The Diagnosis – High Ringbone

July 20, 2010.  The beginning of my journey with Bailey.  This was going to be the fourth best day of my life after my wedding and birth of my two children.  This was also going to be the beginning of owning a horse for the first time and learning very quickly your perfect horse life is not always what you dreamed it would be. Bailey is a 15.2 hh, 10 year old tri colored pinto mare.  She was sold as a sound accomplished horse in hunter shows, hunter pace, fox hunting.

July 27, 2010.  I had accumulated the proper English riding tack to start riding Bailey in a lesson.  In the lesson I am asked to right lead canter Bailey.  Bailey stumbles very bad almost causing me to go over her head after turning right around the bend of the ring.  Both the instructor and I assume Bailey tripped and I continue to try to canter her, but the stumbling continues to the right, not to the left.  Since she was sold as a sound horse, we didn’t expect an issue.


August 10, 2010. The barn I was boarding at was having their driveway paved so for a few days the horses were not being turned out since it would require walking and crossing the road construction to the pastures.  Bailey was in her stall or brought out for grooming and cleaning of her stall for a day and a half.

August 12, 2010.  The horses were all put out in the pasture in the evening after completion of the road.

August 13, 2010.  I receive a phone call first thing in the morning that Bailey is severely lame when they went to bring her back into the barn after being out in the pasture for the evening.  She cannot walk.  This is a phone call no horse owner wants to receive.  I have the barn vet come out that day and examine Bailey’s right foot.

EXAM-LAMENESS – (0.34) (0.34)Lame RF. Was noticed this morning when horse
taken from stall. Grade 4/5 lame on turns, 3/5 lame at walk. Palpable heat medially in
hoof. Pastern region slightly swollen, minimal reactivity to flexion of fetlock, no
sensitivity to hoof testers. PD block partial improvement but still careful on turns.
Abaxial sesmoid block abolishes lameness. Suspect foot bruise or abscess.
Plan: Soak foot daily in Epsolm Salts then bandage in animalintex pad and diaper.

She advises me it might be an abscess and to treat for that.  I am told by fellow horse owners I should feel so lucky it is only an abscess.

Little did I know.

So it is day one of the first 5 days of making a duct tape wrap to fit around my horses hoof with a poultice pad stuck on the hoof bottom to draw out the possible infection.  This was my first medical task as a 23 day old new horse owner.  First you soak the foot for about 10 minutes in a bucket of Epson salt, then carefully without getting the hoof dirty, be ready to apply to the medicated pad, then put hoof in a small diaper pad, and finish up with a duct tape homemade square grid to wrap around and hold everything to the hoof.  Do this 2x a day for 5 days to a 1000 lb. horse you hardly know, plus be prepared to cut it off the hoof to repeat the process.  Luckily I did get help at the barn I was boarding at.  It was very much appreciated.


August 18, 2010.  The veterinarian was called back to check on right hoof.

EXAM – Mare is comfortable on foot, turns with ease, negative to hoof testers. As per
owner mare is running in pasture soundly.
Plan: Dry wrap foot for 2 days then resume normal activity

August 24, 2010.  Bailey is severely lame again!  What could be going on?  It is now 6 days since the vet had examined Bailey and nothing was making sense.  I was beginning to get suspicious to the health of Bailey.  It was appearing to be the classic used car deal.  Salesman says the car is perfect, no issues, and 23 miles later the check engine light goes on.

August 25, 2010.  The vet at the barn I boarded at came out for a third time.  She determines Bailey is still not sound and we need to investigate more.  She advises me that x-rays will be needed at this point.  I authorize 2 x-rays on Baileys right leg.  The x-rays reveal probable high ringbone.  Since the vet had not planned to do x-rays and had a time restriction, Bailey was not properly washed down in the leg area for perfect x-rays, but it would give us some idea.  More x-rays would have to be done at a scheduled appointment.  I now had a new word to research- HIGH RINGBONE!

