needed to share the load.

He was also introduced to Magnetic boots and a process was started to gradually increase the time he wore them per day to assist with inflammation and comfort and hopefully hoof growth from improved blood supply. The boots will stay in use through his rehabilitation and probably for life as part of his routine maintenance.

Products used:

Both products used were selected because they are Structure-modifying osteoarthritis (OA) drugs (SMOADs) may be defined as agents that reverse, retard, or stabilize the underlying pathology of OA, thereby providing symptomatic relief in the long-term.

Equaan 1000 (PSGAG)

As stated above, the gelding had been given Equaan1000 regularly (twice monthly) and showed a significant improvement when put back on the recommended weekly dose for maintenance. It stimulates and feeds the metabolism of joints allowing the joints to function and feed themselves better through renewed and optimized joint metabolism and function.

Similar to PPS, polysulfated glycosaminoglycan (PSGAG) a semi-synthetic polysulfated chondroitin sulfate has been shown to diminish articular cartilage matrix molecule degradation [13, 35, 43], improve lameness score [13] and enhance matrix molecule synthesis [16]. However, there are no studies that have evaluated its effects on chondrogenesis of Musculo Skeletal Cartilage (MSC).

Dosage:

1 ovule weekly with the option to give a 3 day loading dose should he need it.

Pentosan Polysulfate (PPS)

Pentosan alters the underlying pathophysiological process which causes osteoarthritis.

Pentosan polysulfate (PPS) a semi-synthetic sulfated polysaccharide derived from wood of beech plant (Fagus sylvatica) has been shown to improve synovial and subchondral blood flow, stimulate hyaluronic acid (HA) and proteoglycan (PG) synthesis, limit cartilage matrix degeneration and suppress catabolic matrix metalloproteinases (MMPs) [7, 9, 10, 14, 20, 30, 34].

Dosage:

1 injection was given on the afternoon of 18th of December, 2019, to assist him with the changes made to his feet and avoid any unnecessary inflammation developing. 2nd injection was given on the 22nd of December 2019 and the third injection was given on the 30th December 2019.

The first photo was taken in February 2019 when the changes in the foot were first brought to the existing farrier’s attention.

18th December 2019

The gelding was assessed to be mildly unsound and radiographs were taken.

X-Ray 1 LF (Good foot) rear view

Some sidebone is visible but quite common to the breed, conformation and age and level of schooling

X-Ray 2 RF (Bad foot) Rear view

Severe sidebone is present

X-Ray 3 Comparative between front feet

X-Ray 4 Comparative all four feet

Note that R front and L Hind both feet show broken forward hoof pastern axis. R front is severe angle, with the tip of the pedal bone, very close to the sole. Some arthritis is seen between P1 and P2 on the front of the joint.

X-Ray 5 LF and RH

Angles far less than ideal but not as severe as the other diagonal pair

X-Ray 6 RF and LH

This diagonal pair shows broken forward hoof pastern angle. The joint between P1 and P2 in both x rays shows some arthritic changes.

Photos

Photo 1: Taken in February 2019 when the owner first queried the changes in angle of the off fore with the farrier

Photo 2: shows his hoof on the 18th December 2019, stripped and cleaned up prior to being trimmed

Photo 3: Shows R Hind

Photo 4: Shows Front feet – you can see degree of uprightness of O Fore

Photo 5: Shows L Hind

Photo 6 & 7: shows his front feet after trimming, you can see the gap left below his heels, which is why he needs wedge pads to alleviate the strain on his tendons. The foot itself already looks better even with the concave front.

Photo 8: L Hind shod

Photo 9: R Front shod

2nd January 2020

Update:

Video sent to farrier to show him the progress, this video is taken after the last Pentosan injection was administered. To date no strain, heat or filling in his legs through the adaptive period.

Exercise:

Hand walked and paddock time.

Treatments:

Caty Greve twice monthly

Videos:

Video 1: Landing mid foot and more comfortable on heel.

15th January 2020

Update:

Three videos taken by Equine Transeva Therapist, Caty Greve. Caty treats Gerbrant twice a month and she was asked to assist through his adaptive process to ensure that muscles didn’t spasm either from being stretched or overloaded. Her feedback has been critical in how he has progressed from in hand walking to gentle lunging, to ridden walking and the introduction of gentle trotting on straight lines, without incident. When she started treating him, the pulse or contraction on both the Near Hind and Off Fore felt tight and hard and had to be handled very carefully. These videos show an easier pulse reaching further down the tendons (incidentally this is a fantastic treatment modality for injured tendons and ligaments, following the Sports Medicine ethos of controlled movement being essential for correct healing.

Exercise:

Hand walking, gentle walking on lunge and paddock time

Videos:

Video 1: Received from Caty Greve as she treated his N Hind that day. “He shows a huge improvement in the pulse / contraction down the N Hind”.

Video 2: Received from Caty Greve as she treated his O Fore that day – SLOW MOTION

Video 3: Received from Caty Greve as she treated O Fore today – REAL TIME, “Contraction / Pulse reaching further down leg and has a smoother feel”

22nd January 2020

Update:

Gerbrant was taken to the vet for his follow up visit (as per vet request). The owner opted to do the X-rays prior to the farrier’s visit, for the farrier to know exactly what he was working with and what parameters he had. The Veterinarian was incredibly happy with the improvement in his feet. The R Front has an improvement in the shape and size of the hoof capsule (the front wall of the hoof capsule is less concave). On X ray (taken with the shoe on) there appears to be an improvement in reduction of solar angle as well.

