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Old 07-12-2010, 11:50 PM  
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Treatment for Ringbone

Please let me know what you have found to be helpful or unhelpful in the treatment of low ringbone. How long from the onset of symptoms did your horse live comfortably?
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Old 07-14-2010, 07:47 AM  
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Originally Posted by DixieMom View Post
Please let me know what you have found to be helpful or unhelpful in the treatment of low ringbone. How long from the onset of symptoms did your horse live comfortably?

There are two forms of low ringbone.

Nonarticular low ringbone, while more often found in high ringbone cases, represents new growth around the distal interphalangeal (coffin) joint but does not involve the articulating surfaces of the joint.

Articular low ringbone involves bone growth at the joint surface of the coffin joint.

In the early stages of low, nonarticular ringbone, before new bone growth begins (periosteum inflammation), treatment is a cast application.

The prognosis for subacute or chronic cases of nonarticular low ringbone is guarded.

The prognosis for articular low ringbone is unfavorable for return to serviceability.

Veterinary treatment for chronic pain associated with low ringbone is often a palmar digital neurectomy.

Shoeing protocol is focused on stabilizing the coffin joint via easing resultant ground reaction force in the anterior/palmar and medial/lateral axis. Common examples include the application of half round or roller motion shoes. A wide web half round is a good solution for lighter horses. Heavier horses may benefit from the new Kearkhaert classic roller shoe.

Ringbone is degenerative with no real cure. Progression of the disease is influenced by use (riding).

In advanced cases, a neurectomy may not return the horse to serviceability for riding, but will remove the pain and allow the horse to live comfortably for many years.

Best luck,
Mark
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Old 07-15-2010, 11:31 PM  
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Thanks, Mark. Hers is low and articular, both front feet. She is a big boned, heavy structured appy mule. 16.2, 1200 -1300 pounds. She walks short strided and is hittng the toes first. She is on a faily soft sand surface, in a 16X24 covered pen during the day and turned out at night. Her limp is always obvious to me, although sometimes much more noticeable. If I even try to sit on her, she is very, very lame with even the very first step. Can't cross over to the left and may even stumble if in a left turn. Soooo.. needless to say she is not being ridden. She has been recovering from laminitis this year (triggered by onset of insulin resistance which then triggered severe allergies.) Her first nuclear bone scan showed flaming hot laminitis in the left, and moderate in the right. Rest and bute for 3 months helped a lot. The 2nd bone scan showed 70% improvement. Now that the laminitis is settled down, my local vet says she will do some hoof injections for the ring bone, but won't use steroids unless we have another bone scan and make sure every bit of laminitis is resolved first. So that is my next course of action - a 2 hour drive to the vet specialty clinic for the scan. It's just so stinking hot right now that I don't think it is a good idea to transport now. Her IR and allergies are very well controlled now, and hopefully the laminitis is resolved. It leaves us now with the nasty ringbone.

Mark, her shoeing for the laminitis has consisted of rolled shoes with break over toes, a pad, and the purple squirt in spongy sole/frog support to support the coffin bones. SHe has done pretty well with this for the past year, but the lameness vet says now it is time to transition her back to just the shoes. I'm so afraid when the sole supports are gone she's going to be extremely lame. How long do you think it will take for her to be comfortable again? She is in soft sand. Her coffin bones never rotated, but they did drop a fair bit. Recent xrays show the bones to now be in near normal positions.

How many years do most animals with symptomatic low articular ringbone last?
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Old 07-16-2010, 12:39 AM  
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Quote:
Originally Posted by DixieMom View Post
Thanks, Mark. Hers is low and articular, both front feet. She is a big boned, heavy structured appy mule. 16.2, 1200 -1300 pounds. She walks short strided and is hittng the toes first. She is on a faily soft sand surface, in a 16X24 covered pen during the day and turned out at night.
Sorry to hear about her problems Dixie. Wish I had better hope to offer but articular low ringbone is one of the tougher problems to manage with no available cure. Toe stabbing during the landing phase of the stride suggests discomfort in the caudal aspect of the hoof. Given the articular ringbone diagnosis I suspect there may be excess bone growth around the articulating suface of the navicular bone. This can abrade the deep digital flexor tendon causing caudal discomfort. There may also be pressure on the impar ligaments, disturbing the nerves located there. Adding a full wedge pad to your shoeing protocol may reduce tension on the DDFT and offer her some added comfort.

