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Gap in Carpus at 3yo
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ponyfire
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 Posted: Fri Jan 14th, 2011 08:26 pm
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I am an EBW/JENT in Australia, last week I saw a 3yo appaloosa gelding approximately 15hh and in good condition.
His new owner has had him for 2 months, much of his history is unknown.
It is believed he was broken to saddle as a 2yo and had light irregular work since. His new owner is riding him about twice a week for short periods.
The first thing I noticed as he walked towards me was that he appeared to have a huge 'gap' in the front of both carpus (carpi?) and as his hoof lands the part of the carpus directly above the gap appears to bulge forward.
When standing square the bulge appears to be soft tissue, on palpation it doesn't feel like synovial fluid or a bursar, it feels more like thickened skin with inflammation underneath.
His ROM in both carpus is fine.
He has not been lame.
I have seen 'open knees' before but mostly in younger horses and never this big, the gap is approximately 2.5-3cm. I have also never seen the swelling, the others I have seen have had a flat surface.
This horse doesn't have any really significant leg conformation issues although he is a little upright in the pasterns and tied in below knee.
His hooves did need trimming and were a little long in the toe, but perhaps only 2 weeks overdue for a trim.
I would like to know what I am seeing, what is the cause of it and if there is any advice I should give the owner.
The owner is an EBW in training.
Thanks
Robyn

DrDeb
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 Posted: Fri Jan 14th, 2011 09:09 pm
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Dear Pony -- you'll have to post a photo, with the owner's permission.

By the way, for all you adults out there: 'EBW' (I assume) means "Equine body worker". 'ROM' means "range of motion". I have no idea what 'JENT' means.

This is an example of "thumb language" and I wish that all correspondents here would avoid such abbreviations. It may sound hepcat and cool, but it really ain't, because its real purpose, like all pseudoscientific jargon, is to exclude those who are "not in the inner circle." -- Dr. Deb

sahkoyah
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 Posted: Tue Feb 1st, 2011 07:20 pm
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Hi. I'm the horse in question's owner. He had his hooves trimmed a week and a half ago and a few days later, became lame in the nearside foreleg. I had the trimmer back on Monday, and he watched me walk him out. He tested both front hooves and didn't find any sore areas - suggested it could be the knee, but between us, we couldn't determine which leg. He hasn't been ridden in about 3 weeks due to horrible hot weather (and therefore, lack of motivation!) and prior to that, was only ridden lightly for about 15 mins at a time, about once a week. He hadn't shown any lameness prior to what I've described above.

I've attached a picture of the offside carpus first. The bump on his cannon is relatively new, and has not been tender. It doesn't seem to be positioned on the tendons there, and I think he did it by banging his leg on the water trough.

Attachment: IMG_1236.JPG (Downloaded 193 times)

sahkoyah
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 Posted: Tue Feb 1st, 2011 07:21 pm
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Nearside carpus.

Attachment: IMG_1235.JPG (Downloaded 191 times)

sahkoyah
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 Posted: Tue Feb 1st, 2011 07:23 pm
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from the offside

Attachment: IMG_1238.JPG (Downloaded 190 times)

sahkoyah
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 Posted: Thu Feb 3rd, 2011 07:38 am
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I tried to photograph both knees. He looks to be standing base-narrow, but he doesn't, it's just that it was very hard to get him to stand still (I'm on my own here) and he had turned just before I took the photo.

Attachment: IMG_0931.JPG (Downloaded 160 times)

DrDeb
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 Posted: Thu Feb 3rd, 2011 08:18 am
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Dear Sakhoyah, and Ponyfire: When you palpate the horse's knees, do you not detect that there is puffiness that feels cold and squishy there? The puffiness certainly shows up plainly in the photographs. Please go feel the knees.

This is not normal; it might be an injury, but I think more likely it is caused by an ongoing disease process, common in Australia, that is called 'big head' or 'bran disease'. You will need to determine whether the horse in question is being fed or is being pastured on any of the following: Setaria grass, buffel grass, kikuyu grass, guinea grass, signal grass, pangola grass, purple pigeon grass, or green panic grass.

