tag:blogger.com,1999:blog-61478422324882713782024-03-18T23:29:16.105-05:00Innovative Equine Podiatry* Consultations * Laminitis/Founder * Thin soles * Navicular * Crushed/Low Heels * Foal development * Club feet * High Low Syndrome * Angular limb deformitiesSammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.comBlogger42125tag:blogger.com,1999:blog-6147842232488271378.post-9278776821772945152017-04-10T10:48:00.000-05:002017-04-10T10:48:36.850-05:00Hoof mapping<div dir="ltr" style="text-align: left;" trbidi="on">
Need to freshen up the blog as it has been a while since adding information here. I have been playing with different mapping protocols to help find the center of rotation of the coffin joint. I first heard of the golden means ration from Craig Trnka and Scott lampert. I will admit it sounded a little fishy at first but after playing with it for a few years it is amazing how many things in life follow this proportional developent. Follow the link below to learn more. <br />
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<a href="https://en.wikipedia.org/wiki/Golden_ratio." target="_blank">GOLDEN RATIO</a><br />
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Basically the coffin bone follows closely a proportional development. Once you can identify the tip of p3 and the wings you can then use a golden ratio caliper to find a point that is very close to the mechanical center of rotation of the coffin joint. It has long since been known that managing the forces around the coffin joint are very important and identifying this point on the foot surface can be very consistent. It correlates well with other reported mapping protocols. It commonly lines up with the trimmed bars and widest part of the white line. <br />
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Wings can be located very close to the angle of the sole. It is more accurately place at the stratum internum where the bar turns in at the heel. Then carry a line towards the toe very close to parallel to the central sulcus. Where this point crosses the white line will also be very close to the tip of the coffin bone. I confirm this with measuring a thumbs width in front of the apex of the frog. Using the golden means caliper place the short side at the heels and long side at tip of coffin bone. The center point of the caliper will be very close to the center of rotation of the coffin joint. This point will often line up very close to the insertion of the deep flexor tendon as well. A line dropped perpendicular to the wings of the coffin bone and centered on the center of rotation will cross this point on the ground surface of the hoof. <br />
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Note the thumb tack and its alignment to the center of rotation of the coffin joint. Also note the barium marking the point located on the heels that corresponds to the wings. In sound young horses with no lameness or pathology I would strive to balance the leverages around this point. Often times a rockered rolled toe is all that is needed. Many coffin bones and hooves have such long toe levers it is impossible to provide even toe and heel levers. One cannot leave excessive heel length as it is a hazard and can act a lever that could lead to a crushing of the horn in the heel. In these case I recommend placing the toe lever as far back as the tip of the coffin bone and adding modifications to the ground surface that improve ground interaction. A combined rolled toe with concaved inner rim and a fullered heel branch will encourage the toe to sink and the heel to float. This will aid in prevention of heavy tendon load and hyperextension of the coffin joint. <br />
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Fullering the branches behind the COR and concaving in front helps with the interaction of the hoof in soft footing. This could very easily be a maintenance shoe for a young horse in training. This may help delay lameness that often occurs with performance from chronic low grade overload of the deep flexor tendon, navicular apparatus and coffin joint. If lameness exist a much greater mechanical advantage will likely be needed to unload and manage an already painful system. Bar shoes are one very effective way to balance out the sink/flotation aspect of hooves with excessive toe levers. Commonly I use these ground surface modifications combined with wedges that are fully rockered from toe to heel. </div>
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<a href="https://www.facebook.com/innovativeequinepodiatry/videos/1369396876457826/" target="_blank">Follow this link for a Video regarding the foot </a>mapping.</div>
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Wishing you the best of the best!</div>
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Thanks for reading. </div>
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-63633962697519234482016-03-21T21:43:00.000-05:002016-03-21T21:43:44.356-05:00Upcoming clinic in Chazy, NY focusing on Navicular Syndome<div dir="ltr" style="text-align: left;" trbidi="on">
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-89821334935814069132015-08-02T19:51:00.000-05:002015-08-02T19:51:14.227-05:00Moved To Texas!<div dir="ltr" style="text-align: left;" trbidi="on">
We have moved our practice headquarters to Collinsville, Tx. 500 Rice Rd Collinsville, Tx 76233 to be exact. We are in the process of remodeling and building a clinic that will be focused on treating and managing all foot problems. In house rehabilitation for tougher cases, such as laminitis, foot puncture wounds and lacerations, that respond better with daily intense care and monitoring.<br />
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We still continue to offer most equine veterinary services but focus on therapeutic farriery, Lameness exams and consulations, Pre-purchase examinations, managing foal limb development, and designing a hoof management program for all stages of life and careers. <br />
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Thank you for your continued patronage.<br />
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Sammy L. Pittman DVM</div>
Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-52394312407981731312015-01-12T12:42:00.002-06:002015-01-18T14:42:01.130-06:00Upcoming clinic reviewing venogram procedure and interpretation<div dir="ltr" style="text-align: left;" trbidi="on">
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-50466078715961754202015-01-12T12:10:00.000-06:002015-01-12T12:43:15.844-06:00Introduction to the mechanics of the lower limb and evaluation radiographically and clinically<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: 16.0pt;">Introduction to the mechanics of the lower limb and
evaluation radiographically and clinically<o:p></o:p></span></div>
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<span style="font-size: 14.0pt;">Sammy L. Pittman,DVM <o:p></o:p></span></div>
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<span style="font-size: 14.0pt;">Innovative Equine Podiatry and Veterinary Services,
Pllc<o:p></o:p></span></div>
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<span style="font-size: 12.0pt;"> Considering a large component of lameness occurs in the
lower limb and the equine hoof a thorough understanding of the forces at play
are very helpful. We often examine and
treat lameness from a medical standpoint but are not fully recognizing and
changing the biomechanical properties that are very likely involved in creating
the lameness. <o:p></o:p></span></div>
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<span style="font-size: 12.0pt;"> The detailed anatomy is covered at length in many text,
conversely, I want to focus on the functional anatomy as it relates to the
mechanical properties of the equine digit.
Consider the deep digital flexor tendon arising from the combined flexor
muscle bellies coursing distally over the palmar/plantar aspect of the fetlock
and pastern then over the navicular bone to attach to the semi-lunar crest on the solar aspect of the coffin bone. The
tendon attaches firmly to the bone and the bone is attached to the hoof wall
via the lamellar network. Think of these
combined anatomical structures as creating a sling or hammock for the boney
column. See figure 1 for a drawing
emphasizing the suspension and support components. Also consider the frog, ungual cartilages and
digital cushion as support structures accepting load that is determined by the balance of load from
the suspension system. <o:p></o:p></span></div>
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<span style="font-size: 12.0pt;"> To further define the deep digital flexor tendon
suspension theory, consider a deep flexor contracture case versus a tendon
laxity case in young foals. The
contracture case has no load on the heels as they are suspended in the air via
the shortened tendon unit. Compare to
the tendon laxity case in which the toe is popping up and the heels and bulbs
are the weight bearing component. This
is a high suspension versus low suspension comparison and further describes how
the deep flexor tendon has a great influence on what structures are loaded
within the hoof capsule. </span></div>
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Figure 1 Suspension components and
support components</div>
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<span style="font-size: 12.0pt;"> Now let's think about what load does to the hoof. For example compress one side of your
fingernail and watch it turn pale in color.
This is a load induced vascular compression that prevents the vascular
network from filling. The same goes for
the equine digit. When weight is placed
on the limb the vascular network is loaded and blood moves out of the loaded
areas to unloaded areas. This is easily
confirmed by performing venograms. As
long as the compression is temporary and balanced throughout the hoof it is of
no consequence. However when long term
compression occurs, bone and soft tissue suffer the effects of decreased
nutrient flow. This is evidenced by lack
of growth of sole and/or hoof wall and boney remodeling of the coffin
bone. Consider a high grade club foot
versus a crushed heel foot. Club feet
have trouble growing sole directly under the apex of the coffin bone and dorsal
hoof wall. Hooves with tendencies to
have long toes and low heels with difficulty growing heel. These are both load induced vascular
compressions secondary the loads determined by the deep flexor tendon
suspension. Figure 2 compares a foot with a severe negative palmar angle on the
left to a grade 3 club on the right. The
foot on the left has vascular compression under the wings of the coffin bone
and the foot on the right has compression under the apex of the coffin bone. The tighter suspension unit of the club
syndrome transmits a greater proportion of the load to the toe. The crushed
heel with less deep flexor suspension allowing more load at the heels. <o:p></o:p></span></div>
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Figure <!--[if supportFields]><span
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venogram on the left compared to a grade 3 club foot venogram on right.</div>
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<span style="font-size: 12.0pt;"> Radiographic investigation with properly taken podiatry
style radiographs will allow definition of the areas that are chronically
loaded. Coffin bone shapes tell us the history of the loads that have been
applied to it. Wolfe's law describes
that bone remodels along lines of tension and compression Coffin bones shapes of club feet have a
characteristic bump about halfway down the face of the coffin bone, lipping at
the apex and resorption directly under the apex, secondary to forces acting
upon these regions from shortened musclotendinous unit. The articulation will also develop with more
dorsal orientation. Compare to the low
heel foot which will have a straight face and tip of the coffin bone with a scallop resorbed in the wings from the load
placed in this region. The articulation develops
further palmarly closer to the wings.
Evaluation of the center of rotation of the coffin joint will show that
the more upright clubby type foot has much less coffin bone dorsally when
compared to a lower heeled, long toe foot.
This effects the lever arm working against the deep flexor tendon that
is necessary to consider when treating the long toe low heel horse. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12.0pt;">Taking consistent radiographs
before and after shoeing on all my foot lameness cases allows a greater
understanding of the mechanical properties that matter to the horse. Below is a review of the soft tissue
parameters that I routinely monitor. <o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
<span style="font-size: 12.0pt;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjybl4jv7RyS7NJ0L1ZnaLw_iY_ptVDo1fcWBLqG4l9lEymOXfQwFjbT6cIu3G2nUrS9sekGJnymChsKFEGX3mtHsMJ6uMsOW6DvK5KZH9P22-ek1UEyT4WZowQzgF3avDKnmcpJwb-GNQ/s1600/STP+drawing+osu+fall+conferenc1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjybl4jv7RyS7NJ0L1ZnaLw_iY_ptVDo1fcWBLqG4l9lEymOXfQwFjbT6cIu3G2nUrS9sekGJnymChsKFEGX3mtHsMJ6uMsOW6DvK5KZH9P22-ek1UEyT4WZowQzgF3avDKnmcpJwb-GNQ/s1600/STP+drawing+osu+fall+conferenc1.png" height="640" width="506" /></a></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoCaption" style="text-align: center;">
Figure <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->3<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> Soft tissue parameters<span style="font-size: 12.0pt;"><o:p></o:p></span></div>
<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12.0pt;"> <u>Coronary
band to extensor process (CE)</u><span class="apple-converted-space"> </span>is measured from top of paste which is
applied at most proximal aspect hoof wall at the point of the last hair
follicle down to the extensor process of the coffin bone. This will range
from 8 to 30 mm in most healthy hooves. This number does not give you
much information as a single measured parameter. However, when monitored
and compared in serial radiographs, especially when monitoring an acute
laminitis case, it is extremely valuable. For example, an acutely laminitic
patient that measures 8mm on day 1 of clinical signs and then measures 18mm on
day 4. This is a 10mm distal displacement which is usually
accompanied by a 10mm decrease in sole depth as well and varying degrees of
rotational displacement. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"> <u>Horn-Lamellar zone
(HL)</u><span class="apple-converted-space"> </span>is measured in two areas,
one proximal just below extensor process and one distal just above apex of
coffin bone. This will most commonly measure 15 mm in most light breed
horses but can be as high as 20mm in larger breeds, mules and donkeys.
This measure is expressed as proximal HL/Distal HL (15/15). Instead
of measuring only rotation this will give you a measurable displacement that is
more definitive than a generic rotation. Evaluating the dermal-epidermal
junction is also of great importance as it should split the horn
lamellar zone further defining each. This allows more specific
interpretation of changes in the HL zone. For example with laminitis the
L component of the HL zone will change not the H component. Early in
laminitis this may be the only notable change and an increase of 3-4 mm is a
significant finding and may have no measurable rotation. Several
important disease processes can be discovered in this zone and many foot
diseases such as clubs, chronic/acute laminitis, white line disease, keratomas
and abscesses have very unique qualities that can be shown here.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"> <u>Sole Depth (SD)</u><span class="apple-converted-space"> </span>is measured from the tip of the coffin
bone down to most distal aspect of the sole. The cup is also of
importance as it is present to different degrees depending on health or pathology
and can also be falsely created with a hoof knife. This measurement is
expressed as SD/Cup. Healthy feet with no pathology will most commonly
carry 15mm of sole and a 2-3mm cup (15/3). This should be of upmost concern of
the vet/farrier team when striving to obtain soundness and health of the foot.
