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Mike W. Ross, DVM, Dipl ACVS
Professor of Surgery
Department of Clinical Studies
University of Pennsylvania School of Veterinary Medicine
New Bolton Center
Kennett Square, Pennsylvania, United States

Sue J. Dyson, MA, VetMB, PhD, DEO, FRCVS

Head of Clinical Orthopaedics
Centre for Equine Studies
Animal Health Trust
Newmarket
Suffolk, England
3251 Riverport Lane
St. Louis, Missouri 63043

DIAGNOSIS AND MANAGEMENT OF LAMENESS IN THE HORSE ISBN: 978-1-4160-6069-7

Copyright © 2011, 2003 by Saunders, an imprint of Elsevier Inc.

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Notices

Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge
in evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own
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With respect to any drug or pharmaceutical products identified, readers are advised to
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Library of Congress Cataloging-in-Publication Data

Diagnosis and management of lameness in the horse / [edited by] Mike W. Ross, Sue J. Dyson.
– 2nd ed.
    p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4160-6069-7 (hardcover : alk. paper) 1. Lameness in horses. I. Ross, Mike W.
II. Dyson, Sue J.
[DNLM: 1. Horse Diseases. 2. Lameness, Animal. 3. Horses–injuries. SF 959.L25]
SF959.L25R67 2011
636.1’089758–dc22
2010035776

Publishing Director: Linda Duncan

Acquisitions Editor: Penny Rudolph
Associate Developmental Editor: Lauren Harms
Publishing Services Manager: Catherine Jackson
Senior Project Manager: David Stein
Design Direction: Karen Pauls
Cover Art: Fabio Torre
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Printed in the United States www.elsevier.com | www.bookaid.org | www.sabre.org

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 Contributors

Rick M. Arthur, DVM Jeff A. Blea, DVM

Equine Medical Director President
School of Veterinary Medicine Southern California Equine Foundation
University of California, Davis Arcadia, California
Davis, California Partner
Von bluecher, Blea, Hunkin, Inc.
Greg Baldwin, BSc, BVSc Sierra Madre, California
Australian Equine Laminitis Research Unit
School of Veterinary Science Jane C. Boswell, MA, VetMB, Cert VA, Cert ES(Orth),
The University of Queensland DECVS, MRCVS
Queensland, Australia Partner
The Liphook Equine Hospital
Lance H. Bassage II, VMD, DACVS Liphook, Hampshire
Staff Surgeon United Kingdom
Rhinebeck Equine, LLP
Rhinebeck, New York Robert P. Boswell, DVM
Equine Sports Medicine and Diagnostic Imaging
Andrew P. Bathe, MA, VetMB, DEO, DECVS, MRCVS Wellington, Florida
Partner, Head of Equine Sports Injuries Clinic
Rossdale Diagnostic Centre Robert M. Bowker, VMD, PhD
Rossdale and Partners Professor
Newmarket, Suffolk, United Kingdom College of Veterinary Medicine
Michigan State University
Jill Beech, VMD, DACVIM East Lansing, Michigan
Georgia E. and Philip B. Hofmann Professor of Medicine and
Reproduction Julia Brooks, DO, MSc
Department of Clinical Studies Haywards Heath and Burgess Hill Osteopathic Practices
University of Pennsylvania West Sussex, United Kingdom
New Bolton Center
Kennett Square, Pennsylvania Herbert J. Burns, VMD
Pine Bush Equine
Scott D. Bennett, DVM Pine Bush, New York
Equine Services Clinic
Simpsonville, Kentucky John P. Caron, DVM
Professor, Equine Surgery
Philippe H. Benoit, DVM, MS Large Animal Clinical Sciences
Clinique Equine Michigan State University
Les Breviaires, France East Lansing, Michigan
William V. Bernard, DVM, DACVIM G. Kent Carter, DVM, DACVIM
Owner/Manager Professor
Lexington Equine Surgery College of Veterinary Medicine
Lexington, Kentucky Texas A & M University
College Station, Texas
Alicia L. Bertone, DVM, PhD, DACVS
Trueman Family Endowed Chair and Professor Eddy R.J. Cauvin, DVM, MVM, PhD, HDR,
Veterinary Clinical Sciences CertVetRad, DECVS
The Ohio State University Azurvet
Columbus, Ohio Hippodrome de la Côte d’Azur
Cagnes-Sur-Mer, France
Jerry B. Black, DVM
Director of Undergraduate Programs Mark W. Cheney, DVM
Equine Sciences Veterinary Practice
Colorado State University Lexington, Kentucky
Fort Collins, Colorado
Jennifer M. Cohen, VMD, DACVS
James T. Blackford, DVM, MS, DACVS Associate Veterinarian
Professor of Large Animal Surgery Manor Equine Hospital
Large Animal Clinical Sciences Monkton, Maryland
University of Tennessee
College of Veterinary Medicine Chris Colles, BVetMed, PhD, HonFWCF, MRCVS
Knoxville, Tennessee Director
Avonvale Veterinary Practice
Banbury, United Kingdom

v
vi Contributors

Simon N. Collins, PhD, BSc (Hons) José M. García-López, VMD, DACVS

Australian Equine Laminitis Research Unit (AELRU) Assistant Professor of Surgery
School of Veterinary Science Large Animal Surgery
The University of Queensland Department of Clinical Sciences
Gatton, Queensland Tufts University
Australia Cummings School of Veterinary Medicine
Orthopaedic Research Consultant North Grafton, Massachusetts
Centre for Equine Studies
Animal Health Trust Ronald L. Genovese, VMD
Newmarket, United Kingdom Cleveland Equine Clinic, LLC
Ravenna, Ohio
Robin M. Dabareiner, DVM, PhD, DACVS
Associate Professor of Lameness Howard E. Gill, DVM
Texas A & M University Pine Bush, New York
Large Animal Clinical Sciences
College Station, Texas Dallas O. Goble, DVM
Strawberry Plains, Tennessee
Robert Andrew Dalglish, BVM&S, MRCVS
Senior Veterinarian Nancy L. Goodman, DVM
Loveland, Colorado
Veterinary Department
Al Wathba Stables Barrie D. Grant, DVM
Abu Dhabi, United Arab Emirates San Luis Rey Equine Hospital
Bonsall, California
Elizabeth J. Davidson, DVM, DACVS
Assistant Professor of Sports Medicine Kevin K. Haussler, DVM, DC, PhD, DACVSMR
Department of Clinical Studies Assistant Professor
University of Pennsylvania Department of Clinical Sciences
Kennett Square, Pennsylvania Colorado State University
Fort Collins, Colorado
Jean-Marie Denoix, DVM, PhD, Agrégé
Professor Dan L. Hawkins, DVM, MS, DACVS
Director CIRALE–Ecole Vétérinaire d’Alfort Gainesville, Florida
Goustranville, France
W. Theodore Hill, VMD
Stephen P. Dey III, VMD Racing Steward
Dey Equine Veterinarians The Jockey Club
Allentown, New Jersey New York Racing Association
Jamaica, New York
Janet Douglas, MA, Vet MB, MSc, PhD, MRCVS
Special Lecturer in Equine Orthopaedics Jukka Houttu, DVM
School of Veterinary Medicine and Science Tempereen Hevosklinikka
University of Nottingham Tampere Equine Clinic
Sutton Bonington, Nottinghamshire, England Ravirata
Tampere, Finland
Matthew Durham, DVM
Associate Veterinarian Robert J. Hunt, DVM, MS, DACVS
Steinbeck Country Equine Clinic Surgeon
Salinas, California Davidson Surgery Center
Hagyard Equine Medical Institute
David R. Ellis, BvetMed, DEO, FRCVS
Lexington, Kentucky
Newmarket Equine Hospital
Newmarket Kjerstin M. Jacobs, DVM
Suffolk, United Kingdom Private Practice
Chicago, Illinois
Kristiina Ertola
Tempereen Hevosklinikka Joan S. Jorgensen, DVM, PhD, DACVIM
Tampere Equine Clinic Assistant Professor
Ravirata Department of Comparative Biosciences
Tampere, Finland University of Wisconsin
Madison, Wisconsin
Franco Ferrero, Med. Vet. Specialista in Patologia
Equina Chris E. Kawcak, DVM, PhD, DACVS
Pontirolo Nuovo, Italy Associate Professor
Equine Orthopaedic Research Center
Lisa Fortier, DVM, PhD
Department of Clinical Sciences
Associate Professor of Surgery
Colorado State University
Clinical Sciences
Fort Collins, Colorado
Cornell University
Ithaca, New York Kevin P. Keane, DVM
Member
David D. Frisbie, DVM, PhD, DACVS
Sports Medicine Associates of Chester County
Associate Professor
Kennett Square, Pennsylvania
Department of Clinical Sciences
Colorado State University
Equine Orthopaedic Research Center
Fort Collins, Colorado
 Contributors vii

