How to Care for Tendon Injuries

Low bows are serious tendon injuries that must be taken care of immediately. Learn how to care for tendon injuries and what the prognosis will be.


A warm, doughy swelling at the back of your horse’s lower foreleg, extending from a few inches above to just below the fetlock joint. You saw him running with his pasture-mates an hour ago and he was fine; now he’s limping badly on the affected leg, and flinches or snatches his leg away when you touch the swollen area.

[READ ABOUT: Equine Soft Tissue Injury Healing]

Learn what you should do if your horse comes up lame with a low bow. Karen Hayes DVM, MS



WHY: This is a serious bowed tendon injury, specifically called a “low bow.” It involves the lower portion of the deep digital flexor tendon, within the sleeve-like digital sheath in the fetlock (ankle) joint. It may also involve the fetlock joint itself, particularly the sesamoid bone and/or its associated ligament. Injury of a flexor tendon usually results from ripping some of its parallel fibers and is often the result of a misstep, such as stepping into a gopher hole at speed.

Such an injury requires emergency treatment, because blood and inflammatory fluids leak into the injury, distorting the damaged tissues and disrupting their blood supply. This enlarges the injured area and worsens the prognosis.


WHY: To prevent further damage while the damaged tissues are unprotected.

HOW: Have a helper hold your horse while you make your vet call and gather your first-aid supplies. If you’re alone, you’ll have to be creative: Your choices include tying him to a sturdy post (only if he’ll stand peacefully when tied), or dragging corral panels to his location and erecting a stall-sized enclosure around him (a horse-camper’s portable electric fence also would suffice). Otherwise, you’ll have to leave him where he is and hope he stays put while you gather your supplies (if there aren’t other horses to compete for it, dropping a flake of hay in front of him might help).


WHY: To help stop bleeding and swelling that threaten to expand the damaged area, and to lower the metabolic rate of damaged tissues so they’re less likely to die from decreased blood supply.

HOW: Pour one to two quarts of crushed ice into a one-gallon zipper-lock plastic bag (or grab a bag of frozen peas or kernel corn from your freezer). Place this flexible ice pack over the bow and secure it with a soft polo wrap in a figure-eight pattern so there’s no girdling-type tension on the injured tendon. While the ice works to chill the tissues, continue to step 4.


WHY: To relieve tension on the injured tendon.

HOW: Duct-tape a 1-inch-thick roll of 4-inch bandage material, such as a roll of gauze, to the underside of his foot, from left to right under the heel, to raise his heel up.


WHY: To help stop the bleeding, reduce existing swelling, and prevent the development of new swelling within the damaged tissues.

HOW: Replace your ice pack with a fresh one, securing it with the polo wrap. Apply an entire 4-pound roll of cotton wool, wrapping it around and around the leg and ice, with the bottom of the cotton just below the coronary band. Be careful to roll it around the leg smoothly, pressing out wrinkles or bunched areas. Anchor with a layer of Vetrap starting half an inch above the bottom of the cotton, and spiraling up, overlapping each round by 50 percent, as tightly as the Vetrap will permit without ripping—the thickness of the padding makes this amount of tension safe.


WHY: You’ve got the injured tissues well protected.

HOW: Slowly and carefully lead him to a stall well-suited for a month’s-long period of confinement. 

[READ ABOUT: Equine Lameness]


Guarded, depending on the tendon injuries, and on whether the fetlock joint itself is involved.

Your veterinarian will take several x-rays to determine the extent of any bone injury, and may order a series of ultrasound examinations to measure and track the extent of the tendon and/or ligament damage. If the sesamoid bone is fractured, surgery may be required, either to remove loose fragments or to repair the fracture.

For the tendon injury, she may put your horse’s leg in a cast, with the heel wedged, for several weeks, to immobilize the tendon and get the healing process started. She may also recommend pursuing one of the newer, experi­mental treatments, such as stem cell therapy, which has shown promise in encouraging damaged tendon tissue to heal in a faster, more normal configuration that’ll make the healed result stronger. Usually, damaged tendon tissue heals in a rather gloppy, disorganized fashion that is weaker and prone to re-injury.

After a period of strict confinement, your vet will prescribe a rehabilitation program of gradual, controlled exercise and physical therapy to limit scar tissue and maximize the tendon’s flexibility as the healing process continues (it’ll take up to a year to complete the job). If your horse has a strenuous performance career, his prognosis for full recovery is less optimistic than if he’s used for pleasure-type activities. 

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