This should be the measurement at the day of the farrier visit.
Often thin soled horses are at 6-7mm of sole 8 weeks into the cycle and
this is a sign of a compromised foot that requires a different approach to
increase foot mass and health. Two measurements can be made to give you more
information, one at tip of coffin bone and one under wing of coffin bone.
Venogram findings suggest that a depth of 15mm is required to maintain a
healthy appearance to the solar vascular bed with robust and
correctly aligned terminal papillae<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"> <u>Digital Breakover
(DB)</u> is measured from the tip of the coffin bone to where the foot or
shoe if shod would leave the ground. Healthy hooves that maintain
adequate SD and good digital alignment will commonly maintain a DB of 20-25mm.
Many times in perimeter fit shoes, depending on type of foot, bone angle,
and toe lever this number is considerably higher than ideal at the day of the
farrier visit and continues to lengthen throughout the cycle due to hoof
growth. This gives us a measurable lever arm that applies its force to the deep
digital flexor tendon and its subsequent force impacts on apex of the coffin
bone, dorsal hoof wall and navicular apparatus. Below I discuss toe lever
(TL) that in my opinion gives a more accurate understanding of the lever arm
involved.<span class="apple-converted-space"> <o:p></o:p></span></span></div>
<span class="apple-converted-space"> </span><u>Toe Lever (TL)</u> can be expressed as static toe
lever or shod toe lever. Shod TL is measured from center of rotation of the
coffin joint to where the hoof/shoe would leave the ground and static TL is
measured from the center of rotation to the tip of the coffin bone. Shod TL we can effect and static we
cannot. Lower BA coffin bones
typically have a longer TL than higher degree. In my practice I see
static TL as short as 45mm to as long as 75mm in adult horses. Monitoring
this at a young age may allow us to apply orthotics that will decrease
the effective lever arm that antagonizes the lower limb.
Therapeutic shoe packages can be evaluated with regard to amount of lever
arm relief. Simply setting the shoe back only effects this measurement a
few millimeters and sometimes many lameness issues respond to a TL that is
3-4 times less than what is measured on their bare foot. <o:p></o:p><br />
<div class="MsoNormal">
<span style="font-size: 12pt;"> <u>Bone Angle (BA)<span class="apple-converted-space"> </span></u> is the angle of the coffin
bone when viewed in a lateral radiograph. Average BA will be 50 degrees.
In my practice I have measured BA's as low as 36 degrees in very low
heeled and long toed horses to 70 degrees in club feet. The shape of the
coffin bone determines the shape of the hoof. Most of the time the horses
that have low heel long toe conformation will have a less than 50 degree bone
angle with a long measurable toe lever (see below) and the opposite is true for
upright club feet. Granted, horses that have overgrown unkempt feet may have
crushed heels and a long toe but may have a good BA. I feel that
monitoring this parameter early in life could potentially identify feet that
may have a common sequelae with regards to lameness later in life. For
example, a horse with a 42 degree BA and a 70mm Toe lever may be at higher risk
of hyperextension injuries of the pastern, coffin and fetlock joint and
increased tension strain on deep digital flexor tendon, and navicular apparatus
when compared to a coffin bone with a lower bone angle and shorter toe
lever. If we could identify this early in a horse's career and change the
shoeing protocol to better manage this handicap maybe we could reduce the
amount of wear and tear to some degree. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<u>Palmar angle (PA)</u> also known as solar
angle of the distal phalanx or ventral angle is measured from the wings of the
coffin bone in comparison to a level ground surface or embedded wire in block.
It can be tricky to measure in some feet with considerable bone remodeling.
Using the wings will offer the most consistent measurement. This
gives us a manner in which to evaluate flexor tendon engagement. In
general lowering the PA increases tendon tension and raising should
decrease the tension. This angle will average 3-5 degrees in the horse that
maintains adequate sole depth and is free of lameness but can vary greatly.
PA should be evaluated in this manner: Is this PA healthy for this
foot? The answer comes from evaluation of sole depth, clinical exam and
digital alignment. For example, PA measures 8 degrees and maintains a SD
of 15/3 and good digital alignment. This case is higher than what is
ideal but currently considered healthy for this case. On the other hand
PA measures 3 degrees and sole depth is 7mm. This is not likely a healthy
PA as a higher PA with less deep digital flexor tendon tension will unload the
solar corium and vital growth center of the sole. This angle is also of
great value to monitor in a preventive podiatry program. <o:p></o:p><br />
<u>Tendon Surface Angle (TSA)</u> is measured on this distal part
of the navicular bone compared to a level ground marker. This is relative to
the course of the deep digital flexor tendon takes at turns to attach to the
coffin bone. Monitoring the change of TSA with your applied orthotic is
of value especially cases that show navicular bone lesions in this region.
Simply changing DB may be beneficial in many cases however raising
PA and TSA is often required to be therapeutic.<o:p></o:p><br />
<div class="separator" style="clear: both; text-align: center;">
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<div align="center" class="MsoCaption" style="text-align: center;">
Figure <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->4<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> Pre and post shoeing
measurements</div>
<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
<div align="center" class="MsoCaption" style="text-align: center;">
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<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
Figure 4 illustrates the
measurements that changed in a pre and post shoeing lameness case. Note the
shortened shod toe lever, increase in tendon surface angle and palmar
angle. Digital alignment has improved
greatly. By raising the palmar angle and
reducing the lever arm we have reduced tension in the deep flexor tendon. Subsequently reducing load in the solar
corium under tip of the coffin bone, navicular apparatus and extraction forces
at the dorsal wall to sole interface. Horse
was sound and off bute the next day.<br />
<o:p></o:p><br />
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<div align="center" class="MsoCaption" style="text-align: center;">
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<div align="center" class="MsoCaption" style="text-align: center;">
Figure <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->5<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> low versus high on a 6 mo old
foal</div>
<div align="center" class="MsoCaption" style="text-align: center;">
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<div align="center" class="MsoCaption" style="text-align: center;">
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<div align="center" class="MsoCaption" style="text-align: center;">
<br /></div>
Figure 5 is a 6 month old fold that was being evaluated
for management of a club foot. Note the
significant differences in coffin bone angle, palmar angle, and toe lever. The main difference is the deep flexor
suspension. Each have very different
mechanical properties and require different trimming and shoeing
approaches. Trying to match feet with a
perfect toe angle doesn't make since when the internal structures are ghastly
different.<o:p></o:p><br />
<div class="separator" style="clear: both; text-align: center;">
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Figure <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->6<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> long toe low heel/neg pa hoof
versus a grade 3 club</div>
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Figure 6 is comparing measurements in two different adult horses. One with severe negative palmar angle and the
other a grade 3 club. Note the
difference in bone angle, palmar angle, tendon surface angle and the static toe
lever. These differences must be
considered and exemplifies the reason that all hooves can't be shod the exact
same way and expect it to fit all the different foot types. It is similar to asking us all to wear the
same size pants even though we all have our unique characteristics. <br />
<div class="MsoNormal">
<span style="font-size: 12.0pt;"> Clinical evaluation is directed at evaluating growth
rings, hoof quality and length from the widest part of the foot forward. Clubby feet with higher deep flexor tension
will have growth rings that are narrow at the toe and get wider towards the
heel. Again this is secondary to the
loads creating a vascular compression and decreased nutrient flow to these
areas. This widest part of the foot
which correlates very close to the center of rotation will typically be in the
middle of or just in front of the middle of the hoof. The low heel type foot with lower suspension
properties within the deep flexor tendon will have more load in the heels. This results in growth rings that are wider
at the toe and narrower at the heel. The
widest part of the hoof is typically in the palmar third creating a long lever
arm. <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwtSjH-Ttp3mLn2wZVqdW0cMjasaZwBlOTu2afgaGKBA4mJk7dy1p0SkFmHNsy1RDPe1TkKNU4efCZSVpVxdIRPEFEsASusrPFaJIhS7-vB38CtYREcYyozpmRlxZ3dzkrmJnz69mcTJ8/s1600/Slide13.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwtSjH-Ttp3mLn2wZVqdW0cMjasaZwBlOTu2afgaGKBA4mJk7dy1p0SkFmHNsy1RDPe1TkKNU4efCZSVpVxdIRPEFEsASusrPFaJIhS7-vB38CtYREcYyozpmRlxZ3dzkrmJnz69mcTJ8/s1600/Slide13.PNG" height="480" width="640" /></a></div>
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Figure <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->7<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> Grade 2.5 club with heel
outgrowing toe versus a crushed heel with toe outgrowing heel</div>
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Note in
figure 7 the club foot on the has growth rings that diverge from toe to
heel and the crushed heel diverges from the heel to the toe. </div>
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<div class="MsoNormal">
Other aspects to consider from the solar view is frog characteristics. Typically with upright clubby feet that present as adults will have recessed atrophied frogs compared to the crushed heel hoof that will have a robust strong frog. Paying close attention to bulges will also further define regions of excessive load. This will occur around the apex of the frog with higher grade clubs and laminitic feet and just under the wings in negative palmar angle or crushed heel feet. Another good tool is watching your patients go in soft footing and watching what the coronary band, toe and heel does. Watch the heel and toe for sinking into the forgiving footing. Watch the coronary band. Does is stay level, rotate forward and more positive or backwards and more negative. This will also give you a good indication of the deep flexor system and what is will allow. </div>
<br />
<div class="MsoNormal">
<span style="font-size: 12.0pt;"> This
mechanical scenario has implications that must be considered in every foot disease. Using the podiatry style radiograph and
venogram to determine compromised areas and design a therapeutic shoeing
program is paramount to have repeatable success. Simply altering the toe lever length by
setting a shoe back, rolling or rockering the toe and use of natural balance
shoes has proven to offer mechanical advantage but has its limitations. Greater success is obtained by altering and
monitoring sole depth, palmar angle, tendon surface angle and digital
alignment. Difficult cases in my
practice have pre and post shoeing radiographs at every visit. The pre-shoe gives you information regarding
how the horse responded to your mechanical therapy with regards to palmar
angle, sole depth and digital alignment. The post shoeing radiographs sets a
new baseline and confirms you have accomplished your therapeutic goal with your
trim and shoe application. </span></div>
</div>
Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-50153836783571429212014-12-22T10:53:00.000-06:002014-12-22T19:14:29.452-06:00How to Take Farrier Friendly Radiographs. Presented at OSU CVM fall conference 2014<div dir="ltr" style="text-align: left;" trbidi="on">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 18.0pt; line-height: 150%;">How to Take Farrier Friendly
Radiographs<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 12.0pt; line-height: 150%;">Sammy L. Pittman, DVM<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 12.0pt; line-height: 150%;">Innovative Equine Podiatry and
Veterinary Services, Pllc<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12.0pt; line-height: 150%;"> Gaining
relative information within the hoof capsule, that helps the vet/farrier team
make decisions, requires a consistent and detailed approach. Most of us learn radiographic technique that
concentrates a study on bony structures.
The same radiographic views that detail the coffin joint or navicular
bone are essentially useless to designing a therapeutic shoeing program. It gives us no reliable information with
regards to the mechanical properties that are in play. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12.0pt; line-height: 150%;"> Informative
radiographs are relative to the answers we seek. Being attentive to the many details will
allow consistent repeatable and comparative images. Following the guidelines below will give you
the ability to produce consistent and reliable radiographic exams helpful in
evaluating the mechanical properties affected by trimming and shoeing. <o:p></o:p></span></div>
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<span style="font-size: 12.0pt; line-height: 150%;">1) Place both hooves
on blocks that are designed to allow the primary beam to penetrate the hoof
between the palmar rim of the coffin bone and ground surface. Wire embedded into the surface of the blocks
is helpful when measuring relevant angles.
To determine height of blocks set your xray generator on the ground and
measure to the center of the crosshairs on the collimator then subtract 1/2 to
3/4 of an inch. This will consistently
place your beam just below the coffin bone in most barefoot and shod horses
with the exception of large padded packages.
If the horse toes out then the blocks toe out as well and the same
for a toed in conformation. Blocks should be about the same width apart
as the gap in between the upper forearm at the level of the sternum. This will be about one hands width in most
light breed horses. The hoof should be
set to the medial and palmar/plantar edge of the block to allow the radiograph
cassette/plate to be touching the hoaof in the lateral view and as close as
possible in the dorsopalmar views.
