The Truth About Ringbone

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Ringbone is a common diagnosis. Horses young and old, backyard pets and high-level athletes alike are all susceptible to the disease. Some horses are unaffected; for others it spells the end of life, and for those in between it’s a lifetime of arthritis with or without lameness. As a vet, if I find it on a pre-purchase exam it’s a deal breaker. If I tell an owner a horse has it, it conjures up feelings of dread even for the seasoned horseman. Do a Google search on ringbone and you will get thousands of sites, and there are almost that many different opinions on how the disease develops, how to treat it and the prognosis for soundness. Here I will add to the discussion with the latest on ringbone.

Horse galloping on the sand

What is Ringbone?

Ringbone is a horseman’s term for osteoarthritis, or bony arthritis, of the pastern and/or coffin joints—ringbone in the pastern joint is called high ringbone, and in the coffin joint low ringbone. Arthritis is any condition that causes inflammation of the joint. Osteoarthritis forms when the inflammation within the joint creates enough damage that the body lays down bone in an effort to heal the damaged tissue. Typically the bony development occurs at the joint surface or the attachment sites of the joint capsule to the bone. Another term to describe this type of damage to a joint is degenerative joint disease (DJD).

The preferred veterinary terminology for high ringbone is osteoarthritis or DJD of the proximal interphalangeal joint (pastern joint); or in the case of low ringbone: osteoarthritis or DJD of the distal interphalangeal joint (coffin joint). For convenience, I will refer to the condition as ringbone.

Some also classify the type of ringbone as articulating, meaning involving the joint surfaces, or nonarticulating, meaning not involving the joint surface but rather the joint capsule where it attaches to the bone. Ringbone can start out as nonarticulating and advance into articulating. Non-articulating is less painful since it doesn’t involve the joint surface where weight bearing occurs and is therefore considered less serious.

The pastern and coffin joints are located in the lower limb of all four legs. The coffin joint is a large high-motion joint within the hoof; the next joint up is the pastern joint. The pastern joint is a small joint that doesn’t move very much but carries a lot of weight. It is located between the top of the hoof and the fetlock. Most people don’t even realize that a joint exists here.

How Does Ringbone Occur?

The most common cause of ringbone is abnormal stress on the joint, causing joint surface damage and subsequent bony development. The abnormal stress can be in the form of poor conformation, imbalanced shoeing or working on poor ground surfaces. Base-narrow or base-wide conformation, combined with a toed-in or toed-out stance, creates increased weight-bearing forces on the inside or outside of the joint by causing the horse to land first on the outside or inside of the leg. These increased forces can cause microdamage to the cartilage on the joint surface and microtearing of the joint capsule or of the collateral ligaments (stabilizing ligament on either side of the joint). The body reacts to this microdamage initially as inflammation. Inflammatory cells release toxins that create more tissue damage and thin the joint fluid. More tissue damage creates more inflammatory cells, and a cycle begins of increasing damage. As the damage increases the body attempts to heal initially with scar tissue, which then progresses into bony development.

The length of time it takes for this to occur varies and is dependent on many factors. The more trauma, and the more severe the conformational abnormalities, the quicker the disease progresses. Hoof balance, proper trimming and shoeing, footing and exercise are very big factors in this disease. Unbalanced hooves, as well as long toe/low heel, can cause severe stress on the joints. Shoeing a horse with shortened toes to increase breakover decreases the stress on the joints and helps reduce the inflammation, and can help slow the development of disease. Hard footing increases trauma on the joints, while deep footing increases the flexion of the joints leading to possible overflexion and damage to the joint capsule.

Other causes of ringbone include blunt trauma or lacerations to the joint, and osteochondritis dissecans (OCD). OCD is a malformation of the cartilage layer during a horse’s formative years—the disease leads to large flaps of cartilage within the joint. When a cartilage flap or “chip” is present in the joint, it creates a cycle of inflammation. In the case of trauma, a single trauma event, such as direct hit to the joint or a laceration, can cause the initial joint damage and start the cycle of inflammation.

How Do We Diagnose Ringbone?

Radiographs (X-rays) of the leg are the best way to diagnose the disease. The joint surfaces are usually very smooth, but when ringbone is present extra bone is seen on X-ray.