The proper term for 'big head disease' is 'nutritional secondary hypoparathyroidism' (abbreviated NHP), and it is brought on by oxalates that are in these forages that act to prevent the animal from properly absorbing calcium from the gut. It can also be brought on by feeding high amounts of oats and/or bran and/or other grain feeds that contain significant phosphorus. Many people who are hoping to grow a maximum-sized horse feed diets heavy in just these grains, or bagged feed that amounts to the same. Whether caused by culprit grasses or by overfeeding grain, the horse affected cannot then build proper, strong bones and joints. The disease does not just affect the horse's head, but causes lesions throughout the skeleton and can create puffiness in any joint. The animal may or may not be lame, and the areas that appear swollen (or mildly lame) may shift.

Go to this link to get an excellent downloadable PDF document on the subject:

http://www.mitavite.com.au/mitavite06/PDF/Nutritional%20Information%20PDF/Vet%20notes/Big%20Head%20or%20Bran%20Disease.pdf

-- or else you can purchase a copy of "Poison Plants in the Pasture: A Horse Owner's Guide" from the Bookstore section of our main website.

You definitely long since should have called in your veterinarian on this, because you need a diagnosis to know how to proceed. Even if it is just an injury, since neither of you seems to have recognized a puffy knee for what it is -- not "open space in the carpus" by any means -- then you need to call in someone with more expertise. The bumps or knots on the cannon bones could also be part of 'big head disease' -- or they might be due to injury. 

If big head disease is the culprit, you need to take steps immediately, without even one day's delay, to get the horse off the problematic feedstuffs and on to a proper diet. The researcher for the above article recommends a dicalcium phosphate supplement; you can do this, but I would also remove the horse from the offending pasture -- do not depend upon the supplement alone to fix the problem, since it is the pasture that is causing the problem. Horses continue in their skeletal development until they are at least six years old, and so it is particularly important that you give a three year old a fair chance to develop properly. If he is showing symptoms of 'big head disease' and you don't take steps, you will have a horse that is worth nothing because he will be neither sound nor safe to ride.

You mention that you have been riding this horse, and I would question that as well. Please go over to the 'Knowledge Base' section of this website and download the article called 'The Ranger Piece: Skeletal Maturation in Horses'. It's free, and you will learn a great deal that will cause you to question the common practices that you see other people doing, or that are common in 'the horse industry'. It is neither necessary, nor is it a good idea, to regularly ride or to expect real work from a three year old horse. If it turns out that the horse does not have 'big head disease' and is merely suffering from some strain to the knees, then without question the rider herself is at fault, and the workload must be reduced in order to, once again, give the animal a fair chance to mature its skeleton properly.

It would be somewhat helpful to see a well-taken photo that shows both front legs. Take the image from some distance away from the animal, and have someone else hold the lead rope to help him stand still. The photo needs to show the horse all the way from the breast to the ground. This type of image will allow us to determine whether the horse is bench-kneed or knock-kneed, both conformations which would predispose him to strains of the knee.

Taking the time and going to the effort to get someone to assist are other ways in which you as the owner can offer the animal a fair chance -- in this case, a fair chance to have its conformation assessed accurately. -- Dr. Deb

ponyfire
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 Posted: Thu Feb 3rd, 2011 09:36 am
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Thankyou Dr Deb
I apologise for my use of abbreviations, it was in no way meant to exclude anyone.
You are correct, EBW is Equine Body Worker, JENT stands for Jenkins Equine Neurophysiologic Therapy ( Di Jenkins of Australia teaches this).
I don't believe the puffiness was in the lower part of the knee when I saw the horse.
There was a definite bulge in the upper half of the knee which was most apparent when the hoof was heading down towards the ground.
This did concern me and I did palpate it, it didn't feel squishy, it was not hot and felt more like thickened skin with firm swelling underneath.
I did advise the owner that it would be better not to ride the horse and we needed further advice.
The horse certainly doesn't appear to have a 'big head', which I have seen in the extreme in other cases, and I didn't know that it could manifest itself in the knees.
I have certainly learned something and I'm so pleased I have been shown this forum.
Cheers
Robyn

sahkoyah
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 Posted: Thu Feb 3rd, 2011 11:57 pm
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Thanks for your reply Dr Deb.

My horse is definitely not overworked. I have owned him for 6 months and have been on his back only 8 times, each time for no longer than 15 minutes and each ride was mainly walking and light trotting. I have only ever cantered him 4 times, each time was about 10 metres in a straight line. The most regular work he has had was when I rode him two days in a row (15 minutes each time) at Christmas. Prior to me getting him, he had an owner who was a beginner and she never rode him in the 6 weeks that she owned him. She bought him from the breaker. I don't know what intensity of riding he had at the breaker's and I am unable to find out.