Aligning the frog stay or central sulcus with the sagittal wire marker
embedded into the block will aid in appropriate beam alignment for the Dp and
lateral view. </span><br />
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<span style="font-size: 12.0pt; line-height: 150%;"> <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12.0pt; line-height: 150%;">2) Beam orientation must be centered on the area
of interest. Trying to identify
important measurements relative to therapeutic shoeing and trimming requires a
low beam orientation. This is
consistently obtained by setting up your blocks as previously described. A perpendicular beam to cassette/plate
orientation should always be obtained to prevent distortion of your image. <o:p></o:p></span><br />
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<tr><td class="tr-caption" style="text-align: center;">High beam</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEPJty2jjZvtEX5EkNH9XnoHPgXmu20jHcvhHpwn4NdKxUOzYR9zYBi5I0IQehBUxP_dQWNom4VuRWzuvyc6CMMdR3aghgZG-FV1jRlzNHs5z2EYzXQQf4MM1eV8U1IAbPEV3A4jfAYiU/s1600/Equine+Podiatry,+Innovative.Susie+Q.10-5-Oct-2014.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEPJty2jjZvtEX5EkNH9XnoHPgXmu20jHcvhHpwn4NdKxUOzYR9zYBi5I0IQehBUxP_dQWNom4VuRWzuvyc6CMMdR3aghgZG-FV1jRlzNHs5z2EYzXQQf4MM1eV8U1IAbPEV3A4jfAYiU/s1600/Equine+Podiatry,+Innovative.Susie+Q.10-5-Oct-2014.jpg" height="400" width="310" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">High Beam</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Low beam</td></tr>
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<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;">3) The cassette/plate
should be touching the hoof on the medial side in the lateral view to prevent
as much magnification as possible. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12.0pt; line-height: 150%;">4) Use radiographic paste to mark the dorsal hoof wall in the
sagital plane in all lateral views. The
paste should start where the last hair exits and extend to entire length of the
hoof capsule. This allows accurate
measurement of coronary band to extensor process distance, horn-lamellar zones,
and allows definition of every ripple, defect or growth ring. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12.0pt; line-height: 150%;">5) Focal film distance
should be always consistent and can range from 24" to 28". Typically with today's smaller units closer
to 28" allows visualization of just below fetlock. Just keep it consistent. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkAyup-S91tLtmECnSfixtSj8jOuJalHf7odMXX_V2bBrDpl7Xjv1NFoSJ1yYctfXZm9JZYaOgVw5NyZYDeqdgF6hQTndfD1BwOXVlQ8fCZyO0ph7nJhWDFZd_miRZyy6IpfLAnSvQ8W8/s1600/sk_retouch37-63.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkAyup-S91tLtmECnSfixtSj8jOuJalHf7odMXX_V2bBrDpl7Xjv1NFoSJ1yYctfXZm9JZYaOgVw5NyZYDeqdgF6hQTndfD1BwOXVlQ8fCZyO0ph7nJhWDFZd_miRZyy6IpfLAnSvQ8W8/s1600/sk_retouch37-63.jpg" height="213" width="320" /></a><span style="font-size: 12.0pt; line-height: 150%;">6) A calibration
instrument should be placed in the sagittal plane for the lateral and the
transverse plane for the dorsopalmar view.
Most digital radiographic software allows for calibration based on a
known measurement in the radiograph.
Metron software has a built in calibration component and a specific
calibration instrument embedded into their blocks or an autoscaler. However, simply placing a known length of
wire or metal bar stock in the plane of interest will allow you to calibrate
your radiograph regardless of software.
Calibration is important to correct for magnification that occurs. This
magnification will be consistent if you your radiographic technique is
consistent but it is important to document this detail. Typical magnification is around 10
percent. This factor is important if you
are taking measurements on the radiograph and transferring them to the
hoof. Correction of magnification without software
can be accomplished by a simple math equation. Where (actual foot measurement)={ (Length of Calibration tool) x (radiographic measurement of concern)} / ( radiographic measurement of the calibration tool).</span><br />
<span style="font-size: 12.0pt; line-height: 150%;"><br /></span>
<span style="font-size: 12.0pt; line-height: 150%;"><!--[if gte msEquation 12]><m:oMathPara><m:oMath><m:f><m:fPr><span
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</m:r><m:r>lengt</m:r><m:r>h</m:r><m:r> </m:r><m:r>of</m:r><m:r> </m:r><m:r>calibration</m:r><m:r>
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</m:r><m:r>lengt</m:r><m:r>h</m:r><m:r> </m:r><m:r>of</m:r><m:r> </m:r><m:r>calibration</m:r><m:r>
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</m:r><m:r>measurement</m:r><m:r> (</m:r><m:r>x</m:r><m:r>)</m:r></span></i></m:num><m:den><i
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<div class="MsoNormal" style="line-height: 150%;">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhU2rD7fdgTPq3qHqPca_KzzfAN3niN-xY2JMeZMQ_rAvhpkLgTw4cR9E-XzLm30orA8WNpy4WHz5HBhozYrQHlttOedzbOQvE8j-7ypxd2cMq7nhqK58InWNlsmVDsmYhj-wxs5JKOnlY/s1600/Equine+Podiatry,+Innovative.Susie+Q.12-5-Oct-2014.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhU2rD7fdgTPq3qHqPca_KzzfAN3niN-xY2JMeZMQ_rAvhpkLgTw4cR9E-XzLm30orA8WNpy4WHz5HBhozYrQHlttOedzbOQvE8j-7ypxd2cMq7nhqK58InWNlsmVDsmYhj-wxs5JKOnlY/s1600/Equine+Podiatry,+Innovative.Susie+Q.12-5-Oct-2014.jpg" height="320" width="248" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Good Bone Detail but not good for soft tissue</td></tr>
</tbody></table>
<span style="font-size: 12.0pt; line-height: 150%;">7) Radiograph
technique can vary widely but typically
low Kvp and higher Ma produces
better soft tissue detail. Today's
digital units often give us a good representation of bone and soft tissue
detail but it is still worth playing with your settings to find greater grey
scale within the hoof capsule. Seeing
the dermo-epidermal junction is a good guideline to know if you are seeing
enough soft tissue detail. I also like
to see the deep flexor tendon in my foot films.
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<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12.0pt; line-height: 150%;"> Currently I
measure and monitor several distances and angles to follow the health of the
foot, design therapeutic shoeing plans and monitor disease processes. Below is a description and diagram of each
measurement, how to measure and a short discussion about each measurement. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
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<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiAYedev0MCBnyocW4-JbRmVDOr9DYHP11WU8H9YVWGq46RNiJoDJSQ7yiUUexEsZZ8a1vkXS6Y_9GYwrzGWX9X9uW_GkJjdE1ALY8y7O2BOpyRgBJ4qXDlE50jO6jHbEvyARGh4u3OAU/s1600/STP+drawing+osu+fall+conferenc1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiAYedev0MCBnyocW4-JbRmVDOr9DYHP11WU8H9YVWGq46RNiJoDJSQ7yiUUexEsZZ8a1vkXS6Y_9GYwrzGWX9X9uW_GkJjdE1ALY8y7O2BOpyRgBJ4qXDlE50jO6jHbEvyARGh4u3OAU/s1600/STP+drawing+osu+fall+conferenc1.png" height="640" width="506" /></a></div>
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12.0pt; line-height: 150%;"> <u>Coronary band to extensor process (CE)</u><span class="apple-converted-space"> </span>is measured from top of paste which is
applied at most proximal aspect hoof wall at the point of the last hair
follicle down to the extensor process of the coffin bone. This will range
from 8 to 30 mm in most healthy hooves. This number does not give you
much information as a single measured parameter. However, when monitored
and compared in serial radiographs, especially when monitoring an acute
laminitis case, it is extremely valuable. For example, an acutely laminitic
patient that measures 8mm on day 1 of clinical signs and then measures 18mm on
day 4. This is a 10mm distal displacement which is usually
accompanied by a 10mm decrease in sole depth as well and varying degrees of rotational
displacement. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12pt; line-height: 150%;"> <u>Horn-Lamellar zone (HL)</u><span class="apple-converted-space"> </span>is measured in two areas, one proximal
just below extensor process and one distal just above apex of coffin bone.
This will most commonly measure 15 mm in most light breed horses but can
be as high as 20mm in larger breeds, mules and donkeys. This measure is
expressed as proximal HL/Distal HL (15/15). Instead of measuring only
rotation this will give you a measurable displacement that is more definitive
than a generic rotation. Evaluating the dermal-epidermal junction is also
of great importance as it should split the horn lamellar zone further
defining each. This allows more specific interpretation of changes in the
HL zone. For example with laminitis the L component of the HL zone will
change not the H component. Early in laminitis this may be the only
notable change and an increase of 3-4 mm is a significant finding and may have
no measurable rotation. Several important disease processes can be
discovered in this zone and many foot diseases such as clubs, chronic/acute
laminitis, white line disease, keratomas and abscesses have very unique
qualities that can be shown here.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 12pt; line-height: 150%;"> <u>Sole Depth (SD)</u><span class="apple-converted-space"> </span>is
measured from the tip of the coffin bone down to most distal aspect of the
sole. The cup is also of importance as it is present to different degrees
depending on health or pathology and can also be falsely created. This
measurement is expressed as SD/Cup. Healthy feet with no pathology will
most commonly carry 12-15mm of sole and a 2-3mm cup (15/3). This should be of
upmost concern of the vet/farrier team when striving to obtain soundness and
health of the foot. This should be the measurement at the day of the
farrier visit. Often thin soled horses are at 6-7mm of sole 8 weeks into
the cycle and this is a sign of a compromised foot that requires a different
approach to increase foot mass and health. Two measurements can be made to give
you more information, one at tip of coffin bone and one under wing of coffin
bone. Venogram findings suggest that a depth of 15mm is required to
maintain a healthy appearance to the solar vascular bed with robust
and correctly aligned terminal papillae<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
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<span style="font-size: 12pt; line-height: 150%;"> <u>Digital Breakover (DB)</u> is measured from the
tip of the coffin bone to where the foot or shoe if shod would leave the
ground. Healthy hooves that maintain adequate SD and good digital
alignment will commonly maintain a DB of 20-25mm. Many times in perimeter
fit shoes, depending on type of foot, bone angle, and toe lever this number is
considerably higher than ideal at the day of the farrier visit and continues to
lengthen throughout the cycle due to hoof growth. This gives us a measurable
lever arm that applies its force to the deep digital flexor tendon and its
subsequent force impacts on apex of the coffin bone, dorsal hoof wall and
navicular apparatus. Below I discuss toe lever (TL) that in my opinion
gives a more accurate understanding of the lever arm involved.<span class="apple-converted-space"> <o:p></o:p></span></span></div>
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<span class="apple-converted-space"><span style="font-size: 12pt; line-height: 150%;"> </span></span><u><span style="font-size: 12pt; line-height: 150%;">Bone
Angle (BA)<span class="apple-converted-space"> </span></span></u><span style="font-size: 12pt; line-height: 150%;"> is
the angle of the coffin bone when viewed in a lateral radiograph. Average
BA will be 50 degrees. In my practice I have measured BA's as low as 36
degrees in very low heeled and long toed horses to 70 degrees in club feet.
The shape of the coffin bone determines the shape of the hoof. Most
of the time the horses that have low heel long toe conformation will have a
less than 50 degree bone angle with a long measurable toe lever (see below) and
the opposite is true for upright club feet. Granted, horses that have overgrown
unkempt feet may have crushed heels and a long toe but may have a good BA.
I feel that monitoring this parameter early in life could potentially
identify feet that may have a common sequalae with regards to lameness later in
life. For example, a horse with a 42 degree BA and a 70mm Toe lever may
be at higher risk of hyperextension injuries of the pastern, coffin and fetlock
joint and increased tension strain on deep digital flexor tendon, and navicular
apparatus when compared to a coffin bone with a lower bone angle and shorter
toe lever. If we could identify this early in a horse's career and change
the shoeing protocol to better manage this handicap maybe we could reduce the
amount of wear and tear to some degree. <o:p></o:p></span></div>
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<u>Palmar angle (PA)</u> also
known as solar angle of the distal phalanx or ventral angle is measured from
the wings of the coffin bone in comparison to a level ground surface or
embedded wire in block. It can be tricky to measure in some feet with
considerable bone remodeling. Using the wings will offer the
most consistent measurement. This gives us a manner in which to evaluate
flexor tendon engagement. In general lowering the PA increases tendon
tension and raising should decrease the tension. This angle will average 3-5
degrees in the horse that maintains adequate sole depth and is free of lameness
but can vary greatly. PA should be evaluated in this manner: Is
this PA healthy for this foot? The answer comes from evaluation of sole
depth, clinical exam and digital alignment. For example, PA measures 8
degrees and maintains a SD of 15/3 and good digital alignment. This case
is higher than what is ideal but currently considered healthy for this case.
On the other hand PA measures 3 degrees and sole depth is 7mm. This
is not likely a healthy PA as a higher PA with less deep digital flexor tendon
tension will unload the solar corium and vital growth center of the sole.
