And the official lameness begins!

Roughly... 3 days after making it official, Shidoshi went lame. On his left front, the one with the hard swelling just below his fetlock joint. Funny enough, the night before I'd received the official rad report from rads of that fetlock taken in November. 

Findings:

"Moderate to marked undulating to lobular mineral production of dorsal, dorsomedial and dorsolateral cortex of mid-proximal P2

Moderate undulating periosteal proliferation, dorsal cortex of the MC3 distal metaphysis

Moderate dorsal soft tissue swelling

Moderate distal condylar sclerosis of MC3, greater medially

Focal flattening and ill-defined decreased subchondral bone density of the mid portion of the MC3 medial condyle" 

The comments section provided the following interpretation "If there is no evidence of pain on palpation of dorsal P1, this finding may not be clinically relevant at this time." And then, the kicker, "The MC3 condylar damage is of greater concern for long term soundness."

Research and phone calls with my friend who is an equine vet helped me interpret the report. Basically there is a relatively newly diagnosed disease in racing thoroughbreds. More attention has come to it recently because it seems to preempt the traumatic fractures and breakdowns that are so tragic and garner so much negative press. The bone on the distal cannon bone responds to stress inappropriately by becoming weaker rather than stronger. Palmar osteochondral disease. Plantar if you're dealing with a hind leg, but this is in his front. Treatment? Retire from racing. Well that box is checked off. But what about his treatment and then prognosis as a sporthorse? Not a whole lot of info out there. What my friend told me based on conversations with two surgeons is the prognosis is good with 90 days of pasture rest. For full return to work, any level of jumping. 

This information made me panic a bit less while waiting for an appointment with a surgeon here locally, but it was still pretty anxiety inducing. I bought this guy after retiring and ultimately euthanizing my 8 year old mare for cervical arthritis, and I was pretty stressed by thinking that I might be retiring another young horse before he even got a chance to show what he could become. 

Since I went out of town (again, I don't usually travel this much...) shortly after he went lame, he has roughly two weeks off on pasture rest before our appointment. He also moved fully to pasture board, which is a mixed bag for him. On the one hand I can now groom all over without vague waving of a hind leg or swinging of his head indicating he is displeased with what I am grooming and might express it further. It's unclear if that came from 24/7 turnout or from getting to know each other. The definite down side of being a pasture pony now were the difficulties finding someone he could be out with safely. Two separate horses tried to chase him into the pasture fence and he wound up with even more bite marks than he had when I bought him. More concerning is his propensity to put his feet over/through the no climb wire fence and cut up his legs. I returned to find the front of a front leg torn up a bit. My husband and I walked the pasture fence lines and bent in every single tiny protrusion of wire that we could find. It would probably help if he didn't constantly bug other horses over the fence... But... Horses. 

I was gone for a week and when I got back he still had effusion in his left fetlock. This was gone by the time I hauled him down to see the surgeon Friday. The clinic doesn't allow people into the barns but you can still watch them flex and jog outside. The surgeon introduced himself and then started right off with the cheery "He really went through the ringer at the track, huh?" Why yes, I suppose you could call it that. He rattled off findings from his passive lameness exam: Very sore over both front heels, decreased range of motion in the left front fetlock, positive to palpation of proximal front suspensories, and more in the hind legs that my owner brain glazed over. Then they jogged him. And he was dead lame. So lame that I didn't even notice which leg, but felt like it might've been the right front, not the problem child left front. He asked if he could block his feet so we could do something actually productive with flexions. Sure, yes, let's do that, anything that will make him look better. 

And after blocking the right front he did look much better. Mildly lame in both fronts with a mild left hind lameness as well. Slight positives to flexion of both fetlocks. He took rads of his fetlocks and hocks and ultrasounded both front legs. The proximal suspensories both were mildly enlarged at the proximal aspect but there were no tears or very significant lesions. The distal cannon bone looked improved from his December radiographs. No signs of arthritis within his hocks or fetlocks. Feet showed a negative palmar angle - bad news bears 

The lower line is parallel to the ground, the palmar angle is measured with a line from the wings of P3 along the solar surface to the tip of P3. His angle is about 1.7 degrees, but this is artificially improved by the wedge - see how that has lifted the heel? His soles are also very thin - about 7mm of depth at the heel. 

His left front foot was a little bit trickier for me to look at. 

His sole depth is uneven side to side, the medial aspect is to the left in this image and you can see how there is more sole depth laterally 

The uneven sole depth means that in the lateral view the wings of P3 are aligned straight, but the shoe, the bright metal opaque eye catching shoe, is uneven. 

Here we look like we have a positive palmar angle, although just barely (4.3 degrees). I'm not sure how many degrees the wedge shoes add, I had trouble measuring that since the shoe is not the part of the image that is straight. I imagine without them he would either be even more barely positive or slightly negative.

I'm so far from an expert in equine imaging and podiatry, so the above are just my attempts to document and figure this out for myself. The wedge shoes he is currently in help correct the angles by lifting the heel. However, they also then put more weight onto the heels of the foot, crushing the tubules more and worsening his ability to try to develop any kind of heel depth. Also making him more sore. It isn't clear to me right now what the correct solution is. He is getting new shoes put on today - wedges with support across the frog to share in weight bearing. According to the internet this can help. But, there are still people who say this will only further crush the heels. 

This was better news to me than terrible ligament damage, changes to the navicular bone, or radiographic changes to his fetlocks. This doesn't rule out changes to the cartilage in the fetlocks though, and the plan, after getting his feet straightened out over 3-4 shoeing cycles, is to inject his fetlocks. Then I can slowly start bringing him back to work. 3-4 shoeing cycles means 15-24 weeks, which puts us squarely in the hottest part of summer, June 29 - Aug 31. So coming back to work slowly should be just fine. He's also on adequan in the mean time - loading dose protocol of every four days for seven doses and then moving to once every two weeks. 

Getting his weight up is a whole 'nother project that I'll save for another post!