Kevin G. Keegan, DVM, MS, DACVS Christopher (Kit) B. Miller

Professor and Director Miller & Associates
E. Paige Laurie Endowed Program in Equine Lameness North Salem, New York
Department of Veterinary Medicine and Surgery
University of Missouri Martha M. Misheff, DVM
College of Veterinary Medicine Associate Veterinarian
Columbia, Missouri Dubai Equine Hospital
Dubai, United Arab Emirates
John C. Kimmel, VMD
Tequesta, Florida James B. Mitchell, DVM
John R. Steele & Associates Inc.
Simon Knapp, BVetMed, MRCVS Vernon, New York
Straight Mile Farm
Billingbear John S. Mitchell, DVM
Wokingham Pompano Beach, Florida
Berkshire, United Kingdom
Richard D. Mitchell, DVM
Svend E. Kold, DrMedVet, CUEW, RFP, MRCVS President
RCVS Specialist in Equine Surgery (Orthopaedics) Fairfield Equine Associates, P.C.
Senior Consultant to B&W Equine Group Newtown, Connecticut
Willesley Equine Clinic
Tetbury, Gloucestershire, England Patrick J. Moloney, DVM
Stuart, Florida
John Maas, DVM, MS, DACVIM
Veterinarian/Specialist in Cooperative Extension William A. Moyer, DVM
Texas A & M University
Veterinary Medicine Extension
College of Veterinary Medicine
School of Veterinary Medicine
Large Animal Medicine & Surgery
University of California, Davis
College Station, Texas
Davis, California

Benson B. Martin Jr., VMD, DACVS Graham Munroe, BVSc, PhD, DECVS, CertEO, DESM,
Associate Professor of Sports Medicine FRCVS
Flanders Veterinary Services
Dept. of Clinical Studies
Greenlaw
University of Pennsylvania
Duns
New Bolton Center
Berwickshire, United Kingdom
Kennett Square, Pennsylvania

Scott R. McClure, DVM, PhD, DACVS Rachel C. Murray, MA, VetMB, MS, PhD, DACVS,
Associate Professor MRCVS
Senior Orthopaedic Advisor
Veterinary Clinical Sciences
Centre for Equine Studies
Iowa State University
Animal Health Trust
Ames, Iowa
Newmarket
William H. McCormick, VMD, FAAVA Suffolk, United Kingdom
President, CEO
Middleburg Equine Clinic, Inc. Alastair Nelson, MA VetMB CertVR CertESM MRCVS†
Rainbow Equine Clinic
Middleburg, Virginia
Rainbow Farm
Andrew M. McDiarmid, BVM&S, Cert ES(Orth), MRCVS Old Malton
Partner Malton
Clyde Vet Group Equine Hospital North Yorkshire, United Kingdom
Lanark, Scotland, United Kingdom
Frank A. Nickels, DVM, MS, DACVS
Sue M. McDonnell, PhD Professor
University of Pennsylvania School of Veterinary Medicine Large Animal Clinical Sciences
New Bolton Center College of Veterinary Medicine
Kennett Square, Pennsylvania Michigan State University
East Lansing, Michigan
C. Wayne McIlwraith, BVSc, PhD, DSc, Dr. med. vet.
(hc), DSc (hc) FRCVS, DACVS Paul M. Nolan, DVM
University Distinguished Professor Equine Sports Medicine
Barbara Cox Anthony University Chair in Orthopedics Boca Raton, Florida
Director of Orthopaedic Research Center
Colorado State University David M. Nunamaker, VMD
Jacques Jenny Professor Emeritus of Orthopedic Surgery
Fort Collins, Colorado
Department of Clinical Studies
P.J. McMahon, MVB, MRCVS University of Pennsylvania School of Veterinary Medicine
Kings Park New Bolton Center
Plaistow Kennett Square, Pennsylvania
Billingshurst
West Sussex, United Kingdom Timothy R. Ober, DVM
Associate Veterinarian
Rose M. McMurphy, DVM, DACVA, ACVECC John R. Steele & Associates
Professor Vernon, New York
Department of Clinical Sciences
Kansas State University
College of Veterinary Medicine
Manhattan, Kansas
†
Deceased.
viii Contributors

Thomas P.S. Oliver, DVM Virginia B. Reef, DVM, ACVIM (LAIM)