This angle is also of great value to monitor in a preventive podiatry
program. <o:p></o:p></div>
<div style="line-height: 150%;">
<u>Toe
Lever (TL)</u> can
be expressed as static toe lever or shod toe lever. Shod TL is measured from center of center of rotation of
the coffin joint to where the hoof/shoe would leave the ground and static TL is
measured from the center of rotation to the tip of the coffin bone. Shod TL we can effect and static we
cannot. Lower BA coffin bones typically
have a longer TL than higher degree. In my practice I see static TL
as short as 45mm to as long as 75mm in adult horses. Monitoring this at a
young age may allow us to apply orthotics that will decrease
the effective lever arm that antagonizes the lower limb.
Therapeutic shoe packages can be evaluated with regard to amount of lever
arm relief. Simply setting the shoe back only effects this measurement a
few millimeters and sometimes many lameness issues respond to a TL that is
3-4 times less than what is measured on their bare foot. <o:p></o:p></div>
<div style="line-height: 150%;">
<br /></div>
<div style="line-height: 150%;">
<u>Tendon
Surface Angle (TSA)</u> is
measured on this distal part of the navicular bone compared to a level ground
marker. This is relative to the course of the deep digital flexor tendon takes
at turns to attach to the coffin bone. Monitoring the change of TSA with
your applied orthotic is of value especially cases that show navicular bone
lesions in this region. Simply changing DB may be beneficial in
many cases however raising PA and TSA is often required to be therapeutic.<o:p></o:p></div>
<div style="line-height: 150%;">
<br /></div>
<div style="line-height: 150%;">
References:<o:p></o:p></div>
<div style="line-height: 150%;">
1.
Redden, R.F. Clinical and Radiographic Examination of the Equine Foot.
In Proceedings Am. Assoc. Equine Pract.
2003;49:174.<o:p></o:p></div>
<div style="line-height: 150%;">
2.
Merit, K. How to take foot
radiographs. In proceedings Am. Assoc. Equine Pract. 2008.<o:p></o:p></div>
<br />
<div style="line-height: 150%;">
3.
Floyd, A. Mansman, R. 2007 Equine podiatry, Radiology and Radiography of
the Foot. pg 141<br />
<br />
<o:p></o:p></div>
</div>
Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-9919296715003876072014-10-27T06:58:00.001-05:002014-10-27T06:59:53.647-05:00Whats in a toe angle<p dir="ltr">Whats in a toe angle? Here are two foals that would be considered to have a club foot with a toe angle of close to 64 degrees. However what makes up the angle on the inside dictates what the foot will do and what it takes to manage it. The foot on the left has a lower bone angle and a higher Palmar angle. This is a system that is under higher deep flexor tension rasingbthe heel and palmar angle. Notice there is more dishing of the toe on the left radiograph as well. All indications that the deep flexor acting very heavy on the coffin bone. </p>
<p dir="ltr"> The radiograph on the right has a very large bone angle and lower Palmar angle, and no dishing. </p>
<p dir="ltr">Palmar angle plus the bone angle will equal the toe angle. </p>
<p dir="ltr">The hoof on the left will require more attention directed at relieving deep flexor tension via shoeing mechanics (rocker shoe) or surgery (check ligament desmotomy). The hoof on the right will be easier to manage with trimming alone and or low scale rocker shoe to add some foot mass to further protect the fragile coffin bone during development. </p>
<p dir="ltr">This is why radiographs are so very helpful in managing foot problems. You will never go wrong gaining specific information about your problem.</p>
<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLbi62NMCvFllAhQvKMuTP9GdF8u5ciNT7s484Lw_j-177IaF0nO_CFY7QeLcY3VBtFtxwmdaJWK-GCDw_dFtQjNdY4VkyTCR99pgk3O39sVP-ENAUOfZOcLhjF7OleF6kYLkpevLvDlg/s1600/toe%252520angle%252520comp.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"> <img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLbi62NMCvFllAhQvKMuTP9GdF8u5ciNT7s484Lw_j-177IaF0nO_CFY7QeLcY3VBtFtxwmdaJWK-GCDw_dFtQjNdY4VkyTCR99pgk3O39sVP-ENAUOfZOcLhjF7OleF6kYLkpevLvDlg/s640/toe%252520angle%252520comp.jpg"> </a> </div>Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-40464128551734459332014-01-05T23:07:00.000-06:002014-01-05T23:32:37.908-06:00Setting the bar for success in my laminitis cases<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: large;">Welcome to 2014! I wanted to review some of my laminitis cases that have proven very successful with regards to quickly adding sole mass and demonstrating an even hoof wall growth from toe to heel. A couple of cases will also demonstrate how quickly the venogram can change. Improvement in the blood supply is what we are all after.When you can demonstrate a quickly improving venogram study plus the quick addition of sole depth you can be a more positive about the overall situation. Success to me is rapid foot recovery and ideally reversing the damaging effects of vascular compression before it creates irreversible bone and soft tissue damage. Monitoring with venograms will show the level of vascular damage present and allows a quicker more accurate mechanical therapy. </span></div>
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<span style="font-size: large;">For a review on soft tissue parameters measured on a podiatry style radiograph <a href="http://innovativeequinepodiatry.blogspot.com/p/radiographic-parameters-measurement.html" target="_blank">click here</a>.</span></div>
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<span style="font-size: large;">For a reference on a healthy venogram<a href="http://innovativeequinepodiatry.blogspot.com/p/normal-venogram-references-and.html" target="_blank"> click here</a>.</span></div>
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<span style="font-size: large;">The first case is Rocky. Rocky was first examined about 3 months after the initial insult and was well past the ideal time to completely avert any bone change. Note the big divot out of the tip of the coffin bone caused by a severely displaced circumflex artery and terminal papillae is supplies. This chronic history, severe coffin bone displacement and venogram indicated the need for a deep flexor tenotomy (cutting of the tendon) after derotational shoeing. </span></div>
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<span style="font-size: large;">Note the quick addition of sole mass and a decrease in the amount of rotation within the hoof capsule. Loss of rotation is not the goal but a common finding after changing the load dynamics by cutting the tendon. This places a majority of the load towards the back of the coffin bone and can push the tip up in many cases to reduce the amount of rotational displacement and unload the circumflex under the rotated tip of the coffin bone. Left column is the day of surgery and the right column is 30 days later. Note the rapid addition of sole under the tip of the coffin bone. The 3 months prior the hoof wall growth was greater in the heel than in the toe area which is very common with laminitis. This is secondary to the vascular compression in the front half of the foot. This is confirmed in the above venogram. The blood supply to the coronary band should be much fuller than demonstrated here. After the tenotomy the hoof wall began to grow more even as we have unloaded the forces applied by the tendon and allowing a reperfusion of blood to these vital areas. </span></div>
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<span style="font-size: large;"> The images in the left are post shoeing radiograph from the 30 day post tenotomy visit and the images on the right are 30 days after that or 60 days post tenotomy. The inital shoes are glued on and are usually left on for the first 10-12 weeks and many cases are barefoot at that time. This case was growing so rapidly and to properly manage the palmar angle (prevent from getting into the negative zone) the shoe was removed, the foot trimmed and very lightly nailed back on parallel the the wings of the coffin bone. Again note the amount of sole depth recovery within this 30 day period. </span><br />
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<span style="font-size: large;">The bottom two images are 90 days post tentomy. This horse is comfortable barefoot and can maintain a zero to slightly positive palmar angle. </span><br />
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<span style="font-size: large;">Plan is for this horse to start hand walking daily for 5-10 minutes just to get him out of the stall. Recheck at 4-6 week intervals with radiographs to insure continued foot mass recovery and maintenance of the palmar angle. This horse may very well be able to do some light riding in another 6-8 months with some turnout. Because of the severe bone remodeling that had already occurred I am hesitant to say he will return to 100 percent of what he was prior lamintis but can have a good quality of life. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFDEcVUVblTwfdxq0PuqxiGAFFVau2gCUSTf1J-2yCBapzh6hEgSPA5GiF2JyaYqfe3g64GAwdPSRq9goi3XnmreU7j8XH_wdny39mb_ujWHKP23v7EaIV_sSXVYFn8LXn7oF9_lZ6NKk/s1600/Henry%252C+Lindsay.Rocky.4-2-Nov-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFDEcVUVblTwfdxq0PuqxiGAFFVau2gCUSTf1J-2yCBapzh6hEgSPA5GiF2JyaYqfe3g64GAwdPSRq9goi3XnmreU7j8XH_wdny39mb_ujWHKP23v7EaIV_sSXVYFn8LXn7oF9_lZ6NKk/s1600/Henry%252C+Lindsay.Rocky.4-2-Nov-2013.jpg" height="320" width="252" /></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZfBFpYzw-Sy2eqIikkK8Sbbr-xW-_Urn2_GWBqFrdvg0RgsoS5zJtlmhqW465dhwccRJ-a8FNswxVjVuCl_FWR58G4Oj0j0fmwE049beEIc0DYbMEE-f37bcYkO89IAAC_rLB_zf6MVY/s1600/Henry%252C+Lindsay.Rocky.3-14-Dec-2013%2523%25232.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZfBFpYzw-Sy2eqIikkK8Sbbr-xW-_Urn2_GWBqFrdvg0RgsoS5zJtlmhqW465dhwccRJ-a8FNswxVjVuCl_FWR58G4Oj0j0fmwE049beEIc0DYbMEE-f37bcYkO89IAAC_rLB_zf6MVY/s1600/Henry%252C+Lindsay.Rocky.3-14-Dec-2013%2523%25232.jpg" height="320" width="252" /></span></a></div>
