Case Studies

SDFT Injury

Successful Rehabilitation of a Severe Superficial Digital Flexor Tendon Injury: Insights from Ultrasound Imaging

Patient Profile

Age: 21-year-old

Height: 14.3 hands

Gender: Mare

Injury: Incurred field injury, diagnosed with severe superficial digital flexor tendon tendonitis

Date of Injury: 05.04.2023

First Scan: 11.04.2023 - 1 week post injury

The scan showed severe disruption of fibre pattern, loss of tendon echogenicity and swelling.

EqueStride device was applied - 2 weeks post-injury

1st Re-Scan: 12.05.2024 - 5 weeks Post-Injury

The scan revealed significant swelling and marked oedema within the tendon, along with severe disruption of the fibre pattern.

There was a concern that reinjury may be occurring during transitions between lying down and standing. To mitigate this risk, we initiated a gradual acclimatisation protocol over three weeks to build skin tolerance and allow for continuous wear of the EqueStride device.

Rehabilitation Protocol:

Exercise: Light hand-walking for five minutes, three times daily.
Support: Continuous 24/7 stable support using the EqueStride. The device was removed twice daily for skin checks.
Week 9 post-injury: Hand-walking duration increased, with the device set to high support.

2nd Re-Scan: 20.06.2023 - 11 weeks Post-Injury

Improved scan images, granulation tissue filling in the tendon, still disrupted longitudinal fibre pattern, still prominent enlargement of the tendon

Exercise: Started to increase walking exercise and reduce stable support

3rd Re-Scan: 25.07.2023 - 16 Weeks Post-Injury

Excellent progress on the scan, granulation tissue completely filled up the lesion, and a greatly improved longitudinal fibre pattern is present.

Exercise: 30 minutes of walk 2 to 3 times daily, plus small paddock turn out with EqueStride support

4th Re-Scan: 29.08.2023 - 21 Weeks Post-Injury

Excellent longitudinal fibre pattern alignment

Introduced ridden exercise. Sound at walk and trot without support

5th Re-Scan: 10.10.2023 - 6 Months Post-Injury

Exercise:

The mare was ridden 3 to 4 times per week with the EqueStride device, plus small paddock turn out.

Progress Update:
The mare continued to make excellent progress, with a steady increase in ridden exercise - walk, trot, and canter - beginning in November. By April 2024, she had successfully returned to both hacking and schooling, performing at a level exceeding her pre-injury baseline.

18-Month Milestone:
At 18 months post-injury, there have been no reported setbacks or signs of reinjury, indicating a highly successful rehabilitation outcome.

Suspensory Ligament Rehabilitation

Rehabilitation of Degenerative Suspensory Ligament Desmitis

Patient Profile

Age: 18-year-old

Breed: OTTB

Gender: Mare

Injury: Degenerative Suspensory Ligament Desmitis

Date of Injury: 23.10.2024

Clinical History
This case involved an older thoroughbred mare, a former racehorse, presenting with a cribbing collar and a body condition score (BCS) of 3/9, indicative of significant weight loss.

Findings on Initial Examination:

Distal Suspensory Branches (Hind Limbs):
- Bilateral swelling noted.
- Left hind: swelling is symmetric.
- Right hind: swelling is more pronounced medially than laterally.
Left Hind Limb:
- Proximal suspensory thickening observed.
- Marked fetlock hyperextension consistent with chronic suspensory apparatus failure.
- Although a soft angle is present in the right fetlock, the left is significantly more affected.

Locomotor Assessment:

Due to the high risk of overload and potential for sudden failure under stress, the trotting portion of the examination was kept extremely brief. A right hind lameness score of 3+/5 was noted, which cannot be fully explained by palpation findings. No additional joint or synovial distension, nor soft tissue swelling beyond the suspensory branch involvement, was detected.

Supportive Management Plan:

Farrier:
- Hind shoes fitted with long plantar extensions using a second shoe welded in reverse to create a “figure-8” configuration.
- Bandaging may have been required to prevent secondary abrasions or lacerations.
Orthotic Support:
- The EqueStride injury management device was recommended to provide continuous support to both suspensories over the next 2 to 3 months.

Observations at Time of Device Fitting:

Moderate swelling present around both hind fetlocks.
Mare exhibited significant discomfort while standing, frequently shifting weight between limbs.
Marked difficulty lifting either hind limb from the ground.
Fetlock hyperextension measured at approximately -20 to -30 degrees.
Initial reactivity to the support device was noted; however, the owner successfully applied both units under supervision.

Rehabilitation Protocol:

Week 1-5:

Gradual increase in support and duration over a 4 week period, started with 15 minutes/day on Setting 3. Increased up to 2 hours over 4 weeks time and managed to change to a higher setting (level 4) by the end of 4 weeks.

Week 6-12:

Noticeable reduction in swelling, and the mare was less reactive when the device was applied, the horse gained weight and showed less discomfort. Fetlock hyperextension improved by 5 degrees. Further increase in duration with the device on in the highest support setting up to 8 hours/day.

5 Months Post Treatment Progress Report:

The mare began trotting comfortably in the field, demonstrating excellent mobility and overall well-being. She gained weight and showed visible improvement in muscle development.

Fetlock angles appeared normal at rest, with only mild to moderate hyperextension observed during walking, an encouraging sign of improved suspensory function. All previous swelling has fully resolved.

