Lameness remains one of the most common and complex challenges in equine practice, often requiring a collaborative approach between farriers and veterinarians. As understanding of joint health continues to evolve, so do the tools used to diagnose, manage and treat these conditions. 

Recognizing the underlying causes of lameness and understanding emerging regenerative options help farriers play a critical role in supporting long-term soundness.

Understanding Lameness

Lameness is the leading reason veterinarians are called — even more often than colic. While a farrier’s focus is the hoof, many issues that affect the hoof originate higher up the limb. Understanding contributing factors, such as workload, conformation and footing, help improve diagnosis and direct treatment.

“Any change in the horse’s gait that’s caused by pain is considered lameness, and that can present in a lot of different ways. It’s not always obvious right away. In many cases, we’re seeing the result of something that has been developing over time. That’s part of why lameness is the number one reason veterinarians are called out — these issues are incredibly common and often involve multiple contributing factors,” says Zoetis Senior Technical Service Veterinarian Holly Helbig at the 2026 International Hoof-Care Summit.

Equine athletes place significant demands on their bodies, leading to joint stress and degeneration over time. For example, the fetlock and coffin joints, which are high-motion synovial joints, have a greater risk of wear, she says. 

“Horses are athletes and subject to the cumulative effects of repetitive stress,” Helbig says. “But it’s not just workload — conformation, footing, trimming and shoeing, fitness and training all play a role in joint wear.”

Wear can lead to osteoarthritis, which involves far more than just bone changes.

“It involves cartilage, soft tissues and the synovial environment, affecting how the entire joint functions and how the horse moves,” she says.

Osteoarthritis is a progressive process involving cartilage degeneration, changes in underlying bone, inflammation and the development of bone spurs or fibrosis.

“All of these changes contribute to pain and reduced function, and by the time we see clear clinical signs, multiple structures are often involved,” Helbig says. “Conditions like synovitis and subchondral bone cysts can play a role, and within the joint, many different proteins and cytokines are involved. When we understand joint function and contributing factors over time, farriers — who see these horses regularly — can catch subtle changes early and play a critical role in managing lameness and supporting long-term soundness. The goal is to support factors that promote joint health while reducing those that contribute to degeneration.”

Regenerative Therapy

For decades, managing osteoarthritis has largely focused on controlling pain and inflammation rather than addressing the underlying disease. While these approaches can provide relief, they do not stop the progression of joint damage.

“Historically, many of these horses are treated with NSAIDs like Bute, Banamine or Equioxx, and joints are often injected with corticosteroids and hyaluronic acid,” Helbig says. “There are also other equine therapies, such as shockwave, bisphosphonates, acupuncture and chiropractic. Ultimately, none of these fix the problem. They’re more like Band-Aids that help manage symptoms rather than promote true healing.”

As treatment approaches continue to evolve, the focus is shifting toward therapies that aim to support the body’s natural repair processes.

“We now have regenerative medicine options that allow us to move beyond just managing the problem and start promoting healing,” she says. “These orthobiologic therapies use the horse’s own biological materials — such as interleukin-1 receptor antagonist protein (IRAP), platelet-rich plasma (PRP), Pro-Stride APS (autologous protein solution), and stem cells — which are processed and then reintroduced into the body. We’re seeing a significant increase in the use of these treatments as we look for ways to improve long-term joint health rather than just masking the issue.”

Regenerative therapies are gaining popularity due to improved longevity and safety, as well as increasing client demand.^{1, 2, 8, 9}

“One of the main reasons we’re seeing increased use is their longer-lasting effects compared to corticosteroids, as more horse owners look for treatments that support long-term joint health rather than just short-term relief,” Helbig says. “Corticosteroids often peak within a few weeks and may require reinjection around 6 months, while some regenerative options can extend closer to 12 months.¹ We have to be cautious when using corticosteroids in pregnant horses or those with metabolic conditions. In metabolic horses, there’s a real concern for laminitis, and studies show even low doses can cause insulin dysregulation as soon as 24 hours that can last up to 7 days post-injection.”^2,3

Clinical experience and survey data show strong support for intra-articular biologic therapies, with growing focus on what makes them effective at the joint level.

“A 2021 study found that 87% of respondents report seeing noticeable benefits from intra-articular biologic therapies,”4 Helbig says. “What makes these treatments effective is that they’re not targeting just one pathway. We’re working with a combination of components — anti-inflammatory cytokines, platelets, white blood cells and sometimes stem cells — to deliver a range of anti-inflammatory proteins and cytokines that support joint health and help modulate the disease process.”

Options, Research & Real-World Use

As regenerative medicine continues to evolve, new therapies are emerging to target joints and soft tissues more directly using the horse’s own biological components. Ongoing research continues to refine how these products are used, making it increasingly important to understand both their safety and efficacy. Not all regenerative products are supported by the same level of research.

