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11/06/2026

Pinpointing Poor Performance in Horses

Say your horse starts refusing to move off your leg, kicks out, and swaps his lead behind—when you’re able to pick up the canter at all, that is. Your first instinct might be to blame his training or dismiss these issues as bad behaviors. In reality, a horse having difficulty performing as expected could be in pain. From a welfare standpoint, it’s always preferable to investigate and rule out physical reasons for difficult behaviors before handing the reins to a trainer or behaviorist.

But where do you start? Here we’ll walk through a workup with two vets who specialize in identifying roots of poor performance.

Poor Horse Performance Defined
When a ridden horse’s athletic abilities fall short of the rider’s expectations, you’re dealing with poor performance. “The list of potential problems causing poor performance very much depends on what type of poor performance we are talking about,” says Erin Contino, MS, DVM, Dipl. ACVSMR, associate professor of Equine Sports Medicine and Rehabilitation at Colorado State University, in Fort Collins. “If we’re seeing issues with physically being able to perform an athletic job, then respiratory, cardiac, and muscle diseases would be highest on my list of possibilities. On the other hand, if we are dealing with behavioral issues under saddle, then axial (body) skeletal pain and gastric ulcers top that list.”

With this in mind, let’s dive into nine common causes of poor performance in horses and what it takes to get a diagnosis.

The No. 1 Culprit: Lameness
* Diagnostic approaches Practitioners use palpation, lameness exam, diagnostic regional anesthesia (nerve blocks), lameness locator technology, radiographs, ultrasound, computed tomography (CT) scan, MRI, and nuclear scintigraphy (bone scan).
* Possible causes Diagnosing equine lameness involves an almost limitless range of possibilities. “The most common causes are probably hind-limb proximal suspensory disease and generalized front foot pain,” Contino says, reflecting on her experience. A horse’s discipline and workload greatly influence his predisposition to different injuries. Looking at two popular disciplines, researchers have suggested that show jumpers and eventers are especially at risk of developing flexor tendon injuries, while dressage horses are overrepresented in hind-limb suspensory ligament desmitis cases

My Horse Isn’t Lame But Isn’t Performing Well. Now What?
Say your horse is “off,” but a thorough lameness exam, including flexion tests and nerve blocks, didn’t provide any answers. What’s next? We delve into the myriad other problems that can cause poor performance, Contino says. This conversation opens the door to what can be a complex, but necessary, investigation.

This is where an internal medicine specialist like Laura Javsicas, VMD, Dipl. ACVIM, of Rhinebeck Equine, in New York, comes in. After your primary veterinarian has ruled out lameness as the cause of poor performance, you and your horse will likely be referred to an internal medicine specialist. “When evaluating a horse for poor performance, I always start with getting a thorough history to pinpoint exactly what problems the rider is experiencing,” Javsicas explains. “When the source of the issue is nebulous, this process can help to target the area(s) to focus on.”

Regardless of case history, Javsicas starts with a complete physical exam, including careful auscultation (listening) of the heart, a rebreathing exam to listen to the lungs (which causes the horse to take deeper, slower breaths, making lung sounds easier to hear), and a neurologic exam. The results of this preliminary evaluation dictate her next move and could point her in several different directions. The common ones include:

2. Back Pain
Diagnostic approaches
Practitioners use palpation, radiographs to check for overriding dorsal spinous processes (kissing spines) and arthritis. Some veterinarians also start a horse on a 14-day course of the muscle relaxant methocarbamol (Robaxin) and see if the horse’s back pain improves. Some complex, idiopathic (occurring unexpectedly or from an unclear origin), and/or persistent back pain cases might warrant a visit to a board-certified sports-medicine specialist for further diagnostics, including advanced imaging.