Equine Sports Medicine Mark Whittier & Lila Griswold Allam Professor of Medicine
Lahaska, Pennsylvania Chief Section of Sports Medicine and Imaging
Department of Clinical Studies
Gene Ovnicek, RMF New Bolton Center
President, Chief Technician University of Pennsylvania
Equine Digit Support System, Inc. Kennett Square, Pennsylvania
Penrose, Colorado
Patrick T. Reilly
Joe D. Pagan, PhD Chief of Farrier Service
President Applied Polymer Research Laboratory
Kentucky Equine Research, Inc. University of Pennsylvania School of Veterinary Medicine
Versailles, Kentucky New Bolton Center
Kennett Square, Pennsylvania
Eric J. Parente, DVM, DACVS
Associate Professor of Surgery Dean W. Richardson, DVM, DACVS
University of Pennsylvania Charles W. Raker Professor of Surgery
New Bolton Center University of Pennsylvania School of Veterinary Medicine
Kennett Square, Pennsylvania New Bolton Center
Kennett Square, Pennsylvania
Tim D.H. Parkin, BSc, BVSc, PhD, DECVPH
(Population Medicine), MRCVS Mark C. Rick, DVM
Boyd Orr Centre for Population and Ecosystem Health Alamo Pintado Equine Medical Center, Inc.
Institute of Comparative Medicine Los Olivos, California
Faculty of Veterinary Medicine
University of Glasgow Bradley S. Root, DVM
Glasgow, United Kingdom Albuquerque Equine Clinic
Albuquerque, New Mexico
Andrew H. Parks, VetMB, MRCVS, DACVS
Professor of Large Animal Surgery Alan J. Ruggles, DVM, DACVS
Department of Large Animal Medicine Partner, Staff Surgeon
College of Veterinary Medicine Department of Surgery
University of Georgia Rood and Riddle Equine Hospital
Athens, Georgia Lexington, Kentucky

Richard J. Piercy, MA, VetMB, MS, PhD, DACVIM, Allen M. Schoen, MS, DVM
MRCVS Allen M. Schoen, DVM & Associates, LLC
Senior Lecturer in Equine Medicine and Neurology Sherman, Connecticut
Veterinary Clinical Sciences Director/Founder
Royal Veterinary College Veterinary Institute for Therapeutic Alternatives (VITA)
London, United Kingdom Sherman, Connecticut

Robert C. Pilsworth, MA, VetMB, BSc, CertVR, MRCVS Michael C. Schramme, DVM, CertEO, DECVS, PhD
Associate Associate Professor, Equine Surgery
Newmarket Equine Hospital Department of Clinical Sciences
Newmarket North Carolina State University
Suffolk, United Kingdom Raleigh, North Carolina
Associate Lecturer
Equine Hospital Robert Sigafoos, CJF/Farrier Program/Planning
The Queen’s School of Veterinary Medicine Committee
Cambridge Kennett Square, Pennsylvania
Cambridgeshire, United Kingdom
Roger K.W. Smith, MA, VetMB, PhD, DEO, DECVS,
Christopher C. Pollitt, BVSc, PhD MRCVS
Honorary Professor of Equine Medicine Professor of Equine Orthopaedics
School of Veterinary Science Veterinary Clinical Sciences
The University of Queensland The Royal Veterinary College
Gatton Campus, Australia London, United Kingdom

Joanna Price, BSc, BVSc, PhD, MRCVS Van E. Snow, DVM†

School of Veterinary Science Santa Ynez, California
University of Bristol
Langford Sharon J. Spier, DVM, PhD, Dipl ACVIM
Professor
Bristol, United Kingdom
Department of Medicine and Epidemiology
Sarah M. Puchalski, DVM, DACVR School of Veterinary Medicine
Assistant Professor of Diagnostic Imaging University of California
Department of Surgical and Radiological Sciences Davis, California
University of California, Davis
Davis, California Vivian S. Stacy, CNMT
Widener Hospital
Norman W. Rantanen, DVM, MS, DACVR School of Veterinary Medicine
Fallbrook, California University of Pennsylvania
Kennett Square, Pennsylvania

†
Deceased.
 Contributors ix

James C. Sternberg, DVM Tim Watson, PhD, BSc, MCSP

Powell Animal Hospital Professor of Physiotherapy
Powell, Tennessee School of Health and Emergency Professions
University of Hertfordshire
Anthony Stirk Hertfordshire, United Kingdom
Stirk & Associates Ltd.
North Yorkshire, United Kingdom Renate Weller DMV, PhD, MRCVS, FHEA
Senior Lecturer in Veterinary Diagnostic Imaging
Amanda Sutton, MSc Vet Phys. Veterinary Clinical Sciences
Chartered Physiotherapist The Royal Veterinary College
Clinical Director Hatfield, Hertfordshire, United Kingdom
Suttons Animal Physiotherapy
Winchester R. Chris Whitton, BVSc, FACVSc, PhD
Hampshire, United Kingdom Associate Professor
Equine Centre
Alain P. Théon, DVM, MS, DACVR-RO University of Melbourne
Professor Werribee, Victoria, Australia
Department of Surgery and Radiology
Oncology Service Chief Jeffrey A. Williams, DVM
Veterinary Medical Teaching Hospital Rhinebeck Equine LLP
School of Veterinary Medicine Rhinebeck, New York
University of California, Davis
Davis, California Alan Wilson, BVSc, BVMS, PhD, MRCVS
Professor
Fabio Torre, DVM, DECVS, DAMS Structure and Motion Laboratory
Director Royal Veterinary College
Clinica Equina Bagnarola North Mymms, United Kingdom
Bagnarola, Bologna, Italy
Paul Wollenman, DVM
Stephanie J. Valberg, DVM, PhD, DACVIM Palm Beach Equine Clinic, LLC
Professor Wellington, Florida
Veterinary Population Medicine
University of Minnesota James Wood, BSc, BVetMed, MSc, MA, PhD,
College of Veterinary Medicine DipECVPH, DLSHTM
St. Paul, Minnesota Professor of Equine and Farm Animal Science
Department of Veterinary Medicine
Robert Joseph Van Pelt, BVSc, BSc, CertEP, MRCVS University of Cambridge
Partner Cambridge, United Kingdom
The Arundel Equine Hospital
Arundel
West Sussex, England

John P. Walmsley, MA, VetMB, Cert EO, DECVS,

HonFRCVS
The Liphook Equine Hospital
Forest Mere, Liphook
Hants, United Kingdom
 Foreword

