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Ask Dr. Dave

Cari from North Carolina, writes:

Dear Dr. Dave,

I have a six year-old AQHA mare that snatched a front shoe off in the pasture. I'm guessing she caught it in a fence where she was boarded and mildly pulled a tendon per my veterinarian after performing a lameness exam, x-rays and so forth.

I was wondering what your thoughts were on blistering. Is that a viable option to get my horse recovered or are expensive shock wave treatments my only option? I have already spent a whole lot of money on this and shock wave treatments aren't in my budget.

I have had a few people tell me to do a five-day blister on her. Can you tell me the pros and cons of blistering and what would be used to blister? Currently, she has been off for 60 days and I have been sweating her leg and put her on a joint supplement. Are there any other suggestions you may have that I could try and how long is a horse typically out of service with this type of injury?

Thank you for the access to your knowledge!

Dear Cari,

Thank you so much for your question. You bring up some interesting topics for discussion.

Let's take it from the top, and we'll just work through the whole dilemma. When I shoe a horse I rasp my clinches thin enough that if my horse steps on a shoe, or gets one caught in a fence, it is easy for it to come off. I always want my shoes to leave the hoof without taking any hoof wall with it, and not put so much tension on the leg that it causes tendon damage. Your farrier should be commended for attaching the shoe to the hoof so securely, however as per your veterinarian, it may have helped cause your horse to "mildly pull a tendon."

Tendons are interesting structures. For them to function correctly they have to be very inelastic, they must have little to no stretch within them. Remember tendons attach muscle to bone. If the tendons were elastic the muscle would pull, the tendon would stretch, and the bone wouldn't move! Not an efficient method. To be so inelastic the tendon is comprised of dense connective like tissue with scant blood supply.

I have always envisioned a tendon much like a rope. When one end of the rope is attached to a big tree (the bone) and the other end to the trailer hitch on your truck's bumper (the muscle), and the truck is slowly driven away (the muscle is contracting), the rope (tendon) will only stretch momentarily before small strands of rope begin breaking. If you continue pulling you will overcome the strength of the rope, and it will break apart. This scenario encompasses the pulling or bowing of a tendon, from mild to severe.

It is important to know which tendon your horse" pulled" as that will determine how long it will take to heal. Because of the poor blood supply to the tendon, they can take a long time to heal. They will rarely return to their original size, however, many veterinary practitioners feel the repaired tendon can gain their original strength. I believe the jury is still out on that issue.

I assume the radiograpgic study your veterinarian performed revealed no boney involvement. That is good.

Shock wave therapy is a relatively new treatment modality, and some practitioners have reported good success for various injuries. I have had no personal experience with it, however I am always slow to jump on the band wagon with a new treatment regiment until I feel very confident of the outcome. I am presently not at that point.

Blistering is an archaic treatment that is not used much anymore. It is usually done by applying a "hot caustic" salve to the affected area which then causes localized swelling, inflammation and eventually skin sloughing. It is similar in action to "pin firing." It is theorized that blistering returns a chronic condition back into an acute one, hoping the body will recognize the problem and contend with it. It's effectiveness is questionable, its ethics are deplorable. You wouldn't wish it on your best friend, so why do it to your horse?

At this point in her convalescence, I see no benefit in sweating her leg. Initially yes, presently no. I have no quarrel with joint supplements, however if her condition is truly limited to her tendon I don't see the rationale in feeding it.

You have had your mare laid up for two months. I would not even consider starting her back until six months at the earliest. Realistically speaking, she gets this year off. If you bring her back too soon and the tendon is not completely healed, it would be easy to re-injure her and possibly lose her for any future athletic endeavor. I would strongly encourage you to have your veterinarian perform an ultrasound evaluation prior to you bringing her back.

It is my opinion that "time" is your best and most cost-effective treatment available. I encourage you to be patient and provide her the time off she needs. On the bright side of things... this is a prime time to start conditioning and hauling your young horse to some timed runs!

I hope you find this information useful in formulating a management plan for your nice mare. Once again thank you for your great question. Let us know how she does.

Good health for you and your horse,

Dr. Dave