Possible Causes
Horse owners commonly observe back pain in poorly performing athletes and veterinarians frequently identify it as a clinical issue. In 20112 study renowned equine sports medicine and rehabilitation specialist Kevin Haussler, DVM, DC, PhD, Dipl. ACVSMR, estimated that up to 94% of ridden horses experience some degree of back pain. There are likely several factors to blame for this statistic. A 2023 survey-based study revealed the single most diagnosed pathological cause of primary equine back pain is kissing spines2, while other studies have identified ill-fitting saddles, among other riding-associated factors, as a common cause of equine back pain3. “While axial skeletal issues (including back pain) can cause lameness, they often present only as poor performance,” says Contino. “Axial skeletal pain, dysfunction, and/or pathology are the most common causes of poor performance in the horses that present to me.”

3. Muscular Disease or Injury
Diagnostic approaches
Veterinarians use serology, which involves testing blood levels of the muscle enzymes aspartate aminotransferase (AST) and creatine kinase (CK), both baseline and after an exercise challenge; genetic panel; and muscle biopsy. Javsicas also recommends performing genetic testing and having a muscle biopsy sample evaluated by an experienced veterinary pathologist.

Possible Causes
Hyperkalemic periodic paralysis (HYPP)and polysaccharide storage myopathy (PSSM) are genetic diseases that affect horses’ muscles. In Warmblood breeds myofibrillar myopathy (MFM) leads to muscular disease. PSSM and MFM most commonly cause clinical signs of tying-up and/or signs of vague poor performance, muscle soreness, and sometimes hind-limb gait abnormalities (depending on breed), while HYPP can cause muscle tremors and paralysis.

4. Neurologic Deficits
Diagnostic approaches
Veterinarians use physical, lameness, blood tests, and neurologic exams. They refer to an internal medicine specialist or neurologist for cerebrospinal fluid analysis (looking for pathogens that cause neurologic disease), CT scan, and myelogram (radiographs obtained under general anesthesia using a contrast injection around the spinal cord to look for compression). “Neurologic and muscle diseases can cause poor performance and are often confused with lameness,” notes Javsicas.

Possible causes
Equine protozoal myelocephalitis (EPM)stands out as the most common neurologic disorder in horses and is arguably overdiagnosed and overtreated. A 2017 study showed 78% of apparently healthy horses in the U.S. tested positive for EPM antibodies4, meaning they were exposed to but not necessarily actively infected with EPM. However, EPM can cause neurologic deficits that negatively affect a horse’s performance. Other neurologic conditions, such as equine degenerative myeloencephalitis (EDM), cervical vertebral stenotic myelopathy (CVSM), and Lyme disease can produce similar neurologic deficits.

5. Hoof Problems
Diagnostic approaches
Practitioners use lameness exams, hoof balance radiographs (lateromedial and dorsopalmar ), MRI, hoof testers, and diagnostic nerve blocks, and they might refer to a podiatrist.

Possible causes
Most foot problems stem from various musculoskeletal issues, primarily categorized as lameness (see No. 1). Researchers have shown hoof bruising and podotrochlosis (aka navicular syndrome) are the main foot-related causes of lameness and poor performance in both dressage horses and show jumpers7. Primary issues of the hoof capsule can also limit performance and include white line disease, solar abscesses and bruising, and hoof cracks, to name a few.

6. Respiratory Problems
Diagnostic approaches
Vets use auscultation, rebreathing exams, bronchoalveolar lavage (BAL), transtracheal wash (TTW), chest radiographs, lung ultrasound, and airway endoscopy to investigate these issues. Dynamic endoscopy has helped as a means of finding problems only present during work.

Possible causes
Javsicas cites equine asthma as one of the top three causes of poor performance she diagnoses. Otherwise, respiratory problems include everything from laryngeal hemiplegia (roaring) and dorsal displacement of the soft palate to epiglottic entrapment and arytenoid chondritis. Contino agrees, adding that the literature suggests upper airway conditions such as these are another common cause of poor performance in horses.

7. Cardiovascular Restrictions
Diagnostic approaches
Veterinarians use cardiac auscultation, exercise tolerance tests, electrocardiogram (ECG/EKG), and cardiac ultrasound.