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<span style="font-size: large;">Case #2 Gracie</span></div>
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<span style="font-size: large;">Gracie had been guilty of getting into the owners bird seed and dog food and was a touch overweight. Surprisingly fairly sound and would only rock back on hind quarters in turn. A considerable amount of coffin bone displacement had already occurred which indicates the syndrome has been rolling for some time. Owners reported some pain over the last 4 weeks only. Note the distal divergent horn lamellar zones and loss of sole depth. </span></div>
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<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8T846QpFdit8vu2Wv3DnT7KbfRWU7j4657FjSanBz0Ykj8ubudw3Tg4TBgQM_56ohwIR3_b-77V0pC2KpJZ5_nD6BlEhzA6-zgSF7JAYAHppauU3vYNHMxVrmW12_LQw1JIbIAj7U2Qc/s1600/Elkins,+Jane.Grace.1-8-Jul-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8T846QpFdit8vu2Wv3DnT7KbfRWU7j4657FjSanBz0Ykj8ubudw3Tg4TBgQM_56ohwIR3_b-77V0pC2KpJZ5_nD6BlEhzA6-zgSF7JAYAHppauU3vYNHMxVrmW12_LQw1JIbIAj7U2Qc/s1600/Elkins,+Jane.Grace.1-8-Jul-2013.jpg" height="320" width="250" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLjts1yyp4yEYL1VImoqQsqeOTfQtMduNpfJGa8eViTrb4R0jy0r7MCXIWjunN2MmKBb1GOSI7rgAOa-4EcLakn8t6INbx8maTnyKBRzBq-r-lI2P_3XnyDer3FPpOijBrlfPCmdIMgHQ/s1600/Elkins,+Jane.Grace.2-8-Jul-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLjts1yyp4yEYL1VImoqQsqeOTfQtMduNpfJGa8eViTrb4R0jy0r7MCXIWjunN2MmKBb1GOSI7rgAOa-4EcLakn8t6INbx8maTnyKBRzBq-r-lI2P_3XnyDer3FPpOijBrlfPCmdIMgHQ/s1600/Elkins,+Jane.Grace.2-8-Jul-2013.jpg" height="320" width="251" /></a></span></div>
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<span style="font-size: large;">Placed in Nanric modified ultimates the performed a venogram. Venograms in the left column are the first exams and the right column are venograms performed 9 days later. Note the improvement in the vascular structure around the tip of the coffin bone. This is secondary to the wedges unloading the tendon tension by decreasing the distance from its origin to insertion with the coffin bone. This allows the load to be transferred to the heels an back of coffin bone. I also measured a 3mm increase in sole depth in this short period. This is likely due to the unloading of the solar corium directly under the tip of the coffin bone. Think of placing a clothes pin on your finger smashing is flatter. It will measure a greater thickness once the clothes pin compression is removed and the tissue is once again filled with blood. </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmHRM_wMgJN1ORqbHrQFw9YzaSLbGl957xfnu2ND60UHvATcKTEkPwe2RWDZRgsWNbY8shWPPItDpswZM3AcFHEhAimD6a-BRTYlb9aGyAHs-8URFuytkqXst0C2zXZrW6Rhfgrizssoc/s1600/Elkins%252C+Jane.Grace.6-9-Jul-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmHRM_wMgJN1ORqbHrQFw9YzaSLbGl957xfnu2ND60UHvATcKTEkPwe2RWDZRgsWNbY8shWPPItDpswZM3AcFHEhAimD6a-BRTYlb9aGyAHs-8URFuytkqXst0C2zXZrW6Rhfgrizssoc/s1600/Elkins%252C+Jane.Grace.6-9-Jul-2013.jpg" height="320" width="251" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhibR-W1LtWbJJcQSAYT9RUgrUSI3N-IYcN2nWJZT6leNBSIxd3hBF-3vFfHryH2MHToWXG7_p9QH1WbZSQlJ2wCoOzmKKqRrDDsBwZPp0bzWr5J3vQel2Cr8bM0EZ2GYKcJjjktnuPec8/s1600/Elkins%252C+Jane.Grace.3-18-Jul-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhibR-W1LtWbJJcQSAYT9RUgrUSI3N-IYcN2nWJZT6leNBSIxd3hBF-3vFfHryH2MHToWXG7_p9QH1WbZSQlJ2wCoOzmKKqRrDDsBwZPp0bzWr5J3vQel2Cr8bM0EZ2GYKcJjjktnuPec8/s1600/Elkins%252C+Jane.Grace.3-18-Jul-2013.jpg" height="320" width="244" /></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi24DSpGM2Xf77JhyPibeeDh9kXvt9jde_I5myyA5-HX3fp9Pc4JUdvgBX3H_DegYsW5snM3P0pCMJBx-p8H91T_XUFmbjmLkQMkZJGKA0ku7wm0H47McTUsx9DFYSxW1LNeuvSJ-SK5bU/s1600/Elkins%252C+Jane.Grace.7-19-Aug-2013.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi24DSpGM2Xf77JhyPibeeDh9kXvt9jde_I5myyA5-HX3fp9Pc4JUdvgBX3H_DegYsW5snM3P0pCMJBx-p8H91T_XUFmbjmLkQMkZJGKA0ku7wm0H47McTUsx9DFYSxW1LNeuvSJ-SK5bU/s1600/Elkins%252C+Jane.Grace.7-19-Aug-2013.jpg" height="320" width="249" /></span></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZtDmbuyIMxEazR89rUViNxQjbXACPlQQWU0T_eNRZcNYVa15LF9Pe1qMPqrn7BWfhsA1rjuicke5VUYRgl73T56kX8wM0W8bUuWhKMtLKfGy5u6xqVfNqorvXKbtZIHpGoV4Vl8KT4YU/s1600/Elkins%252C+Jane.Grace.10-9-Jul-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZtDmbuyIMxEazR89rUViNxQjbXACPlQQWU0T_eNRZcNYVa15LF9Pe1qMPqrn7BWfhsA1rjuicke5VUYRgl73T56kX8wM0W8bUuWhKMtLKfGy5u6xqVfNqorvXKbtZIHpGoV4Vl8KT4YU/s1600/Elkins%252C+Jane.Grace.10-9-Jul-2013.jpg" height="320" width="251" /></span></a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGPQ4c4isquaNV24BuruOY4LcRLicwRdGShoQgaU5rcVXxIKj2ZZnsV_A-TafVjKNN6YhyZ68YDU3vx1YjnDVjWeD4qmLQRa5MI99Ri3wgDcOY-j9mSJ565B-Nk0-MC4wcF-czXk4929A/s1600/Elkins%252C+Jane.Grace.2-18-Jul-2013.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGPQ4c4isquaNV24BuruOY4LcRLicwRdGShoQgaU5rcVXxIKj2ZZnsV_A-TafVjKNN6YhyZ68YDU3vx1YjnDVjWeD4qmLQRa5MI99Ri3wgDcOY-j9mSJ565B-Nk0-MC4wcF-czXk4929A/s1600/Elkins%252C+Jane.Grace.2-18-Jul-2013.jpg" height="320" width="251" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb27OptVNnczzgQxCNNXccCmEhXU0N2qY6df9ic_YBmjEtdoLndgocpabSu3IRvcp59Dzm4QaplvujmxjGgO3L3w-tXWSr821EmyEs2ThV8LHKf5fNdlBtBm3Jw-3ENYOMZ3tjoDLyGLo/s1600/Elkins%252C+Jane.Grace.2-9-Jul-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb27OptVNnczzgQxCNNXccCmEhXU0N2qY6df9ic_YBmjEtdoLndgocpabSu3IRvcp59Dzm4QaplvujmxjGgO3L3w-tXWSr821EmyEs2ThV8LHKf5fNdlBtBm3Jw-3ENYOMZ3tjoDLyGLo/s1600/Elkins%252C+Jane.Grace.2-9-Jul-2013.jpg" height="320" width="251" /></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm7XTm-oSKzCYRcGpnMgYrjfx_A8p8TsKqkhTM2qYmBo8eL-tXUI8rfcEr8gV-UReIIXbyVbbPYfJiKHWC6ZATwK-ObfFppZzLzTf2QZ7EoQa8-2_cCglOAtlbVKWVyCTtXjWEIYzqzLM/s1600/Elkins%252C+Jane.Grace.1-9-Jul-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm7XTm-oSKzCYRcGpnMgYrjfx_A8p8TsKqkhTM2qYmBo8eL-tXUI8rfcEr8gV-UReIIXbyVbbPYfJiKHWC6ZATwK-ObfFppZzLzTf2QZ7EoQa8-2_cCglOAtlbVKWVyCTtXjWEIYzqzLM/s1600/Elkins%252C+Jane.Grace.1-9-Jul-2013.jpg" height="320" width="250" /></span></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIdudBID3SjBcR2S-u5GI8euvUsO-c23hXoiWFdyDBjW0qC89lM-49bjXbr-hkgO6ucqshyphenhyphenSfVnsTpfCD-o1lt-BlkhEhY4vsx6LgobgvB0ROntM952VMN8rpY7KQnINdUaMQFgvUa4Fo/s1600/Elkins%252C+Jane.Grace.1-18-Jul-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIdudBID3SjBcR2S-u5GI8euvUsO-c23hXoiWFdyDBjW0qC89lM-49bjXbr-hkgO6ucqshyphenhyphenSfVnsTpfCD-o1lt-BlkhEhY4vsx6LgobgvB0ROntM952VMN8rpY7KQnINdUaMQFgvUa4Fo/s1600/Elkins%252C+Jane.Grace.1-18-Jul-2013.jpg" height="320" width="252" /></span></a><br />
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<span style="font-size: large;">Below are images that are taken 30 days after placement in the nanric modified ultimates placing the palmar angle at approximately 20 degrees</span><br />
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<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRtePtKXugXG3zLBGApTJrwwT_yJj0e-DeTjEYVfDb611HZk1pHCImjstba6PdJdn563tNgcG-pRJR4CXlnWYdP5r6QqC1kuyyNzQzpbG9NcKma94QIXFMCRnlYUf7Hs2-OB6BZ8XJ2TA/s1600/Elkins%252C+Jane.Grace.1-5-Aug-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRtePtKXugXG3zLBGApTJrwwT_yJj0e-DeTjEYVfDb611HZk1pHCImjstba6PdJdn563tNgcG-pRJR4CXlnWYdP5r6QqC1kuyyNzQzpbG9NcKma94QIXFMCRnlYUf7Hs2-OB6BZ8XJ2TA/s1600/Elkins%252C+Jane.Grace.1-5-Aug-2013.jpg" height="320" width="251" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMleo7CeGS8nygZWkVrjeXAzoxYTfzPun8v04OI7AHJ3M9KDq11iiPY-6UwuuFjVyt4CF7COW-qxg8hhEhB-rgCWpCy8FOamoHQZ2oOcDKZNoZC2mpZ_dOJRP8fN7JRwtRe00ifM6MWpY/s1600/Elkins%252C+Jane.Grace.2-5-Aug-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMleo7CeGS8nygZWkVrjeXAzoxYTfzPun8v04OI7AHJ3M9KDq11iiPY-6UwuuFjVyt4CF7COW-qxg8hhEhB-rgCWpCy8FOamoHQZ2oOcDKZNoZC2mpZ_dOJRP8fN7JRwtRe00ifM6MWpY/s1600/Elkins%252C+Jane.Grace.2-5-Aug-2013.jpg" height="320" width="253" /></a></span></div>
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<span style="font-size: large;">Below are images that are 90 days in the ultimates wedges</span></div>
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<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg96jvweWsCaC9XhtxD8P86rIEitcRGMwT2Ym7SKYW4OPjDIkCvpvwF3JMHlQ5GAHpIQJ5qB2IogVmwk2T_8Nw71aiIM1FoPVjNTHN_lnQzIZf4IzZzlj7eb1AT9D4w2BTL09O6v8CCyig/s1600/Elkins%252C+Jane.Grace.2-15-Oct-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg96jvweWsCaC9XhtxD8P86rIEitcRGMwT2Ym7SKYW4OPjDIkCvpvwF3JMHlQ5GAHpIQJ5qB2IogVmwk2T_8Nw71aiIM1FoPVjNTHN_lnQzIZf4IzZzlj7eb1AT9D4w2BTL09O6v8CCyig/s1600/Elkins%252C+Jane.Grace.2-15-Oct-2013.jpg" height="320" width="250" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjd35fNf3p0DP9xOaTOMPeLw6Nk-WX9fAWHsqaGvz94FG_2Z8PIXyFvMXJtXd5LE6ttRvF6ioRQTpuWkLUQ0FErcfKYtWo8evxl1KEhnoP45S9xxXL3tiM_kDisntMLOFp_lAI4lTJLzX8/s1600/Elkins%252C+Jane.Grace.1-15-Oct-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjd35fNf3p0DP9xOaTOMPeLw6Nk-WX9fAWHsqaGvz94FG_2Z8PIXyFvMXJtXd5LE6ttRvF6ioRQTpuWkLUQ0FErcfKYtWo8evxl1KEhnoP45S9xxXL3tiM_kDisntMLOFp_lAI4lTJLzX8/s1600/Elkins%252C+Jane.Grace.1-15-Oct-2013.jpg" height="320" width="250" /></a></span></div>
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<span style="font-size: large;">This demonstrated a rapid change in the vascular pattern with the addition of the wedging and did not require a higher level of deep flexor tendon relief as the previous case in which the tendon was cut. Just placing a little slack in the tendon system is often all that is required to unload the vascular supply in important compromised areas in the front of the foot and directly under the tip of the coffin bone. This horse will then be transitioned to a rockered 4pt rail shoe that will continue to offer a greatly reduced load on the flexor tendon, solar corium and the lamellar attachments. The level of rocker/mechanics will be slowly lowered as long as continued soft tissue response is noted. </span></div>
