Welcome, About us

Hello and welcome. My name is Sammy L. Pittman, DVM and I am a veterinarian, farrier, and horsemen with a great interest in the field of equine podiatry. My wife and I own and operate Innovative Equine Podiatry and Veterinary Services in Collinsville TX. I offer a full line of horse veterinary care, however my passion lies within the health and well being of the hoof to better serve your equine companion. With so much lameness attributed to the lower limb many horses require an out of the box approach to achieve the success desired.
Give us a call and we will be glad to help you in any way we can. Thanks so much.
I will be discussing different Cases and thoughts from our world with the horse. Feel free to contact us via text or call at 918.235.1529 or send an email to iepvs11@gmail.com. Thank you for reading and enjoy

Friday, May 31, 2013

Hoof wall resection and update on Blackie the laminitis case.


     This is Blackie a previously posted laminitis case.  Click here to see previous radiographs and venograms. He is showing response with added sole depth and comfort. A hoof wall resection was required and I thought it would be a good representation as to what to expect from a hoof wall resection.

Below are radiographs from immediately post deep flexor tenotomy and 60 days post tenotomy.  Noteworthy change on both are additional sole depth under tip of coffin bone.  However continued remodelling of the tip of the coffin bone and a slight increase in palmar angle on the left hoof are suggestive that the dorsal portion still fails to grow at a rate similar to the palmar portion.  This hoof suffered more damage as it was the "club".  Deep flexor tenotomy was not performed at the recommended time.  Significant pathology was identified within 5 days of onset of acute laminitis but owner refused tenotomy at that time.



   
   
     A resection is required in laminitis cases that have coronary band swelling that is prolapsing over the hoof wall.  The hoof will act as a tourniquet as the inner laminae experience swelling.  The lack of expansion of the hoof creates massive vascular compression and starves the laminae and coffin bone of needed nutrient flow.  Often times this is all secondary to inflammation arising from compromised soft tissue and bone along the toe and medial quarter as this area tends to receive the most significant load induced vascular compromise when laminae fail to suspend the coffin bone.

     I like to use a cast cutter or multi-purpose oscillating saw to cut through the hoof.  Usually an 1 1/2 in below the hairline is a minimum and often times I find myself removing more at a later date.  The width of resection will depend on amount of coronary band involved and should extend at least  1/2 in wider than the affected coronary band.

   





Next I use a sharp hook on the end of hoof knife to round and smooth the proximal (upper) edge of the  intact hoof wall.  It is important to perform this prior to removing hoof wall because it will get somewhat bloody after removal and occlude good visualisation. 


Next the hoof wall can easily be removed by grasping one end with half rounds or regular nippers.  Ease of removal is directly related timing of resection.  Resections based on early evidence from venograms are usually more attached  versus the case that has already separated and has drainage.  


One removed, a gentle massage of the coronary papillae and lamina to encourage hemorrhage and lay the papillae in a more normal position pointing downward. Note the lack of hemorrhage in the most compromised region.  

Next 1/2 inch felt heavily coated in silvadene cream is cut to fit the void left behind.  This is tightly wrapped with elastikon as adequate pressure is important to prevent excessive swelling and granulation.  Many times with cases that are far away and I am uncomfortable with the owners ability to maintain a bandage, I will place a cast over the elastikon up to the fetlock to maintain adequate compression.  Preferably, daily changing for the first three days to ensure adequate hoof wall has been removed is recommended.  After that a cast can be applied and changed every 7-10 days or bandage changes every 3-4 days.  Each time a new piece of felt is applied with a fresh layer of silvadene.  I will also use dmso gel applied to the coronary band to aid with inflammation.  


  



Images below are representative of what the hoof will look like at bandage or cast changes.  This will depend greatly on the amount damage or compromise present.  This case has significant damage with a lot of granulation already present.  Ideally a resection should have been performed much earlier to prevent this level of damage to the coronary papillae.  The first thing you will see is secretion of the secondary matrix horn which signifies the cornification process.  Once this has covered the entire resection site, compression bandaging can be stopped and patient can go without any bandage at all.  I like to see the cornification at the level of the previous hoof wall prior to stoppage of bandaging or casting.  

