What is Ringbone in Horses?

What is Equine Ringbone?

• Think of ringbone as extra bone growth around an area, as if the bone has jumped out of its original shape to spread.

• Ringbone happens when your horse’s body creates more bone than it needs. Usually, there’s injury or swelling around the pastern, where the extra bone growth typically occurs.

• Ringbone can happen in the joint – called articular – or on the side of the pastern bone. The extra calcification can have zero consequences or be quite dangerous and debilitating.

Where Ringbone Affects Horses

Ringbone is typically around the pastern and fetlock area.

Equine anatomy refresher

The bones

• The last bone in the horse’s lower limbs is the P3, also called the coffin bone or distal phalanx. Just above that sits the P2, or short pastern bone, and P1 also called the long pastern bone.

• In between the P3 and P2 is the navicular bone, seated at the back of the hoof.

The joints

• Above all of the P’s is the fetlock joint.

• The P3 coffin bone sits inside the hoof. Where the P3 and P2 meet is the coffin joint.

• Where the P2 and P1 meet is the pastern joint.

The types of ringbone

High ringbone

• Ringbone is a type of arthritis that likes to hang out in the pastern joint, called high ringbone. This joint has tons of movement and, therefore, can be painful and problematic if extra bone growth occurs. This is the most common type of ringbone.

Low ringbone

• If ringbone interferes with the coffin joint, it’s called low ringbone. This happens just inside the hoof. There’s less movement here than the pastern joint, but this joint holds your horse’s weight. This situation is also quite painful, as the associated swelling and inflammation have nowhere to go – the hoof capsule contains it all. The coffin joint degenerates easily at the hands of damage.

The bottom bone here (the P3 Coffin bone) can be seen. This horse’s ringbone was high, affecting the P2 and P1.

Articular ringbone

• If the bony growth occurs on the joint surface, it’s called articular ringbone. This type is more painful and likely to cause severe lameness.

• When the outer layer of bone, the periosteum, is pulled and torn by the soft tissues around a joint, bony growth happens on the joint surfaces.

• Bulky horses with short patterns that weigh more often have articular ringbone. Their job doesn’t need to be speed-related for this to happen.

Non-articular ringbone

• When the bone grows outside the joint, it’s called non-articular or periarticular ringbone. It’s usually related to high ringbone cases, and lamenesses are not as severe.

Ringbone Causes – Swelling, Osteoarthritis, Infection, Injury

• Horses, like humans, will try to heal themselves and prevent further damage to their bodies. If a horse’s joint starts to experience stress, the surrounding soft tissues also get involved. The tendons and ligaments inflame, which can quickly spiral out of control.

• If there’s too much tension in an area, your horse’s body says, “Do something – make it stable again!” Sometimes, stability happens by laying down more BONE. Then, the bone gets in the way of movement.

• It’s a cyclical process – more damage, more bone, more damage, more bone.

Side note: Has anyone noticed how adamant I am about icing a horse’s legs after work? Ice reduces inflammation. 

So much ice. So much goodness.

Risk Factors for Ringbone in Horses

• As with all things horses – there’s a lot of genetics, conformation, and a horse’s job that come into play.

• The shape of your horse’s legs and hoof plays a significant role here. Conformation with upright pasterns and horses that are toed in are likely to develop ringbone.

• Horses subjected to a lot of concussion, like the jumpers, polo ponies, and even some horses in the western disciplines like reining, are more likely to develop ringbone. All of these horse jobs have one thing in common – repetition. It’s wear and tear.

• Footing matters, too. Repeated work on hard ground, especially with young horses, can lead to ringbone.

• A sudden injury in the pastern region is also predisposed to ringbone. An injury can jump-start that inflammation that escalates into excession bone growth.

• Overweight horses are more likely to develop metabolic disorders, like PPID and EMS, and therefore increase laminitis risk. Added weight also strains muscles, joints, tendons, ligaments, and hooves.

Read more about overweight horses here.

Signs of Ringbone

• You may have seen photos of horses with ringbone – you can actually SEE the damage and extra bone change the shape of the pastern area. By the time this happens, there is significant damage and, most likely, considerable pain.

• Like all things horse – signs of ringbone are subtle. It might start with a mild lameness or a different way of going, which should always be checked out. Early intervention is key.

• You may also find your horse’s pastern area swollen or warm. Or your horse is flinching when you inspect the coronary bands.

• You can feel or see changes to the pastern area sometimes. Abnormal bone development in that area is a source of pain you can palpate and sometimes visualize.

• Under saddle, you may find your horse’s gait choppy, different, or tight. A horse in pain often loses forwardness and may become unwilling to turn or jump.

• The signs of ringbone are quiet and subtle, so keep your eyes peeled and notice trends.

Your vet will need X-rays for a diagnosis.

How a Veterinarian Makes a Diagnosis

• A lameness exam is the first step in uncovering the cause of severe lameness or chronic lameness, which is subtle and mysterious. Any acute trauma to the area from an accident also warrants a thorough exam.

• A lameness evaluation usually begins with flexion tests. Your vet will flex and hold a joint and then watch as they trot away.