My first employer, the late Gordon Carter, and a man of “management,” acknowledging that although we cannot
real wisdom, once said to me: “You won’t know the always expect a total cure with treatment, the horse
meaning of ‘experience’ as a clinician until you have been may be useful or may compete with careful management
in practice for 20 years, and then you will realise you don’t nonetheless.
have any.” At the time I had no idea what he was talking Isaac Newton once said “If I have seen a little further
about. I know now. than others, it is only because I have stood upon the shoul-
The longer one is in practice, the less dogmatic and ders of giants.” We are in a golden age of equine diagnostic
certain one often becomes. Horses accumulate, which just imaging, with ultrasonography, radiography, scintigraphy,
will not fit neatly into their diagnostic buckets. Prognoses, computed tomography, and MRI all in frequent clinical
which were once certain fact, become turned on their use, allowing us to define with greater clarity the damage
heads by the horse that defies the clinician’s worst predic- that produces the pain and therefore lameness in our
tions, and comes back from injury against all the odds. patients. So who were those giants to whom we collectively
Nerve blocks seem increasingly to eliminate pain from owe so much? Many were mentioned in the Foreword to
regions that were not their target, or do not abolish pain the first edition of this book, and some are omitted here
from areas that were. Radiography repeatedly shows no solely through lack of space rather than respect. Ron Geno-
abnormalities in bones when magnetic resonance imaging vese and Norman Rantanen set up the field of ultrasono-
(MRI) demonstrates gross and marked pathology. graphic examination in the horse for us all to enjoy. In
When meeting this plethora of square circles for the radiography, almost every useful paper in my formative
first time, the previously available textbooks just made one years seemed to have the name Tim O’Brien on it some-
feel even more hopeless. Nerve blocks were either not where. He, along with Bill Hornof and other colleagues at
needed at all for a diagnosis because a clinician of experi- the University of Davis, California, United States described
ence did not NEED to block a horse to know where the the oblique images of the third carpal bone, the flexed
problem was. When it WAS employed, diagnostic analgesia image of the distal aspect of the third metacarpal bone, and
eliminated pain in a totally predictable and specific way. the “skyline” flexor surface image of the navicular bone,
All was black and white, clear cut, and specific. This was so valuable and yet now taken for granted.
not the world of equine lameness that I was picking my A single issue of Veterinary Clinics of North America
way through as a novice clinician. Was I simply doing it devoted to Racetrack Practice published in 1990 advanced
wrong? Or was it perhaps that there are reasons why bio- our knowledge vastly in the field of lameness in this field
logical systems refuse to be pigeon-holed in the neat thanks to all of the authors, but from my own perspective,
manner we would like them to be pigeon-holed? especially from the work of Roy Pool and Greg Ferraro,
The first edition of Diagnosis and Management of Lame- masters of their craft. Roy Pool was able to highlight the
ness in the Horse was a revelation in that respect. Here were dramatic role that chronic, daily, repetitive microdamage
clinicians determined to use a scientific and methodical played in the development of many “spontaneous” frac-
approach to their horses, but at the same time describing tures. The days of the single misstep as the cause of the
all the many and varied ways that diagnostic tests could majority of fractures were becoming numbered, and even
mislead. Moreover, here were clinicians who were even the acute carpal “chip” was shown to be anything but acute
admitting to sometimes not making a diagnosis at all. in most horses, certainly in terms of aetiology. I was fortu-
The feeling of excitement one experienced in realising, nate in my early career to share a month “seeing practice”
as one read succeeding chapters, that other people were with Greg Ferraro, Tim O’Brien, and that pantheon of
groping slowly forward in the same dark tunnel, with the orthopaedics, Larry Bramlage, and that month altered the
same dim candles as one was oneself, was invigorating. way I worked for the remainder of my career. There cannot
Mike Ross and Sue Dyson redefined the equine lameness be three people of greater wisdom, clinical skill, and will-
textbook in a way that was truly new, breathtaking in its ingness to share that expertise with others on the planet.
breadth and depth of coverage, and for the first time As an equine orthopaedic surgeon also of great tact and
addressing the fact that horses who perform in the many humility (something of an oxymoron), Bramlage has also
different disciplines we serve have many different clinical been a wonderful ambassador to our profession. He, along
problems. Even horses with the same problems may be with Wayne McIlwraith, Dean Richardson, Ian Wright, and
managed differently. For the first time each of our speciali- David Nunamaker, have added greatly to our knowledge
ties was addressed in a clinically relevant manner, often by of lameness from a surgical perspective.
people at the height of their clinical powers. Although no Scintigraphy was perhaps the biggest diagnostic leap
substitute for experience itself, this massive accumulation forward for the racehorse, and has been useful in most
of wisdom was put into the public domain, available to other disciplines. This was only because of the dedication
novice and expert alike. The very title uses the word and willingness to share openly their knowledge with
xi
xii Foreword

others by its founding fathers, and their able technicians. and second and fourth metacarpal bones, or in areas of the
These include Gottlieb Ueltschi, Bob Twardock, Mike O’ third and radial carpal bones simply not visible radiologi-
Callaghan, and one of the editors of this book, Mike Ross, cally. Ray Hopes, my mentor, previous employer, and now
all giants indeed, to whom we should be grateful. good friend, who founded the racing division of the Ross-
In the field of MRI and diagnostic analgesia, the other dale practice in Newmarket, England could not have recog-
editor of this book has made an enormous contribution. nised these injuries. Did he diagnose the condition of
The name Sue Dyson has become a by-word for elegant, horses with the blocking history we have outlined? Yes he
meticulous, probing studies by her and her team at the did. Did he treat these horses and successfully manage their
Animal Health Trust, Newmarket, England, carried out return to training and competition? Very much so. He
with great scientific integrity, documented in detail and could not have known the true nature of the lesions.
published for all to share. She has made a unique and No-one in that era could have done so, but he accumulated
lasting contribution to studies of equine lameness, and the enough wisdom and experience to know what one had to
interlocking problems of the atypical consequences of the do, in terms of rest, therapy, and rehabilitation, to get
use of diagnostic analgesia, without in any way diminish- those horses back to work, a legacy we still employ to the
ing their importance as the foundation stone of lameness same end point today, possibly for different reasons and
work—in fact, just the reverse. In MRI studies she joins with more knowledge now of why it works.
other giants such as Russ Tucker and Rachel Murray who This second edition is not simply a reprint with
have opened up and explained this fascinating technique minor changes to some sections. Every single chapter has
to the equine practitioner, and whose insights into the been updated, some such as “The Tarsus” and “Navicular
structural damage that leads to pain and consequently Disease” virtually rewritten; such is the avalanche of new
lameness have added so much to the various sections of knowledge that has come our way in the intervening 8
this new edition. years. Almost all of the figures have been replaced with
We must not forget the value of thorough clinical better quality digital images that significantly enhance the
examination. The previous generation of lameness clini- text. In addition some subjects not previously covered have
cians had no recourse to the advanced imaging modalities now been included. Alan Wilson and Renate Weller con-
listed above, but they nevertheless diagnosed and treated tribute a new Chapter, “The Biomechanics of the Equine
horses, many of which returned to a useful life. We can Limb and Its Effect on Lameness.” Whilst it may sometimes
argue that their presumptive diagnoses may have been seem to us that all horses are lame, the majority of course
incorrect in the light of what we know now, but they are not. Careful study of biomechanics, particularly in the
accumulated experience of which factors worked in restor- context of conformation and shoeing, may help us under-
ing a horse with a specific set of clinical signs to soundness. stand why one horse goes lame when its cohort group
Lameness practice, as pointed out in the first edition, is remains sound under the same exercise regimen.
both an art and a science. The science is often dogma, a There are certain seminal textbooks that become so
“best fit” for the current facts, but the art is a more continu- widely known, used, and respected in their field that the
ous and constant tradition that many of the contributors title of the book becomes subsumed by the name of the
to this second edition uphold and in turn pass on. An author in the public mind, as succeeding editions are
example of this would be pain which is abolished by both updated and published. Sisson (anatomy), Lehninger (bio-
proximal palmar metacarpal (subcarpal) nerve blocks and chemistry), and Roitt (immunology) are books of this type.
later also by intraarticular analgesia of the middle carpal With this second edition, “Ross and Dyson” is about to
joint in a Thoroughbred racehorse. Many of these horses join that list. It has become THE textbook on equine lame-
have slight thickening, possibly mild tenderness to palpa- ness. Clinicians certainly do not write textbooks with
tion of the proximal suspensory ligament, and increased financial rewards in mind, or if they do, they have been
severity of lameness after carpal flexion, but no clinically wickedly deceived by their publishers! One has to hope
significant lesion on ultrasonographic examination or radi- that the knowledge that entire generations of equine prac-
ography. For my generation, MRI is an available option, titioners will be enthralled, educated, and engaged by this
and in these circumstances one often finds a combination masterly work will serve as just reward.
of injuries to the most proximal part of the suspensory
ligament or its bone origin, the origin of the accessory liga- Rob Pilsworth
ment of the deep digital flexor tendon, the palmar carpal Newmarket, England
ligament, the interosseous ligaments between the third January 2010
 Second Foreword

