Surgical Arthrodesis and Natural Hoof Care

Dear Dr. Teskey:

I believe I have an interesting case, and wondered if you could answer some questions for me.

SURGICAL FUSION AND RINGBONE.  This past May, a vet school performed arthrodesis on my upper level dressage gelding for high ringbone.  Prior to having the surgery, it was clear that he would not be sound without the surgery, so I felt I had no choice except to go ahead with the fusion.  He now has a plate and 6 screws placed in his pastern.  Up until the time he came up lame, he had been shod regularly.

Up until recently, I was comforted by studies that I found online, and by the confidence of the ortho surgeon at the school that horses that are fused have a high % chance of returning to the level of work they were at prior to the injury.  These papers reported that the pastern is a low motion joint, with little to no movement, so fusion would not affect the gait, so I felt sure that my horse's beautiful movement would not be affected by fusing that joint.  That was the least of my concerns -- it was surviving the surgery, the cast and getting through post surgical recovery and stall rest without further injury.  Which did!  My horse has an incredible and strong spirit and was the world's best patient!  My concern is this:

1. I am trying to recover his foot and am dedicated to the idea of staying barefoot.  I believe that the ringbone that exists in the other leg (though minor) would only be accelerated by putting restrictive metal on his feet.
2. I am trying to rehab the horse physically from the surgery at the same time I am trying to grow a normal foot on him.  Heʼs foot sore from crossing the gravel, crushed stone driveway to go out to his paddock and he is obviously heel sore from having his heels lowered to get contact with the ground.
3. When we fitted him with Old Macʼs last night, he was markedly improved when we put comfort pads in the boots with the frogs cut out.  However, he looks like he has a bucket on the end of each foot and Iʼm worried about the effect that more than 1 pound on the end of each leg is going to have on the arthrodesis.

My additional concern is about return to movement:

I spoke to the surgeon about my concerns, and he once again assured me that my horse is going to have his full range of movement and be as good as he was prior to the lameness.  He said that it is too early to expect him to be moving well; to expect periodic lameness, that there is a lot of soft tissue inflammation which will cause him to be a bit choppy, and not show suspension.  That naturally he is being guarded with himself because of the insult to his limb.  My vet feels that there is every reason to feel confident that my horse will return to his former capabilities; that he in fact is way ahead in his recovery than most horses would be.  (This horse is tough btw).  Now while I do see daily improvement with respect to strength and balance - still, when I ride those few steps of trot, I think OH MY GOD, this isn't the same horse.

My question is:  If that joint is fused, can a horse regain his suspension and thrust off the ground, his spring?  Can I hope for a return to dressage training?  This horse was a fabulous and flamboyant mover and I'd only imported him a couple of years ago.  He really has made incredible strides in his recovery and the surgeon is VERY optimistic.  But as I said, these recent reports have me alarmed that, although I think he'll be sound, he won't have the impulsion and suspension he had before the fusion.

Can you give me your thoughts on arthrodesis and loss of movement in that joint - how will that affect a good moving dressage horse? Can you give me your thoughts on the road Iʼm traveling to recover a good foot, on the proper boots to be using and whether or not they might have a detrimental affect on my horseʼs fused joint?

Thanks so much!

Chris

Hi Chris,

 

Sounds like quite the adventure you're having with this horse.  If you're working with someone knowledgeable, you're way ahead of the game.  I would trust their judgment as long as they have some experience.  About all I can tell you, without consulting directly with you, is that you'll likely have several months or even a couple of years getting this horse going.  There's a lot that's happened "wrong" to this horse from the sounds of it, but now that you're going a better direction, progress should be more the norm.  I would be surprised if the horse can be 100% given what he's been through, but he may not need to be "100%" to do what you want to do.  Lower level performance is still an achievement- I don't think any horse with a fused pastern can perform as well as a horse with a normal joint.  If the surgeon is so optimistic, he/she must have a good reason.  Are they aware of your decision to be rebellious and make your horse work on his own feet?      

 

Using hoof boots is not a problem.  Think about how heavy some of those crazy "corrective" shoes with pads weigh!  I would defer to your trimmer again on use of boots and which kinds will work best on your horse with his specific problems.  Using boots is very important.

 

Keep up the good work.  Sounds like a lucky horse to have found you.

 

Dr. TT