Possible Causes
Heart problems also made the top-three list of causes of poor performance in Javsicas’ caseload, but this statistic likely does not represent the entire equine population. “Cardiac issues are a relatively rare cause of poor performance, but horses are referred to me—an internal medicine specialist—for further cardiac workup if a murmur is auscultated or arrhythmia detected, hence the bias,” she explains. Cardiovascular malfunction is, however, the most common reason for sudden death in horses during and immediately after exercise, says Cris Navas, LV, PhD, Dipl. ACVIM, a large animal internist at the University of Pennsylvania’s New Bolton Center Veterinary Hospital, in Kennett Square. In his presentation at the 2023 Veterinary Meeting and Expo (VMX) in Orlando, Florida, Navas cited atrial fibrillation as the No. 1 cause of cardiac limitation to horses’ athletic performance.

8. Gastric Ulcers
Diagnostic approaches
“Gastric ulcers have a variety of clinical signs, including colic signs after eating, bruxism (teeth grinding), and girthiness,” Javsicas says. “Gastric ulcers can also cause poor performance. The most common manifestations I see are reluctance to move forward and bucking, signs that may mimic back pain. While these observations are helpful in guiding horse owners and veterinarians toward a gastric ulceration diagnosis, only a gastroscopy can confirm or rule out the presence of ulcers in an individual horse’s stomach and determine the location and severity of the ulcers, which dictates treatment.”

Possible Causes
Gastric ulcers are prevalent in many populations of equids, from racehorses and eventers to stabled horses in general. Risk factors include insufficient forage access, consuming grain on an empty stomach (not buffered by forage), high starch intake, and stress9. Javsicas says gastric ulceration is one of the most common culprits of poor performance she sees in her caseload.
Repro or Behavioral Challenges
Diagnostic approaches
Practitioners use serology to test for abnormal hormone levels in mares (estrogen and testosterone) and ultrasonography of the mare reproductive tract.

Possible causes
If a mare has a granulosa cell tumor on an o***y, the hormonal imbalance might cause her to display stallionlike behavior10. The neurologic disease EDM can also cause lethargy and aggression in horses of both sexes

When Health Is Not the Problem
When dealing with a poorly performing horse, Contino reiterates first ruling out pain and lameness with a thorough clinical exam and the diagnostics listed above. “If my examinations don’t reveal anything obvious, depending on the case, I may recommend a Bute trial,” she says.

Much like the methocarbamol trial mentioned earlier, a Bute trial involves giving a horse the non-steroidal anti-inflammatory drug (NSAID)phenylbutazone daily for seven to 10 days. “The goal is to determine if the horse is any different on Bute—or not,” explains Contino. “If he improves, this indicates the performance issue does indeed have a pain or inflammation component.”

If Bute doesn’t ameliorate performance, Contino might recommend a gradually increasing fitness and conditioning program, depending on the case. She also adds physical therapy and gymnastics exercises and sees if the horse trends better—pointing to a fitness and conditioning issue. “If the horse gets worse during the fitness program, this suggests we are aggravating an underlying issue, and it’s back to the drawing board.”

Take-Home Message
“I do think horses with axial skeletal pain present more often for poor performance or behavioral issues than they do for lameness,” Contino says. “There isn’t a ‘one-size-fits-all approach’ to these complex poor performance cases. They can be tricky for sure!” Recognizing your horse is struggling and reaching out to your veterinarian is the best first step you can take to get to the bottom of the issue. It could take some time and trial and error, but trust your veterinary team will do everything possible to get you back in the saddle with a horse that’s feeling and performing his best.
The Horse

11/04/2026

The All-Important Pre Purchase Exam

Prepurchase exam steps, ethics, and best practices
You’re in the market for a new horse and find one across state lines that checks all the boxes; he’s the right age, within your budget, and you love what you see in the seller’s videos. Why spend time and money performing a prepurchase exam (PPE) on this unicorn? In this hot market, you want to sn**ch him up right now!

“I think of prepurchase exams as an information-gathering mission for the prospective buyer prior to making the decision of purchasing a horse,” says Rachel Roemer, DVM, owner of Great Bay Equine, in Portsmouth, New Hampshire. “I perform them to look for any indication of existing issues that may limit performance in the future for whatever desired job.”

