Ringbone in Horses: Prevention, Diagnosis & Treatment

Ringbone is a degenerative condition that affects the bones and joints in the horse’s lower limbs. It is characterized by the inflammation of surrounding connective tissue, triggering the formation of bony growths around the affected joints. ^[1][2]

These visible bony growths can manifest on the front of the pastern and coffin bones, potentially resulting in permanent fusion of bones in the joint. ^[3][4] Ringbone may or may not cause pain, but common signs include lameness, stiffness, and swelling of the pastern joints. ^[4]

The development of ringbone may be influenced by various factors, including conformation, trauma, repetitive stress and joint instability. ^[4] It can occur in horses of any age or breed but is more commonly seen in older horses.

To ensure the horse’s comfort and soundness, regular monitoring and effective management of ringbone are essential. Seek guidance from a veterinarian and a knowledgeable farrier to develop a comprehensive, individualized treatment plan.

Ringbone in Horses

Ringbone is a form of osteoarthritis that can occur in both the front and hind limbs of horses. Osteoarthritis is a specific type of arthritis (degenerative joint disease) that involves the degeneration of joint cartilage and the underlying bone.

Ringbone in horses primarily affects the pastern and/or coffin joints. These are the joints located between the long pastern bone (P1 or proximal phalanx) and the short pastern bone (P2 or middle phalanx), and between the short pastern bone (P2) and the coffin bone (P3) respectively.

The pastern, located between the hoof and fetlock joint, is a flexible and resilient structure that plays a vital role in absorbing shock and providing support during movement. It serves to cushion the impact of the horse’s weight and forces generated during locomotion. ^[1]

Ringbone is characterized by the development of bony growths, called exostoses, along the edges of the affected joints within the pastern. These bony growths are the result of the body’s attempt to repair and stabilize the damaged joint.

As the condition progresses, these bony growths can cause pain, lameness, stiffness, inflammation, and reduced range of motion in the affected limb.

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Low vs. High Ringbone

Ringbone is classified into two types based on the location of the bony growths:

• High ringbone: Also known as proximal interphalangeal (PIP) joint arthritis, affects the joint between the long pastern bone (P1) and the short pastern bone (P2). This condition is a common cause of lameness in horses of all breeds. ^[5][6]
• Low ringbone: Also known as distal interphalangeal (DIP) joint arthritis, affects the joint between the short pastern bone (P2 or middle phalanx) and the coffin bone (P3 or distal phalanx). The DIP joint is situated inside the hoof, below the coronary band. ^[7]

The specific regions of the horse’s leg where degenerative changes take place can influence the severity of lameness and the response to treatment.

Articular vs. Non-Articular Ringbone

Ringbone can also be classified into types based on the location of the bony growths within the joint. This classification takes into account whether the bony growths occur on the joint surfaces or on the structures surrounding the joint.

• Articular ringbone: Characterized by the development of bony growths on the joint surface, specifically in the proximal interphalangeal (PIP) or distal interphalangeal (DIP) joint. It is associated with more severe lameness and joint pain compared to non-articular ringbone, as the bony growth directly affects the joint surfaces. ^[3][8]

Articular ringbone occurs when the periosteum, the outer sheath of the bone, becomes inflamed due to stress-induced pulling and tearing of the surrounding ligaments and attachments. This disturbance of the bone sheath can lead to excessive bone growth.

This condition is commonly seen in horses that do not perform at high speed, such as the draft horse. Their stocky conformation, increased weight and upright patterns put additional stress on the bones.

• Non-articular ringbone: Also known as periarticular ringbone, this condition refers to bony growths that develop outside the joint in the surrounding tissues, tendons and ligaments. Non-articular ringbone is commonly associated with high ringbone and typically leads to mild to moderate lameness. ^[3]

Clinical Signs

Bony growths that manifest in horses with ringbone often present as visible protrusions, raised bumps, or ridges on the front surface of the lower limb. These growths can give rise to the following clinical signs: ^[1][4]

• Chronic lameness (moderate to severe)
• Sudden, acute onset of lameness
• Joint or ligament swelling
• Pain during flexion of the joint
• Loss of mobility of the joint

Signs of ringbone can vary in severity among horses and are influenced by factors such as the disease stage, the location and extent of bony growth, and the horse’s pain tolerance.

