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Ask Dr. Dave

Becky from Queensland, Australia, writes:

Dear Dr. Dave,

I have just found out that my six year-old gelding has ringbone on his offside front pastern and is starting to get it on his nearside front pastern. What treatment do you recommend?

When you goggle ringbone, there are hundreds of sites and many opinions. I am interested in what you think. Many thanks.

Dear Becky,

Thank you for your question. Before we get into the treatments and prognosis, let’s discuss ringbone – what it is, where it is, and what might be causing it.

Ringbone is defined as a periosteitis of the phalanges in a horse. OK, not much help there, so let’s break it down to what we all can understand. Ringbone begins as an inflammation of the periosteum, (the thin membraneous covering of all bones) of the bones below the fetlock, better known as the long pastern bone (P-1), the short pastern bone (P-2), and the coffin bone (P-3.) Frequently, if the inflammation stays around long enough, it causes some boney proliferation which is what we can see on radiographs, called ringbone.

Ringbone is categorized by its location: high ringbone, low ringbone, and articular ringbone vs. peri-articular ringbone. High ringbone involves the long pastern and the top of the short pastern. Low ringbone involves the lower short pastern bone and the coffin bone. Articular ringbone is thought to affect the joints, and peri-articular ringbone is situated away from the joints. Although peri-articular ringbone doesn’t directly affect the joints, it may be situated where soft tissue structures like tendons or ligaments rub across it, and it can be just as debilitating. So the term “high peri-articular ringbone” describes a boney growth on the long pastern bone which does not involve the joint, whereas “low articular ringbone” would indicate the coffin joint is affected.

In my experience, the “typical ringbone” of the western horse is usually “high articular ringbone” which is a boney growth around and involves the pastern joint between the long and short pastern bones.

Ringbone is usually a result of either trauma or less-than-correct conformation of the lower limb, or a mixture of both. An example of trauma induced ringbone might be the result of a severe wire cut around the pastern which takes a long time to heal. The wire cut might have disturbed or cut into the periosteum causing the initial inflammation. Long after the skin has healed, a slight enlargement is noticed in the area, and the horse may begin showing slight lameness. This doesn’t always happen; in fact, we hope it never does, but it is a possibility. Or, if a horse continually hits itself with the opposite hoof, a minor inflammation may start, and if not corrected, may develop into chronic inflammation leading to ringbone. Another example of trauma induced ringbone would be the cart or carriage horse that works on hard pavement, usually with a high-stepping stride causing increased concussion. Extended concussion will cause inflammation of the periosteum and bone leading to ringbone.

Crooked legged conformation, as viewed from the front, will cause an unequal distribution of stress and concussion to the lower leg bones and joints. The crooked legged horse will invariably have damage to the joints with inflammation and resultant boney changes.

The most common conformation that I see causing ringbone in the rope and barrel horse, is the horse with “up-right” and short pasterns, as viewed from the side. This horse is usually a quick starter with short strides, able to make fast turns with good acceleration away from a barrel. Frequently, however, this horse pounds the ground and because of the shorter stride, takes more steps to cover a given distance. The combination of increased concussion and increased number of strides can culminate in inflammation of the pastern’s periosteum and resultant ringbone.

Ringbone is usually diagnosed after taking a good history of the horse and its lameness, a hands-on physical exam, radiographs, and possibly nerve blocks. Recently, ultrasonography has been used to look at the boney structure, as well as MRI’s.

A word of caution. If radiographs were not taken, and the diagnosis was based solely on manual palpation, it is possible to jump to the conclusion of ringbone erroneously. Ringbone typically has a gradual onset, the lameness worsening with time. A suddenly appearing palpable swelling in the pastern area causing lameness is likely not to be ringbone, but rather an acute trauma induced bruising and swelling. A little hydro-therapy, bute, and some time is usually sufficient to create a cure.

Treatment of ringbone is dependent on the cause. It is difficult to surgically remove boney proliferation. It is equally difficult to change a crooked leg or an “up-right” pastern. In my opinion, the ringbone that occurs around the pastern joint signifies the horse has “acknowledged the problem” of pain within the joint and is attempting to bridge or fuse the joint, thereby ceasing the pain. It is possible for the horse to accomplish this if given enough time, frequently resulting in a less painful joint. Veterinary surgeons are able to surgically fuse the joint by destroying and removing the articular cartilage, or by “fixing” the joint with steel rods reaching from the long pastern, through the joint into the short pastern.

With a mild case of ringbone, it can often be helpful to shoe the horse with a rolled or rocker-toed shoe, keeping the toes short, and the feet well beneath the axis of the leg. “Natural-balance” shoeing can also be helpful. I personally avoid the use of wedge pads. I have not had much success treating articular ringbone with bute, however it does seem to provide temporary relief for some peri-articular cases of ringbone.

In my experience, the prognosis for ringbone is very dependent on the horse’s condition, the chosen treatment, and the expected degree of success. I think it is possible to manage ringbone so that we have a steed to hand-walk the grandchildren around the yard, but to have a high level performance horse has worse odds than winning the lottery.

Becky, I am concerned that your gelding is only six years-old. He has his whole future ahead of him, and beginning his journey with ringbone makes for a tough row to hoe. You may consider looking for another horse to invest your time and money in, on your road to high level competition.

Many thanks for your questions. I hope I have been of some help.

Let me know if I can be of any further assistance,

Dr. Dave