You might think, so what if the horse has a little hitch in his giddyup or less-than-stellar teeth, right? Wrong.

Always remember: Buying the horse is the least expensive part of ownership. “Often, horses are large investments, and it’s a financial commitment to take care of horses in the long run,” says Roemer. “So I get as much info as I can to let them know of any potential issues that they may deal with in the future. Even if a horse is not being sold for much or given away, the potential costs of dealing with underlying chronic medical or lameness issues can be really significant and, in many cases, can exceed the purchase price of the horse. Prepurchase exams help ensure you are not taking on a horse that cannot do what you want it to do and may (cause you to) incur high financial and emotional expenses.”

Here are considerations to make and what to expect when a veterinarian performs a PPE on a prospective equine partner.

Scheduling an Exam
Avoid potential conflicts of interest when choosing a veterinarian to perform your prepurchase exam.

“Any existing relationship between the seller and the veterinarian is a potential conflict of interest,” says Roemer. “I usually have my staff make sure whatever horse we’re looking at has not been a patient of ours previously.”

At a prepurchase exam the buyer is the veterinarian’s client. The buyer is paying the bill, and they own the report and any images within it. As a practicing veterinarian, I also try to refrain from doing prepurchase exams when the seller is my client.

“There can certainly be pressure on the vet from a good client to ‘pass’ the horse to a seller,” says Roemer.

When looking for a veterinarian to perform a PPE, your regular vet is typically a good choice if the horse is local. If the horse is not local, he or she might recommend a practitioner or clinic where the horse is located. Further, if you need help interpreting the prepurchase exam findings, your veterinarian can help steer you in the right direction, because they understand your needs and situation.

The Pass/Fail Myth
It is a (false) understanding in the equine community that the veterinarian performing the prepurchase exam “passes” or “fails” the horse they’re examining. For me, this is truly the most frustrating aspect of performing a prepurchase exam.
The Pass/Fail Myth
It is a (false) understanding in the equine community that the veterinarian performing the prepurchase exam “passes” or “fails” the horse they’re examining. For me, this is truly the most frustrating aspect of performing a prepurchase exam.

“Passing a horse for one buyer is not passing for another,” says Roemer. “It depends on what the horse is to be doing and what the buyer is willing to tolerate as far as preexisting or potential issues. The high-level jumping prospect will have a different threshold than the backyard pony for a child. The needs, and priorities, of buyers vary wildly.”

As a veterinarian, it should not be my concern whether the purchase goes through. My job is to give the buyer as much information about the horse prior to purchase so he or she can make an educated decision.

Buyer Considerations
A buyer who doesn’t know what they want in a horse can be a recipe for disaster. “Whenever I start a prepurchase exam, before I even lay hands on a horse, I make sure to have an upfront and honest conversation with the potential buyer,” says Zach Loppnow, DVM, an equine veterinarian at Iowa State University’s Lloyd Veterinary Medical Center, in Ames. “I want to make sure that they tell me exactly what they are wanting from the horse in terms of future use, as well as what they are looking for from the examination.”

Every client has different levels of disposable income, experience maintaining or treating conditions, and levels of risk they’re willing to take when buying a horse. “It is not my job to make decisions regarding those factors for a client,” he adds. “That is up to them, even when they ask, ‘What would you do?’ In the end, it’s up to the client to decide whether what I report is significant enough to them to buy or not buy the horse, and if it will fit what they are intending to do.”

Look at the Whole Horse
Clients often view prepurchase exams as simple soundness evaluations. “The lameness and musculoskeletal evaluation is obviously a large part of this examination, and often the main focus of a buyer, but it is by no means the only portion that matters,” says Loppnow. “When it comes to prepurchase exams, I am going through a horse from nose to tail. This includes evaluating parts of the respiratory system, gastrointestinal system, neurologic system, eyes, ears, skin, muscles, joints, etc. The list can be quite long.”

