Application of the Fetlock Support Shoe for Suspensory Desmopathy

Suspensory ligament injuries are a significant cause of lameness in performance horses and racehorses. Although treatments to decrease inflammation and stimulate ligament healing are used to treat most injuries, stress on these structures is unchanged as the result of normal weight-bearing required during rest. Use of a fetlock support shoe can facilitate healing by preventing excess stress on the suspensory ligament. This technique is particularly helpful in supporting the rear fetlock during treatment of suspensory ligament desmopathy. Authors’ address: Marion duPont Scott Equine Medical Center, Virginia Tech, PO Box 1938, Leesburg, VA 20177; [email protected].

1. Introduction

The fetlock support shoe or brace (also known as the “Roberts Shoe”) is depicted in books published in the early 1900s for treatment of tendon or suspensory rupture (Fig. 1).^1,2  In more recent texts, the various modifications of the support shoe are described. Although there are numerous descriptions in textbooks, there are few reports in the literature describing success or failure with different types of injuries.^3,4  A support shoe used for support of tendon lacerations was reported to be successful in restoring use in 60% of horses.⁵

Dorsal support of the fetlock can be provided by splints such as the Kimzey Splint^a  or in a cast, however, these are normally used during the initial phase of support but do not allow the partial loading of the suspensory ligament needed for healing over the long term. Attempts to attach a splint on the dorsal aspect of the limb have been used by the authors, but these splints do not allow normal flexion of the fetlock, and tension applied by the bandage behind the metacarpus/metatarsus and fetlock can result in pressure sores (Fig. 2).

Treatment for proximal rear suspensory ligament desmopathy (injury at the origin) is reported to be less successful in horses with straight rear limbs and excessive dorsiflexion of the fetlock, causing constant stress on the suspensory ligament (Fig. 3).⁶ 

To facilitate healing in cases of suspensory desmopathy, a fetlock support shoe was used by the authors to limit fetlock dorsiflexion and relieve stress on the suspensory ligament(s) during healing.
 

2. Materials and Methods

Chronically lame horses with rear-limb suspensory ligament lesions at the origin or in the suspensory branches (diagnosed by ultrasonography) were treated with a fetlock support shoe. All the horses had rest and surgical or regenerative medical treatment of the hypoechoic lesions. Selected horses with excessive fetlock dorsiflexion associated with proximal suspensory desmopathy were fitted with a fetlock support horseshoe for 1 to 2 months during a recommended period of stall rest.

The fetlock support shoe, which requires experience and skill for proper construction, was designed as a bar shoe with toe clips, an extended heel (3–5 cm), and two hex nuts welded to the heel extension. Two support rods were designed and measured with a length to reach just past the level of the fetlock for each horse. The rods were welded together near the shoe and inserted into the hex nuts. A setscrew in the side of the hex nut was used to keep rods from moving. This allows the rods to be removed for management of the bandage, which is needed for padding (Fig. 4). A support wrap with several layers of sheet cotton was applied from the coronary band to the proximal metacarpus/metatarsus. An elastic adhesive bandage^b was wrapped from side to side around the support rods and positioned tightly to support the fetlock when the horse bears weight on the limb. An alternative is the use of rubber tubing around the supports to provide more flexibility during weight-bearing. The brace can be left open or covered with a light bandage placed to cover the support rods, which allow the fetlock to flex during walking without any pressure on the limb. Adequate padding on the limb is required to prevent pressure sores on the back of the fetlock.

3. Results

Seven horses with excessive rear fetlock dorsiflexion and chronic suspensory ligament desmopathy were treated with a fetlock support shoe and rest. [...]