But it’s not always so easy. In the early stages of the disease, the bony changes may not be so evident. Often only a small “spur” is seen on the front of the joint, or some calcification away from the joint surface is visible where the joint capsule or collateral ligaments attach to the bone. Pain, and therefore lameness, is caused by inflammation within the joint. Sometimes a horse is more lame at this stage of the disease.

In these situations your vet must determine if the cause of lameness is from the joint or some other disease process; therefore it’s always important to perform a thorough lameness exam. This exam should include watching the horse move on hard and soft ground, jogging straight and in circles. Flexion tests and diagnostic nerve blocks are also important. Horses with ringbone flex positive in thelower limb, meaning lameness results when the lower limb is held in flexion for one minute and then jogged off.

Nerve blocks are invaluable in determining the location of the pain. Once the pain has been localized to the lower leg by response to an abaxial nerve block (block around the fetlock), the pain can be further localized by blocking out each joint. If low ringbone is the cause of pain, then the lameness resolves when the coffin joint is blocked out; in cases of high ringbone, lameness resolves when the pastern joint is blocked out. Diagnostic nerve blocks are very important in the cases where the X-rays are not so obvious.

The severity of the disease varies. Lameness doesn’t always correlate with radiographic changes. Some horses with mild bony changes on radiographs are very lame and vice versa. There are many sound horses with obvious ringbone in their pasterns. When a horse has significant high ringbone it can be seen on the front and sides of the pastern as hard lumps or a “ring” of extra bone around the front and sides of the pastern. If the ringbone can be seen easily it is already very advanced. Ringbone in the coffin joint is much more significant and always causes severe lameness since this is the higher motion joint.

As the disease advances it can spread into the joint, causing severe cartilage deterioration and joint collapse, ending in full fusion of the joint. During the process, the horse is severely lame. Sometimes the lameness can become so severe that the quality of life for the horse is very poor and humane euthanasia is chosen.

How Do We Treat Ringbone?

Dealing with ringbone is not a single treatment but rather a whole management scheme that is lifelong for the horse. Everything is aimed at decreasing the inflammation in the joint and saving the cartilage surface.

We start by trying to balance the hoof and increase the breakover for the horse. This means making sure the hoof is level from side to side and the toe is short so that the leg can roll over the front of the hoof quicker, decreasing the stress on the joints.

Next we address the inflammation in the affected joint. Often this means injecting the joint with anti-inflammatory drugs such as corticosteroids, along with synthetic joint fluid called hyaluronic acid that helps replenishthe existing thin, weak joint fluid. This helps stop the disease progression and hopefully slows down the damage to the joint surface.

Along with joint injections comes complementary therapy in the form of supplements, exercise management and physical therapy. Oral joint supplements given daily, such as chondroitin sulfate, glucosamine, MSM and more recently oral hyaluronic acid, may help the body to develop more cartilage and joint fluid.

Intravenous hyaluronic acid, called Legend I.V., and Adequan I.M. (polysulfated glycosaminoglycan) are also used quite successfully to preserve the joint. Legend works to produce more joint fluid and act as an anti-inflammatory. Adequan works at the joint surface helping the cartilage. Both are very effective and are often used together.

Herbal supplements may be given in feed to help support the joint. Yucca and devil’s claw are common herbal anti-inflammatories. A host of other products are available that combine all of these ingredients as well some others not mentioned in this article. Most appear to help, but none seem to be outstanding in resolving pain for ringbone. Care must be given when feeding herbal products to avoid allergic reactions or colic. Product concentrations are often inconsistent, and many of these herbs haven’t been studied fully in horses.

Horses with ringbone do best with consistent low-level exercise. Horses that stand excessively all day long tend to get more inflammation in the joints and therefore more lame. Constant walking around all day on pasture helps stimulate circulation and decrease inflammation within the joint, therefore decreasing lameness. The amount of exercise varies depending on the degree of ringbone and the tolerance of the horse. Some horses with this condition are able to maintain careers in the lower levels and often do better if kept in a consistent work program. Soft footing is better than hard, but too soft causes overflexion of the joint and increased inflammation.

Physical therapy is also available for these horses. Warm therapy helps loosen joints; liniments and wraps help support the joint. Massage therapy, acupuncture, chiropractic and other alternative therapies have varying degrees of efficacy, but all aim to loosen tissue and decrease inflammation, as well as help other muscles and joints that are compensating for the ringbone.