Dental issues, ophthalmic problems, or respiratory concerns can be significant findings at a prepurchase. Furthermore, owners can request specific diagnostics. For example, a broodmare prospect might also receive a breeding soundness exam, or a Thoroughbred coming off the track might get a gastroscopy to evaluate for gastric ulceration. Another common practice is pulling blood for drug testing to ensure the horse was not medicated prior to the examination.

“Ultimately though, that’s what a prepurchase exam is: looking for something that could be a problem for this horse and its expected job down the road,” Loppnow says.

Assessing the Athlete
The meat of the prepurchase is, indeed, the soundness evaluation. Mark Baus, DVM, is a founding partner of Grand Prix Equine, a sports medicine practice in Bridgewater, Connecticut, and prepurchases make up a large portion of his practice. He says most of his vettings are for high-end sport horses, where the horse’s competitive potential is the first thing on the buyer’s mind.

“My responsibility at the time of a prepurchase exam is to discuss physical findings only,” says Baus. “Athletic ability, to me, is outside of that wheelhouse.

“How you best predict future competitive ability, in my currency, is pain,” he adds. “When I’m looking at a horse, my job is purely to be assessing sources of pain.”

Baus does this by watching the horse move in hand and under saddle and performing joint flexion tests. These simple techniques are paramount to assessing a horse’s soundness, he says.

“I always tell clients the best (and soundest) horses have the least amount of pain,” he says. “Competitive ability is directly tied to soundness. And the soundest horses I’ve ever vetted were seven-figure horses. I truly believe that horses are priced relative to athletic ability, and athletic ability is tied directly to soundness.”

The significance of PPE findings can vary depending on the intended use for the horse. “In the hunter world, a horse with mild hock changes will probably not have any clinical lameness, so I would probably not warn the client of any potential limitations to their ability,” says Baus. “As the changes progress and the clinical signs are more apparent, I do feel the need to say that this horse may be restricted in certain circumstances.”

The prospect’s workload is another important factor to consider. It’s all too common to come across young horses that seem to have incredible athletic potential, even though they aren’t yet in work. The purchase proceeds, but once workload increases the horse develops a lameness. This is the unfortunate reality of prepurchasing a horse that is not in regular exercise, as some clinical findings only manifest once work begins.

While veterinarians and buyers should consider all prepurchase exam findings, again, not all findings are equal. “I address two factors with every finding: Is this going to change with time or with use?” says Baus. “I think it is important to help clients understand that some findings are going to change no matter what you do with the horse, and some will change more with what you do with them. Some findings will change more rapidly with what you do with a horse. If you rested a navicular horse for X period of time, they’ll likely be sound for a while. If you do too much with them, they’re going to be crippled.”

Radiographs and ultrasound are great diagnostic tools that can tell us a lot about a horse. While it would be wonderful to image every horse getting a prepurchase, this is not financially feasible for many prospective buyers.

Some buyers always request radiographs of the hocks or front feet or back. While this can be good practice, I recommend financially conscious buyers let the exam guide the imaging. “My imaging definitely highlights areas of clinical findings and concerns, based on flexion responses, joint effusion (fluid swelling), palpation, and hoof tester responses,” says Baus. Ultrasound comes into play as well. “I probably scan about a third of the horses that I vet,” he says.

An important development in the veterinary community is the use of board-certified radiologists to help assess PPE findings. “I am now recommending to all of my clients buying that we send out the radiographs to a radiologist for their opinion,” says Baus. “First of all, it is humbling, because I’ve been looking at horses for 40-odd years and drinking my own Kool-Aid, writing down whatever description I want, and these guys are coming up with very professional, very detailed reports, frankly seeing things I didn’t see. Furthermore, they’re describing things better than I would describe them.”

Take-Home Message
Hunting for the perfect horse is exciting but can also be frustrating. My piece of advice for any prospective buyer: Decide what you want, know your deal breakers, and don’t fall in love with an ad. Look for a horse that fits your budget, lifestyle, and goals. Take everything the seller says at face value. Ask your regular vet to perform the prepurchase exam. If they can’t, chances are they have a colleague in the area they can recommend.