The production of veterinary texts addressing lameness in privileges of my veterinary career to have been a student
the horse has been very enlightening and, needless to say, of Adams, a part of his notes in 1957, and then a very close
a valuable tool to the equine practitioner. It is remarkable friend. Until Adams’ first edition of Lameness in Horses was
that the majority of the veterinary texts have been formu- published, his notes were invaluable to me. The historical
lated within the past 50 years. Naturally, this incentive to perspective by Dr. Mike Ross echoes my thoughts regarding
produce texts has come from the resurgence of the number the assessment of the texts and information relevant to
of horses in the United States. In the late 1920s, the number the study of the lame horse, including his reference
of horses in the United States was reported to be approxi- to those that have influenced the molding of modern
mately 27 million. Dollar’s Veterinary Surgery was a text of lameness detectives. An insight into the history of the
note during this period, first being published in 1912; the printed material directed toward the diagnostic and thera-
second edition appeared in 1920, the third in 1937, and peutic management of the lame horse allows a better
the fourth in 1950. In the Preface to the Fourth Edition, JJ insight into the appreciation of the modern printed texts
O’Connor, MRCVS, who edited the third and fourth edi- relevant to this subject. Specifically the editors, in the first
tions, made note of the nine additions of new material it edition, presented the contents throughout the text in a
contained. The last of the additions was “the examination very logical manner, providing excellent approaches to the
of horses as to soundness” (approximately 200 pages). This resolution of the lame horse’s problems. The contents
time period is significant because the number of horses in reflect the objective thinking of both editors and their
the United States had dramatically dropped to approxi- contributors. The first nine chapters are vital to the lame-
mately 750,000 by 1957. This precipitous drop in the ness examination; the CD-ROM component enhances
number of horses prompted a general prediction that if the this segment in an extremely useful manner. When those
practice of equine veterinary medicine was not going to principles are applied, then the logical application of the
completely disappear, it would be a very limited part of material in Chapters 10, 11, 12, 13, and 14 will follow as
veterinary medicine. Consequently, research into equine necessary.
issues of note was very limited, if at all, and publications Paramount to lameness management is the identifica-
of scientific articles relevant to horses were also very tion of the pain site causing the lameness. When that has
limited. Basically no texts were produced after Dollar’s been accomplished, the direction to be taken to resolve the
fourth edition until the early 1960s; however, in the 1950s issue will be set. Certainly the material provided in Section
a small number of devoted veterinarians, both practitio- 2 of Part I will be utilized as the next step in arriving at the
ners and college professors, were diligent in pursuing the specific site of the infirmity; however, when the factors
cause for the diagnosis and treatment of the lame horse. described in Section 1 of Part I are carefully followed, reso-
At the same time, there was a reversal in the decline of the lution of the problem may not require the employment of
number of horses in the United States. This stimulated diagnostic imaging. The approach outlined by Section 1
more interest in equine veterinary medicine and spawned Part I serves as a reminder that the modern “lameness
the resurgence of written material relevant to the lame detectives” are provided with the faculties of observation,
horse. A reference point to this increase is the fact that the palpation, and a brain. When used properly, these will
number of horses was reported to be 9.2 million (American facilitate a diagnosis without the necessity of further diag-
Horse Council’s DeLoitte Report, June 5, 2005). Concur- nostic modalities; however, when necessary, diagnostic
rently, the American Association of Equine Practitioners imaging is vital to the identification of the pain-producing
(AAEP) was born; this association has served since its incep- lesions. Certainly the advancements in the diagnostic
tion as a medium to accumulate and disseminate informa- imaging modalities have enhanced our ability to arrive at
tion relevant to the lame horse. It was through the AAEP a more precise diagnosis with the obvious benefit of arriv-
that I became familiar with the contribution by Dr. Mike ing at a more complete treatment and prognosis. The
Ross and Dr. Sue Dyson. second edition contains the revelation of more diagnostic
In the first edition of Diagnosis and Management of detail than was available in the first edition.
Lameness in the Horse, in 2003, “Part I: Diagnosis of Lame- The editors have clearly provided a logical progression
ness,” “Section 1: The Lameness Examination,” “Chapter by structuring the contents of the text with the foot (Part
1, Lameness Examination: Historical Perspective,” Dr. Mike II) following the general remarks regarding the diagnosis
Ross states “in the mid to late 1900s Adams had the most of lameness (Part I). Incorporation of recent discoveries of
profound influence by his teachings and writings.” He Robert Bowker, Christopher Pollitt, the editors, and others
further references O.R. Adams’ 1957 “Veterinary Notes on involved in studies of the foot will be useful information.
Lameness and Shoeing of Horses” becoming the classic The assessment of the information and input by the editors
textbook, Lameness in Horses. As a graduate of Colorado with their clinical experience should prove to make the
State University in 1957, I consider it to be one of the understanding of the foot even more applicable to
xiii
xiv Second Foreword

management of the information encountered in arguably athletic endeavors of horses, but also those differences
the most common site of lameness in the horse. encountered throughout varying geographic locations.
The flow of the text continues in a manner in which There is a difference in the degree of lameness from navicu-
the diagnostician should proceed to arrive at an informed lar disease and other soft tissue causes of palmar foot pain
solution to the lameness problem. The incorporation of the at 1609 meters compared with those at sea level.
axial skeleton (Part V) in the first edition continues to The CD-ROM component of the first edition has
remind the equine practitioner that its evaluation is very evolved into the website feature of the second edition. The
much a part of the assessment of the lame horse. Certainly 47 narrated videos of equine lameness provide not only
in my career the axial skeleton has gone from being of very insight into evaluating the more common types of lame-
little consideration to its importance today. The inclusion ness, but also provides examples of unusual cases that
of recent approaches to the diagnosis of axial skeleton escape accurate description by the written word.
issues is going to be another welcomed event. I am confident that this second edition of Diagnosis and
The contributions to lameness other than those involv- Management of Lameness in the Horse will be a major addi-
ing the skeleton and articulations as outlined in Parts VI, tion to the libraries of equine practitioners around the
VII, and VIII of the first edition are updated as well. Cer- world. As a recipient of the contents of the texts that have
tainly, there have been several new therapeutic modalities been produced over the past years, I am extremely grateful
available for the management of lameness since the first and appreciative of the time and effort the editors, Mike
edition. Again, the experience of the contributors and the W. Ross and Sue J. Dyson, and the contributors have put
editors will provide welcome information. Since publica- into this text. Not only does this information and the
tion of the first edition, the value of complementary therapy information provided by other similar literature aid the
in equine practice continues to evolve, to demonstrate practitioner, but it has materially improved the health and
where it fits in Western medicine and the management of welfare of the horses we care for.
the lame horse.
Part V, “Lameness in the Sport Horse” in the first edition Marvin Beeman
provided valuable information into not only the differ- Littleton, Colorado, United States
ences between the types of lameness encountered in various January 2010
 Preface

