A newly published case report in the Journal of Equine Veterinary Science describes what is believed to be the first documented case of bilateral hindlimb superficial digital flexor tendon, SDFT, tendinopathy in the mid metatarsal region of a sports horse.
The case involved a 16 year old Irish Sport Horse gelding who developed severe bilateral hindlimb lameness following the cross country phase of an international CCI 1* event. While SDFT injuries are common in the forelimbs of racehorses and sports horses, hindlimb involvement is rare, and bilateral hindlimb presentation even more so.
What happened?
The horse was presented with marked swelling in the plantar metatarsal region of both hindlimbs and was visibly lame at the walk. Ultrasonography confirmed extensive core lesions in both hindlimb SDFTs.
Superficial digital flexor tendinopathy is reported in up to 34 percent of Thoroughbred racehorses and is frequently seen in eventers, showjumpers and dressage horses. However, hindlimb SDFT injuries account for fewer than 3 percent of cases leading to retirement in some racing populations, and as little as 0.06 percent in large flat racing cohorts.
Event horses are considered particularly at risk of tendon injury due to the substantial mechanical strain placed on the limbs during high speed galloping and landing from fences, especially during cross country.
Treatment and rehabilitation
In this case, treatment involved ultrasound guided intralesional injection of autologous bone marrow aspirate concentrate, BMAC, combined with a structured and controlled exercise programme.
Tendon healing in horses is notoriously slow and often results in scar tissue formation that is biomechanically inferior to the original structure. The superficial digital flexor tendon has limited adaptive capacity and typically heals with increased collagen type III deposition, producing stiffer, less elastic tissue.
Despite the severity and unusual bilateral presentation, the outcome was positive. After eight months of rehabilitation, the horse returned to showjumping. Follow up at 44 months post treatment revealed no recurrence of the injury.
Why this matters
To the authors’ knowledge, this is the first report describing bilateral hindlimb SDF tendinopathy localised to the mid metatarsal region in a sports horse.
Although rare, this case highlights that bilateral hindlimb tendon injuries can occur in event horses and may respond well to a combination of orthobiologic therapy and carefully managed rehabilitation.
For clinicians and owners alike, the report adds valuable information to the understanding of tendon injury patterns in sports horses and reinforces the importance of prompt diagnosis, imaging and structured recovery plans.
The full paper is available via the Journal of Equine Veterinary Science. Click here to read.