EXAM-LAMENESS – Horse appeared sound for several days while being turned out.
Mare had a day and a half in stall due to weather conditions(8/22/10+8/23/10), and when
brought back in after first day of turnout was grade 4/5 lame. Owner bandaged leg and
kept inside for the remainder of the day and until seen 8/25/10. Today grade 1.5/5 lame
RF on straight line. Grade 2/5 lame on turns to left. Horse is negative to hoof testers.
Lower limb flexion horse becomes grade 4/5 lame. Small degree of swelling is still
present on dorsal aspect of pastern. Discussed full evaluation including joint block and
radiographs. Owner is undecided as to course of action to take and is considering
returning horse to seller. 2 Radiographic views of the pastern were obtained. Lateral view
shows small osteophyte on dorsal surface of P2 which may be the cause of underlying
lameness. Recommended pastern joint block as next step in lameness diagnosis. Owner
needs to consider options before going further.

September 8, 2010.  The vet comes back again and does 2 more clean x-rays on Bailey’s leg and confirms high ringbone is the reason for her lameness.

EXAM-LAMENESS – (0.34) Grade 2 lame RF at trot on lunge in both directions. To left
horse tends to drift to outside of circle and to right horse prefers to drift to inside of circle.
RF lower limb flexion mare becomes grade 3 lame. Injection of 4cc Carbocaine into distal
phalangeal joint does not improve lameness. Injection of proximal interphalangeal joint
was difficult and only 3cc could be deposited in joint abolished lameness in RF and horse
was more relaxed in both directions. Two oblique views of RF pastern were then
obtained. The DLPMO view shows a large irregular osteophyte on proximal P2 with
lipping into joint surface.
DX: Osteoarthritis of proximal interphalangeal joint centered over dorsal medial aspect of
joint (a.k.a. High Ringbone).

9-8-2010 x-ray

I will never forget the words the vet said to me.  She’s junk, get rid of her.  Those words have haunted me for 5 years.  I was obviously quite upset and concerned as I was now faced with owning a horse for a little over a month, that I hardly knew, had ridden about three times, and was now diagnosed with a pre-existing progressive condition with a very poor outlook.


noun ring•bone \-ˌbōn\
Definition of RINGBONE
: a bony outgrowth on or near the articulating surface of the pastern or coffin bone of a horse that typically results from injury and usually produces lameness

pastern illustration

The pastern is a part of the leg of a horse between the fetlock and the top of the hoof.  The pastern consists of two bones, the uppermost called the “large pastern bone” or proximal phalanx, which begins just under the fetlock joint, and the lower called the “small pastern bone” or middle phalanx, located between the large pastern bone and the coffin bone.  The joint between these two bones is aptly called the “pastern joint”. This joint has limited movement, but does help to disperse the concussive forces of the horse’s step and also has some influence on the flexion or extension of the entire leg. The pastern is vital in shock absorption. When the horse’s front leg is grounded, the elbow and knee are locked. Therefore, the fetlock and pastern are responsible for all the absorption of concussive forces of a footfall. Together, they effectively distribute it among both the bones of the leg and the tendons and ligaments.

The veterinarian caring for Bailey concluded:  It is my medical opinion that the origin of lameness is directed at the proximal interphalangeal joint (diagnosed as osteoarthritis of the proximal interphalangeal joint). Osteoarthritis begins as inflammation within the synovium of the joint and is not evident on radiographs at this stage. As the disease progresses, the inflammatory mediators break down joint cartilage and synovial fluid. Bony changes are a later manifestation of the disease and represent irreversible pathology. It is my medical opinion that “Bailey’s” radiographic changes are chronic in nature, occurring well before the 26 days between initial examination and final diagnosis. Treatment of this condition can be unrewarding, and consists of systemic and local anti-inflammatory therapy (both topical and intra-articular). Additional treatment may consist of fusing the affected joint, but this is of last resort as the animal is not generally sound for riding.

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