During the initial appearance of ringbone, horses commonly experience intermittent swelling and lameness. However, with sufficient rest, these symptoms are likely to subside. If the horse is reintroduced to work, there is a possibility of lower leg swelling recurring until the bony growths have fully formed. ^[3]

In cases where ringbone forms outside of the joint surface, lameness may resolve once the bony growths become apparent. However, if the joint is directly affected, lameness is likely to persist and worsen over time. ^[1]

Risk Factors

The development of ringbone in horses can be influenced by various risk factors, including the type of work performed, limb and foot conformation, shoeing practices, size, and age of the horse.
Although the exact cause of ringbone remains unclear, the following factors are commonly associated with an elevated risk of developing this condition: ^[4]

• Trauma: Ringbone can be caused by traumatic accidents and infections, including wounds resulting from wire fencing. Significant joint trauma can occur from direct blows to the limb following a fall or collision, potentially leading to the development of ringbone. ^[1][4]
• Wear-and-tear: Factors such as wear and tear, including strain or stress injuries, to the joints and associated cartilage can contribute to the development of ringbone. ^[4]
• Performance sport: Jumping and dressage horses have a higher risk of osteoarthritis in the limb joints. Polo ponies and horses engaged in Western disciplines are also more prone to developing ringbone due to the nature of their sports, which involve high-speed work and sudden stops.
• Osteochondrosis (OC): This orthopedic disease is characterized by the abnormal development of joint cartilage and underlying bone. It is most seen in young, growing horses and can result in joint damage in various areas of the body. Horses affected by OC may be predisposed to developing ringbone. ^[4][9]

Diagnosis

The diagnosis of ringbone in horses commonly includes a comprehensive veterinary evaluation encompassing injections, diagnostic imaging, and clinical observation.

The veterinarian will evaluate the horse and gather a medical history, observe its movement and flexion, and perform palpation of the pastern and coffin joints in the affected limb.

By comparing the affected limb to the unaffected contralateral limb on the opposite side of the body, the veterinarian will look for indications of swelling, pain, or bony abnormalities that could suggest ringbone or another joint condition. ^[4]

Nerve Block

A nerve block is a diagnostic technique employed by veterinarians to precisely locate the source of pain and inflammation in horses. It involves injecting a local anesthetic around the nerves of the limb, temporarily blocking pain signals in the suspected ringbone-affected joints.

Because the nerve block numbs the joint, the horse becomes sound following injection. This allows the veterinarian to identify the specific area where the horse experiences pain and inflammation related to ringbone. ^[1][3] The veterinarian can then assess the degree to which ringbone contributes to the horse’s lameness.

Radiography

Radiography is a musculoskeletal imaging modality used to evaluate the extent and location of the bony changes associated with ringbone. X-ray images can provide detailed information about the condition of the affected joint, the severity of bony changes, and the presence of any associated joint inflammation. ^[4][5]

The horse’s leg is positioned and immobilized so images of the distal limb can be taken. Images of the contralateral limb can help to determine the severity of ringbone in the affected leg. ^[3]

During the early stages of ringbone, soft tissue swelling may be noticeable, but X-rays might not reveal any evidence of the condition. However, upon re-evaluation of the horse several weeks later, the X-ray images may show positive indications of ringbone.

Treatment

The treatment for ringbone focuses on managing pain, reducing inflammation, and slowing down the progression of the condition. The specific treatment approach can vary based on the severity of ringbone, the affected joints, and the unique needs and intended work of the individual horse. ^[4]

Resting the affected horse and limiting exercise can help to reduce stress on the joints and alleviate symptoms. Some controlled exercise, such as hand-walking or light turnout, may be recommended by a veterinarian to maintain joint mobility without exacerbating lameness. ^[1]

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs), such as phenylbutazone (bute), flunixin meglumine (Banamine), and ketoprofen are frequently used to manage pain and reduce inflammation associated with ringbone. ^[1][4]

These medications temporarily relieve discomfort and improve mobility. Consult a veterinarian before treating your horse to determine the appropriate dosage, treatment duration, and potential side effects.

