What is Greasy Heel?
In horses with greasy heel the lesions are commonly symmetrical and affect the back of the hind limbs, particularly in horses that have thick hair feathers. If left untreated this condition can spread towards the front of the legs and up to the chest. As this condition is often hidden by the hair on the back of the legs, often owners do not notice it’s presence until significant disease progression has occurred. The first symptoms noticed are often hair loss, crusting of the skin and pruritus, in some cases exudate may also be seen.
Greasy heel, or scratches, is a term used to describe a skin reaction pattern that affects the horse. This is a seborrheic dermatitis characterized by hypertrophy, the enlargement of the skin cells, and exudation on the hind limbs. Factors such as feathers on the pasterns, excessive environmental moisture, non-pigmented skin on the lower limbs and poor stable hygiene may predispose a horse to developing this.
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Symptoms of Greasy Heel in Horses
The symptoms vary depending on the severity of the reaction. The most common symptom is swelling, erythema and scaling, which may lead to the hair becoming matted. Over time, particularly in chronic cases, the thickening of the skin may occur, leading to reduced movement, lameness and pain. Symptoms that may be seen are
- Painful, cracked skin
- Thick, purulent discharge
- Fatigue and loss of appetite
Mild reaction - This form is commonly referred to as scratches or mud fever at this stage. This stage is characterized by :
- Dry scales or crusts
- Pruritus and pain may be present
Exudative reaction - This is commonly referred to as greasy heel and dew poisoning. This stage is characterized by :
- Hair loss
- Crusting dermatitis with exudate
Chronic proliferative reaction - This is also called verrucous pododermatitis. This stage is characterized by:
- Fissures and papillomas may be seen
- Excessive granulation tissue
- Lameness, pain and reduced appetite may be observed
- Foul smelling purulent discharge
Causes of Greasy Heel in Horses
The underlying causes can vary, however, horses with non-pigmented skin as well draft horses such as Shires and Clydesdales appear to be more prone to developing the condition. Furthermore, environmental factors such as poor stable hygiene increase the risk of developing this condition. Other predisposing factors are:
- Excessive sweating
- Skin trauma
- Suppressed or compromised immune system
- Prolonged damp conditions or exposure to mud or soiled bedding
- Presence of parasites such as mites
Diagnosis of Greasy Heel in Horses
Your veterinarian will carefully evaluate your horse and perform a nose to tail examination. They will discuss with you your horse’s medical records, particularly any note of allergies. A diagnosis of greasy heel is often made based on clinical symptoms and history; however further diagnostics may need to be done to rule out secondary infections or factors.
Your veterinarian may choose to take a biopsy of the skin for culture to rule out skin infections of infectious, parasitic or bacterial origin, and neoplasia. A complete blood count and chemistry panel may also be performed to rule out metabolic diseases.
Treatment of Greasy Heel in Horses
Your veterinarian will carefully clip and clean the area with a chlorhexidine solution and warm water. In some cases, debriding of necrotic skin or cauterization of granulomas may be necessary to promote healing. If your horse becomes distressed during this, sedation may be required. This should be repeated daily, ensuring the area is clean and dry before dressing. Medical treatment will vary depending on the results of the biopsies; however, may include:
- Topical antibiotic therapy for treatment of secondary bacterial infections; shampoo may be used 1-2 times daily for 7-10 days, followed by 2 times weekly (the leg should be dried carefully following application)
- Systemic antibiotic therapy may be required in severe bacterial infections
- Lanolin ointments or other topical creams may be used with your veterinarian’s guidance to promote healing
- Lime sulphur dips, miconazole shampoo and antifungal powder may be used if antifungal treatment is indicated
- Ivermectin treatment may be given orally for 4 weeks if anti-parasitic treatment is required
- Natural products, such as Fiske’s Hoof and Hide care, have been proven to be effective in most cases
Recovery of Greasy Heel in Horses
The prognosis relies heavily on the environmental management following and during treatment. The following steps should be made:
- Environmental decontamination should occur, including all bedding and stalls
- Stabling should be provided during wet weather, with turnout avoided until the grounds are dry
- If your veterinarian suspects contact allergies may be causing the condition trial other bedding sources
- For horses that have heavy feathers, keep these short to prevent moisture retention
- Keep a close eye on the hind limbs of your horse for signs of reoccurrence
- Discuss the use of barrier creams to protect your horse’s legs