One promising new therapy called extracorporeal shockwave therapy (ESWT) is proving to be very effective for horses with ringbone. The true nature of how shockwave therapy works is still unknown, but it is the focus of much research right now by many major institutions.

What is known is that many horses show dramatic improvement with ESWT, so it’s become a therapy that is now being tried for a variety of problems. For ringbone it has proven to be effective for horses that are not too severe. I personally have seen many horses respond to the therapy, including my own horses.

Response to shockwave therapy appears to depend on severity of the ringbone and the aftercare. More severe cases require more than one treatment, typically one treatment weekly for three weeks. Many horses with less severe changes respond after only one treatment. It also appears that if the horse returns to regular exercise, the lameness resolves, but if the horse stands idle for any length of time, the lameness can return. Horses with severe ringbone don’t appear to respond to this therapy. As with all therapies, ESWT should be discussed with your veterinarian.

The Big Picture

The time between when a small spur forms and the joint fuses is our time to help the horse with ringbone. I use a combination of all the therapies mentioned above, and in most cases I can keep a horse active and happy for many years before the ringbone gets too severe. Thankfully, I haven’t had too many ringbone cases that I have had to put down, but I currently have a couple that I know I will have to sooner or later. These severe cases are lame but comfortable, and I usually inject their joints approximately once a year. Each time though, it becomes harder to inject the joint, and I know there will come a time where I won’t be able to due to the severe joint collapse and bony development.

For my ringbone patients that are doing well, I attribute it to good management on the owner’s part—essentially catching the problem early and giving good joint support. However, I have seen some of these horses become very lame, even with good joint management. Unfortunately I can’t predict which horses will do well and which won’t. Ringbone can affect any horse.

Janice Posnikoff, DVM, heads up Orange County Equine Veterinary Services in Southern California


This article originally appeared in the June 2005 issue of Horse Illustrated. Click here to subscribe.

38 COMMENTS

  1. My mother’s horse has high ringbone, so I’m reading up on it. The horse, a 15.2, 18-year-old TB mare, is sound even though the vet could easily diagnose it without X-rays. She was a hunter/jumper in a major show barn before we got her. This article helped me understand ringbone better.

  2. I own a 22 yr old gelding that has severe ringbone and sidebone in both front legs. He was diagnosed almost three years ago. Sadly my family doesnt have enough money for joint injections, or even for expensive joint supplements. But we have found that the only thing that helps him besides bute is MSM. Currently he is only taking bute on bad days when he hurts or is stiff. Which is a miricle in itself as both my farrier and vet who have lots of experiance with ringbone told me he would likely be on bute daily for the rest of his life. Once the weather gets warmer I even have their ok to ride him again. He just gets special trims by a corrective farrier and special shoes when needed. I thought it was a death sentance when I found out what was wrong with my boy. But as the time went on it showed how much of a trooper he is. We had a close call this last summer with his pain managment I thought I would have to have him put down. But he recovered from that bout of being ouchie. Today he bucks, canters, spins, rears, and raced with his best buddy, my dad’s horse. Which two years ago I would have never thought I would see him canter again.
    I hope that you do another article, maybe one with less of a sad tone to it and more encouraging with less expensive ideas. When he was diagnosed with ringbone I only found articles like this one. With just the hard facts and the extremely expensive treatments and it really dicouraged me.

  3. My comment is a question. Great article. Exactly how do you tell orginially the difference between laminitis or ringbone?

  4. I enjoyed reading this article. It has given me alot of information I needed. I recently found out my 8 year old gelding has navacular both front hoves and low ringbone in the front left. The vet said the ringbone is sever. I had my farrie put wedges on and cut his toe back, per my vets request. We was given two sets of injection in his joints. The injections seem to work for about 3 weeks but he came up limmping again. So we did the seccond set. Which was only 2 months from the first. The Vet took xrays to make sure the farrie had him in the corret postion, he is. The ringbone is cauing most of his pain and lameness. My Vet said there isn’t much more we can do. I can’t give up. I raisd Blaze from 6mo old we’ve been thru alot together. He is an awsome horse to ride. I would realy love to get in contact with the Vet how wrote this article, Janice Posnikoff, to see if she would let me send her my horses xrays and give me her opnion. Of course I would pay for her consult. Or I would trailor my horse to her. Again thank you for writing this article it has given wonderful inforation and hope for my horse. My e-mail is carterranch@mchsi.com

  5. Thank You for that very informative article regarding Ring Bone.
    I have a 13 yo mare who may have developed ring bone NYD. This article has assisted me in understanding RB, diagnostics, and treatment.
    I have had Maggie for 11.5 yrs. We plan on having at least another 12 together! THANKS!