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<span style="font-size: large;">Case #3 is a mustang that suffered lamintis in all four feet. The fronts required a deep flexor tenotomy as the circumflex artery was displaced above the tip of the coffin bone and no contrast is noted below the tip of the coffin bone. The hind venogram was also compromised but to a lesser degree. The fronts where shod with a derotational tenotomy shoe followed by a deep flexor tenotomy and the hinds were placed in the ultimate wedges. A follow up venogram performed on a hind foot demonstrated a positive improvement and suggest that a tenotomy is not needed at this time and supports continued use of the wedges. One can already see the addition of sole depth in this short 10 day period in the fronts and hinds.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwnTsM_6cNcJntUZarmzGGoaDRJ9j06UYfm4G27jRZVbH_CLdhg-6J0LehHMCnwT2d3-GsON31SYHXMwD6kbcYkFATteOPyF6STmOigtm0EqfKwa-g-qwiOF1QUD5_Eyu34xgmwr_TSjg/s1600/Majors,+Nancy.Hercules.1-2-Oct-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwnTsM_6cNcJntUZarmzGGoaDRJ9j06UYfm4G27jRZVbH_CLdhg-6J0LehHMCnwT2d3-GsON31SYHXMwD6kbcYkFATteOPyF6STmOigtm0EqfKwa-g-qwiOF1QUD5_Eyu34xgmwr_TSjg/s1600/Majors,+Nancy.Hercules.1-2-Oct-2013.jpg" height="320" width="256" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6C1-R5T4jItzPnO7vxsuUPmMCl34ulBWXsDgxxpZgbsxQTRKBKMY07hMnm5_nxHZa_a6APoAvs4bf0Reoea_kjfoCuJ47TaGxV6K03m1zrhR7nwa094V7FbxWdrVDMKRdLY-Se5m0k2w/s1600/Majors,+Nancy.Hercules.2-2-Oct-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6C1-R5T4jItzPnO7vxsuUPmMCl34ulBWXsDgxxpZgbsxQTRKBKMY07hMnm5_nxHZa_a6APoAvs4bf0Reoea_kjfoCuJ47TaGxV6K03m1zrhR7nwa094V7FbxWdrVDMKRdLY-Se5m0k2w/s1600/Majors,+Nancy.Hercules.2-2-Oct-2013.jpg" height="320" width="252" /></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpj1aawUqOXp2_hyphenhyphen5ujM9Jw05UwwJeKLnTEii9QM41kE_m05TNvUBtZ3Imb-lbvPrWg-6dGrBNrWvNMnEsMt8OrVFmmPTe1mwOAjL_-_fgU7Plk9LdqajX8q-HlqXHlnpZ-L9IqWFs6RI/s1600/Majors,+Nancy.Hercules.3-2-Oct-2013.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpj1aawUqOXp2_hyphenhyphen5ujM9Jw05UwwJeKLnTEii9QM41kE_m05TNvUBtZ3Imb-lbvPrWg-6dGrBNrWvNMnEsMt8OrVFmmPTe1mwOAjL_-_fgU7Plk9LdqajX8q-HlqXHlnpZ-L9IqWFs6RI/s1600/Majors,+Nancy.Hercules.3-2-Oct-2013.jpg" height="320" width="252" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg5UcsNPelNFawleNb4LQf7QVN3xp-MUSW1Hy7uiISEGzcj_AJO9I2JlSwLR6fUeS9ziSOSRrWgTB3czGIxCyydYlpaFF0afQTR0JOt8G-zNAOJ1ydnqdtT2C7j50-7MjxSDWZf_kyMkw/s1600/Majors,+Nancy.Hercules.7-2-Oct-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg5UcsNPelNFawleNb4LQf7QVN3xp-MUSW1Hy7uiISEGzcj_AJO9I2JlSwLR6fUeS9ziSOSRrWgTB3czGIxCyydYlpaFF0afQTR0JOt8G-zNAOJ1ydnqdtT2C7j50-7MjxSDWZf_kyMkw/s1600/Majors,+Nancy.Hercules.7-2-Oct-2013.jpg" height="320" width="254" /></span></a></div>
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<span style="font-size: large;">On the left below is a venogram of the left hind on initial exam and a follow up venogram 10 days later while wearing the modified ultimates placing the palmar angle at 20 degrees. Note the significant improvement in vessel filling over the coronary band, the more normal appearance in the circumflex junction and return of solar and terminal papillae.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCpnE58yfhTscxkbuDLrnnAhC_9BU5jU2snot_4u6LKPqagSES8fOVUSVRHTr6K7bJ_Xqu87wpeTLJK-YYuapWod9NQztl82B_GJ5NTrB9G5UZ2B-MqkZVpoqAgBXcLu9quOvPfArxp4U/s1600/Majors,+Nancy.Hercules.8-12-Oct-2013.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCpnE58yfhTscxkbuDLrnnAhC_9BU5jU2snot_4u6LKPqagSES8fOVUSVRHTr6K7bJ_Xqu87wpeTLJK-YYuapWod9NQztl82B_GJ5NTrB9G5UZ2B-MqkZVpoqAgBXcLu9quOvPfArxp4U/s1600/Majors,+Nancy.Hercules.8-12-Oct-2013.jpg" height="320" width="257" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjg7dIA_GJo3DqgfINIpnKesbvlQdNdkMt3DFWlsGlmXikKMjDLaPFC3wvN1_B1ZfnTTH5CEs7J-eX0WSTFe0361_GcxAadGBUWCOllS-m8g5cl4KsqB3Jm3AOYVsGJ9NAz7SsBRTpVXg/s1600/Majors,+Nancy.Hercules.12-2-Oct-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjg7dIA_GJo3DqgfINIpnKesbvlQdNdkMt3DFWlsGlmXikKMjDLaPFC3wvN1_B1ZfnTTH5CEs7J-eX0WSTFe0361_GcxAadGBUWCOllS-m8g5cl4KsqB3Jm3AOYVsGJ9NAz7SsBRTpVXg/s1600/Majors,+Nancy.Hercules.12-2-Oct-2013.jpg" height="320" width="245" /></span></a></div>
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<span style="font-size: large;"> Below are radiographs of the fronts. The images on the left are taken on the day of surgery and radiographs on the right are 30 days post surgery. Sole depth has easily more than doubled. This is the rapid response required to quickly unload the vascular structures and aid in prevention of irreversible bone disease and chronic pain.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL_gKPLOrKwl6GdccMPv0aiQ3ip5q-Mh_p3t25LiJoeoD5dWmQKzJ23mfGvRvTFcWrl06jUKb6IQMCcAZlOc4mp_-pTWgaWkpqIgKVl4am9vqk70vDdydZ7SF_uIMIvTAOxlQGrNisq0Y/s1600/Majors%252C+Nancy.Hercules.2-9-Nov-2013.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL_gKPLOrKwl6GdccMPv0aiQ3ip5q-Mh_p3t25LiJoeoD5dWmQKzJ23mfGvRvTFcWrl06jUKb6IQMCcAZlOc4mp_-pTWgaWkpqIgKVl4am9vqk70vDdydZ7SF_uIMIvTAOxlQGrNisq0Y/s1600/Majors%252C+Nancy.Hercules.2-9-Nov-2013.jpg" height="320" width="250" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja5q4rmBmaDv9Qjdubedl-_Q38N9XOc4QMTUrpoKZk_PnyrY7HERammYhMX1Q3BQGHdts9XAcH-2mCpWdH50OW6R6Dif3JB8cjc_fXeCkbRv8egeTD4iQh0PTVeFuH3LuxsUGu5GIPg-A/s1600/Majors%252C+Nancy.Hercules.8-3-Oct-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja5q4rmBmaDv9Qjdubedl-_Q38N9XOc4QMTUrpoKZk_PnyrY7HERammYhMX1Q3BQGHdts9XAcH-2mCpWdH50OW6R6Dif3JB8cjc_fXeCkbRv8egeTD4iQh0PTVeFuH3LuxsUGu5GIPg-A/s1600/Majors%252C+Nancy.Hercules.8-3-Oct-2013.jpg" height="320" width="252" /></span></a></div>
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<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnnSBEmmpqIeoMGzXjyYKNzgXSyghG75F0naYJtivZWVXlTjAdDSNtBQrIOQP1XaBg4EXR-t3YR7voNbWsX-wIc2bUXH5wi0DjlPriy-jjTJ9vxqx7EHwKyE-XapsdzVr1rPVXucdiMwk/s1600/Majors%252C+Nancy.Hercules.7-3-Oct-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnnSBEmmpqIeoMGzXjyYKNzgXSyghG75F0naYJtivZWVXlTjAdDSNtBQrIOQP1XaBg4EXR-t3YR7voNbWsX-wIc2bUXH5wi0DjlPriy-jjTJ9vxqx7EHwKyE-XapsdzVr1rPVXucdiMwk/s1600/Majors%252C+Nancy.Hercules.7-3-Oct-2013.jpg" height="320" width="251" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDvaCAwjDyuaROeQAkpvfdWENdh0y6r5LNxQOQxKL1aT7WTLNaBgQ7nm-nX1-aWEXdsLlVLloLzz0ZYCBR67SeWFB6Plg5yamtdAU_N46EPI3vx18RuuHPk85iMH_FC74pIsxJRF4u520/s1600/Majors%252C+Nancy.Hercules.1-9-Nov-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDvaCAwjDyuaROeQAkpvfdWENdh0y6r5LNxQOQxKL1aT7WTLNaBgQ7nm-nX1-aWEXdsLlVLloLzz0ZYCBR67SeWFB6Plg5yamtdAU_N46EPI3vx18RuuHPk85iMH_FC74pIsxJRF4u520/s1600/Majors%252C+Nancy.Hercules.1-9-Nov-2013.jpg" height="320" width="251" /></a></span></div>
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<span style="font-size: large;">Below in the left column is 10 days post wedging and 30 days post in the right column. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0IWMgMH4zbx1xib15uCJjhVzJk_aH1c5TsBUf2ce7qZwgD-W-5vYNH_Uqh-Q1BjzlIlPwStxKsCAh78YwjkY46FZSWQljbWJe8qf0_Q7aCZbCnIyqZyY1F4aqza-JPlbvRN11ee2O2kk/s1600/Majors%252C+Nancy.Hercules.2-12-Oct-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0IWMgMH4zbx1xib15uCJjhVzJk_aH1c5TsBUf2ce7qZwgD-W-5vYNH_Uqh-Q1BjzlIlPwStxKsCAh78YwjkY46FZSWQljbWJe8qf0_Q7aCZbCnIyqZyY1F4aqza-JPlbvRN11ee2O2kk/s1600/Majors%252C+Nancy.Hercules.2-12-Oct-2013.jpg" height="320" width="251" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhES-HC8gJ6tmrmApxD-rwiELxPIy5uhysGYB0pCfkaGx0mbMulqvaiTYV8sdweHxqexNP4YTK0Wbm4Edj250NQ2MWWJ6zpQsaQn1B6P_3eWRtGNMAcmhxhTh1MSJtjUctGBBfYP1L1KuM/s1600/Majors%252C+Nancy.Hercules.4-9-Nov-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhES-HC8gJ6tmrmApxD-rwiELxPIy5uhysGYB0pCfkaGx0mbMulqvaiTYV8sdweHxqexNP4YTK0Wbm4Edj250NQ2MWWJ6zpQsaQn1B6P_3eWRtGNMAcmhxhTh1MSJtjUctGBBfYP1L1KuM/s1600/Majors%252C+Nancy.Hercules.4-9-Nov-2013.jpg" height="320" width="251" /></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJbMuXaKSzLZRvGIbAjqbJUL_FxDO2jeM-39PpcINYo0X3ahWnr6xuRXVNoE-HOmYbqG9QgsGhsCQ_GvKbbd-cmJ9b09UXyema4XCa8QJll6Qun54iQ20Xtfu0soB-f8YXnSEl4cd5lu4/s1600/Majors%252C+Nancy.Hercules.1-12-Oct-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJbMuXaKSzLZRvGIbAjqbJUL_FxDO2jeM-39PpcINYo0X3ahWnr6xuRXVNoE-HOmYbqG9QgsGhsCQ_GvKbbd-cmJ9b09UXyema4XCa8QJll6Qun54iQ20Xtfu0soB-f8YXnSEl4cd5lu4/s1600/Majors%252C+Nancy.Hercules.1-12-Oct-2013.jpg" height="320" width="252" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHXawcU4-jnBcd4D9b6NfY1kEhC910zbuWNp65B5dMiR4E_zHDUHSz6a85_J3uPqavNCfhRGTgcDS4XDLJ5AT7Zhe_15_LJ6byUK0m9tV15NReExmpoMz214s9XhMRBp3K1ApQbAzWB5U/s1600/Majors%252C+Nancy.Hercules.3-9-Nov-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHXawcU4-jnBcd4D9b6NfY1kEhC910zbuWNp65B5dMiR4E_zHDUHSz6a85_J3uPqavNCfhRGTgcDS4XDLJ5AT7Zhe_15_LJ6byUK0m9tV15NReExmpoMz214s9XhMRBp3K1ApQbAzWB5U/s1600/Majors%252C+Nancy.Hercules.3-9-Nov-2013.jpg" height="320" width="252" /></span></a></div>