    Below are images of 5 days post resection.  Notice the medial (inside) and lateral (outside) portions have already began to fill in with secondary matrix horn.  The central portion suffered so much damage that the lamina are dead and unable to secrete matrix.  This will fill and contract very similar to a wound anywhere else on the body via epithelialisation.  A moist environment maintained with bandaging and/or cast will expedite the process.



Below are images from approximately 15 days later.  A cast was placed over felt pad and elastikon for this period.  Note the matrix is at the level of the hoof wall at the medial and lateral aspects and the granulation is reduced to 1/3.  






These images are approximately 30 days post resection.  Continued epithelialisation and secondary horn formation aka cornification.  





Images below are about 6 weeks post resection and complete epithelialisation and cornification has occurred.  At this point it is no longer necessary to apply cast or compressive bandages unless coronary band begins to get inflamed again.  


Thursday, May 30, 2013

New navicular case study

    This is a 9 year quarter horse gelding that has had lameness issues since he was 3-4 years old.  He has never been used outside of light training.  I feel this type of navicular bone disease must have a genetic component as lesions where noted at an early age.  This horse responded early on to low level mechanics that included a four point style shoe with digital breakover at the tip of p3.  It progressed to needing significant mechanical enhancement but did respond to the enhanced mechanics applied  via a rockered 4 point rail shoe.  The horse was 4/5 bilateral lame on front before shoeing and 1/5 immediately post shoeing.  A significant improvement was noted after the below shoeing method.  The horse was euthanized due severity of disease and dissection was performed to further evaluate the navicular bone and compare to the radiographs.  You will see below the lucent lesions noted in the high beam dorsopalmar radiographs and the 65 dg dorsopalmar radiographs.  These lesions are present on the flexor surface of the navicular bone in which interacts with the flexor tendon.  Note the tissue protruding from the lesions.   This is tendonious tissue that has grown into the tendon and anchors the tendon to the navicular bone.  I can imagine that at lower palmar angle the attachment tugging at the navicular bone lesions is terribly painful.  This also explains why an increase in palmar angle and reduced digital breakover that reduced leverage and tension on the DDFT is so very helpful in this situation.

     Many medical therapies are used in treatment of  navicular disease however without appropriate mechancial treatment many medical therapies only offer temporary relief.  Bursa injections, coffin joint injections, isoxoprine and tildren are common treatments.  But you can see that without mechanical therapy that offers appropriate physical relief it can be difficult to manage.  Cases like this can be difficult to manage at a performance level long term with mechanics and medical therapies and all but impossible without mechanical therapy.



 






Note the lucent regions on the radiographs and the corresponding lesion below.  The tendon has grown into the navicular bone secondary to years worth of the tendon rubbing against the roughened flexor surface of the navicular bone.  This causes abrasions on the tendon that leads to the adhesions connecting it to the navicular bone.

Viewing from front of hoof with navicular bone flipped up to expose the flexor (back) surface of the navicular bone in which the tendon glides over then attaches to coffin bone.
Note the two adhesions on flexor surface.  These where cut away from tendon 

This drawing shows the DDFT in green and adhesions in red
 The above drawing shows the ddft (green) coursing over the navicular to attach to the palmar surface of the coffin bone.  The adhesions (red) are drawn in between the flexor surface and the tendon.

     Below are pre- and post-shoeing radiographs.  Note the drastic changes in palmar angle, tendon surface angle and distance of navicular bone to the condyle of proximal second phalanx (short pastern).  In the rocker shoe the system is  now a self adjusting mechanism with greatly decreased load on lesions and a greatly reduced leverage on the ddft.  Again, this horse's lameness improved at least 80 percent with application of this shoe.