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Is My Horse Lame? Treatment and Subtle Signs to Watch For

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My trainer recently told me that our newly purchased racehorse, “ShirleyIgotchanow,” is lame. She looks fine to me and hasn’t been seen by a veterinarian. I wondered if he was right, so I decided to research lameness to find out.

A lame horse has a hindrance to its ability to travel normally because of physical impairment. Some horses present subtle signs of lameness, like a bob of their head when they walk. Many conditions that cause lameness can be treated successfully.

Lame horses can be a significant problem, but many fully recover with proper treatment and early diagnosis. The following sections explore identifying various lameness types and treatment options.

What is a lame horse?

A lame horse is analogous to a person with a limp. It is anything that can cause a horse to walk abnormally. If it’s not treated, it can turn into a long-term problem.

Lame animals adjust their gate to avoid putting pressure on the injured limb, which leads to imbalanced muscles, arthritis, and atrophy. The source of lameness may be diffuse pain or an injury to a specific area of the body.

The first step on the road to recovery is to determine the source of the pain. So what are the methods used to determine where the pain is coming from?

Picture of a horse with a bowed tendon, causing lameness.
Bowed tendon

Identifying the Source of Lameness in a Horse.

When trying to determine the origin of the lameness, you need to perform a physical examination of the horse. Feel each limb, pick up each leg, flex all the joints, access the range of motion, and palpate all the tendons and ligaments.

Look at the horse’s muscle symmetry and overall muscle of the horse, and watch her in action. Start by watching her walk towards you and then away from you. Did you notice a bob of the horse’s head?

If so, try to determine which foot hits the ground when her head rises. She will drop her head and neck when the good foot hits the ground and raise her head when the unsound foot hits the ground.

Watch her travel on both hard and soft surfaces. Bone and joint problems are more noticeable on a hard surface, and soft tissue injuries are easier to discover on a pliable surface. Repeat this process at a jog. Look for both subtle and obvious signs of lameness.

Watch her jog while being led. Examine her move in a straight line and circles. To accomplish this, put her on a lunge line, and have her move in circles in both directions. (Click here to check Amazon prices for lunge lines) Do you notice she favors her inside leg?

Lunging will place more pressure on the inside leg and will pronounce the pain indicators making it easier to determine the source of lameness. Next, tack her up and watch how she moves under the saddle — watching the horse move while being ridden can disclose underlying pain or sign of lameness.

Sacroiliac pain is worse when ridden. If she only displays lameness when ridden, you need to examine her tack to ensure it’s appropriately fitted. Throughout this process, look for subtle and visible signs of lameness.

Subtle Signs of Lameness:

  • changes in the way she usually goes forward
  • difficulty turning,
  • she is not paying attention
  • changes lead incorrectly
  • her body stays stiff
  • pinning her ears,
  • flaring nostrils
  • intense staring, unusual blinking, or keeping her eyes closed

Obvious signs of Lameness

  • reluctance to move in a small circle,
  • head bob,
  • shortened stride placement of the foot of the lame leg
  • lack of flexion of the foot,
  • asymmetrical hips

Once the general area has been identified as the source of pain, it will need to be isolated further.

For example, if we identified she is favoring her left front leg, we have to determine if the pain is from the foot, tendon, muscle, joint, or a combination of more than one area. We have a couple of ways to accomplish this goal.

First is the manual method, which is my term for manipulating the injured limb to determine the pain site. Manual manipulation involves putting pressure on the muscle, checking for heat in the tendons, and flexing the joints.

One standard test is the flexion test. To perform the flexion test, extend the joint fully, and hold for a full minute. Upon release, encourage the horse to walk immediately. If she walks with a limp, she may have a joint abnormality.

The flexion test causes an increase in pain in the joints and exacerbates the lameness. Repeat this for each joint until you rule out all joints in the unsound leg.

You can then examine the foot by putting pressure on the frog, soles, and hooves with hoof testers. The horse should react when the testers hit a sensitive area (See Here for Amazon Pricing of hoof testers).

A more advanced method to determine the source of the pain is nerve blocks. Nerve blocks are injections into an area believed to be the source of the pain.

If, after injection, the horse seems relieved of the pain, we know that we have identified one troubling area. At this point, we may need to perform further diagnostic testing. An MRI or X-ray can be used to further detail the damage’s extent.

Nerve blocks are useful for every area; an example where it would not be helpful is the fetlock joint.

Picture of yearlings in a field.

What causes a horse to be lame?

There are two categories when referring to causes of lameness: sudden onset lameness and subtle onset lameness.

Sudden Onset lameness

Sudden onset usually occurs when a horse takes a wrong step or stumbles; it can also be caused by overreaching or even an accident in the stall. It is an injury that has an identifiable source.

Some examples of sudden onset lameness are, stepping on a nail, getting kicked, or turning an ankle during a race.

Subtle Onset lameness

The subtle onset of lameness can be subtle or minor movement restrictions. This type of lameness often goes unnoticed. Low-grade inflammation, overextension, and a slight warmth in the tendon are types of subtle onset lameness.

They progressively get worse over time. The longer it goes untreated, the harder it is to heal fully and lead to severe problems.

