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Melissa from Alberta, Canada, writes:

Dear Dr. Dave,

I am writing to update on the last question. The gelding with the joint problems is a barrel horse. His feet were a mess two and a half years ago; they were not balanced, and the heels were strung out and the toes were long; he had strain on the suspensory tendons, causing a fluid fill in the joints. Coffin joint and fetlocks were injected with cortizone, lasting about three months; with the second injection, the effects lasted six months. To rectify the problem with the feet, we are using a size seven (started in a six) world race plate shoe, with a break over on it. This seems to keep him as sound as he can be. The knee was injected with cortizone, do to pain on a stress test and slight fluid filling. The last injection in the coffin joint (three years later) has only lasted five months. I got radiographs done in the left front, which seemed to be the biggest issue with him on stress tests, and there are bony changes in the short pastern, diagnosed "lower ringbone." The bony changes are not on the joint, but above on the front of the bone and are possibly causing problems with the soft tissue moving over these bony changes. This seems to fit the description of problems occurring throughout the season. We made the choice to inject again with cortizone and DMSO. His shortness of stride only occurs now in the turn (in a small circle on the lunge line) and the straights seems to be smooth. In terms of the X-rays: is there any new miracle treatment available for this condition? Can it be worked with, or is it career-ending? Again, I do not want to injure this horse further, but do understand the risks of the sport. He will pack my kids and if that is his future, I am not ready to give him up, but that is what I will do. Thank-you for your input, I appreciate it!

Dear Melissa,

I suspect that the improved hoof care had more to do with the improvement than did the cortizone injections, but be that as it may. You are definitely on the right track with the shoeing – bigger feet = better support. I like the world race plates with the breakover, however I am not a fan of aluminum shoes. I would much prefer to see him shod in steel shoes. Contrary to popular belief, steel absorbs way more concussion than does aluminum, and I believe gives much better support. Weight differences between the different types of shoes is not a concern for the short distances a barrel horse has to run.

The knee was injected with cortizone, do to pain on a stress test and slight fluid filling, although the last injection in the coffin joint (three years later) has only lasted about five months.

As you know, I am not a believer in indiscriminate joint injections unless justified, however, the fact that the beneficial effects are now only short-term might indicate advancing wear-n-tear in that joint. Any current radiographs of the knee?

I got radiographs done in the left front, which seemed to be the biggest issue with him on stress tests, and there are bony changes in the short pastern, diagnosed "lower ringbone." The bony changes are not on the joint, but above on the front of the bone and are possibly causing problems with the soft tissue moving over these bony changes.

Did you by any chance take any radiographs of the right front pastern to use for comparison? Sometimes this is helpful to rule out "normal" abnormalities. Nonarticular (not involving the joint) ringbone can cause the symptoms you describe, however I would typically expect him to be short striding on the straight away as well as the turns.

This seems to fit the description of problems occurring throughout the season. We made the choice to inject again with cortizone and DMSO.

I do not understand the rationale for injecting the joint when, as you describe, the bony changes are not within the joint. DMSO does seem to help as an anti-inflammatory superficially, and may be of benefit in this case.

His shortness of stride only occurs now in the turn (in a small circle on the lunge line) and the straights seems to be smooth. In terms of the X-rays: is there any new miracle treatment available for this condition?

Sorry, not to my knowledge, although some may suggest shock-wave therapy in that area.

Can it be worked with, or is it career-ending?

I believe that he will limit his own usefulness before you cause any additional significant damage. I encourage your continued good hoof care, and the occasional judicial use of phenylbutazone. You are way too sensitive to your horse's condition for me to worry that you are going to abuse your horse. Thank you for your concern and the passion for your horse. Thank you for your questions to Ask Dr. Dave. Let me know if I can answer any more questions.

Safe travels, fast times and slow clocks,

Dr. Dave