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from the outside inward. Grouping pieces of similar design and color may also help to facilitate completion of certain portions. Others will make use of the picture on the box as a guide. Many of us sort pieces by appearance, whereas another group might use the shape of the pieces to determine their location. Although the knowledge of general puzzle-building concepts would be helpful to all of the individuals, all will find the specific method that works best for them. And in the end, everyone completes the same puzzle successfully.
It is important to realize that multiple observers formulating a multitude of visual impressions still have the ability to reach common conclusions when it comes to the location, degree, and nature of a horse’s lameness. Our visual perceptions, if carefully codified, can only facilitate and accelerate the process of accurate diagnosis.
In summary, don’t worry if you don’t see what others see. It is not important that we all agree on what we perceive, but rather that we reach similar conclusions. Use your own “built-in” detection hardware to find the alterations in movement that will steer you in the right direction. The important thing is that we glean as much as possible from the visual exam before moving forward.
SECTION III
Forms of Lameness
There are many terms used to describe and characterize lameness in the horse (fig. III.1). Gaining familiarity with both the literal and conceptual meaning of each (as it pertains to one’s visual interpretation) is vital to becoming a competent observer. The outward expression of various forms of lameness will be discussed in section VI (p. 157).
III.1 Common Forms of Lameness
| Limb Lameness | Associated with one or more of the horse’s limbs. Example: Foot abscessation usually causes severe limb lameness. |
| Axial Lameness | Affects the median anatomy of the horse, which comprises the head, neck, chest, back, pelvis, and tail. Concurrent limb lameness may or may not be present. Example: Horses with lower back pain will often display axial lameness when trotting in a tight circle. |
| Primary Lameness | Occurs as a result of injury, trauma, or an event outside of the horse’s body or control. Example: A chip fracture in the horse’s knee would result in primary forelimb lameness. |
| Secondary Lameness | Occurs as a result of an issue or lameness that coexists elsewhere in the horse’s body. Example: A horse suffering from a chip fracture in the knee might develop secondary suspensory desmitis in the other forelimb due to excessive overloading of the latter. |
| Simple Lameness | Only one limb or region of the horse is affected. Example: The recent loss of a shoe might produce a simple lameness associated only with the affected limb. |
| Complicated Lameness | Multiple limbs or areas are affected. Complicated lameness can be interpreted as a conglomerate of simple components, since each is assessed separately during the evaluation process. Each complicated lameness comprises at least one primary component; other components might be secondary or tertiary. Example: Laminitis often results in complicated lameness involving both front or all four limbs. |
| Multifactorial Lameness | Refers to complicated lameness with two or more primary components, each of which will require exclusive attention during the diagnostic and treatment processes. Example: A horse with lower hock pain and forelimb coffin joint disease might be suffering from multifactorial lameness in all four limbs. |
| Unilateral Lameness | Affects the right or left side of the horse, but not both. Example: A loss of a single shoe often produces a simple, unilateral lameness. |
| Bilateral Lameness | Affects both sides of the horse. Example: Navicular syndrome is often considered a bilateral disease, affecting both front feet. |
| Quadrilateral Lameness | Affects both sides and both ends (i.e. all four limbs) of the horse. Example: Grass founder can make all four feet sore, producing quadrilateral lameness. |
| Pain-Mediated Lameness | Lameness resulting from something that produces pain (i.e. something that “hurts”). Example: Foot abscessation results in pain-mediated lameness. |
| Biomechanical Lameness | Lameness resulting from something that physically prohibits or restricts normal movement, in the presence or absence of pain. Example: Fibrotic myopathy of the horse’s hamstring musculature can generate biomechanical lameness in the affected limb. |
| Neurologic Lameness | Lameness resulting from neuropathy and usually due to a lack of motor innervation and/or reduced proprioception. Example: Horses diagnosed with wobbler’s syndrome often exhibit neurologic lameness. |
| Weight-bearing Lameness | Gait abnormalities will be most obvious during the stance phase of the stride, when the foot is in contact with the ground surface. Example: Due to severe pain, foot abscessation often results in obvious weight-bearing lameness in the affected limb. |
| Non Weight-bearing Lameness | Gait abnormalities are most evident during the flight phase of the stride, when the foot is airborne. Example: Fibrotic myopathy of the hamstring musculature often produces a biomechanical, non weight-bearing asymmetry by prohibiting full extension of the affected hind limb. |
| Combination Lameness | Lameness displaying both weight-bearing and non weight-bearing characteristics. Example: A recent chip fracture in the horse’s knee often produces simple, unilateral, combination lameness of the affected limb |
| Associated Lameness | A secondary lameness that occurs in the same locality and as a direct consequence of a primary issue. Example: Altered loading of the lower limb due to fetlock joint pain could precipitate associated bruising of the foot. |
| Compensatory Lameness | A secondary issue that occurs in a different locale or limb and as an indirect consequence of a primary lameness. Example: Moderate hock pain might produce compensatory forelimb lameness as a result of chronic overloading and excessive challenge to the suspensory ligaments. |
| Referred Lameness |
An artificial precipitation of gait deficit(s) occurring in one
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