We know our 22 year old gelding has arthritis and can only be ridden lightly. But yesterday my sister forgot to give him his medication and but still rode him

Really thoughtless of her I know. Anyway, he was limping really,really badly with his left hind. Every time he took a step, he'd put his toe down first and then his heel. It was quite pronounced and I was wondering if anyone had heard of a horse do this before? Perhaps it is just his arthritis. Its just that I've seen horses limp, but never do the toe first and then heel thing... what causes it?