The second edition of Diagnosis and Management of Lame- reflects as far as possible state-of-the-art information, there
ness in the Horse has been substantially revised. The knowl- are inevitably a few minor omissions.
edge that has been accrued through the clinical application A major criticism of the first edition of the book
of magnetic resonance imaging (MRI) and, to a lesser was the quality of the binding. We were delighted to
extent, computed tomography has revolutionized our learn that the book was being used to such an extent
understanding of many conditions, most especially those that the bindings failed. We suspect that the second
of foot pain. This is reflected by the greatly expanded edition, being bigger, unfortunately may also suffer in the
section on the foot. In each chapter we have tried to reflect same way.
both our own advances in knowledge and those of our We continue to learn by looking and seeing and encour-
authors, as well as what has been published in the litera- age readers to watch the videos on the companion web site
ture. Relevant new references are cited. We have intro- and listen to the commentaries, which we believe provide
duced many new images, most acquired digitally and a fundamental background to the art of assessing a lame
therefore of superior quality, but space constraints restrict horse. We continue to hold the philosophy that a compre-
what can be included. Some original illustrations reflecting hensive clinical examination, combined with a logical
unique conditions have been preserved. approach to investigation, usually results in an accurate
Some chapters have been written by different authors. diagnosis, while acknowledging that a minority of horses
This did not necessarily reflect that we were unhappy with elude diagnosis. There is a danger that with advances in
the original authors, but rather that we wanted a different imaging technology there is a temptation to utilize these
approach in some instances. We have again added editorial tools excessively. We must remember that in many horses
comments to some chapters when our personal experi- a correct diagnosis can be achieved by accurate palpation,
ences differed greatly from those of an author. observation, and use of diagnostic analgesia, combined
As we work daily with lame horses our own knowledge with radiography and ultrasonography.
and experience continue to grow. It is also inevitable that
between submission of the material for the second edition Sue J. Dyson and Mike W. Ross
to the publishers and the book’s publication, new literature Suffolk, United Kingdom and Pennsylvania,
has been published. Therefore although this new edition United States, December 2009

Although our views are similar in determining the end

PREFACE—COMPANION WEB SITE result of our examination during movement, we differ in
our visual appraisal of the lame horse; for instance, Sue sees
more vividly the downward movement of the pelvis when
WWW.ROSSANDDYSON.COM a horse with hindlimb pain causing lameness is in motion,
When approached with the idea of developing the first whereas Mike sees the upward movement during a differ-
edition of Diagnosis and Management of Lameness in the ent portion of the stride. These differences and the differ-
Horse we immediately determined that having video seg- ent venues at which we complete our lameness examination
ments to accompany the text was a necessity, a way of are thoroughly explained in the narration.
providing moving figures to teach the fundamentals of the Examples are given of horses with unilateral and bilat-
lameness examination during movement. At that time eral forelimb lameness, some with pain originating from
there were few textbooks with accompanying digital media common locations such as the foot or lower forelimb,
and it was necessary to convert to digital format existing while in others we contrast movement of these horses with
analog video footage. We then added newly acquired those with pain emanating from the upper forelimb. Uni-
digital video segments to create the 47 individual files used lateral and bilateral hindlimb lameness is demonstrated
in the CD-ROM that accompanied the first edition. It was and the concept of hindlimb lameness causing a head and
not our intent to capture on video each and every nuance neck nod—a situation during which a lameness diagnosti-
of the lame horse. We did, however, feel strongly in pre- cian can confuse hindlimb with forelimb pain—is demon-
senting the fundamentals of the lameness examination strated in several video clips. The effect and use of circling
and the gaits and movement of the normal horse, and to a horse during lameness examination, a useful maneuver
contrast movement with the horses that have pain causing used to exacerbate lameness, is shown in horses with fore-
lameness, neurological abnormalities, mechanical deficits, limb and hindlimb pain causing lameness. Concurrent
and in brief esoteric gait disturbances. The art of the lame- forelimb and hindlimb lameness, the effect of a rider, and
ness examination during movement was captured. gait restriction as a result of thoracolumbar and sacroiliac
xv
xvi Preface

region pain are demonstrated. Four horses with neurologi- Hindlimb Lameness with an Associated Head and Neck Nod
cal gait abnormalities ranging from obvious to subtle, six 16. Severe right hindlimb lameness from pain associ-
horses with classic mechanical gait deficits causing lame- ated with fracture of the central tarsal bone
ness, and, finally, esoteric causes of gait abnormalities are 17. Severe left hindlimb lameness
shown. 18. Right hindlimb lameness as a result of severe osteo-
Listed below is the table of contents of the narrated arthritis of the medial femorotibial joint
video segments included in the web site accompanying the 19. Severe left hindlimb lameness
second edition of Ross and Dyson’s Diagnosis and Manage-
ment of Lameness in the Horse. Using technological advances
Bilateral Hindlimb Lameness
20. Bilateral hindlimb lameness and plaiting while
developed in the 8 years since the first edition was pub-
trotting
lished we have changed the appearance of the media and
21. Bilateral hindlimb lameness exhibited as a reluc-
improved its efficiency and utility. We have chosen to
tance to work
retain the original video segments and narration, feeling
strongly that we have captured the essence of the lameness Effect of Circling on Hindlimb Lameness
examination during movement and demonstrated the 22. Right hindlimb lameness and toe drag
numerous principles of the lame horse. We debated end- 23. Toe dragging while circling
lessly whether to expand and include many more exam- 24. Right hindlimb lameness worse going to the right
ples, to discuss flexion tests, to describe responses to local
Concurrent Forelimb and Hindlimb Lameness
analgesic techniques and all the associated nuances, and
25. Left forelimb and left hindlimb lameness
to describe the many different clinical manifestations of
26. Left forelimb and left hindlimb lameness in a Stan-
pain arising from specific areas. Ultimately we decided not
dardbred racehorse
to, but we encourage readers to think about their own
27. Left hindlimb and right forelimb lameness causing
experiences and to share these with others.
a “rocking-type” gait
The video segments, moving figures, have been num-
28. Left hindlimb and right forelimb lameness in a
bered from 1 to 47, and in the right margin of the text,
trotter before and after low plantar diagnostic
when appropriate, we have printed an icon referring analgesia
29. Bilateral hindlimb and mild forelimb lameness in
the reader to one or more of the video segments included
a Thoroughbred racehorse with mal- or nonadap-
in the accompanying web site we feel will be helpful to
tive subchondral bone remodeling
visually evaluate a horse during movement.
Other Aspects of Hindlimb Lameness
30. Hindlimb lameness while ridden
TABLE OF CONTENTS OF COMPANION WEBSITE 31. Gait restriction from thoracolumbar pain
32. Gait restriction from sacroiliac region pain
Normal Gait
1. Gait of a normal horse when evaluated in-hand Neurological Gait Deficits
and while lunged 33. Gait deficit in a horse with a cervical spinal cord
2. Gait of a normal horse while ridden lesion
34. Hindlimb ataxia and right shoulder instability
Unilateral Forelimb Lameness 35. Hindlimb weakness
3. Left forelimb lameness
36. Gait deficit in a horse with cervical stenotic
4. Right forelimb lameness
myelopathy
5. Unilateral forelimb lameness resulting from upper
limb pain Mechanical Gait Deficits
6. Unilateral forelimb lameness resulting from upper 37. Fibrotic myopathy
limb pain 38. Stringhalt
39. Shivers
Bilateral Forelimb Lameness 40. Upward fixation of the patella
7. Bilateral forelimb lameness worse in the right
41. Fibularis (peroneus) tertius injury in a mature
forelimb
horse
Effect of Circling on Forelimb Lameness 42. Fibularis tertius avulsion injury in a foal
8. Right forelimb lameness
Esoteric Gait Abnormalities
9. Bilateral forelimb lameness
43. Right hindlimb gait abnormality
10. Characteristics of carpal region pain
44. Running type of hindlimb gait
Hindlimb Lameness without a Head and Neck Nod 45. Aortoiliac thrombosis
11. Left hindlimb lameness in a horse with stifle pain 46. Left hindlimb lameness and gait deficit in a horse
12. Left hindlimb lameness in a horse with bilateral with gastrocnemius origin injury
suspensory desmitis 47. Idiopathic shortening of the cranial phase of the
13. Right hindlimb lameness in a horse with peritarsal stride in a right hindlimb
soft-tissue injury
14. Right hindlimb lameness Mike W. Ross
15. Left hindlimb lameness, effect of the pace and trot Sue J. Dyson
during lameness examination December 18, 2009
 Acknowledgments

