The Power Of A Good Pair Of Shoes: Supportive Solutions For Soft Tissue Injuries by Sarah Coleman|01.13.201601.17.2016|6:45pm7:24pm Horses can seem like they're an accident waiting to happen. With over 1,000 pounds of mass traveling at 35 miles per hour, the demands placed on each tendon and ligament in an equine limb can seem overwhelming. Although they usually work together in harmony, even the fittest Thoroughbred can experience over-extension of a soft tissue. One of the most common (and difficult) soft tissue injuries is the strain of a ligament, the strong connective tissue band that connects bone to bone. Ligaments are stabilizing structures that help hold bones together and keep them from overextending. Ligament injuries can occur in both the forelimbs and the hind limbs, with the suspensory ligament being one of the primary sites of ligament failure. The suspensory ligament holds the back of the equine ankle in place and prevents overextension of the fetlock during the weight-bearing phase of a horse's stride. Dr. Raul Bras, DVM, CJF, APF of Rood and Riddle Equine Hospital, has extensive experience in caring for tendon and ligament injuries in horses. He believes that tendon and ligament injuries in racehorses have increased over the past few years, and he suspects the advent of artificial surfaces could have contributed to a perfect storm of factors influencing the injury rate. “Equine practitioners started to notice that soft tissue injuries became more common,” said Bras. “This this was due to many variables that affected the conditions of the [track] surface and the effect on the horses.” Add this to the hoof issues Thoroughbreds are known for, such as thin walls and soles, and low heel/long toe, and there could be a predisposition to soft tissue injuries. “Otherwise, these types of injuries [tendon and ligament strains and tears] seem to be more common in sport horses due to the extended careers beyond racing and types of discipline they inhered as a second career, such as hunter jumpers, eventers and/or dressage,” Bras said. Other factors contributing to a horse's proclivity for ligament injury could include limb conformation (i.e. long pasterns with dropped fetlocks) and foot conformation (i.e. low heels with a negative palmar angle of the coffin bone). “Typically, horses with soft tissue injuries are diagnosed with ultrasound evaluation; nowadays the use of MRI has become more common as well, especially for injuries within the foot,” said Bras. “Therapeutic shoeing is also commonly used to treat soft tissue injuries as well.” For this treatment method to work well, the veterinarian and farrier must understand the forces at play on the injured structures, said Bras. “The purpose of therapeutic shoeing is to decrease the tension and stress on the [injured] structures while allowing them to heal appropriately,” he said. A horse isn't built to spent the many weeks of his recovery lying down, so the farrier's job is to disperse the forces the leg will take to prevent further stress to the injured area. This varies depending upon the injury location. Bras said that an injury to the deep digital flexor tendon is commonly approached with a shoe with an elevated heel, which is thought to decrease the tension on the tendon. The last phase of stride is where the deep digital flexor tendon takes the most strain, so adding a break over modification to the shoe would facilitate range of motion in hopes of decreasing the stress forces and tension in the tendon. A different strategy is at work when relieving stress from ligaments. “A horse with a suspensory injury [is shod] where the shoe would ideally allow the heels to sink in more in the deep footing, decreasing the stress on those specific structures,” said Bras. “A horse diagnosed with a collateral ligament [injury] is treated with a wider-web branch shoe on the side of the injury to support that ligament when in soft footing,” Bras said. The type of footing a horse is recovering in also dictates the farrier's strategy. These types of supports are most helpful for horses dealing with deep footing, like the type that would be found in a stall, according to Bras. Soft tissue injuries usually take approximately 90 days for primary healing, but experts usually suggest horses wait longer (six months to a year), to bring the horse back to the previous level of work. A thoughtful program is strongly recommended to slowly introduce the horse back to work. “Therapeutic shoes are usually recommended throughout all this time, and the horse is slowly weaned from them as he continues to improve.” Bras said re-evaluation with diagnostic tools and close monitoring of these structures throughout the healing process by your veterinarian is imperative for a successful outcome.