30/03/2026
Misty's road to recovery ❤️🩹
This cheeky little Welsh pony has had a bit of a rough time of late but we are happy to report she is on the mend thanks to her diligent owner, our ambulatory vets and the fabulous referral team at Rainbow Equine Hospital.
At the start of 2026, Misty developed a sudden onset severe right forelimb lameness that did not improve within the initial rest period she was recommended. In the first instance, our vet Alex nerve blocked her foot (palmar digital nerve block) which did not improve the lameness, meaning we need to look higher up! We often start with nerve blocking the foot as it is a very common cause of forelimb lameness as well being quick and easy to do while out on a yard.
In a follow up visit, as Misty was still not improving, our vet Luke repeated locomotor examination and noticed Misty was very reactive to fetlock flexion and palpation - particularly on the palmar (on the back of the leg) aspect. After a low-4 point nerve block (essentially blocking from the mid cannon, downwards), Misty's lameness was significantly improved (even so much so that she felt well enough to charge towards the grass verge for a quick snack!).
Now that we had determined the area the lameness was coming from, it was then a hunt to find exactly where! Luckily, there were a few clues... alongside resentment to palpation of the fetlock, after clipping the leg it became apparent that the back of the fetlock was markedly swollen and had a very firm prominence across the area that she was painful to touch.
With stableside ultrasound examination it was then determined that Misty's palmar annular ligament (PAL) was abnormal. Alongside general thickening there was also an irregular linear tear with loose superficial fibres. This gives us a diagnosis of PAL desmitis.
After discussion with Misty's owner, it was decided to refer Misty to Rainbow Equine Hospital in Malton, North Yorkshire to undergo MRI examination of the fetlock region and tenoscopic surgery (if required).
Misty's MRI confirmed the PAL desmitis and therefore surgery went ahead as planned. Surprisingly, when the PAL was cut during surgery, it became apparent that Misty also had a longitudinal tear of the lateral head of the DDFT... not visible on ultrasound or MRI until the PAL was cut! This case highlights the importance of tenoscopic examination for some conditions, in which surprises can compromise our initial prognosis.
Thankfully, Misty recovered well from surgery and seem to enjoy her stay at the hospital for the a few days! Nevertheless she is happy to be back in her own stable to carry out her rehabilitation period.
Today we visited Misty, 4 weeks post-operatively to carry out a planned tendon sheath medication as part of her treatment plan. As Misty is a patient that we carefully monitor for laminitis she is not a prime candidate for steroid use - luckily we can now offer a type of biologics called ProStride. This is a combination of PRP (platelet-rich plasma), IRAP (interleukin-1 receptor antagonist protein) and A*M (alpha 2 macroglobulin) all rolled into one injection. A blood sample is taken from the patient, we run it through 2 specialised biologics tubes and centrifuge the samples to collect a highly concentrated anti-inflammtory, regenerative solution. This solution is then directly injected into the structure that is damaged, to help the tissues to heal.
We wish Misty and her owner all the best luck in the world for the remainder of her rehabilitation period and we will of course always be on hand to help! 🐴