Just as when we wrote the first edition of Diagnosis and of artwork we admire, and who has produced a number of
Management of Lameness in the Horse, we owe tremendous new drawings for this edition.
gratitude to our co-authors, many of whom have updated Both of us have learned the art and science of the lame
their original chapters, updated and changed figures, and horse by dedicated and experienced lameness diagnosti-
continued to provide us with their unique lameness experi- cians who preceded us and then taught us through their
ences. In most instances we have returned to the original own experiences and in their own unique way. Sue con-
authors for this second edition, but found it necessary to tinues to acknowledge the timeless support of Bill Moyer,
change authors and to proceed in a new direction with Charlie Reid, Ron Genovese, and Midge Leitch. Sue also
some of the chapters. We give wholehearted thanks to acknowledges the knowledge about riding, feeling, and
previous authors not included in this edition and welcome horse management taught by David Arthur and Sheila
our new contributors. Writing textbook chapters is often a Willcox. Mike believes strongly his career path was hugely
thankless job, with little remuneration, and we appreciate influenced and supported by many high-quality lameness
the efforts of all who have contributed. In many ways the detectives, but singles out Jack Lowe, Loren Evans, and
project to complete the second edition was an easier task Gene Gill as particularly influential in practice, and in life.
than our previous mission, because the skeleton of the While working on the first edition and now in the years
textbook, including the major subsections of the written subsequent to its publication we have had a special oppor-
text, remained largely the same. We are grateful to all who tunity to learn from each other, often sharing our own
inspired the development of the first edition and remain unique experiences and perspectives, questioning each
indebted to their initial and continued support. other, keeping each other “on their toes,” occasionally
We are honored by the continued support of our friend, with timely and critical questions, and sometimes with
colleague, and co-author, Fabio Torre, who once again has answers. We have often shared a podium with each other,
provided us with inspirational cover art. Fabio’s original listening to and learning first hand from each other’s work.
paintings for the first edition hang with pride in each of Sue has made an indelible contribution to Mike’s profes-
our homes, reminding us daily of Fabio’s unique contribu- sional life, and has become a much loved, close friend.
tion to the success of this book. The artwork on the cover We both greatly appreciate the love and support given
of the second edition continues a theme dedicated to the us by our families. The time commitment necessary to
movement of the horse, in the form of images of racing complete this project and the countless hours we have
Thoroughbred and Standardbred horses in motion. Move- both invested in refining our skills and interest in the lame
ment is an integral part of the lameness examination and horse invariably took time away from our loved ones. John
is captured in still form in Fabio’s artwork. and Beth, our partners, we thank you for your love and
We have both continued to be blessed to work with willingness to provide us time to complete this edition, and
true professionals, our co-workers, at the Animal Health for your countless suggestions and enthusiasm. Mike gives
Trust and New Bolton Center, University of Pennsylvania special thanks to Stone, Kennedy, and Allie for their
and are thankful for their continued help and support as unwavering love, and his parents. Neither one of us will
we revised this textbook and continue our interest and ever forget the horse.
work in the area of equine lameness. The constant support
and professionalism of the staff at Elsevier Health Science, Sue J. Dyson
including Lauren Harms and Penny Rudolph, was felt Mike W. Ross
throughout. We also thank Alex Baker whose high standard December 17, 2009

xvii
 PART I

Diagnosis of Lameness

SECTION 1
The Lameness Examination
lameness examination, yet most difficult to teach. Great

Chapter 1 lameness diagnosticians likely possess this ability to read

or feel the horse and skilled, workmanship-like qualities
to appreciate the art in lameness diagnosis. Some, with