However, if addressed, early conservative treatment should treat the injured area and return the horse to full strength. Seventy to Seventy-five percent of tendon injuries are caused by subtle onset.

Foot Lameness in horses

Front foot pain is the leading cause of lameness in sport horses. The pain can be attributed to many things, but mainly performance horse places a lot more weight and pressure on their front end.


For this reason, we will look in more detail at some of the sources of pain in a horse’s foot.


An abscess is an infection in the foot. It is typically caused by bacteria entering the hoof. It is a common problem and can show up on your horse quickly. The symptoms may be severe, but the prognosis is for full and fast recovery with proper treatment.


A bruise is swelling in the sole area. The injury can result from the horse having very soft feet or stepping on hard objects. It’s analogous to humans having a foot bruise. However, it can lead to an abscess if bacteria get into the bruised area.


Founder is technically referred to as laminitis. It is an inflammation of the laminae (folds of tissue connecting the pedal bone to the hoof). It can lead to the necessity of euthanization.

Founder is a common forelimb foot disease that causes pressure on the hoof wall and bone displacement. The pain is severe, and you can typically feel the hoof’s pulse and cause pain by applying pressure to the sole.

Coffin bone fracture

The coffin bone or pedal bone can be broken by a jump or misstep while running hard. The coffin bone is similar to our middle finger, but theirs extends into the tip of the hoof. With treatment and some time off, the bone can heal, and the horse returns to its normal activities.

Coffin joint inflammation

Coffin-joint inflammation may show as soft swelling above the coronary band, on either side of the extensor tendon running down the center of the pastern. The swelling is caused by increased fluid in the joint capsule.

Coffin bone inflammation

Coffin bone inflammation and degradation sometimes referred to as Pedal Osteitis, is the demineralization of the lower edge of the pedal bone. If caught early full recovery is possible; if not, it can be irreversible. The symptoms are similar to navicular disease or coffin bone fracture.

Tendon or ligament swelling and inflammation

Tendon injuries in the foot occur most often within the hoof capsule and the sheath around the tendon. Ligaments attach to the many bones in the foot. Tendons course throughout a horse’s leg and into its feet.

Deep digital flexor tendons stretch from a horse’s foreleg to its foot. In the hind leg, the deep digital flexor tendon originates in the tibia and inserts into the coffin bone.

Ligament injuries can be mild to severe. With early detection and treatment, full recovery is possible.

Low ringbone

Low ringbone develops because of the stress put on the pastern and ligaments. It’s an arthritic condition in the coffin joint just within the top of the hoof wall. Low ringbone tends to be very painful because any swelling or enlargement has little room to expand under the hoof wall, which adds pressure to the joint.

It can be treated with diet and proper shoeing if caught early enough. It is a difficult problem to detect in its early stages. High ringbone occurs in the lower pastern joint and can also cause lameness, but typically isn’t as severe as low ringbone.

Bursal inflammation

Bursal inflammation or cartilage injury- Bursa is a sack filled with fluid that provides lubrication to muscles, skin, or ligaments. Bursal inflammation is a swelling of the bursa, also referred to as bursitis.

It can be caused by trauma or stress. If left untreated, it can lead to long-term problems, including infections.

Navicular syndrome

Navicular syndrome is a group of problems associated with the navicular bone. The cause is not known, and the navicular syndrome is rarely cured. The navicular bone is a flat bone that lays across the back of the coffin joint and is attached to the pedal bone with a ligament.

Once the condition in the foot has been identified, then a treatment plan needs to be started. Usually, the treatment will include a combination of therapies. A critical starting point is ensuring proper feet balance with good trimming and shoeing.

As you can see, a lot can go wrong with a horse foot.

Treatment Options for Lameness in the Racehorse’s foot.

Proper shoeing

The right foot care begins with proper trimming and shoeing. The goal is to provide side-to-side stability, decrease the toe’s length to ease break over, and provide adequate heel support.


The support will decrease the tendon tension in the heel area. Less resistance at the toe equals less hoof wall stress and heel pain. A farrier may use therapeutic shoes in conjunction with the proper trimming to change the hoof’s angle and promote healing.

Pain medication

The most commonly used pain medication is “Bute”(Phenylbutazone). “Bute” also has anti-inflammatory properties to assist in the healing process.

Although not the only medication used for pain and inflammation, it is the most common. “Bute” is useful for treating foot lameness when combined with other therapies.

Intra-joint treatments

Steroid injections are the same treatment used on humans. Shooting cortisone into a joint to relieve pain. In a horse, the veterinarian will often use cortisone in combination with hyaluronic acid.

The cortisone will rapidly decrease joint inflammation, and the hyaluronic acid will help with the lubrication of joint edges and assist in rebuilding joint fluid.

Shockwave Therapy

Shockwave Therapy has been successful with some horses and not others. Its effectiveness is controversial and not often used.

Systemic joint medications

Systemic joint medications are designed to treat generalized joint inflammation and to help maintain soundness. They have limited benefits if the problem involves tendons, ligaments, and hoof balance.