Lastly, know that there’s nothing worse for vets than performing a postpurchase exam on a horse that didn’t receive a PPE and delivering the news that a new equine companion has terrible navicular changes or severe kissing spines (ask me how I know).

11/02/2026

Reminder this is Dr. Sisk’s last week to see appointments before starting maternity leave, as pony girl has a strict eviction notice by atleast 11/18. We have a few select appointments still available at the clinic on the 5th and 6th, as long as she does not have other plans. We will be seeing all appointment types, except for chiropractic.

Our plan is for Dr. Sisk to enjoy leave the remainder of November and December and slowly return back in January. She will still be available for some select appointments at the clinic, like health certs/coggins/vaccines, as well as virtual consults during November and December. The office will still be available to help field questions and med refills. Please do not hesitate to contact us during this time 417-448-0131.

10/30/2026

Why Does My Horse Have A Fat Leg?

Your horse’s sleek, strong legs have remained taut and unblemished throughout (and sometimes despite) his athletic pursuits. Then one day as you offer him breakfast, you notice he has a “fat” leg. Is it cause for alarm or something simple to deal with? Let’s look at the variety of causes for limb swelling.

Initial Assessment Steps
Before you assume the worst, consider that in many cases prompt recognition and treatment can resolve leg swelling. Jump on the situation and contact your veterinarian immediately rather than trying the wait-and-see approach.

First, you’ll want to gather information to share with your veterinarian before making the call. Rosemary Cuming, BVSc MS, MANZCVS, Dipl. ACVIM, of Scone Equine Hospital, in New South Wales, Australia, advises owners to make notes about the whole horse—not just his limbs.

“Pay attention to the horse’s demeanor, appetite, water intake, and f***l output,” she says. “Has the horse shown any signs of illness recently, or has anything changed regarding diet, deworming, medications, blanketing, bandaging, or bedding, for example?”

Matt Randall, DVM, of Collier Equine, in Waller, Texas, urges horse owners to also take the horse’s re**al temperature.

Cuming suggests making a checklist of questions to address. Watch the horse closely when he is standing still and then moving, and ask yourself:
* Does the horse appear comfortable, or is he showing stiffness?
* Is he lame? If so, to what degree?
* Is only one leg or are multiple legs swollen?
* Do you see any drainage or signs of a puncture or other wound?
Feel the affected limb(s), and note any abnormalities:
* Is there heat in the limb?
* Does the horse pull away due to pain following a light touch or firm palpation of the swollen area?
* Do you feel irregularities in the skin or hair, such as scabs and crusts, moist or oozing discharge, or abnormal lumps?
* Is the swelling localized (limited to a specific area), or is there generalized pitting edema (the fluid swelling is over a larger area and the tissue stays depressed after you press on the swelling with your finger)?
* Is the swelling in proximity to or within a synovial structure such as a joint or tendon sheath?

“Fever, lameness, and wounds involving synovial structures definitely increase the potential urgency for veterinary attention to limb swelling,” Randall says.

“Limb swelling can be innocuous or may be indicative of a localized disease process within one or more legs, or due to more serious systemic diseases involving other body systems,” adds Cuming. “Having a clear description of the type and location of swelling, the horse’s overall state of health, any history of previous limb swelling, and any recent management changes is information that helps your veterinarian assess over the phone whether the limb swelling requires immediate veterinary attention or can first be treated symptomatically and monitored.”

Here are five common diagnoses your veterinarian might make.

1. Stocking Up
“Stocking up describes swelling of the lower limbs (below the knees or hocks) in horses due to pooling of fluid (edema) in the tissues,” says Cuming.

Stocking up often occurs when horses undergo a period of restricted movement such as stall confinement, she says. A reduction in the normal physiologic pumping of fluid causes the lower limbs to swell. She likens it to swelling that might develop in your ankles following a long plane ride.
RELATED CONTENT: Is Hot Weather Making My Horse’s Legs Stock Up?
A horse’s lymphatic system is always working to move fluid, proteins, and nutrients around the body. “In the normal horse, fluid, proteins, and nutrients frequently leak out of blood vessels to bathe the cells of the tissues with needed nutrients,” says Cuming. “This fluid, together with cellular debris, dead blood cells, bacteria, and other pathogens (disease- or damage-causing organisms), toxins, and protein molecules, is then removed from the leg via lymphatic vessels, which are thin-walled, valved structures capable of containing large volumes of fluid. The lymph fluid is filtered through the lymph nodes and then returned to the bloodstream via the veins.