“There are many regenerative medicine products on the market, and it’s important to choose products backed by solid science,” Helbig says. “There have been multiple independent peer-reviewed publications evaluating Pro-Stride and Restigen PRP.^1,5-8 For example, with Pro-Stride, it was found that the platelet-poor plasma contains beneficial anti-inflammatory cytokines and can be used to treat joints.”⁵

Pro-Stride is commonly used to treat mild to moderate osteoarthritis and cases of synovitis.9

“Pro-Stride is essentially a highly concentrated combination of IRAP and PRP, so you get both anti-

inflammatory cytokines and platelets,” Helbig says. “It’s processed stall-side in about 20 minutes using the horse’s own blood and is most often injected into the joint. What makes it unique is that it’s not targeting just one pathway. It’s more like a soup of beneficial proteins working together to decrease inflammation and promote healing. Clinically, we’re often seeing efficacy around 12 months, which makes it a strong alternative to repeated steroid injections, especially in younger horses.”

Restigen PRP represents Zoetis’ PRP option, commonly used in soft tissue injuries where healing and tissue quality are key concerns.

“Restigen is a device that separates and concentrates platelet-rich plasma from a sample of the horse’s own blood,” Helbig says. “It reaches about 7-9 times platelet concentration, which provides a high level of growth factors.¹⁰ Platelet-rich plasma helps repair and regenerate damaged tendons while encouraging healing with less scar tissue.”

CenTrate BMA is an additional therapy used that takes a more advanced approach, concentrating bone marrow aspirate to deliver stem cells and other regenerative components.

“CenTrate involves collecting bone marrow — typically from the sternum — which allows us to access a wide range of cells,” Helbig says. “That includes progenitor stem cells, along with many of the beneficial components found in blood and plasma. These cells support tissue repair and regeneration at a deeper level, giving us another option beyond simply managing symptoms.”

To support a horse’s long-term soundness, it’s important to understand the various causes of lameness, including how structures higher up in the leg can affect the farrier’s job. Effective management requires close collaboration between veterinarians and farriers. By thoroughly evaluating and diagnosing lameness issues, and by staying informed about current and emerging treatment options within the industry, both professionals can ensure the most appropriate and successful outcomes for the horse. 

References:

1. Bertone et al. Evaluation of a single intra-articular injection of autologous protein solution for treatment of osteoarthritis in horses. Am J Vet Res 2014, 75 (2 ): 141-151.
2. Page AE, Johnson M, Parker JL, Jacob O, Poston R, Adams AA, & Adam EN (2024). The Effects of Intra-Articular Triamcinolone and Autologous Protein Solution on Metabolic Parameters in Horses. Animals, 14(15), 2250. doi.org/10.3390/ani14152250
3. Page AE, Rauber-Ramos AM, Humiston M, McPeek JL, Adam EN. Initial investigation into the metabolic effects of intra-articular betamethasone on normal and insulin dysregulated horses. J Equine Vet Sci. 2025;147:105404. doi:10.1016/j.jevs.2025.105404
4. Zanotto GM, Frisbie DD. Current joint therapy usage in equine practice: Changes in the last 10 years. Equine Vet J. 2022;54:750-756. doi.org/10.1111/evj.13489 
5. Ortved KF, Alward L, Cowles B, et al. Use of quantitative mass spectrometry-based proteomics and ELISA to compare the alpha 2 macroglobulin concentration in equine blood-based products processed by three different orthobiologic devices. Front. Vet. Sci. 2024;11. doi.org/10.3389/fvets.2024.1335972
6. Brown KA, Gregoria E, Barot D, et al. Single-dose nonsteroidal anti-inflammatory drugs in horses have no impact on concentrations of cytokines or growth factors in autologous protein solution and platelet-rich plasma. AJVR, Feb 15, 2024. doi.org/10.2460/ajvr.23.11.0258 7. 
7. Brown KA, Gregorio E, Barot D, et al. Prolonged administration of oral phenylbutazone and firocoxib in horses has no impact on selected cytokine and growth factor concentrations in platelet rich plasma and autologous protein solution. AJVR June 18, 2024. doi.org/10.2460/ajvr.24.04.0098 8.
8. Usimaki A, Ciamillo S, Barot D, et al. Single injection of intra-articular autologous protein solution in horses with acute interleukin-1B-induced synovitis decreases joint pathology scores. EVI July 25, 2024. doi.org/10.1111/evj.14203
9. Data on file, Equine Orthobiologics Market Research Study Parts 1-4 US Market Research Dept. Jun 27 2025.
10. Chahla et al. A call for standardization in platelet-rich plasma preparation protocols and composition reporting: a systematic review of the clinical orthopedic literature. J Bone Joint Surg Am. 2017 Oct 18;99(20):1769–1779.