Horses are part of an ever growing industry, with over 600,000 horses in the UK, 1.4 million riders and 5 million people with an active interest in the equine industry*. Most people acquire a horse out of choice, so if you make this decision you should think carefully before going ahead. A horse needs lots of love and care, including regular worming, vaccinations and dental care. Owning a horse is time consuming and can be costly; not only will you will need to consider where you will keep your horse, you must also consider the ongoing costs of owning a horse which include accommodation, bedding, feed and healthcare.

In the unlikely event that your horse goes missing it is going to be very difficult for anyone to know who it belongs to, unless your horse carries some form of permanent identification. It is wise to get your horse microchipped or freezemarked, this will avoid heartache in the long run, should your horse go missing or is stolen.

Horses are herd animals, and thrive on being together with other horses. Don’t forget that your horse will need somewhere to graze, a stable for warmth in the winter time, a constant supply of water, feeding daily and regular exercise. It can cost hundreds of pounds a month to care for a horse, including accommodation, food, veterinary care and insurance; there will be other costs, including buying tack and rugs and extra livery charges when you go on holiday.

Horses can live into their thirties, over this time your horse will need lots of care and attention. Being able to provide all of this will ensure you and your horse make the most of your time together.

* Research conducted in 2004 by the Henley Centre for DEFRA and the British Horse Industry Confederation.

Suspensory ligament injuries

The suspensory ligament is a strong, slightly elastic band of collagen fibres that runs at the back of the horses’ lower leg. It originates at the top of the cannon bone in both the forelimb and hindlimbs, and splits into two branches which insert onto the sesamoid bones at the back of the fetlock. The ligament’s main purpose is to prevent hyperextension of the fetlock at exercise.  

How does the suspensory ligament become damaged?

Suspensory ligament desmitis (inflammation) can usually be considered a repetitive strain injury caused by excessive over-stretching of the ligament during exercise, although some cases will be attributable to age-related degeneration of the ligament. Excessive stresses can occur when the horse is travelling at speed, landing after jumps, during abrupt turns, and during collected or extended movements.

Torn fibres can be found at the ‘origin’ (upper cannon bone), in the main ‘body’ of the ligament, or in the branches at the ‘insertion’ (sesamoid bones). Severe injuries may result in a ‘core lesion’ (hole) in the ligament. Complete rupture may occur in extreme cases, but fortunately these are uncommon and tend to be due to age-related degeneration, rather than due to an athletic injury. Lesions at the origin may also involve injury to the back of the cannon bone where the ligament has torn away from the bone surface. Lesions found at the insertion can sometimes involve the fetlock joint or be associated with fractures of the sesamoid bones. Occasionally, desmitis of the body or branches can be secondary to fractures or fracture healing of the splint bones.

What type of horses are most at risk?

Suspensory ligament desmitis occurs in all types of horses. Sport and leisure horses tend to suffer more from lesions at the origin and at the insertion, while core lesions in the body of the ligament are more common in racehorses. Certain risk factors such as straight hock conformation, foot imbalance and fatigue have been reported, although varying work surfaces and exercise regimes have also been attributed to injury. Upper-level dressage horses for example commonly develop proximal suspensory ligament desmitis of the hindlimbs (lesions at the origin) due to the extravagant movements required by the sport.

What are the clinical signs?

Clinical signs vary depending on the severity and site of injury. Mild-to-moderate lameness is the most common clinical sign associated with desmitis. In some cases, lameness may be subtle, especially in cases with bilateral injury, and can go undiagnosed for some time, with owners usually complaining of poor performance, rather than lameness. Heat, swelling and ligament thickening may also be present with more severe injuries. Joint swelling may be apparent if the fetlock joint is involved. If the ligament is severely injured or ruptured, the horse will have an obviously abnormal gait and the fetlock will sink towards the ground, but fortunately this is uncommon.

How are suspensory ligament injuries diagnosed?

The diagnosis is based on a combination of the history and clinical signs, combined with nerve blocks, radiography (x-rays) and ultrasound. Scintigraphy (bone scan) or MRI may also be utilised to identify complications such as splint bone fractures or fetlock joint involvement. Depending on the degree of damage, follow-up ultrasound scans are usually necessary at certain intervals of rehabilitation, especially before any significant increase in exercise level.

What treatments are available?

As for the clinical signs, treatment varies depending on the severity and location of the lesion. Mild injuries often respond well to rest and controlled walking exercise, usually for a minimum of 3-6 months. Good corrective farriery is required to optimise foot balance and a suitable rehabilitation plan is needed, with periodic veterinary re-evaluation to monitor progress and guide further increases in exercise.

More chronic injuries often do not respond well to rest and rehabilitation alone. Shockwave or laser therapy are potential treatments, and intralesional injections, such as stem cell therapy and platelet-rich plasma (PRP), can be used to improve outcomes. 

Conservative treatment for more degenerative injuries (such as hindlimb proximal suspensory desmitis) can however be disappointing and many of these horses require surgery (neurectomy and fasciotomy) with more encouraging results. Surgery may also be indicated if the fetlock joint or sesamoid bones are involved, or if there is a fractured splint bone.

What is the outcome?

As with many ligament injuries, outcome depends on a number of factors however early recognition and treatment of the problem can improve the prognosis. Damaged ligament fibres heal in an irregular scar formation, creating a weaker and more compromised structure, more susceptible to re-injury. Mild injuries of the forelimb carry a good prognosis, while due to underlying anatomical differences, hindlimb injuries often carry a more guarded projection.

Prevention (or more accurately, protection) is better than cure. A good, varied exercise programme targeting core muscles, posture and fitness reduces fatigue and the risk of repetitive overload. Collected and extended paces are more demanding on the suspensory ligament and should be spread out within the training program. Exercising on a variety of different surfaces can help to condition the ligament and good farriery practices should be followed, with regular trimming and shoeing to optimise foot balance.  

Good conformation is also a key factor for avoiding suspensory ligament problems and should therefore be a fundamental consideration when buying a horse.