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<span style="font-size: large;">Below are the hinds 60 days post placement into the modified ultimates. </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj74eOIbS7sMcYMcxuXbO8TA0Ir-HWQOp0v-jhU6Q0FCf3hZb9yVm8VnaiRsczQHzZS0Je8uOTZBTuXXtorCT_2v58S9LtKX8kZlaMCXPe7JDK4z-pa0DA8-0glJi_aKs97Wap7CMjIufM/s1600/Majors%252C+Nancy.Hercules.9-12-Dec-2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj74eOIbS7sMcYMcxuXbO8TA0Ir-HWQOp0v-jhU6Q0FCf3hZb9yVm8VnaiRsczQHzZS0Je8uOTZBTuXXtorCT_2v58S9LtKX8kZlaMCXPe7JDK4z-pa0DA8-0glJi_aKs97Wap7CMjIufM/s1600/Majors%252C+Nancy.Hercules.9-12-Dec-2013.jpg" height="320" width="252" /></span></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSjxjlo6nF4PMU6urKmX-s3tltQITHTxtOrHrfDkK5oumYk4jt0Ndsrl54v7KC8KQw8scQYUH4IvJ07ffyVFo373JJIpodZAPSXThkUdwPpfnwbP8-n0iAvkJMKrTZ_vNNwp7VCTMW5h4/s1600/Majors%252C+Nancy.Hercules.4-12-Dec-2013.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSjxjlo6nF4PMU6urKmX-s3tltQITHTxtOrHrfDkK5oumYk4jt0Ndsrl54v7KC8KQw8scQYUH4IvJ07ffyVFo373JJIpodZAPSXThkUdwPpfnwbP8-n0iAvkJMKrTZ_vNNwp7VCTMW5h4/s1600/Majors%252C+Nancy.Hercules.4-12-Dec-2013.jpg" height="320" width="252" /></span></a><br />
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<span style="font-size: large;"> Below are the fronts 60 days post tenotomy. Horse is barefoot with greater than 20 mm of sole. You can see the new growth coming in at the upper hoof wall. Note this case has very little if any boney changes or remodelling at this tip of coffin bone. This is what I am shooting for in my laminitis therapy. Prevent continued vascular compromise as quickly as possible to prevent irreversible bone disease. This horse will likely go back to doing whatever he wants in two years with some light riding at one post tenotomy. </span><br />
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<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXFZCQwLzCe_eX0n9BmSeRKww-NzKTmbWNgYtVlnqExuG5Yv2m7t2IPdPyrMp4k7sjjnGs7X92lMw18EXPJYxsQsYGZslN2H9PUOrYzsxAMV9VnBjegr3RKTKa08pTekfEhY0uI5-yMmk/s1600/Majors%252C+Nancy.Hercules.7-12-Dec-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXFZCQwLzCe_eX0n9BmSeRKww-NzKTmbWNgYtVlnqExuG5Yv2m7t2IPdPyrMp4k7sjjnGs7X92lMw18EXPJYxsQsYGZslN2H9PUOrYzsxAMV9VnBjegr3RKTKa08pTekfEhY0uI5-yMmk/s1600/Majors%252C+Nancy.Hercules.7-12-Dec-2013.jpg" height="320" width="249" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZrw6YxbABuXZxl2zU69JwgsSC2PDC_Jr-ILl-hWsS2M_MubQL2Z4lLwDSKL1u72gOgpXqxLMFexu83WY9q0axPh7RbX-lLExLqkGc1jFBRL6hBq3nKs30s7jyyH0-sulO4YG1GICaLhM/s1600/Majors%252C+Nancy.Hercules.5-12-Dec-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZrw6YxbABuXZxl2zU69JwgsSC2PDC_Jr-ILl-hWsS2M_MubQL2Z4lLwDSKL1u72gOgpXqxLMFexu83WY9q0axPh7RbX-lLExLqkGc1jFBRL6hBq3nKs30s7jyyH0-sulO4YG1GICaLhM/s1600/Majors%252C+Nancy.Hercules.5-12-Dec-2013.jpg" height="320" width="251" /></a></span></div>
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<span style="font-size: large;">These are just three cases from this summer and fall that demonstrated the quick response I am looking for. Understanding the mechanics relative to the deep flexor and its role in a failing lamellar bond has proven very beneficial in my practice. Monitoring the failing system with serial venograms will inform you quicker than plain radiographs. Instead of waiting around for 4-6 weeks to evaluate the response in sole depth and hoof wall growth the venogram will demonstrate the level of compromise days to weeks before any changes can be noted otherwise. This allows quicker changes in mechanical therapy and less irreversible damage. This prevents chronic pain and abscesses. </span><br />
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<span style="font-size: large;">What do you consider a success? Patient comfort? What level of sole depth recovery in a period of time do you expect with your laminitis therapy?</span><br />
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<span style="font-size: large;">Wishing you happy and prosperous new year.</span><br />
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<span style="font-size: large;">All the best</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Sammy L. Pittman, DVM</span><br />
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com14181 North Osage Drive, Tulsa, OK 74127, USA36.2143151 -96.009206510.6922806 -137.3178005 61.7363496 -54.700612500000005tag:blogger.com,1999:blog-6147842232488271378.post-7065021248712515572013-06-24T10:11:00.001-05:002013-06-24T10:11:37.636-05:00Upcoming Seminar <div dir="ltr" style="text-align: left;" trbidi="on">
A one day lecture and demo at countryside veterinary clinic. We will look at the basics of mechanical evaluation of the distal limb and review radiographic and venographic evaluation of the equine distal limb.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJMCiisMvYlqrLZTVf9DbDin3y2QkfEMpxV8AyM_bdqPeNLGTy_cOf8GqwrdeQtPNgKOkaugWOX0E6vSOXWa0iPA9ymYgoaKGuDSV2rzKx2LpdzIWAXPCVC7oXY-WbVaJRP0K-pp_uoHo/s1600/20130608154602243.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJMCiisMvYlqrLZTVf9DbDin3y2QkfEMpxV8AyM_bdqPeNLGTy_cOf8GqwrdeQtPNgKOkaugWOX0E6vSOXWa0iPA9ymYgoaKGuDSV2rzKx2LpdzIWAXPCVC7oXY-WbVaJRP0K-pp_uoHo/s640/20130608154602243.jpg" width="494" /></a></div>
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-25345814492384591252013-05-31T09:44:00.001-05:002013-05-31T11:38:51.760-05:00Hoof wall resection and update on Blackie the laminitis case.<div class="separator" style="clear: both; text-align: center;">
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This is Blackie a previously posted laminitis case. <a href="http://innovativeequinepodiatry.blogspot.com/2013/03/acute-laminitis-case-showing-value-of.html" target="_blank">Click here to see previous radiographs and venograms.</a> 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. <br />
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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. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKNN87e-qMijhennjZsrZI0H8IsAhcIu03xeY6vLlo_YSwnHLJjdLjN5GiPzzeO932uORupIl6aQqkiNTz7V_fxx17AKyaMUHdK2q3NwqajQQNSLSsJOyjGagUePFU8nHRiPp86DyOlgw/s1600/Geronimo.Blackie.3-23-May-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKNN87e-qMijhennjZsrZI0H8IsAhcIu03xeY6vLlo_YSwnHLJjdLjN5GiPzzeO932uORupIl6aQqkiNTz7V_fxx17AKyaMUHdK2q3NwqajQQNSLSsJOyjGagUePFU8nHRiPp86DyOlgw/s1600/Geronimo.Blackie.3-23-May-2013.jpg" height="426" title="Radiograph immediately post tenotomy and 60 post tenotomy" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjuIG2WBhLC5e85Dt1d47nAfWBlMOzX0CSB7v78Zr-Dhp4ZhgrYhzpi0iZE_TnFkozawlNDkaAU5eEVPkfS7zIgDaO2ubpcg0yxsEt5N_vHP5twm9Fzf0JxLv5NpwLr6M_QrLPe6Q0tz8/s1600/Geronimo.Blackie.4-23-May-2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjuIG2WBhLC5e85Dt1d47nAfWBlMOzX0CSB7v78Zr-Dhp4ZhgrYhzpi0iZE_TnFkozawlNDkaAU5eEVPkfS7zIgDaO2ubpcg0yxsEt5N_vHP5twm9Fzf0JxLv5NpwLr6M_QrLPe6Q0tz8/s1600/Geronimo.Blackie.4-23-May-2013.jpg" height="412" title="Radiograph immediately post tenotomy and 60 days post tenotomy" width="640" /></a></div>
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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.<br />
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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. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTHdL5SVbRMR_30qgR97bLOvUWy3oeNagSs0q4MVh8LJLLEuccpTUG2gYqwVpw6CZzvVKN8gf4l75Y6PJvfyC6KhX-2p-HUTKlFqvLxCdzPLSEDwtTXp3pqSsG7mj1a9F8VV5Z1MeuAIM/s1600/2013-04-10_16-40-33_47.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTHdL5SVbRMR_30qgR97bLOvUWy3oeNagSs0q4MVh8LJLLEuccpTUG2gYqwVpw6CZzvVKN8gf4l75Y6PJvfyC6KhX-2p-HUTKlFqvLxCdzPLSEDwtTXp3pqSsG7mj1a9F8VV5Z1MeuAIM/s1600/2013-04-10_16-40-33_47.jpg" height="640" title="Hoof wall resection" width="356" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMEDhgamPXMHuv9gcLHFRyL5zSU1Von1PCgoJLrWcyDSbDeEECHWyvXPQHCreLEb7haLIKSoTgGG9aj93oM7PulpEifg7ahhLYCZft-DBTtFWUu8mrB_0EK3ch2N7VHYaa0kXFZ97ppYc/s1600/2013-04-10_16-41-05_936.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMEDhgamPXMHuv9gcLHFRyL5zSU1Von1PCgoJLrWcyDSbDeEECHWyvXPQHCreLEb7haLIKSoTgGG9aj93oM7PulpEifg7ahhLYCZft-DBTtFWUu8mrB_0EK3ch2N7VHYaa0kXFZ97ppYc/s1600/2013-04-10_16-41-05_936.jpg" height="640" width="356" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcJdoUGajBzy4CA0EpkBhdbPPks7JDSQVYNW499ZLZ6ipYLt0KLMPOcMpRl0DMafj2gqOg8do2HSo7cHVfFFG7Ple46KtXOCA2GbOtXEQCgRUQJ3Gvue8K8FyTijtiRQkhdz1nG29bibI/s1600/2013-04-10_16-42-28_64.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcJdoUGajBzy4CA0EpkBhdbPPks7JDSQVYNW499ZLZ6ipYLt0KLMPOcMpRl0DMafj2gqOg8do2HSo7cHVfFFG7Ple46KtXOCA2GbOtXEQCgRUQJ3Gvue8K8FyTijtiRQkhdz1nG29bibI/s1600/2013-04-10_16-42-28_64.jpg" height="640" title="Hoof wall resection" width="356" /></a></div>
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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. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgE6-fs40QWBXAdZ8hmtkpMc1SB_7buis6iI9mmbzZIyf9004OWcbB5c2QwCf1qbkkkV_u97BSTZ-laqRqsSLlcBLvryjubpJ4vtiPV0s_kJlvJI5zRH8WRrossfol9nZyUA00OoWDLccc/s1600/2013-04-10_16-46-47_687.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgE6-fs40QWBXAdZ8hmtkpMc1SB_7buis6iI9mmbzZIyf9004OWcbB5c2QwCf1qbkkkV_u97BSTZ-laqRqsSLlcBLvryjubpJ4vtiPV0s_kJlvJI5zRH8WRrossfol9nZyUA00OoWDLccc/s1600/2013-04-10_16-46-47_687.jpg" height="640" title="hoof wall resection, Using loop of knife to smooth edges prior to removal" width="356" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibTC8PvEHCAOUiLEmpToJw6MZyOMvapWAr7FbMyBFKM1QHJlbrhNah0u-xqPlwiwI5oV41qGmrSztwNqeMIOgCM0liWyrWflp2mvk84KeMDTw0d4_1-uEFzuRbD-ZaqV6DZwUO8ri_NNY/s1600/2013-04-10_16-47-20_144.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibTC8PvEHCAOUiLEmpToJw6MZyOMvapWAr7FbMyBFKM1QHJlbrhNah0u-xqPlwiwI5oV41qGmrSztwNqeMIOgCM0liWyrWflp2mvk84KeMDTw0d4_1-uEFzuRbD-ZaqV6DZwUO8ri_NNY/s1600/2013-04-10_16-47-20_144.jpg" height="640" title="hoof wall resection, Using loop of knife to smooth edges prior to removal" width="356" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIF5DXoPcNun3LHTN7LxSFXphWWAT1Jx6d0hI_T9RovOsdmHIBNn1hdVB07FbOBlrMlej17EK0D6QjtkKH-z3KKueJ2bmueICw8F-6cPn2kwfqMHHpgbPpgmLA5TQ2nloEELNDu69ODCE/s1600/2013-04-10_16-48-54_817.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIF5DXoPcNun3LHTN7LxSFXphWWAT1Jx6d0hI_T9RovOsdmHIBNn1hdVB07FbOBlrMlej17EK0D6QjtkKH-z3KKueJ2bmueICw8F-6cPn2kwfqMHHpgbPpgmLA5TQ2nloEELNDu69ODCE/s1600/2013-04-10_16-48-54_817.jpg" height="640" title="hoof wall resection, Using loop of knife to smooth edges prior to removal" width="356" /></a></div>
