Jewel: Rehabilitation of a severe right hind straight sesamoidean ligament tear

Jewel is a 10-year-old pony cross mare who presented to VRSVA for rehabilitation of a severe right hind straight sesamoidean ligament tear.  While it was not completely ruptured, the injury affected the majority of the ligament.  Jewel was very sore to palpation over the back of her pastern and was lame at the walk.  The ligament was injected with Pro-Stride and she was treated with topical and systemic anti-inflammatories, cryotherapy, and support bandaging.  She was taken out of the stall only to hand graze on level ground.

Despite treatment to quiet the inflammation, her pain level seemed to be worsening and she preferred to bear weight only on her toe. She was hesitant to put her heel to the ground as it applied too much pressure to the weakened ligament. The decision was made to put a wedge pad on the bottom of her foot to relieve tension on the ligament. She was immediately much more comfortable.   Her rehab continued incorporating therapeutic ultrasound and laser therapy.  She was also able to tolerate passive range of motion exercises and frictional massage to help resolve swelling and decrease the chance of adhesions.

Once the tendon began to show significant healing on ultrasound evaluation, we began to gradually decrease the angle of the wedge pad over the course of several weeks.  During this process, she was able to start hand walking and then walking under saddle. She began trot work while in a low wedge and was eventually able to switch back to a flat shoe and increase her workload.  The degree of this injury and the degree of lameness she exhibited gave this mare a guarded prognosis. The triad of an excellent referring veterinarian, a wonderful farrier, and a dedicated rehab team has helped this lovely girl make a full recovery!