Pyramidal Disease in Horses

Pyramidal Disease in Horses - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost

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Pyramidal Disease in Horses - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost

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What is Pyramidal Disease?

Because the shape of your horse’s foot will change shape as pyramidal disease gets worse, the foot may become squared and narrowed if significant time has passed since the condition started. Also, the bones can fracture, which causes a lot of discomfort when walking, standing, or even at rest as time goes on.

Pyramidal disease (buttress foot or low ringbone) is a serious and painful condition that is described as inflammation of the coronary band, which is where the hoof starts growing. If not treated right away, pyramidal disease can cause a deformity in your horse’s foot which may be permanent. This may be caused by a fracture of the pyramidal process, new bone growth, or injury. Some breeds of horse, such as Quarter horses, are more likely to get pyramidal disease because of the stress put on their lower limbs during performance, which includes sharp turning and sudden stops.

Symptoms of Pyramidal Disease in Horses

The symptoms of pyramidal disease can be different for every horse, but the general symptoms are:

  • Swelling of the coronary band
  • Warmth in the back of the foot
  • Trouble standing
  • Lameness that may be mild or moderate
  • Short and choppy gait


  • High ringbone is arthritis or degenerative joint disease of the pastern joint
  • Low ringbone is arthritis or degenerative joint disease of the coffin

Causes of Pyramidal Disease in Horses

  • Straining of the tendons in the front of the leg
  • Swelling of the soft tissues for any reason
  • New growth in the bones of the pastern
  • Heavy exercise or working
  • Trauma to the periosteum
  • Poor shoeing
  • Avulsion fracture

Diagnosis of Pyramidal Disease in Horses

Call your equine veterinarian if you suspect that your horse has pyramidal disease. A complete history and detailed physical examination will need to be done first. The history should include your horse’s medical records (if possible), abnormal behavior or appetite, recent illness or injury, type of work your horse does, and what symptoms you have noticed so far. The physical examination consists of reflexes, height, weight, body condition score, body temperature, blood pressure, heart rate, breath sounds, respirations, capillary refill time, and overall behavior. 

The veterinarian will ask you to walk your horse around to get a good look at how the muscles work while in motion. A hoof tester (large pincers) will be used to assess the sensitivity of the hooves; the veterinarian will assess all of them, not just the injured one. An ultrasound will be done to check the tissue damage and x-rays to get a look at the pastern and coffin joints. A full set of x-rays are needed to get oblique views to see the sides of the joints. A CT scan or MRI can show hairline fractures or new bone growth that could be affecting the foot. In addition, some of the diagnostic tests needed are a complete blood count (CBC), serum biochemistry analysis, blood urea nitrogen (BUN), packed cell volume (PCV), glucose and insulin levels, bacterial and fungal culture.


Treatment of Pyramidal Disease in Horses

Treatment of pyramidal disease may be divided by surgical and medical choices. Some of the medical options focus on reducing pain and slowing the degeneration of the cartilage. Special shoes, medications, and joint therapy are a few of these treatments. Surgery may be the only choice for some injuries or disease.

Support Shoes

There are several kinds of support shoes such as bar shoes or egg shoes. The provide more stability so that too much pressure is not placed on the injured area.

Extracorporeal Shockwave Therapy

This is a special treatment tool that uses a high amp pressure wave to send energy into the tissues. This pressure improves the metabolism and circulation of those tissues and destroys the calcification that is causing problems. It also helps to stimulate cells that can promote bone production and healing.

Surgical Fusing (Arthrodesis)

Surgically fusing the two bones of the pastern joints will stabilize the joint and get rid of the inflammation. This has been known to virtually eliminate pain in over 4 out of 5 horses treated. It is done by using a plate and screws, affixed to the bones, making them unable to bend.


Arthroscopy includes removing any bone fragments by using an arthroscope and a tiny tool through small incisions in the foot. This is a minimally invasive procedure that is very safe and needs less rehabilitation time than surgical fusion.


Nonsteroidal anti-inflammatory drugs (NSAIDS), corticosteroids, or phenylbutazone (bute) are excellent choices to decrease swelling and pain. Oral joint supplements are used in conjunction with intramuscular injections of Adequan to lubricate the joints. Also, hyaluronic acid may be injected directly into the joints for lubrication to ease damage and pain.

Recovery of Pyramidal Disease in Horses

No matter what the treatment is, you will likely have to maintain regular visits with the veterinarian for evaluation of the progress. Unfortunately, once your horse has been diagnosed with pyramidal disease, the condition will progress. Together, you and the veterinarian will have to keep trying to stay in front of the disease in order to keep your horse comfortable.

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Pyramidal Disease Average Cost

From 530 quotes ranging from $2,500 - $6,000

Average Cost


Pyramidal Disease Questions and Advice from Veterinary Professionals

Pyramidal Disease Average Cost

From 530 quotes ranging from $2,500 - $6,000

Average Cost