Lameness Examination: the added ability to share this knowledge effectively,

have influenced clinicians more than others simply by

Historical Perspective
writing about those experiences. In the early twenty-first
century, Ross and Dyson’s Diagnosis and Management of
Lameness in the Horse chronicled the exhaustive clinical
Mike W. Ross experience of over 100 authors worldwide to capture
the essence of the subject at that time.3 Moving figures
captured as video segments on an accompanying CD
and individual chapters detailing lameness distribution
If your horse is lame in his shoulder, take off his shoes.…
among different sporting activities complemented basic
Young and inexperienced practitioners are quite too apt to
and advanced material.3 The book quickly became a staple
commit the error of overlooking the examination of the foot,
of every lameness diagnostician’s library. In the mid-to-
looking upon it as a matter of secondary importance, and
late 1900s, Adams had the most profound influence
attending to it as a routine and formal affair only.
with his teachings and writings. His former students and
References A. Liautard, 18881
on page friends acknowledge his artistic talent, gained primarily
1255
As the twenty-first century continues, the extent of change from a ground-up approach to the lame horse, and his
in the diagnosis of lameness in the horse depends on the profound interest in corrective shoeing. More important,
individual’s clinical and ideological perspective. A veritable Adams’ original lameness notes became his classic text-
explosion of new imaging methods such as digital radiog- book.4 For most clinicians, Lameness in Horses represented
raphy, computed tomography, and magnetic resonance the “lameness Bible,” an excellent resource of information
imaging has advanced the current understanding of many on equine lameness. Adams himself revised the textbook
musculoskeletal abnormalities. Yet to accurately assess several times; most recently, his respected colleague,
clinical relevance, the clinician must possess a feel for the Ted S. Stashak, has continued in Adams’ footsteps. This
horse, developed only by careful clinical examination, a important work served as the foundation for learning the
procedure that has changed little in hundreds of years. fundamentals of equine lameness for many during this
Successful detection of equine lameness does not so much period.
require knowledge of science as it does art. Inasmuch as art Adams was influenced greatly by the work of Dollar
is defined as “skilled workmanship, craft, or studied and Lacroix. Adams’ original notes contain many drawings
action,”2 the lameness examination demands artistic expe- similar to those originally published in Dollar’s A Hand-
rience acquired by years of clinical practice and working book of Horseshoeing,5 a wonderful collection of drawings
and learning from experienced practitioners. From Liau- and excellent descriptions of shoeing, conformation, and
tard’s advice more than 100 years ago to that of modern lameness of the equine foot. Adams references the work
lameness diagnosticians, the change in the basic skills of of Lacroix6 in the late 1800s. In fact, until Adams’ treatise
lameness diagnosis may be small. on lameness, scant information about equine lameness
Development of the artistic skills needed to become a existed. The information available in the American litera-
true lameness diagnostician requires a thorough, some- ture during most of the 1900s consisted of only sporadic
what methodical approach, much like that of a crime scene case reports or case series in the Journal of the American
detective. I often refer to the lameness diagnostician as a Veterinary Medical Association. A potential explanation may
lameness detective, and although this statement may lack lie in the importance of the World Wars or other impor-
sophistication, in reality, how boring would the task be if tant social events in the early-to-mid 1900s. Experience in
the horse could talk? To make a horse talk to you through the cavalry also may have influenced later writings in the
careful palpation and observation is the essence of the 1900s.
1
2 PART I Diagnosis of Lameness

Peters’7 work detailing lameness in the Thoroughbred diagnosticians remain integral parts of a successful lame-
racehorse emphasized the importance of lameness in the ness management team today. In fact, “the term veterinar-
racetrack practice and the most common cause of poor ian came into use when colleges were established in
performance. Many problems he observed in 1939 still different parts of Europe for improving, or rather for creat-
exist, although treatment options have expanded consider- ing the art of treating disease in the lower animals.”17 The
ably. Early important writings included manuscripts by first veterinary school was founded in France in 1761, and
Churchill8 and Wheat and Rhode9 on surgical removal of soon veterinary schools were formed in the United
proximal sesamoid bone fractures (the Churchill approach), Kingdom.18
Forsell10 on surgical management of navicular bursitis and Although an exhaustive historical review might be
tendonitis, and Lundvall11 and later Delahanty12 debating interesting, this brief review highlights critical issues
the subject of the existence or nonexistence of fibular frac- central to modern lameness diagnosis. First, the basics have
tures. An early reference of note was the surgical textbook not changed for hundreds of years and will likely not
by Frank.13 Originally written in 1939, with several subse- change in the foreseeable future. Second, with the excep-
quent editions, this influential and often quoted textbook tion of Adams’ work, and more recently that of Ross and
contained information about numerous musculoskeletal Dyson, few comprehensive reports on lameness diagnosis
problems and often sensational examples of common and were written before the twenty-first century. The modern
rare abnormalities. lameness detective likely has learned most from experience
In the late 1800s, several informative, interesting, and working with accomplished lameness diagnosticians and
entertaining textbooks about equine lameness were by word of mouth. Third, many of our most knowledgeable
written, primarily by European authors. Most publications colleagues have not published writings but have made
contained wonderful descriptions of lame horses, and their contributions in day-to-day teachings in academic
many emphasized shoeing techniques, a mainstay in settings, private practice, and small gatherings at national
management of the lame horse both then and now. The meetings.
writings of Percivall14 and Gamgee15 are particularly infor- Since 1955 the annual convention of the American
mative. Although a definitive reason was not provided, Association of Equine Practitioners has played a special role
Gamgee observed that 42% of horses in the United in the dissemination of information and ideas about lame-
Kingdom were lame, whereas only 9% of horses in Paris ness. Early meetings included a handful of practitioners,
were lame. Disorders of the foot, many of which increased gathering and discussing equine medicine and surgery,
in frequency with age, were most common, and marked sometimes late into the night. Much current lameness
remodeling of the distal phalanx was seen in horses experience can be traced to these early meetings and
undergoing postmortem examination.15 In addition to practitioners such as Adams, Peters, Frank, Farquharson,
the time-honored management technique of shoeing the Churchill, Goddall, Gabel, and Delahanty. Loren Evans
lame horse, conformation and its relationship to lameness and Howard “Gene” Gill influenced the molding of many
also were emphasized. In How to Judge a Horse, Bach16 modern lameness detectives, including me. Emphasizing
emphasized balance, body part length and angulation, the value of acquiring horse sense and spending time pal-
and distal extremity conformational faults. In modern day pating and “learning” the horse, Gill often quotes Will
lameness examinations, conformation and its role in the Rogers, “… the outside of a horse is good for the inside of
development of lameness are often given cursory empha- a man.”
sis but remain an important part in the art of the exami- In the United Kingdom the British Equine Veterinary
nations. In a chapter entitled “Horse-Docturing [sic] in the Association was established in 1961, providing a similar
Nineteenth Century,” Dunlop and Williams17 emphasized formula for dissemination of information through its
the contribution of Mayhew, described as artist, activist, annual congress and regular day meetings. The establish-
and veterinary surgeon. Mayhew described and illustrated ment of the Equine Veterinary Journal in 1968 provided
many common abnormalities of the locomotor system a high-quality, refereed journal. The standard for the
recognized at that time, including splints, spavin, curb, journal was set by the first editor, John Hickman, an astute
tendon sprains, and thoroughpin, most of which are still observer of lame horses and an influence on many
recognized today.17 Of interest, Mayhew was credited for practitioners.
trying “experimental” injections into inflamed areas, an No substitute exists for careful clinical examination and
obviously important treatment modality practiced today.17 observation, experience gained over many years of treating
Detailed descriptions of laminitis, navicular disease, and and developing a feel for the lame horse. The second
other common conditions of the equine foot were pro- edition of this textbook on lameness is once again a col-
vided.17 Dunlop and Williams,17 in their treatise on the lection of the best and most knowledgeable lameness
history of veterinary medicine, also detailed the transition diagnosticians worldwide. Some are “household lameness
from farriery to veterinary medicine that occurred in the names,” whereas others are less renowned. All have one
1700s, although the close association and harmonious thing in common: they practice the art of lameness diag-
working relationships between blacksmiths and equine nosis and management in the horse.