Quote:
Her limp is always obvious to me, although sometimes much more noticeable. If I even try to sit on her, she is very, very lame with even the very first step. Can't cross over to the left and may even stumble if in a left turn. Soooo.. needless to say she is not being ridden.
The chronic lameness suggests the disease is advanced enough that comfort should probably be the primary goal at this point.

Quote:
She has been recovering from laminitis this year (triggered by onset of insulin resistance which then triggered severe allergies.) Her first nuclear bone scan showed flaming hot laminitis in the left, and moderate in the right. Rest and bute for 3 months helped a lot. The 2nd bone scan showed 70% improvement. Now that the laminitis is settled down, my local vet says she will do some hoof injections for the ring bone, but won't use steroids unless we have another bone scan and make sure every bit of laminitis is resolved first.
As I'm sure you already know, stabilization of the coffin bone to avoid rotation is the primary consideration. The shoeing protocol typically involves moving weight distribution to the back half of the foot. Unfortunately, if the mare is toe stabbing, she probably can't handle much additional pressure caudally. That makes managing laminitis even more difficult.

Quote:
So that is my next course of action - a 2 hour drive to the vet specialty clinic for the scan. It's just so stinking hot right now that I don't think it is a good idea to transport now. Her IR and allergies are very well controlled now, and hopefully the laminitis is resolved. It leaves us now with the nasty ringbone.
I agree that a two hour drive may be a real challenge for your mare.

Quote:
Mark, her shoeing for the laminitis has consisted of rolled shoes with break over toes, a pad, and the purple squirt in spongy sole/frog support to support the coffin bones.
I'll presume that by "rolled shoes" you mean that farrier forged a rolled toe into the shoe to ease anterior breakover. Nothing wrong with that but I might experiment with providing ease of breakover in both the A/P and M/L planes using half round or roller motion shoes. One doesn't want to be too aggressive with the anterior breakover as this can cause problems in the extensor tendon and suspensories. Might take your farrier a few sessions to "dial-in" the package offering the greatest comfort and ease of movement. A flexion exam can be very helpful in these cases to determine just how much stabilization to include in the shoeing protocol.

Hopefully your farrier is keeping most of the supportive packing in the back half of the foot. I'd want to experiment with a few different packing materials to determine what best serves to help the mare remain comfortable. Hoof testers can help identify just how much support (pressure) she can handle and where.

Quote:
SHe has done pretty well with this for the past year, but the lameness vet says now it is time to transition her back to just the shoes.
Given your description, I'm at a loss to understand your veterinarians suggestion. Ringbone is degenerative. It is not going to improve with time. If the horse needs a therapeutic package (shoe, pads, packing) to be comfortable, I would offer that this need is forever. There won't be a time when she'll get better and can return to standard shoeing.

Quote:
I'm so afraid when the sole supports are gone she's going to be extremely lame.
I absolutely agree! The last thing you need is for this horse to transition from past laminitis to a full blown "sinker". I'd stay with the pad/packing unless there was strong reason to remove it.

Quote:
How long do you think it will take for her to be comfortable again? She is in soft sand. Her coffin bones never rotated, but they did drop a fair bit. Recent xrays show the bones to now be in near normal positions.
Wish I could answer this question but without first hand experience with the mare it is impossible for me to say when, if ever, she will be comfortable. If I had to choose between rotation and sinking, I'll take rotation every time. Sinkers are as bad as it gets. If the distal phalanx (coffin bone) is in a normal position (zero or slightly positive palmar angle with respect to the ground surface) I'd keep that support in place and focus on trying to retain/grow as much solar tissue as I could. Perhaps a supportive packing laying over a softer layer of Magic Cushion in the back half of the foot. A thinner layer of Magic Cushion in the front half. I might use a plastic pad, possibly wedged (toe stabbing reduction), to offer a solid base under the packing. A wide webbed shoe helps with mass distribution.