Intra-articular corticosteroids, such as dexamethasone, are frequently employed in veterinary medicine due to their anti-inflammatory properties. They serve as an effective treatment for arthritis and ringbone in horses by managing pain, reducing inflammation, and enhancing joint function. ^[10]

Corticosteroids work by suppressing the immune response, effectively diminishing inflammation within the joint. When administered directly to the arthritic joint, they can have a more potent and immediate effect compared to systemic medications, targeting the inflammation more precisely. ^[4]

Chondroprotective drugs, such as hyaluronate or polysulfated glycosaminoglycans injected into the joint space may also benefit horses with ringbone. ^[3]

Nutritional Support

Horses with ringbone typically have significant inflammation in and around the affected joint(s), which can contribute to discomfort and pain. Omega-3 fatty acids are recognized for their beneficial role in managing osteoarthritis, primarily because of their anti-inflammatory properties. ^[11]

Mad Barn’s w-3 Oil is an essential fatty acid supplement that is enriched with natural Vitamin E and docosahexaenoic acid (DHA). Feeding DHA can support joint comfort and mobility in exercising horses.

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Corrective shoeing

Your veterinarian may recommend corrective trimming and shoeing to help slow the progression of the condition and improve the horse’s comfort. Trimming the hoof or applying specialized shoes can change the toe positioning to support limb movement in horses recovering from ringbone. ^{[3] [4]}

In horses, breakover denotes the point in the stride when the hoof shifts from the stance phase (touching the ground) to the swing phase (lifting off the ground). Enhancing breakover can be achieved by using rolled or squared toe shoes. This modification may help reduce the leverage on the affected joint. ^[12]

Surgery

In cases of acute or chronic ringbone, surgical arthrodesis (pastern joint fusion) may be recommended by your veterinarian. By permanently fusing the joint, movement is limited and the joint is stabilized, reducing pain and restoring functionality. ^[4][13]

Following surgery, the lower limb is typically put in a cast for up to two months. After the removal of the cast, the horse may be kept on stall rest depending on the horse’s recovery rate. Your veterinarian may recommend limited hand-walking once the X-rays show no abnormalities. ^[3]

Prognosis

Non-articular ringbone in horses typically has a favorable prognosis if treated promptly. On the other hand, articular ringbone, which involves the joint surface and is degenerative in nature, tends to have a more guarded prognosis.

Compared to surgery in the forelimb, horses undergoing fusion surgery in the hindlimb generally experience fewer complications and have favorable outcomes. Approximately 65-85% of horses that undergo this surgery are able to return to their previous level of activity. ^[8]

Complete reversal of either type of ringbone is not possible, emphasizing the importance of appropriate management to alleviate symptoms and maintain soundness in affected horses. ^[3]

Prevention

While prevention of ringbone may not always be possible, there are measures that can be taken to minimize the risk or delay its onset. It’s important to acknowledge that certain factors, such as genetics or poor conformation, may be beyond control.

The following management practices can be implemented to help reduce the risk of horses developing ringbone:

• Proper hoof conformation: Regular trimming and appropriate shoeing play a crucial role in maintaining balanced hoof angles, proper alignment, and optimal hoof health. Proper farrier care ensures that forces are distributed evenly across the hoof, reducing stress on the joints.
• Regular exercise and conditioning: Training programs should be tailored to the horse’s fitness level. Proper conditioning plays a key role in promoting optimal joint health. By gradually improving the horse’s strength and stamina, it is possible to limit excessive or sudden stress on the joints.
• Appropriate footing: Providing appropriate footing in turnout areas, arenas and track surfaces can minimize the impact on the limbs and reduce the likelihood of joint strain. Proper footing also reduces the risk of trauma-associated ringbone.
• Weight maintenance: Obese or overweight horses face an elevated risk of degenerative joint disease (DJD) and ringbone due to excessive forces applied to their joints and lower limbs. Maintaining a healthy body condition in horses is crucial and can be achieved through a balanced diet and appropriate exercise.^[14]
• Balanced diet: Nutrient deficiencies can affect the maintenance of joints by negatively impacting tissue growth. Ensuring the diet is well-balanced with vitamins and minerals is imperative for developing strong bones, hooves and connective tissue, especially in growing horses, to support joint health.