The L Front (better foot), also appears to show a significant improvement in solar and pedal bone angles. Please note the gelding had pulled a shoe on the N Fore, which is why that foot is unshod in the x ray.

X-Rays:

X-Ray 1: L Front (good foot) showing improved alignment for P1, 2 and 3 and solar angle is reduced.

X-Ray 2: R Front (bad foot) showing an improved hoof profile, the hoof is not as nearly as concave as the previous x-rays. The solar angle appears to be slightly better.

X-Ray 3: Comparative between two front feet

29th January 2020

Update:

Second farrier visit, trimming and shoeing Gerbrant taking the latest X-rays into account for angles and trimming parameters. Pentosan administered day of shoeing.

Exercise:

He is always left the week after showing to acclimate to the new angles and changes in his feet.

Photos:

Photo 1: Hoof cleaned and trimmed, hoof gap is noticeably smaller than the previous shoeing. He was also more comfortable being shod. A Pentosan was administered the same day as he was trimmed and shod.

Photo 2: R Front shod, greatly reduced heel gap between back of the shoe and ground. Immediately post shoeing, he was more comfortable standing mid foot.

Photo 3: Standing very comfortably mid foot immediately post shoeing, with the weight distributed equally over both front feet.

Videos:

Taken directly after shoeing, landing clearly mid to rear of foot.

26th February 2020

Update:

He has been ridden for the last few weeks, gently at walk on soft to good going. He takes time to loosen up and be able to stretch the O Fore and walk well through both shoulders. He has started bouncing into trot under saddle and asking to do more. His owner has allowed the boucing and jogging but not actively asked for anything more.

Videos:

Caty sent us a video of his latest treatment. “Best contraction EVER!”. The contraction / pulse reaches further down the leg, it has a smoother softer feeling and he is more comfortable with the treatment.

4th March 2020

Update:

This is his third set of shoes post initial x-rays. His feet are incredibly hard with not much growth. Farrier has asked us to stop his Stockholm tar daily and allow them to become more moist and softer. There wasn’t much to change in terms of angles, without the growth to work with. He is however more comfortable standing to be shod before new shoes go on. Unfortunately, we missed getting those photos.

He is already on his heel, straight after shoeing and very comfortable walking out immediately.

Treatments:

No Pentosan administered in March. Caty’s treatments continue twice monthly, he wears the magnetic boots daily.

Exercise:

His ridden walking was gradually extended to longer walks ridden, venturing onto firmer ground for greater periods of time. He lunges in between ridden walking and has been allowed to trot on the lunge, to the extent of what he offers and looks comfortable with. His lunge work also incorporates theraband work to keep his hind legs strong, stifles and sacro-iliac stable with no compensatory issues, exercises provided by Equine Physiotherapist. Ridden walk also includes walking hills on good going, initially down hills were harder but he has improved in reach and straightness as he eases into them. He has also started doing diagonal lines up and down hills building proprioception and strength in individual hind legs as one is more loaded and flexed (uphill) and one is stretched and extended (downhill).

Photos:

Photo 1: Gerbrant standing immediately on his heel post shoeing, no tension visible in his entire O Fore.

Videos:

Landing happily heel first straight after shoeing.

15th March 2020

Update:

He hacked out for 45 min on the good dirt roads, which were beautifully soft after all the rain. On a short stretch of soft level ground, he was actively asked to trot and set into an easy rhythm to assess the reach and comfort of his off fore. The GOOD news is he felt amazing and comfortable on his feet and through his body. (Prior to this he has been trotting short sections because he bounced into it of his own volition).

He was then taken to the neighbouring indoor arena with a phenomenal quality surface and trotted on a big oval to feel how he coped with changes of rein, weight and bend. He was 100% sound both reins and kept offering to do more.

His work is backed down again after a new loading phase, to assess for any negative changes and then stepped up again to incorporate the new level once a week until he is obviously ready for more, based on feedback from the experts involved in his rehab.

25th March 2020

Update:

Photos were taken of his feet for a record just before SA went into lock down for Covid-19. The farrier would be due for the next shoeing on the 8th April (prohibited by lock down), causing huge concern about the interruption of Teddy’s progress with hoof pastern angles and landing in each stride.

It had also been noticed that he was using the rolled toe (meant to facilitate ease of breakover), as a way of being lazy eating from the ground when in the stable. The stable has rubber matting across the front section and he was using the rocker shoe and the give in the mats to stand with his toes down and heels off the ground on both front feet. (To be discussed with farrier and vet, re the use of the mats and the use of the rocker shoe).

20th April 2020

Update:

Lock down finally made provision for horses to be shod as long as all the criteria were met, and the necessary paperwork in place.

After speaking to the Farrier, it was decided that the mats would be removed from his stable, as he always stands normally on hard ground.

For the first time, Teddy is standing fully on his heels before trimming. He also had a huge amount of growth, from the extended shoeing cycle due to lockdown. After trimming and balancing he was still able to stand comfortably on his heels for the first time since his rehabilitation started.

He was very comfortable walking and landed heel first from the moment he was walked out. He had a Pentosan administered as part of his ongoing support and maintenance.

The plan during lock down is for the yard to lunge him three times a week, as he does stiffen with standing. We also don’t want to lose the suppleness and reach that we have achieved through the O fore and the degree of comfort he has in that limb.