  6. I just found out that my horse may have a ringbone, the vet is going to take x rays the day after tomorrow to just be sure. But I would really like to get the daily program that you used, to improve my horse’s condition. If possible you can email me on nonmotor@pdeb.co.za I will really appreciate it, because I don’t know where to turn to. Many Thanks…. Sunita….

  7. my 31 year old has it and we arent giving up on himm we r giving him the chance to the things he doesnt do much like frolic( not really frolicing) in the pastures by himself, but there is nothing we can do to help him because we dont have all that much money and i really love clowny(the horse)too.

  8. This is the best article I have read on this issue. Very informative, with specifics as well as case studies. I am curious about the use of cortiosteroids, however. As I understand it, in some breeds (mainly draft type and ponies) use of steroids can lead to founder. How is it determined if this option is safe to use on these breeds?

  9. very informative article, I have 2 horses with high ringbone. My old mare is now 26, she was 24 when I heard of the legend shot. Even though there was no guarantee on success I felt it was my only option left. It worked. My mare is retired but at least now it’s in comfort and not constant pain. My second horse is a 2yr old, his symptoms are different then the other horses but xrays
    confirmed his fate. I was excited to read about the shock therapy and will definitely be looking into trying it when it comes our way. Thanks again for the article.

  10. Thank you for this informative article
    my 9 y/o Tenn Walking horse was diagnosed with ringbone on his rt rear let 1 yr ago
    I am trying to be as educated as I can on the condition, he is respnonding well so far with wraps and steriod cream RX’d by the vetenarian

  11. I just wondered why you didn’t discuss surgical arthrodesis as an option for treating high ringbone. My horse wad diagnozed with high ringbone in both front legs three years ago. One leg was symptomatic, so we opted to have the surgery. He was back in work in 6 months and schooling third level dressage. This past summer he began to show symptoms in the left leg, and another surgery was done in September with even better results. Surgeon is well known for doing this procedure and has done it here in the States as well as overseas. He did a fantastic job; my horse fused faster this time around, and has barely shown any lameness since coming out of the cast. We were able to begin walking after only three weeks, when the cast was removed. He is now back in full work under saddle and have just begun to canter again. No sign of lameness whatsoever! Just barely 5 months after surgery. So there is hope for some horses that may be candidates for surgical arthrodesis.

  12. My mare that I have had since the day that she was born, 19 years will be 20 May 28th. I am a handicapped women, and she has taken such good care of me through the years! That I have no idea what in the heck I’m gonna do. Eventually I know she will get so bad that I can’t ride her. I’m glad that you wrote that, that way I know what to expect. Thank you

  13. I just found out my horse might have ringbone. At first we thought he had navicular disease, and we were going to do that thing where you numb their nerves or whatever, but my mom and blacksmith think its ringbone now. We are taking him to get x rays this weekend, and if he has it, we are going to put him to sleep there. My mom says theres nothing we can do for him if he has ringbone, do the supplements really work? I just cant believe Im going to lose him, ive been crying ever since last night. This is just so hard, he is such a good horse and i love him so much :'(

  14. My cob Ari was diagnosed with high and low ring bone and sidebone too 4 years ago in both front legs. Was very close to the joint but not in it. I was offered injections into the joints for him but decided to rest him an give him cortaflex ha liquid daily (which he is still on). He stayed in the field for 6months before I brought him into light work. He went on the following year to win a county level show and compete in the south of england champs (and came 7th). Also went on to win a couple of dressage comps with no sign of lameness. That was in 2008, he is 14 now and goes for a hack once or twice a week and does some shows including occasional jumping, did his first 2’6 xc and sj this year 🙂 he seems happy and sound sofar. Seemed to me when the initial pain of the bone forming settled he was ok again. But im very careful to never trot on the road or hammer him on hard ground. We head for the woods where its nice and soft to have fun 🙂

  15. Hi there….I have great news! I have an nutraceutical aid for ringbone and a politice wrap that works! If you can bring me your animal for 7 days, I can administer this poltice and save you thousands of dollars on surgeries, ointments, injections and false theories! It works!

