Ringbone in Horses


Among the things that can happen to our horses is the dreaded ringbone. It’s named ringbone, as it often creates a bony growth around the pastern. But it’s not just that simple.


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What is ringbone, anyway?


  • Ringbone happens when your horse’s body decides to create more bone than it needs. Usually, there’s injury or swelling around the pastern, and this is where the extra bone growth occurs.


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


Where does this happen?


  • Let’s talk a little anatomy here. From the bottom up on your horse’s leg, there’s the P3 (coffin bone), the P2 (short pastern bone) and P1 (long pastern bone). Above that is the fetlock. In between the P3 and P2 is the navicular bone, sitting at the back of the hoof.


  • The P3 coffin bone sits inside the hoof. The P3 and P2 joint is the coffin joint. The P2 ad P1 joint is the pastern joint.


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


  • If ringbone is interfering 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 is holds the weight of your horse. This 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.


front view of a skeleton model of ringbone

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


What causes ringbone?


  • Horses, like humans, will try and 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 easily spiral out of control.



  • Ok – back to the inflammation in and around the joints. If there’s too much tension, your horse’s body says “do something – make it stable again!”. He does this by laying down more BONE. And then the bone gets in the way of movement. This creates a cyclical process – more damage, more bone.



icing a horse fetlock and pastern area

So much ice. So much goodness.


What are risk factors?


  • 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 pay a large role here. Upright pasterns and horses that are toed in are likely to develop ringbone. As is the horse that sustains a lot of pounding – like the jumpers, polo ponies, and even some horses in the western disciplines like reining. All of these horse jobs have one thing in common – repetition. It’s wear and tear.


  • A horse that has a sudden injury in the pastern area is also predisposed to ringbone. An injury can jump-start that inflammation that escalates in a bad way.


  • And let’s talk about footing and fat. Repeated work on hard ground, especially with young horses, can lead to ringbone. And overweight horses! Besides being bad for a horse’s metabolism and increasing a horse’s laminitis risk, that added weight strains your horse’s legs.


jumping horse showing strain on the front legs and pasterns

That’s a lot of strain on the legs!

What are the 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 significant 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. I’ve never been a fan of “wait and see”, I’m not going to start now.


  • You may also find that your horse’s pastern area is swollen or warm. Or your horse is flinching when you inspect his coronary bands, which you do daily. Right?


  • Under saddle, you may find that your horse’s gait is choppy, different, or tight. A horse in pain often loses forwardness and may become unwilling to do his job. Again – the signs of ringbone are quiet and subtle, so keep your eyes peeled and notice trends.


x ray of hoof and pastern

Your vet will need x-rays for a diagnosis. Most likely.


How is ringbone diagnosed?


  • At the first signs of anything going on with your horse, you vet should be looped in. Lameness exams that include flexions are a great place to start. Very often, vets will also add nerve blocks to a lameness exam to pinpoint the origin of pain. The lower leg is numbed in stages from the hoof upward. When a horse trots soundly or is improved after a nerve block, it’s likely that the last nerve block affected the location of the pain.


  • The diagnosis of ringbone is also made with x-rays. You can physically see bony changes that ringbone can create. Ringbone is degenerative and doesn’t have a cure, which makes early intervention important.


How do you support your horse?


  • There are SO many options to help a horse that has ringbone! Some of them are designed, as the condition progresses, to help your horse be as comfortable as he can be. You may also need to combine therapies and attack ringbone from all angles.


Your farrier should absolutely be a part of your horse’s ringbone routine.


  • Every single horse will have a different treatment that helps him, largely due to the conformation and movement differences between horses. However, many horses with ringbone are helped when the horse’s breakover point changes so that he can lift that hoof off the ground quicker. Many horses also benefit from heel support, in the shape of pads, pour-ins, and modified horseshoes like a bar shoe. It’s likely that your vet and farrier need to collaborate to make a game plan and try several options.



farrier with horse hoof on hoof stand


And then there are the nutraceutical options.


  • You may recognize things like hylauronic acid (HA), methylsulfonylmethane (MSM), Omegas, and others. There’s a lot of missing information when it comes to nutraceuticals, as they are not regulated in the same manner as actual medications. You might get snake oil, or you might get something that helps your horse. More and more, there are reputable companies making supplements that are backed by actual and legit science, not just testimonials and fancy marketing. Your vet can be a great source of information on brands to explore.


  • All of these nutraceuticals aim to help the inflammation and discomfort that goes along with arthritis. The good thing about supplements that your horse eats is that they may also help other locations in your horse with arthritis – like hocks or stifles!


Ringbone may also be helped by targeted and tested treatments.


  • There are anti-inflammatory meds on the market for horses, like bute, banamine, and firocoxib. These meds are prescription, and like nutraceuticals, help the whole horse. They are not created equal, and some anti-inflammatories are not appropriate for long term use.


  • Biophosphate drugs are designed to interfere with bone remodeling. You may have heard of these to treat navicular diseases, and they show promise in other areas of a horse’s body, too.


bottle of horse medications

Many good things come in bottles.


  • And then you have the injections and treatments that go directly into your horse’s affected joints. You may have heard of steroids? These anti-inflammatory powerhouses are great at taking away pain in a joint. With a big but. They are not suitable for every horse, and may not be able to be used over time.


  • Joint injections may also be of the HA variety, or cells taken from your horse’s own blood, as in interleukin-1 receptor antagonist protein (IRAP) and platelet-rich plasma (PRP). There’s a new IRAP/PRP combo product, called Pro-Stride, that may also be an option for your horse. Good ol’ fashioned stem cells are also an option.


There are also fusion and surgical options for horses with ringbone.


  • When a joint has painful arthritis, the movement and pain can be lessened when the joint is fused. The fusion of a joint has a few steps – the cartilage needs to degenerate and the resulting bone surfaces start to grow together.


  • Your vet can inject a damaged joint with caustic substances to hasten this process. The injection jumps starts your horse’s own body to fuse the joint. While this is relatively inexpensive compared to surgery, it’s not accurate and may not be successful.


  • When it comes to surgical fusion, the procedure is best done on high ringbone situations. A fused coffin joint is best for horses that are going to be pasture ornaments. In high ringbone situations, the surgeon will physically remove the cartilage in the joint. Plates and screws are then used to join the bones together. Recovery is long, and outcomes uncertain. For low impact horse jobs, like light trail riding, return to work is more likely than a big-time show jumper.



ringbone in horses after surgery

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


Yes, this is a lot to take in. And ringbone does take time to develop. Working closely with your vet over time is a great place to start. Do try and avoid the denial that something is ever so slightly wrong with your horse and that in time, he will “work out of it”. Be the best advocate for your horse!


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