“There is no active pump (like the heart) in the lymphatic system, and so pressure and movement in the tissues and organs around lymph vessels influence flow,” she continues. “In horses’ lower legs, movements of the hoof’s digital cushion (the soft tissue beneath the sole that separates the frog and heel bulb from the underlying tendons and bones), the pasterns, fetlocks, ligaments, and tendons play an important role in helping to ‘pump’ lymph fluid up the lymphatic vessels against the force of gravity.”

While stocking up can occur in any horse, Cuming says veterinarians most commonly see it in older horses or those with previous leg injuries, cellulitis, or lymphangitis (see next section) due to less-efficient circulation. The best thing to do is to get the horse moving, she says. Active exercise with hand-walking, longeing, or riding should resolve at least some of the swelling. Support bandaging also helps reduce swelling rapidly. However, if used too long, bandaging further reduces lymphatic and blood flow and can perpetuate the condition.

2. Cellulitis and Lymphangitis
Significant and alarming limb swelling is often due to cellulitis or lymphangitis. Limb cellulitis typically occurs acutely—the horse seems fine, then becomes lame suddenly, says Cuming. Cellulitis is a diffuse bacterial infection of the skin and subcutaneous tissues that dissects rapidly and extensively through tissue planes. Bacteria such as staphylococcal or streptococcal species enter a break in the skin—sometimes you’ll see a wound, sometimes the infection’s entry point isn’t obvious, such as might occur if leg boots cause microabrasions in the skin, she says.

“The swelling causes significant lameness and fever and is usually in a single limb,” says Randall. “I have seen cases where multiple limbs were involved after too much time standing in nasty water when horses were trapped for days in floodwater after Hurricane Harvey” in 2017.

“The affected limb is characteristically swollen, hot, and very painful to the touch, with an associated moderate to marked lameness,” adds Cuming. “A small number of horses, however, will pull up lame without obvious limb swelling, and you only suspect cellulitis when you feel heat and mild pitting edema in the lame leg. In addition to pain and swelling, cellulitis may also cause a poor appetite, lethargy, elevated heart rate, fever, and oozing of serum from the skin of the swollen leg.”

Rapid recognition and early treatment of cellulitis are important to avoid other serious complications, such as supporting limb laminitis (founder in the opposite or supporting leg), dermal necrosis (skin tissue death, seen as sloughing), recurrent cellulitis, persistent lameness, and vascular thrombosis (clotting of the vessels). Any of these advanced problems can result in chronic debilitation or even the need for euthanasia, says Cuming.

Horses with ulcerative lymphangitis also exhibit lameness, fever, and lethargy, but with an additional clinical sign: Infection and inflammation can result in cording of the lymphatic vessels into chains of hard nodules that turn into abscesses that rupture. This occurs due to bacterial infection, such as Corynebacterium pseudotuberculosis (which causes pigeon fever), which is transmitted by biting flies, or due to deeper pe*******on by staphylococcal or streptococcal species. Cuming says bacterial infection isn’t always the cause of lymphangitis, though. It can also develop due to genetic anomalies, particularly in draft horses.

In chronic cases of lymphangitis, Randall and Cuming say permanent thickening of the tissue surrounding the lymphatic system can result in persistent swelling and stocking up, resulting in the limb staying thicker and larger in circumference than normal.

3. Infectious Disease
Infectious causes of limb edema tend to involve multiple limbs. “Typically, the horse has a fever and varying degrees of lameness and limb edema,” says Randall.

“Look for swelling involving all four legs, edema in other parts of the body such as under the jaw and in the sheath, and monitor for other clinical signs that your horse is sick rather than injured,” adds Cuming.