It really becomes a matter of experimentation to determine what combination of orthotics help the most. From what you've shared, it appears your farrier is on the right track.

Quote:
How many years do most animals with symptomatic low articular ringbone last?
It depends largely on the animals comfort level and your judgment. I've seen horses with low ringbone live out a full life as a pasture pet. Shoeing protocols allow us to provide much greater stabilization of the coffin joint which reduces discomfort. If the joint ultimately fuses, the pain may completely subside for several years until small chips (floaters) break away and impinge on sensitive tissues.

Your vet can best advise you regarding how advanced the problem is and the graded level of discomfort the mare is experiencing. Proper shoeing can go a long way towards maintaining comfort and quality of life. You might also talk to your vet about Isoxsuprine, Corticosteriods, Polysulfated Glycosaminoglycans and a Palmar Digital Neurectomy. These are all potential treatment approaches that afford varying levels of success dependent upon your horses condition.

Best luck,
Mark
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Old 07-16-2010, 05:04 AM  
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Dixie so sorry to hear that your going through this..Ringbone isn't a pretty thing to deal with. You sound like your doing the best you can do for your mule. It's hard to see your eqiune hurt. I'm dealing with a stifle issue myself...Every time he gimps I cringe.....
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Old 07-16-2010, 08:35 AM  
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Originally Posted by Mark_Gough View Post
Given your description, I'm at a loss to understand your veterinarians suggestion. Ringbone is degenerative. It is not going to improve with time. If the horse needs a therapeutic package (shoe, pads, packing) to be comfortable, I would offer that this need is forever. There won't be a time when she'll get better and can return to standard shoeing.

Mark
Mark.
I believe this was in regard to the laminitis and not the ring bone(changing shoeing package). I agree though and would not change protocal to quickly. (OP)Even though this package is for the laminitis, it has benafits for the ring bone as well.
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Old 07-17-2010, 01:13 PM  
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Thanks for the advice. It really does help to hear another opinion. I need to get her up to the specialist for one more evaluation. I will tell my farrier that we will continue with the present regimen, rather than removing the pads and cushion support. That makes no sense to me. I am at a quandry regarding the palmar pain and toe stabbing. If we raise the heels that will put even more pressure on the anterior laminar tissue. I neurectomy is not an option in our case, as I can see that if you had an old valuable stud, but not for an animal with no reproductive value. Taking away sensation would be like a diabetic foot without sensation. I'd never know if she had a problem like an abcess, hot nail, or injury. Although I can appreciate the pain relief it would give, it sounds like a future hoof disaster waiting to happen. I will certainly be asking about the injections and perhaps a different shoe.

To me, it seems significant that she is showing more continuous discomfort now than she was a year ago when we were battling the laminitis. This is a very stoic mule. She has amaxingly thick walls and a high thick sole. Hoof testing is ALWAYS negative with her, even at her worst. The vet was very surprised at the degree of laminitis she had, given that he could hardly get her to take a lame step on exam. She wasn't even lame enough to do nerve blocking to determine the location of pain, which is why we went ahead with the nuclear bone scan, which revealed flaming hot laminitis on the left. It was bad enough that the vet was not sure she would actually recover from it. But she has - at least from the laminitis. She is the "come-back kid" if there ever was one.

Even now, with obvious lameness, she begs to come out and go for walks. When I give in, she gimps and limps around the block, short strided, toe pointing, walking slightly sideways because she takes a shorter step on the left. Sounds pretty pathetic when I describe it that way, doesn't it? We have several sets of Xrays over the past 2 years, so I think the vet should be able to see if the ringbone is rapidly progressing. If it is, I think I need to look at the hard reality of keeping this sweet soul mate alive for my own sake, versus letting her go before if gets to the point of regret. Very very hard to even think about.
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