by Dr. Justin High, DVM
Have you ever seen a horse so lame you just don't know where to start trying to figure it out? Well, it seems like here lately I have had more than my share of them. Hopefully, this has not happened to one of your horses, personally, but I bet you have a friend that has. Since it is the curse of any animal owned by a veterinarian, I will exclude myself from the conversation, and stay with client horses.
Typical presentation – one of my trainers brings a horse up, smiles and hands my tech the lead rope then says, "It's off behind." This usually gets my attention pretty fast because most of the professional trainers have a good feel for where a horse will be lame based on how they ride or what they've been working like. More often than not, they will suggest that the hocks or stifles, or maybe the suspensory ligament is bothering a horse, but they've seen enough lame horses to know that nothing is for certain. So, when they just smile and hand one off, you'd better watch out.
Single leg lameness is typically straightforward. The horse may be non-weight-bearing lame, but you know it's just A leg. The process of diagnostic nerve blocks can proceed until you have your answer (most of the time). But when I see a horse trot/hobble off where I have no idea which of the four legs hurts the worst, it can be a little trying.
This may seem anticlimactic to you. The horse is crippled; it should be obvious where the problem is because it's so lame. Easier said than done, my friend. The goal for me here is to pick out the leg I think is the worst and start from there. After quite a few years of looking at lame horses, this has become more of an art than science, combining every sense God has given me to evaluate their stride, to include sound.
One of the best vets I've ever seen could pretty much tell you which leg a horse was lame in just by turning away from them and listening to the sound of their trot. It made me furious he could do that without looking at a horse, but he is just that good. I have to use everything I have, which may or may not include the Magic 8 Ball.
By taking your time and not using the "shotgun" approach to multiple limb lameness, things tend to progress well. Many issues that are not the primary cause of lameness are compensatory in nature. Meaning one leg has been injured to the point the horse shifts excess weight to another leg, thereby causing another gait deficit compounding the problem. So, as you address the big things the minor issues return to being minor issues. As one limb is sorted out, the others, when approached systematically, will be as well.
A single leg may have multiple issues. I blocked out a horse today that had a partial suspensory tear, and a lumbar/pelvic subluxation. So, he's sound at the walk, crippled at the trot, and hardly off at a cantor. Don't ask me to explain that one – I can't, but after several hours of peripheral and intra-articular nerve blocks, I proved it to myself and my client. The one before that was a nice, stout ranch gelding that was, to the best of my assessment, crippled in three out of four legs. The LF was "sound," kind of. I started with the left hind. Everything I flexed on the horse made him worse, so I started at the bottom to work my way to the top. Did I mention he was supposed to go to one of the biggest ranch horse competitions in the state in three days? No pressure.
Even though the horse had no hoof tester response, I decided to block out his foot just to be sure. After hobbling around for 15 minutes to let the block set in, he limped back to me. As he stepped down with his LH foot to start hobbling off again, a huge abscess shot out of his coronary band 5 feet away from him, and he never took another lame step! Some problems can be so overwhelming for horses that they affect how the entire horses travels. Remember, all parts work together.
I counted at least 10 new gray hairs on my head that night when I went home, but everyone was happy and the horse was sound. Only pilot error prevented the horse from winning that weekend, so I was in the clear. God teaches us patience in many different ways. Don't get going so fast you miss the learning experience.
Dr. Justin High is a veterinarian and partner in Reata Equine Hospital in Weatherford, Texas. He graduated vet school from Texas A&M University and completed an internship at The Littleton Equine Medical Center in Denver, Colo. High’s years of practice focuses on the Western performances horse. Send any comments or questions to firstname.lastname@example.org.