Making a Diagnosis
Horse and Rider|Spring 2021
Is your horse lame? Learn why it’s important to do what it takes to make an accurate diagnosis before you treat.
BARB CRABBE, DVM

When I entered equine practice 30 years ago, I got my schedule from the office at the beginning of the day, then checked in when I had finished my appointments. I carried a beeper, and when I got a page, I had to stop at a convenience store along my route to use a pay phone. If I had to take radiographs, I developed them at the end of the day by dumping them in vats of chemicals in the practice darkroom. If I needed more or different views, I had to go back to the farm to repeat the process. Diagnosing a lameness was tricky, and chances were a horse would be treated based on a “likely guess” about what was wrong. Sore hocks? Inject them with corticosteroids and see if that helps. Sore feet? Talk to your farrier about corrective shoes.

Times have changed. These days, my cellphone is always at my side. My office can reach me any time they need me, and so can my clients. The beeper is long gone, and I haven’t seen a pay phone in years. I can take as many radiographs as my heart desires on the digital system, and if I don’t like what I see, I can simply repeat the view—right then and there. I honestly don’t know how any of us did it “back in the day,” but I do know things are better now. Technology has not only improved on the things we use every day, it’s also opened up a whole new world of tools for diagnosing lameness, and has led to treatment options that increase the chances for a successful outcome.

If you’ve had horses forever, you may long for the day when things were simple and wonder if it’s really necessary to do all of those things your vet recommends when your horse comes up lame. Yes it is, and in this article I’m going to show you why. I’ll look at three common scenarios where a lameness might not be exactly what it seems, and show you how making assumptions and treating the wrong thing is likely to be unsuccessful. Not only that, you’ll see how making a bad decision because you didn’t have a diagnosis can be downright dangerous for your horse.

Scenario #1: My Aching Feet!

The Signs: Your horse has always started out a little bit stiff and is sensitive to shoeing changes, but otherwise he’s been pretty sound—until last week when he had an obvious head nod. Your vet came out to do a lameness exam and saw that your horse was exhibiting a right front lameness that seemed more pronounced when longeing on a circle to the left. He trotted off lame when your vet flexed the lower joints of both front legs, and when your vet performed a nerve block that eliminated sensation to the back portion of your horse’s right front foot his lameness disappeared and shifted to the left side.

The Question: Does your horse have navicular bone issues? Or could he have a soft tissue injury in his foot? In times past, a foot-origin lameness that blocked to the heels might have been labeled navicular disease and treated accordingly—with corrective shoeing, pain relieving medication and possible corticosteroid injections in the coffin joints. Now we know that it’s not that simple. There are many different structures that can be injured within the foot and successful treatment depends on identifying the underlying problem.

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