Months 5–7: Tapering Phase
During this period, supportive measures were gradually reduced while closely monitoring for any signs of swelling, discomfort or fetlock hyperextension. The mare remained stable throughout, with no recurrence of clinical signs. Based on her sustained improvement, treatment was successfully concluded at the 7-month mark.

Suspensory Ligament Desmitis Treatment

Treatment of Degenerative Suspensory Ligament Desmitis (DSLD)

Patient Profile

Age: 12-year-old

Breed: Andalusian

Gender: Gelding

Injury: Degenerative Suspensory Ligament Desmitis (DSLD)

Date of Injury: 2020

Initial Management:
Conservative treatment focused on conditioning and strengthening the hindquarters. Shoeing adjustments were implemented, including the application of extended heel shoes in June 2024 to improve support and alignment.

Diagnostic Update:
A follow-up ultrasound (see above) on 02.07.2024 revealed persistent pathology in the suspensory ligament branches, indicating progressive degeneration. In response, EqueStride injury support management was initiated on 22.07.2024.

Biomechanical Assessment at Treatment Onset:
Fetlock hyperextension was measured using internal guidelines :

Left Hind (LH): –20° during walk
Right Hind (RH): –15° during walk

Clinical Observations Prior to EqueStride Injury Management:
The owner reported that the gelding consistently adopted a stance with his hind limbs placed forward and underneath his body, suggestive of compensatory behaviour due to suspensory discomfort.

Visual reference taken on 22.07.2024 to track progress

Visual reference taken on 23.08.2024 to track progress

1 Month Post-EqueStride Injury Management:

Significant improvement in fetlock stability was observed following one month of Equestride support management.

Fetlock Hyperextension Measurements (at walk):

Left Hind (LH): –5°
Right Hind (RH): –10°

These values reflect a marked reduction in hyperextension compared to initial measurements, indicating a positive response to treatment and improved suspensory support.

8 Weeks Post-Equestride Injury Management

At the 8-weeks, the gelding continued to show encouraging progress with improved fetlock stability.

Fetlock Hyperextension Measurements (at walk):

Left Hind (LH): –5°
Right Hind (RH): –5°

These values reflect a notable improvement from baseline, indicating a positive and sustained response to the EqueStride rehabilitation device.

Visual reference taken on

19.09.2024 to track progress

Rehabilitation Progress – October 2024

The owner reported a reduction in palpable swelling over the suspensory branches, with improved definition around the fetlock region.

A follow-up ultrasound examination conducted on 23.10.2024 revealed a mild residual increase in the diameter of the left hind medial suspensory branch. However, echogenicity and structural integrity had significantly improved, with a well-organised fibre pattern at the branch insertion, indicating positive tissue remodeling.

Ridden Work Initiation:
Ridden exercise commenced on 10.10.2024 using the EqueStride device, marking three months since the start of treatment.

Rehabilitation Protocol:

Gradual increase in device wear time, reaching 8–9 hours per day at the highest support setting (Level 4).
Controlled turnout maintained in a small paddock throughout the rehabilitation period to minimize strain and support recovery.

Distal Limb Injury

Rehabilitation of a Complex Traumatic Distal Limb Injury

Patient Profile

Age: 2-year-old

Breed: Warmblood

Gender: Mare

Injury: Complex Traumatic Distal Limb Injury

Date of Injury: 2024

Injury Overview : 30.04.2024

This horse sustained a severe traumatic injury in the field, involving multiple structures of the distal limb:

40% lesion of the Deep Digital Flexor Tendon (DDFT)
Avulsion fracture of the navicular bone
Impar ligament involvement
Lateral oblique sesamoidean ligament damage
Desmitis of the distal digital annular ligament

This multifaceted injury required a carefully staged rehabilitation plan focused on stabilising the affected structures, minimizing further strain and promoting tissue healing.

The mare experienced significant discomfort, spending up to 90% of her time lying down due to pain. Her treatment plan included multiple rounds of platelet-rich plasma (PRP) therapy and shockwave sessions. Initially, her leg was casted to stabilise the injury, followed by application of a Patten bar shoe to provide additional support and offload the affected structures.

Initial Response to EqueStride Injury Management

Although some improvement was noted, the filly remained reluctant to bear weight on the injured limb prior to intervention.

EqueStride Injury Rehabilitation Management Started: 09.07.2024
The filly showed improved comfort immediately after application of the EqueStride device and continued to put more weight on the injured leg.

Rehabilitation Protocol:

Exercise was gradually increased under controlled conditions.
After one month of consistent use, the filly was turned out for 10 - 11 hours a day, in a small paddock to encourage natural movement while maintaining a safe environment.

Imaging Follow-Up
Serial ultrasound scans demonstrated clear and consistent improvement in the affected structures over time.

Initial Imaging Date: 06.06.2024 Review Imaging Date: 20.08.2024

Final Outcome and Recovery Summary

Repeated ultrasound imaging at 2.5 months post-injury management revealed near-complete resolution of the lesion within the Deep Digital Flexor Tendon (DDFT), indicating excellent tissue healing.

The full course of treatment spanned 8 months. The filly returned to soundness and successfully resumed training one year after the initial injury, with no reported setbacks throughout recovery.