Q: My horse’s hind legs above his fetlocks swell up when he’s in a stall overnight. The swelling goes down when I turn him out or ride him. He doesn’t seem lame or sore. Should I do anything to treat the swelling?
GINA TRANQUILLO, VMD
A: This is a very common condition, especially in older sporthorses. Although it is likely benign, double-check that there is no heat or pain associated with your horse’s leg swelling. Slowly run your hands over the swollen areas to feel for heat and gently palpate the region to identify any tenderness. If he flinches in response to your touch or his skin feels warmer in these areas than elsewhere on his legs, he may be experiencing an acute inflammatory reaction to a tendon or ligament injury. Consult your veterinarian for a definitive diagnosis. Should he or she pinpoint a problem (most likely via ultrasound), the treatment may include stall rest.
If neither heat nor pain accompanies your horse’s swelling, he probably has a non-acute condition, such as windpuffs or stocking up. Windpuffs, also called windgalls, are residual inflammations from old tendon and ligament injuries. They usually occur on the back of the leg, at or just above ankle level, and are symmetrically shaped with the same amount of swelling on the medial side (inside) of the leg as the lateral side (outside). Windpuffs normally occur on both hind legs, although they occasionally appear on just one leg and sometimes can also be found in the front legs.
People often discover windpuffs without having known about the past injury because it never caused obvious lameness. Many times the initial condition is subclinical (showing no obvious symptoms), so when the resultant chronic inflammation is noticed later in the horse’s life in the form of a windpuff, no one is able to put a finger on the exact time of injury or trauma.
The original source of a windpuff can be any previous damage done to a soft-tissue structure in the ankle area, such as the superficial digital flexor tendon, the deep digital flexor tendon, the suspensory ligament or the sesamoidean ligaments. A windpuff can also result from a compromised tendon sheath (the protective tissue surrounding the tendons). Even though the injury may have healed a long time ago, the lining of the tendon sheath may continue to produce excess synovial fluid, which leaks into nearby structures. Noticeable in both acute and chronic conditions, excess synovial fluid is what provides the visual appearance of the windpuff. This fluid is usually removed by the lymphatic system, which pumps the body’s waste products and unused nutrients back up to the heart. However, gravity is always working against the horse. Especially in inactive and/or older horses whose lymphatic systems may be impaired, fluids naturally tend to accumulate in the lower hind legs.
The same gravitational forces and general impairment of the lymphatic system lead to stocking up, which is also characterized by excess fluid accumulation. Unlike windpuffs, stocking up may not be caused originally by an old injury. It is simply the body’s failure to pump fluid efficiently back to the heart, similar to a pregnant woman’s tendency to retain fluid in her ankles. Stocking up can occur in both hind legs, both front legs or all four limbs. The swelling is more generalized around the entire circumference of the lower leg compared to windpuffs’ relatively localized swelling.
Both stocking up and windpuffs occur in horses of all disciplines. Although aesthetically unpleasing, they are generally painless and tend not to interfere with a horse’s soundness or athletic ability. Depending on their severity, they usually subside with normal activity—riding and turnout. People often first notice the swelling at shows because their horses are confined to stalls and deprived of the regular turnout they enjoy at home.
The best way to treat chronic windpuffs and stocking up is with daily activity. At home, include plenty of turnout and exercise in your horse’s routine. When you are at a horse show, hand-walk him frequently or ask the organizers if a roundpen or paddock might be available for rent. Supportive standing bandages can also help to push the swelling out of the lower leg when your horse is stabled. Be careful, however, not to wrap the bandage unevenly or too tightly, which can damage tendons. Always apply at least a 1-inch-thick layer of quilting underneath the wrap. If you are unsure of your bandaging skills, ask an experienced horseperson for guidance.
If the appearance of your horse’s legs continues to bother you, consider trying acupuncture on him. I have found that performing acupuncture on horses with this type of benign swelling successfully reduces the aesthetically unpleasing appearance while also improving the horse’s overall health. Acupuncture can help to remove stagnation (blockages) in the various meridians of the body and increase movement of fluid, energy and blood. Placing an acupuncture needle into an acupoint releases an array of hormones in the body, triggering cells to aid in repair and producing a small inflammatory reaction (which contributes to the healing process) and pain relief as well as improvement in lymphatics.
When selecting an acupuncturist, be sure to use a vet who has been certified in acupuncture. Depending on the severity of the case and how long the condition has been going on, owners generally see improvement after just one treatment, although a horse may require maintenance treatments at different intervals, based on the individual.
Gina Tranquillo, VMD, grew up in Reading, Pennsylvania, showing Arabians. She then attended Wilson College, where she joined the intercollegiate hunt-seat team. After graduating from college, she worked as first a field reproductive assistant and then a technician for the Hagyard Equine Medical Institute in Lexington, Kentucky. She went on to complete her veterinary degree at the University of Pennsylvania before returning to Hagyard for her field-care internship. She joined Hagyard’s team as a field-care associate in 2011. Her current areas of interest include reproduction, field neonatology, preventive medicine, emergency services and sports medicine.
Riding took a back seat in Dr. Tranquillo’s life as she pursued her veterinary career and started a family—she and her husband, Jason, are expecting their second child—although she still enjoys spending time with horses through her work.
This article originally appeared in the July 2015 issue of Practical Horseman.