The final option is surgery for horses not responding to other treatments. The type of surgery and the likelihood of recovery depend on the cause of lameness. I wrote a detailed article on equine leg injuries and why it’s often necessary to euthanize horses when they break a leg.

Picture of our horse after surgery on its hock.
Swollen hock

Other Causes of Lameness in horses

As we know, foot disease is the leading cause of lameness in a horse, but it is not the only cause.

Tendon lameness

Tendon lameness can be caused by overstretching of tendons that can damage the fibers in the cord. The damage can range from very minor to significant tears or even rupture.

If caught early enough, it can be treated with rest. This injury will display heat in the damaged region. Bowed tendons are tears of the superficial digital flexor tendon in the middle of the cannon bone region.

These tears cause a curved, bow-like swelling on the back of the leg between the knee and the ankle. 

Bone spavin

Bone spavin is an inflammation of the hock. It is the most common hind leg lameness, and it’s treated with injection into the hock joint.
Tenosynovitis is also a cause of lameness involving the hock area.


Osselets are inflammation and swelling in the fetlock joint. It likely is caused by overworking the joint. Heat is often present in the joint.

Stifle lameness

Stifle lameness is a common condition in the hind leg. The stifle joint is the largest joint in the horse and is similar to the human knee. And like our knee can have the same problems. Meniscus tears, joint instability, and arthritis.

Knee lameness

The knee on a horse is complex. It can be damaged for various reasons, including conformation irregularity, repetitive use, and traumatic impact. Most damage to the knee can be recognized by radiating heat in the affected area.

If knee damage is left untreated, it could lead to arthritis. Chip fractures can be treated with surgery and are often successful.

Back pain

Back pain is usually secondary to lameness in a leg and is caused by compensating for the pain by unnaturally twisting the back. Once the primary source of pain is removed, the back pain will also be relieved.

Pelvic lameness

Pelvic lameness is not common; however, it can occur from a traumatic event. A fall can damage ligaments in the pelvic area leading to a horse not being able to walk correctly. If the injury to the pelvic area is diagnosed, early full recovery is expected.

A horse’s body is complex, and many things can disrupt a horse’s gait. We looked at some of the causes and will now turn to the rehabilitation process.


Rehabilitation of a lame horse.

A veterinarian should design a targeted physiotherapy plan to address your horse’s lameness. Some programs may include massage, chiropractic, acupuncture care, joint mobilization, and activation exercise.

The following rehabilitation program is standard for early-onset signs of lameness caused by tendon strain.

After a tendon injury occurs, it is important to ice the affected area or run cold water over it. Next, wrap the leg and give an initial treatment of nonsteroidal anti-inflammatory drugs. (Check Amazon for prices on leg wraps here) Contact the veterinarian and try to determine the severity of the tendon damage. 

Often your horse should get stall rest, and its exercise is limited for at least two months. During this time, run cold water over the tendon and wrap the leg with polo wraps. During periods outside of the stall, she should be kept on a lead rope.

Two months of treatment should allow the tendon to heal and prevent any injury recurrence. The topical application of DMSO may help decrease residual swelling in the leg.

Ultrasounds of the tendon are warranted every sixty days to evaluate the progress of the injured tendon. Once the leg begins to improve, you can introduce jogging and allow the horse into a small paddock to move around independently.

Check here for asymmetry, atrophy, and abnormal development. Look for swelling, heat, or lumps and bumps. Increase exercise gradually over the next couple of months.

Eventually, she will be able to go through an hour of activity, with 30 to 35 minutes of trotting and five minutes of galloping. You should continue ultrasound exams to monitor the progress of the tendon, along with full lameness examinations.

The plan is to move the horse to full recovery without causing any setbacks. Ligaments are fragile and can be reinjured easily. Monitoring progress with the ultrasound and palpating the leg will help prevent recovery delays.

There are several other techniques used today to heal tendons. However, none have been universally accepted. These include pin firing, stem cell, plasma therapy, tendon splitting, electromagnetic, and low-power laser treatment are just some of the methods.

Your veterinarian is the best source to determine the best plan for your horse. Although tendon injuries are a severe lameness source, they can be successfully treated, just like most other sources of lameness.

However, the horse will need time to heal and return to his pre-injury condition. Be patient, monitor your horse, and realize you can’t eliminate some types of pain.


If you are ever in doubt about your horse’s health, it is always best to consult with a veterinarian. Early detection of lameness can prevent further damage and help get your horse back to being his healthy self. Have you ever had to deal with a lame horse? What tips do you have for others who may find themselves in this situation?


Can a lame horse recover?

It depends. Some horses with minor lameness may recover with rest and proper treatment, but others may have permanent damage and never fully regain their former soundness.

Can you ride a horse with slight lameness?

You shouldn’t ride a lame horse. Horses should be sound and able to carry a rider without any pain. If you are unsure whether or not your horse is sound, consult your veterinarian.

Can a horse be lame but not in pain?

Yes. A horse can be lame but not in pain. Horses may be lame for many reasons (e.g., injury, joint problems, muscle problems, etc.), and not all of these will cause them pain. For example, a horse may have ligament damage that restricts its movement but doesn’t cause any pain.

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