We have approximately a 4 acre paddock which is almost entirely native grass. There is definitely no buffalo, kikuyu, guinea, signal, pangola, purple pidgeon or green panic grasses here and I know this for certain as I had Landcare (an Australian government funded environmental group) come here to assess an erosion problem we have and asked them specifically about my grasses whilst they were here. This was done not longer than 4 months ago. We do have some weed content, which I have been poisoning (the horses are fenced out of each area while I spray the weeds, and not let back in until the weeds are completely brown and dead). The weeds we have are St John's wort in small quantity, flat weed and a few other weeds in small quantity which I haven't identified as yet.

I feed this horse on good quality lucerne hay, oaten chaff, speedi beet, and maxi soy pellets (the website says these are "super fibre, low GI, cereal grain free"). I also feed him Dr Jennifer Stewart's bone formula which is a fortified calcium supplement. He doesn't get any bran or pollard or any grain. Again, though, I don't know what feed he received prior to me getting him. I've been feeding him the above for the whole 6 months I've had him. If he had big head when I got him, would 6 months be long enough for recovery to take place?

I have just been outside to take the following photos and I have also palpated both knees. Neither of them feel soft & squishy or cold. As Robyn has said above, the puffyness feels firm.

 

Attachment: IMG_1299.JPG (Downloaded 138 times)

sahkoyah
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 Posted: Fri Feb 4th, 2011 12:03 am
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closer up...

Attachment: IMG_1298.JPG (Downloaded 138 times)

sahkoyah
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 Posted: Fri Feb 4th, 2011 12:04 am
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side-on

Attachment: IMG_1307.JPG (Downloaded 138 times)

DrDeb
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 Posted: Fri Feb 4th, 2011 02:27 am
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OK, Sahkoyah, I'm very pleased you've taken every opportunity to have experts view what's in your pasture. It does not seem that the horse is either being over-grained (i.e. high-phosphorus diet), nor eating tropical grasses containing significant oxalates, nor either does your pasture look like it's being over-fertilized (high nitrogen, high phosphorus fertilization of the grasses is another causative factor for 'big head' disease).

This leaves us with either work or conformation as the cause for the problem. The horse definitely has puffy knees. If the puffiness is not soft and squishy and cold (i.e., "cold" means "feels like normal skin temperature with fluid underneath", so that it's not hot) -- then it must be, as you say, hard and cold.

If it is hard, it means that the bones themselves have become deformed. The swelling, as I mentioned previously, is certainly abnormal, so this is why I say "the bones have become deformed".

It is the bones of the lower carpal row that are affected. Look in the "carpal bones" thread to see good pictures from an equine anatomy book that show what the carpal bones look like when they are normal.

Again, "big head disease" would induce such a deformity, but so will strain to the legs. If the swellings are indeed hard and not soft puffiness, then I think it is not your riding as much as it would be something that creates a more chronic strain. If the swellings are hard, the name of the deformity that is produced is called "big knee". One normally does not see this in young horses, but it can occur in any horse that has either 'primary' or 'induced' conformation problems at the knees.

As to conformation, the horse is admirably broad through the chest, but he's 'grade 2' bench-kneed (on a scale of 1-3). He's also somewhat knock-kneed. Both of these involve misalignments of all the bones between the forearm and the ankle. This is the 'primary' conformation problem.

There is also an 'induced' conformation problem, in that the horse is being forced to stand 'back at the knee' by the fact that the hoofs are not in good antero-posterior (A-P) balance. Look at the side view photo that you submitted, and note that the animal bears too much weight upon the heels. This causes him to walk and move essentially 'rocked back' onto the heels -- note the telltale shadow under the toe of the hoof. If the animal were standing properly upon its heels, you would not see that shadow. There would also be a different 'feel' to the stance, i.e. your inner eye would see that the weight was passing plumb through the center of the foot, instead of through the heels. I attach a photo of my own horse, Oliver, taken immediately after the farrier had finished trimming him a few weeks ago, showing what a horse looks like when he stands "right" on his feet.