• To help pinpoint specific areas and joints, your vet may perform nerve blocks. Starting low in the leg, the area is numbed, and the flexions are repeated. That area is likely involved if the numbing changes how your horse responds to the flexion test.

• The diagnosis of ringbone uses X-rays and perhaps ultrasound, depending on the case. Several imaging techniques can help your vet narrow down causes and a treatment plan when evaluating joint health.

• You can physically see the bony changes that ringbone can create. Ringbone is a degeneration of the area and does not have a cure.

What’s the Prognosis?

• While there is no cure for ringbone, many horses find comfort depending on the severity of the condition.

• Try different therapies to find the best fit for your horse.

• Because this is a degenerative condition, the stiffness, mobility, and pain will change over time. Progression of the disease is not kind for some horses.

Corrective shoeing can be helpful.

Shoeing and Hoof Care with Your Vet and Farrier

• One place to begin helping your horse is by adjusting trimming and shoeing. If there are recent radiographs, these can help your farrier and vet come up with a hoof care treatment plan that mirrors their exact anatomy.

• Your farrier can change the breakover point so the hoof lifts off the ground quicker than usual.

• For the heels, supportive shoeing can help reduce pain. Pads, pour-ins, bar shoes, and other horseshoe variations support the heel better than plain shoes or barefoot trimming.

Ringbone can happen in any leg. 

Nutraceuticals, Supplements, and Medications for Inflammation

• There are plenty of supplements available to support joint and bone health.

Hyaluronic acid

• Hyaluronic acid (HA) is a natural substance that works to grease and cushion joints. There are oral forms and injectables, which directly target the specific joint.

• It’s found in the synovial fluid surrounding joints and helps reduce inflammation. When injected, it also prompts the joint cartilage to make more HA.

Methylsulfonylmethane (MSM)

• This inexpensive supplement has many functions. First, it may help with joint swelling, especially when associated with arthritis versus an injury.

• Range of motion and recovery after exercise may also improve.

• MSM may also stimulate the production of cartilage cells, act as an antioxidant, and support a healthy immune system.

Stabilized or cold-milled flax is delicious and so easy to feed. 

Omega-3 fatty acids

• Omega-3 fatty acids help your horse make prostaglandins, which are anti-inflammatory compounds. These acids also help support cartilage and soft tissues, like tendons and ligaments.

• The horse’s body needs Omega-3s and Omega-6s, but a healthy ratio is generally at least 4:1. A horse’s diet often lacks enough 3s to make this happen. Look for flax, chia, and fish oils to supply Omega-3s. Like MSM, it’s affordable and plentiful.

Snake oil or valuable supplement?

• The neutraceutical industry is not regulated the way medications are. The FDA regulates companies, and supplements are treated as a subset of food, not medicine.

• Supplements only have to be safe to consume, nothing else.

• For horse owners, we need to differentiate between testimonials and science and ignore fancy marketing.

• Many neutraceutical companies back their products with objective science, and it’s easy to find on a manufacturer’s website if you are looking for studies. Ideally, you can also find information about a specific product in a scholarly article.

Prescription Medications for Ringbone in Horses

Anti-inflammatory meds

• Bute, Banamine, and firocoxib are the big 3 pain meds for horses. These work on your horse’s entire body and are generally not intended for long-term use. Each has a different mechanism in the body and may exacerbate ulcers.

Bisphosphonates 

• Bisphosphonate drugs interfere with bone remodeling. You may have heard of these to treat navicular diseases. For horses with ringbone, these help relieve pain and strengthen the bones.

Injections

• Aside from intra-articular injections of HA, your vet can use steroids in the joints. Direct injection is a powerful way to deliver more benefit to the exact location. However, not all horses are candidates for steroid injections.

• Joint injections made from your horse’s blood are another option. Cells taken from your horse’s blood are spun down and multiplied before re-injection into an area. Two methods are interleukin-1 receptor antagonist protein (IRAP) and platelet-rich plasma (PRP). A new IRAP/PRP combo product called Pro-Stride may also be an option for your horse.

Many good things come in bottles.

Surgical Options for Ringbone in Horses

Non-surgical joint fusion

• Fusion occurs naturally when the cartilage degenerates and the bone surfaces join together.

• Your vet can inject the joint with medications to hasten this process, which triggers your horse to fuse their joint.

• While this is less expensive than surgery, it’s not as accurate and may be unsuccessful.

Surgical joint fusion

• When it comes to surgical fusion, the procedure is best done in high ringbone situations. A fused coffin joint is best for horses that will be pasture ornaments.

• The surgeon will physically remove the cartilage in the joint. Plates and screws join the bones together. Recovery is long, and outcomes are uncertain. For low-impact horse jobs, like light trail riding, return to work is more likely than a big-time show jumper.

This horse had surgery to fuse the pastern joint. You can see one of the three screws here, going from P1 into P2.

Ringbone in horses does take time to develop. Working closely with your vet over time is a great place to start. Do try to avoid the denial that something is ever so slightly wrong with your horse and that he will “work out of it” in time. Be the best advocate for your horse and seek veterinary care early.

That’s a lot of strain on the legs!