b'SPORTS MEDICINEprognosis for soundness. However, OA is a progressive disease with no cure, meaning treatment options will eventu-ally diminish.You go from one extreme to the other: You might have a little bit of spurring on the edge of one hock joint and you can treat them successfully with steroids and HA, Dryden says. Then you get five or six years down the road and the osteoarthritic changes have advanced, and youre much more limited as to what you can do.Caudal Heel PainWhile not necessarily related to sport itself, Bell says caudal heel pain (local-ized to the rear or back part of the horses hoof) is more common in Quarter Horses and stock breeds than in the general equine population.The challenge with this condition, Dryden adds, is the multitude of struc-tures that could be affected, including the: Navicular bone and/or bursa (collec-tively the navicular apparatus);Suspensory ligament near where it con-nects to the navicular bone; DDFT; Impar ligament; Extensor tendon; and Coffin joint (where the coffin bone, na-vicular bone, and short pastern meet).The horse will be described as having a shuffling gait, sore in the shoulders, shortened stride, tripping or stumbling, and may prefer to stand with one of the ABIGAIL BOATWRIGHTfeet ahead of the other or with the heel elevated, he says. The horse is visibly sore at a trot, most commonly.Caudal heel pain typically only affects the forelimbs, Dryden says, and com- Osteoarthritis of the hocks is a common issue in all Western performance disciplines.monly both at once.How its diagnosedIn addition to awhile adjusting to the new foot anglesfrom a class of bone drugs called lameness exam, veterinarians can useand trim, he adds. bisphosphonates.hoof testers, nerve blocks, and imagingIf that doesnt provide desired results,If those treatments arent effective, (radiographs, ultrasound, and MRI) toveterinarians might opt to inject the cof- surgeons can perform bursoscopy (plac-diagnose caudal heel pain, Bell says. fin joint and/or navicular bursa. ing a small arthroscope into the navicular Identifying all the structures involvedInjections can be with hyaluronicbursa) to assess and debride lesions and allows more targeted treatment andacid, corticosteroids, IRAP, platelet-rich adhesions.helps improve the chance of a successfulplasma therapy, or, in advanced diseaseFollowing treatment, Bell says, reha-outcome. including the coffin joint osteoarthritis,bilitate horses with traditional in-hand, How its treatedInitially, treatmentpolyacrylamide gel, Bell says. Shock ponied, and under-tack exercises as they involves corrective shoeing to shorten thewave therapy can also be effectiveslowly return to work, along with tread-toe, ease breakover, and support the heelsin modulating caudal heel pain andmill work and water exercise, if possible. to avoid their contraction, Bell says. inflammation for a period of time. Hyperbaric oxygen therapy can also help.Anti-inflammatories are used concur- He adds that horses with navicularIn horses where all surgical and rently with the shoeing to decrease in- bone cysts, bone loss, or bone edemamedical treatment options have failed, a flammation and allow for better comfort(fluid buildup) diagnoses can benefitpalmar digital neurectomy (cutting the 44August 2019The Horse | TheHorse.com'