Signs of illness include fever, lethargy, decreased appetite, nasal discharge, increased respiratory rate or effort, colic (abdominal pain), or diarrhea.

Strangles, an infectious disease caused by Streptococcus equi, can create a potentially fatal secondary immune syndrome known as purpura hemorrhagica. In these horses, “edema is often quite severe in the limbs, chest, and abdomen, and petechiation (red spots due to small hemorrhages) develops in the mucous membranes and/or the sclera (white) of the eye,” says Randall.

Systemic viral infections can also cause leg swelling due to vasculitis (leaky blood vessels). “These diseases may be mild and self-limiting (resolving on their own) or can be life-threatening,” says Cuming. “Examples include viral infection from equine influenza, equine viral arteritis, equine herpesvirus, or Hendra virus (currently only present in Australia).”

While not infectious, low blood protein concentrations or circulatory compromise related to congestive heart failure or inflammatory bowel disease can also result in multiple limb edema.

4. Injury
Swelling in a single limb is commonly associated with a problem located anywhere from the skin surface or deeper subcutaneous tissues to tendons, ligaments, tendon sheaths, joints, or bones. The many reasons a single limb might swell include:
* Tendon or ligament injury;
* Bony sequestrum formation (when a piece of bone dies and separates from healthy bone) following previous blunt or penetrating trauma to the leg;
* Pastern dermatitis (greasy heel/mud fever/scratches);
* A foot abscess;
* Joint or tendon sheath sepsis; and
* Ringbone.

“Probably one of the biggest tipoffs that swelling is related to an injury is that at least initially, the swelling is localized near a tendon or ligament rather than circumferentially surrounding the entire leg,” says Randall. “Typically there is no fever, but lameness varies significantly depending on the injury and the individual. I’ve seen horses with ruptured superficial digital flexor tendons that walk fine, except for increased fetlock drop. Chronic suspensory branch injuries may have more diffuse and extensive swelling, but it’s usually more fibrous with less edema.”

He says swelling from a foot abscess usually doesn’t advance past the upper pastern. However, at times edema might extend all the way to the carpus (knee) due to constricted blood vessels in the foot, combined with low-grade ascending cellulitis related to the infection.

Similarly, wounds tend to develop localized swelling that might become more widespread due to infection.

To differentiate between the many injuries a horse can incur, your veterinarian will perform a thorough physical examination, followed by a lameness exam and appropriate diagnostic tests based on clinical findings. Testing possibilities include radiography (X rays), ultrasound, advanced diagnostic imaging (MRI, CT, nuclear scintigraphy), tissue biopsy, and bacterial culture and antibiotic sensitivity.

5. Windpuffs
Windpuff is a word that simply describes swelling within a digital structure, such as a tendon sheath, bursa, or joint capsule. Randall says many of these are innocuous and mostly cosmetic in nature, especially if they’re similar in both front or hind legs.

“I don’t get too excited if a horse is doing its job without complaint, showing no lameness, and is negative to palpation and flexion of the limb, especially if the effusion (fluid buildup) improves or doesn’t worsen with exercise,” says Randall. “Windpuffs tend to occur secondary to an inflammatory response within the joint or tendon sheath that increases synovial fluid that distends and stretches the synovial structure

Just like the loss of elasticity that occurs after you stretch a rubber band, the capsule or sheath often remains stretched and retains some fluid to make a “puff.”

the effusion is in only one limb or the horse is sensitive to palpation or joint flexion, Randall recommends doing further diagnostic testing. Cuming agrees: “If these swellings are asymmetrical (just in one leg or on one side of the leg) or appear suddenly, grow in size, are hot or painful on palpation, or are associated with a known injury or lameness, then this may indicate an acute injury.”

Examples include a torn ligament or tendon or an acute flare-up of a chronic injury, both of which necessitate prompt veterinarian attention, she says.

Take-Home Message
Many instances of limb swelling are fairly innocuous but can foretell a significant underlying problem. Always get your veterinarian involved to assess if and what needs to be done to address the swelling.
The Horse

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