  16. Thank you for posting this article. I have a horse in his mid twenties. He was diagnosed with ringbone about 3 years ago. He has ups and downs. I rode him until about 9 months ago. He had a bad abcess and it seemed to really flare up his ringbone, he just had another abcess in the same spot and the farrier really got to it and now he has been walking better than he has in a long time. but still I am not sure if we will ride again but he sure loves being hand walked through the neighborhood! We keep him moving and we have special shoeing done for him that helps alot too. I have been considering adequan for him, after reading this I think I will give it a try!
    Thank you for the advice!

  17. Thanks for the detailed info. I have a large draft cross that is very heavy and flat footed in the front. He has started a weird habit on trail of biting at his upper hoof/band area and I am suspicious of this as an area of some kind of discomfort.

  18. Just had a call about a horse diagnosed with Ringbone. I have a biofeedback tool and some energetic medical tools that I use. SCIO and Q1000 Low Light Laser and the Immune Cleanse System that has been making remarkable progress. I have found that the essential fatty acids and amino acids and virus levels must be taken into consideration to get the full wellness that will help. Which means that some emotional treatment on the horse is very beneficial as well. http://www.lectrochi.com/myotech, http://www.q1000lasers.com, http://www.lubbockwellness.com

  19. I was glad I read this article as it gave me informaton on the treatment. My horse has the high ringbone and some days is not lame. i do have some hope that I can continue to ride him on trails but not barrel race him ??

  20. My horse has high ringbone and I’ve been trying to learn as much as I can about it so I can help him to be more comfortable- very helpful article

  21. This is an excellent article. My gelding was diagnosed with high ring bone arthritus this afternoon. I was hoping this article would be updated to discuss the effectiveness of ESWT treatments. I also am hoping fo r suggestions on the best supplements to use. Anyone have more information?

  22. My horse has been diagnosed with high ringbone and I am about to start IRAP therapy. This is not mentioned in this article and I was wondering if anyone has had success. I will do my best to post my results. Good luck to all who share these difficult times!

  23. My 2yr old horse has been diagnosed with hight ringbone on his left rear pastern, we started the new treatment available to fuse the joint, he had his first injection of alcohol in the joint. Has anyone heard of this treatment?

  24. I have heard of alcohol being injected into the joint–this is a treatment meant to make the joint “fuse” faster, essentially destroying the cartilage in the joint to encourage the development of bone. Once the horse fuses, they are usually more comfortable and may be sound for light work.

  25. Cheryl,
    I too have a 2 yr old with high ringbone in his right hind. Have the treatments been successful to the point where you will be able to still use your horse in the future?

  26. I have a horse lame right foot all jis blocked out nothing is showing specifically except something in foot goin for MRI.xrays show nothingDo you think this is ringbone?

  27. i have a foal of just 12 month old he has ring bone in 3 feet 2 backone front this horse has been trimmed no adverse running etc no feed only hay and carrots has he bin born with it

  28. I have a horse that has pigeon toe he is 9yrs old and has become lame on his front left where the pigeon toe is more noticeable could this be ringbone

  29. Hi there, my horse Amigo is 3 1/2 or 4 years old. We had found out be our farrier that he had ringbone and you can tell that its there. Amigo is lame but has his good days where he can run and play in the field with no limping. I was really hoping to be able to treat him so I could ride him more and I really dont want to put him down because he is such a great horse. I hope these treatments will work. 🙂 thanks

  30. hi my horse Flynn is due to have nerve blocks and x-rays on both legs front may I add.
    he is constantly lame and tripping . and he is only 15
    iv had Flynn since feb 2013 .
    but imp petrified that this is going to be the end of his riding life and will have to retire him . as when I found him he has the manners of an angel . never bited kicks or anything else, the perfect pony everyone wants .
    but I do believe he was given something before I brought him as his lameness was not noticeable .
    im really scared as I no im being selfish in the respect that I don’t want to let him go as we are so very close .
    his x-rays are due to be done on Wednesday so please if u can give me a glimmer of hope as my boy is amazing .
    but it my head there is something telling me its not good ,
    ness lewis

  31. Thanks for writing this. It helped me understand the condition a lot better and didn’t know shockwave treatment could be used on this and also heat. Makes sense now I have read it.

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