History
The patient presented following a left front limb (LF) shoe loss on July 10, 2021, while in the paddock. Both clips from the shoe remained in the foot. The patient was lame at a walk, and the client began packing the foot and administering Bute. Although the patient showed some initial improvement, lameness persisted at the trot.
Within two days, swelling developed in both the left front (LF) and left hind (LH) limbs, appearing consistent with cellulitis. The swelling continued to improve over time.
Exam Findings
First Examination — July 17:
The patient was sound at a walk but demonstrated 2/5 lameness on the LF at a trot. No elevated digital pulse was noted. Both the LF and LH limbs remained swollen with changes appearing consistent with cellulitis, although the swelling was steadily improving.
Second Examination — July 19:
Mild swelling was observed over the LF mid-tendon region, with no heat or pain noted on palpation. The patient demonstrated 1/5 lameness on the LF both in a straight line and on a circle. Lameness was significantly more pronounced under tack than in hand, reaching 3+/5 on the circle to the right.
A diagnostic block of the LF was highly PDN positive, with significant improvement in lameness to the right, although some lameness remained to the left. Ultrasound examination identified desmitis of the LF inferior check ligament (ICL).
Treatment
July 21:
The LF carpal sheath was injected with hyaluronate and triamcinolone. The limb showed improvement for approximately one week before swelling began to recur.
August 10:
A follow-up ultrasound showed that the LF ICL desmitis was more significant than initially observed. Heat and pain were noted on palpation, and additional treatment options were discussed.
August 27:
Regenaflex-RT was administered to the LF ICL using ultrasound-guided injection.
August 29:
Following bandage removal, the LF limb appeared approximately 50% smaller than prior to the ICL injection. No heat or pain was observed on palpation.
Follow-Up
September 16:
A follow-up ultrasound demonstrated significant improvement of the LF ICL desmitis.