When the horse stands "wrong" on its feet, in the sense that he is bearing, as your horse does, too much weight upon the heels, the stance, acting through the check ligaments which attach the flexor tendons to the cannon bone, pulls the cannon bone backwards relative to the knees. This results in a "calf kneed" conformation -- though it really is not conformation in the sense that the horse would have been born that way, because he was not born that way and is not intended to be that way. He is "functionally" calf-kneed (sometimes this is called 'being back at the knee' or 'being back on the knee') only because of the poor trim.

You correct this trim, or rather I should say you ask your farrier to correct it, by moving the heels back until a ruler laid across from the apex of the inner buttress to the apex of the outer buttress is at least as far back as the widest part of the frog. Then you also trim the toe back as far as possible without actually having it bleed. After having been nipped and rasped across the sole, the foot should be placed on a stand and rasped down from the top to get as much toe off as practically possible. See the next post for a photo of my own horse's right forefoot with the apices of the buttresses (the "heels") moved back as I am describing.

If your farrier objects to doing this, find another farrier who is better educated.

When you correct the A-P imbalance in the feet, the horse will stop moving "functionally" calf kneed, and you will then have removed this source of strain to his knees. You cannot remove the knock-knees nor the bench kneed conformation, but you should certainly try to give the horse a correct hoof trim every time.

If the swellings are, as you say, hard and cold, then they will never go away. If you correct the hoof trim, you may be able to delay or even prevent further deposition of abnormal bone (for it is the deposition of bone that isn't supposed to be there that creates the swollen-looking areas). The likelihood is, however, that over time the problem will get slowly worse, eventually resulting in the complete fusion of the mobile joints of the knees (i.e. the upper two joints). At that point, the horse will no longer be able to flex its knees by any means. He will be able to walk -- but even the walk will be abnormal.

As I mentioned before, you do need to consult with your veterinarian about all of this. You need a complete set of knee XRays, and you need a consultation with a qualified practitioner who will be able to give you a specific diagnosis, advise you concerning the severity of the problem and its prognosis, and work with you to implement ameliorative measures. -- Dr. Deb

Attachment: Oliver standing foursquare on his feet 1-2011.jpg (Downloaded 139 times)

DrDeb
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 Posted: Fri Feb 4th, 2011 02:31 am
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Here is the view of a properly-trimmed forefoot in sole view. I took this photo of Ollie's right forefoot two minutes after the photo above, so it shows an absolutely fresh trim. This photo shows what it means to "move the heels back" -- and they need to be moved back this much with each and every trim.

Note also that the toe has been trimmed off properly, leaving no "junk" or dis-attached hoof wall.

The shape of a normal fore hoof is ROUND. Your horse's fore hooves are almost certainly U-shaped instead. This is a reflection of their not being in correct A-P balance. When you get after trimming the feet correctly, the shape will gradually normalize. This process will take two years, or the equivalent of almost two "new hoofs" that will grow out during that time. -- Dr. Deb

Attachment: Oliver Rt foreft trimmed rasped heels moved back.jpg (Downloaded 139 times)

sahkoyah
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 Posted: Fri Feb 4th, 2011 08:47 am
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Thanks Dr Deb. Your horse's hooves are definitely significantly different to my horse's and I will definitely see about having this corrected asap. I'll also be calling the vet and arranging knee x-rays. 

After seeing the photo of your horse's hoof post-trimming, I went outside tonight and took more photos. My horse was trimmed on Monday this week. Previously, I had thought my horse's hooves were in relatively good shape and I am so glad to have had it pointed out what is wrong with his hoof shape, and what I should be aiming for.

On some of my photos, I have attempted to mark where the heels currently end, and drawn a line as to where I think they need to be. Can you please confirm if I have interpreted your description correctly? I also noticed that the inner buttress is currently not even with the outer buttress. To what extent would this affect the strain on the knees?

One other thing I'd like to clarify - I wouldn't describe the swellings as 'hard' either. Just firm - like thickened skin. It's quite hard to describe. It doesn't feel like there is a fluid sac there, nor like there is bone build-up there. It's not hot, so I suppose that means it's 'cold'. I wish you could reach through the computer screen and feel it, because I sure don't know how to describe it.

Attachment: IMG_1313.JPG (Downloaded 131 times)

sahkoyah
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 Posted: Fri Feb 4th, 2011 08:48 am
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my lines drawn in.

Attachment: IMG_1321.JPG (Downloaded 131 times)


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