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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. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-lpZ_5SZk7DBpK0k6YkL9YgTdNs9jdyO2qvKqSCaTU8WVxVx5oDUWwMmOAF3TWu69HBsaiPrAl2c8x18Boic7qfOjlSVaWbYCV8KAaEFOTFqAeZiiMK67SqBR9KMZWo8bLnv_nNBqEOc/s1600/2013-04-10_16-58-41_103.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-lpZ_5SZk7DBpK0k6YkL9YgTdNs9jdyO2qvKqSCaTU8WVxVx5oDUWwMmOAF3TWu69HBsaiPrAl2c8x18Boic7qfOjlSVaWbYCV8KAaEFOTFqAeZiiMK67SqBR9KMZWo8bLnv_nNBqEOc/s1600/2013-04-10_16-58-41_103.jpg" height="640" title="Immediately post hoof wall removal." width="360" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiF0-jEhrvyJ1h-aDp9K4yf3Y45XD0sw_l-RTuClostLoR4_pBf-zy3LAXmJOIKRc17S98_9HbEpKfmuDruol_1jSCcbK-UOWWQRshxfIJVpHKTfXgNlnRmgSvsdMOX4AUdviQgkzxS7-w/s1600/2013-04-10_16-58-52_443.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiF0-jEhrvyJ1h-aDp9K4yf3Y45XD0sw_l-RTuClostLoR4_pBf-zy3LAXmJOIKRc17S98_9HbEpKfmuDruol_1jSCcbK-UOWWQRshxfIJVpHKTfXgNlnRmgSvsdMOX4AUdviQgkzxS7-w/s1600/2013-04-10_16-58-52_443.jpg" height="360" title="Immediately post hoof wall removal." width="640" /></a></div>
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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. </div>
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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. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYESp4q-RfN4vzsXxh1PrAFLhXxWjbhByce8Zvw89OgiIXVQEWgdI2uzio-OmDfih1c9GZyl12sDFm6UE9o8AntNxe7Yr5Gf6iTV2ML0L3ii9ovLo2s2DyCOZ2xs34kPpsn40KTSHE2Dc/s1600/2013-04-10_17-19-47_25.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYESp4q-RfN4vzsXxh1PrAFLhXxWjbhByce8Zvw89OgiIXVQEWgdI2uzio-OmDfih1c9GZyl12sDFm6UE9o8AntNxe7Yr5Gf6iTV2ML0L3ii9ovLo2s2DyCOZ2xs34kPpsn40KTSHE2Dc/s1600/2013-04-10_17-19-47_25.jpg" height="360" title="Section of hoof removed" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEr6b6_AGrjWljrGylNAEPcpvSBLQJzRdb2VDdL-A8qTvriDaGn6ziwCoRNCRpcCMVQu-OT0-tD80hfHeIIb4GFkspkRvkFpboTGnBkfWy5Rr0qxMGjMI6Ddv8uI-lg2m5xkkvBKELiNg/s1600/2013-04-10_17-20-10_15.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEr6b6_AGrjWljrGylNAEPcpvSBLQJzRdb2VDdL-A8qTvriDaGn6ziwCoRNCRpcCMVQu-OT0-tD80hfHeIIb4GFkspkRvkFpboTGnBkfWy5Rr0qxMGjMI6Ddv8uI-lg2m5xkkvBKELiNg/s1600/2013-04-10_17-20-10_15.jpg" height="360" title="Section of hoof removed" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7nQ26oz95_yEEPLOFpIPRlgpvOHGVCgDq0xUYqabtmVJEKCCeSzPHQ58RycQOI3fBAvZCf8_tf97sfgjNOgkO4_-wNlhcJIUjP0r-uqqbYGgKowqyzzbt1aPaCVNdJhZ-M84nOfb01kQ/s1600/2013-04-10_17-20-16_817.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7nQ26oz95_yEEPLOFpIPRlgpvOHGVCgDq0xUYqabtmVJEKCCeSzPHQ58RycQOI3fBAvZCf8_tf97sfgjNOgkO4_-wNlhcJIUjP0r-uqqbYGgKowqyzzbt1aPaCVNdJhZ-M84nOfb01kQ/s1600/2013-04-10_17-20-16_817.jpg" height="360" title="Section of hoof removed" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJMSFKah-WpXQmFMyK0lByaZzyz62a_Dp3W2ohN_FHWWKMHawweQ1_BcWWI8sIYyQ1EbBHMhkK1WsjsmVO6lOwf1BfcK7-SiXb49hNhoTDpjygaZBATAy9dFg3oTa76oQ3OEydvDl0-2Y/s1600/2013-05-11_10-15-01_101.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJMSFKah-WpXQmFMyK0lByaZzyz62a_Dp3W2ohN_FHWWKMHawweQ1_BcWWI8sIYyQ1EbBHMhkK1WsjsmVO6lOwf1BfcK7-SiXb49hNhoTDpjygaZBATAy9dFg3oTa76oQ3OEydvDl0-2Y/s1600/2013-05-11_10-15-01_101.jpg" height="640" title="1/2 felt heavily coated with silvadene cream. Elastikon adhesive wrap is used to apply firm pressure while wrapping around hoof." width="360" /></a></div>
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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. </div>
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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.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJiiQ-X5gFolp7FDLQOKmFRNjJiwicK93bRsH1yHZ8mx3qT4zPhQNsB1UnQ7s5R4qdJq5M9jEp_k1Fw_uROZw8ZiIZHkEbJBDDnBH9Y2KVz45JLaZOacagjvhwzLTndA4a7lOdmwnopzU/s1600/2013-04-15_11-51-15_474.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJiiQ-X5gFolp7FDLQOKmFRNjJiwicK93bRsH1yHZ8mx3qT4zPhQNsB1UnQ7s5R4qdJq5M9jEp_k1Fw_uROZw8ZiIZHkEbJBDDnBH9Y2KVz45JLaZOacagjvhwzLTndA4a7lOdmwnopzU/s1600/2013-04-15_11-51-15_474.jpg" height="640" title="5th day bandage change. granulation has began and secondary matrix horn is beginning to fill in." width="360" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyohF56GCWOvXrJcX70dDuu2uj5Jv7B7EYphEUv1IIvQF22bsoR0tgbJ5tAcVUJ3shwnaSeFYBuqgaEX0O1HT-AT4n7aR-ZyGiFIlQap6cK6GqZpq1er6CNcDg4y1ER25Oe_GvRd8bwmc/s1600/2013-04-15_11-51-40_861.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyohF56GCWOvXrJcX70dDuu2uj5Jv7B7EYphEUv1IIvQF22bsoR0tgbJ5tAcVUJ3shwnaSeFYBuqgaEX0O1HT-AT4n7aR-ZyGiFIlQap6cK6GqZpq1er6CNcDg4y1ER25Oe_GvRd8bwmc/s1600/2013-04-15_11-51-40_861.jpg" height="360" title="5th day bandage change. granulation has began and secondary matrix horn is beginning to fill in." width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0XCYUnAXJH3EhZba5QAIDTffXo-TA7w8n44lo0l6msdDzMNlgNsY2TAOlZtx_RcjhC1uQ2hNbWx1lzL45HAS2s6CNQZRZkUGtS9TKwA6SP5EPoy9u-Flu75XDxz6VxWELlPBp1d5QMJg/s1600/2013-04-15_11-52-05_231.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0XCYUnAXJH3EhZba5QAIDTffXo-TA7w8n44lo0l6msdDzMNlgNsY2TAOlZtx_RcjhC1uQ2hNbWx1lzL45HAS2s6CNQZRZkUGtS9TKwA6SP5EPoy9u-Flu75XDxz6VxWELlPBp1d5QMJg/s1600/2013-04-15_11-52-05_231.jpg" height="640" title="5th day bandage change. granulation has began and secondary matrix horn is beginning to fill in." width="360" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBnmyo8AQomeRkN2lPtCc3g8AZKvJTEKdASwEDubeqC0jRshQTkqLmCh2KpGe06bKq500Vp8cLai6k6WlCc_xPg8fwraWNe3zajXHE6QsXtfN77-yyxLjK-su195taxsSsb-ZZ7m1oOvk/s1600/2013-04-15_11-52-38_899.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBnmyo8AQomeRkN2lPtCc3g8AZKvJTEKdASwEDubeqC0jRshQTkqLmCh2KpGe06bKq500Vp8cLai6k6WlCc_xPg8fwraWNe3zajXHE6QsXtfN77-yyxLjK-su195taxsSsb-ZZ7m1oOvk/s1600/2013-04-15_11-52-38_899.jpg" height="640" title="5th day bandage change. granulation has began and secondary matrix horn is beginning to fill in." width="360" /></a></div>
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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. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYHRbXl-JGzQWslixZ5IDJUPLNjr2WWxry-ovjmKvAGtmf7aOeMkj89mP5aJY5Ont8aBxESNA1cpMi6xvLicEBoIqJ_260rUZhZ5hq5xUgp6Fw9eMWyICKfPtgCyXBJIx9h0hlgciXxTw/s1600/IMG_6565.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYHRbXl-JGzQWslixZ5IDJUPLNjr2WWxry-ovjmKvAGtmf7aOeMkj89mP5aJY5Ont8aBxESNA1cpMi6xvLicEBoIqJ_260rUZhZ5hq5xUgp6Fw9eMWyICKfPtgCyXBJIx9h0hlgciXxTw/s1600/IMG_6565.JPG" height="480" title="15 days post resection. Hoof was maintained in a elastikon wrap with a cast applied up to fetlock for this period." width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4X6q5OglovnQRWuQCCD0p_Uv_Jl7mkpMhatVLuX8uDTkvcUMMSzIzt2o1ahIoItf96yQeo9-Wug1s8J1GXlFp-OUSZQpyyhdJSdXg626OZUSazMZw6hmAU7oIW5PtdO8wsSIhjZAlD04/s1600/IMG_6566.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4X6q5OglovnQRWuQCCD0p_Uv_Jl7mkpMhatVLuX8uDTkvcUMMSzIzt2o1ahIoItf96yQeo9-Wug1s8J1GXlFp-OUSZQpyyhdJSdXg626OZUSazMZw6hmAU7oIW5PtdO8wsSIhjZAlD04/s1600/IMG_6566.JPG" height="480" title="15 days post resection. Hoof was maintained in a elastikon wrap with a cast applied up to fetlock for this period." width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiWxwXAvvfEDZLF6yUd05927VavwW8t8yHX4KnUb-EjEfDf4I6HVe5izoSFptgVDWXeM34yK6T9lvues65q6k0iEkvl__OSOmsK3PJiGg4mOtAsXBtUR2KNJbDAytUknrfSGpK92ueOV8/s1600/IMG_6569.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiWxwXAvvfEDZLF6yUd05927VavwW8t8yHX4KnUb-EjEfDf4I6HVe5izoSFptgVDWXeM34yK6T9lvues65q6k0iEkvl__OSOmsK3PJiGg4mOtAsXBtUR2KNJbDAytUknrfSGpK92ueOV8/s1600/IMG_6569.JPG" height="480" title="15 days post resection. Hoof was maintained in a elastikon wrap with a cast applied up to fetlock for this period." width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRWz3HqVAs3nGVy1QXiNUNYnsm0WzdpHMtP4u652zxpo2gKqMjcPJwnegBt1O4g7_aqFCLQF2B-rSBS_8NCfjS0PRavO09oH8WwxXeEjPphA4En-H85RBYBmsPOgIl7wszWv4sbgSBFnY/s1600/IMG_6570.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRWz3HqVAs3nGVy1QXiNUNYnsm0WzdpHMtP4u652zxpo2gKqMjcPJwnegBt1O4g7_aqFCLQF2B-rSBS_8NCfjS0PRavO09oH8WwxXeEjPphA4En-H85RBYBmsPOgIl7wszWv4sbgSBFnY/s1600/IMG_6570.JPG" height="480" title="15 days post resection. Hoof was maintained in a elastikon wrap with a cast applied up to fetlock for this period." width="640" /></a></div>
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These images are approximately 30 days post resection. Continued epithelialisation and secondary horn formation aka cornification. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn7hPOZy1B57GsiwZyFKI2jl-4vM2wg4dbBNFEDHEP3Gn7srue2_YDJvc-cEPWKyUaEr5DUCpuUPP_3TYRh_l4qUlZsJvL-SretxmNIesU4h1wX2oF7ZNt0yG4-xMBPUDI7ep3whwFkTw/s1600/2013-05-11_10-15-13_839.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn7hPOZy1B57GsiwZyFKI2jl-4vM2wg4dbBNFEDHEP3Gn7srue2_YDJvc-cEPWKyUaEr5DUCpuUPP_3TYRh_l4qUlZsJvL-SretxmNIesU4h1wX2oF7ZNt0yG4-xMBPUDI7ep3whwFkTw/s1600/2013-05-11_10-15-13_839.jpg" height="360" title="30 days post resection" width="640" /></a></div>
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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. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA5nOyLw8rK8LP2DslY-FFMaaC0WtoZcvgdxJYtng1ck7RarNyCk10rxbelMuFJW_YafVLy6U8JgdGpzzUSzXnMauS1pfE-jNprlSFu2w1jS8rlRj2xcN91s7gKblLVyITFU8pNlum7lo/s1600/2013-05-23_16-30-10_416.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA5nOyLw8rK8LP2DslY-FFMaaC0WtoZcvgdxJYtng1ck7RarNyCk10rxbelMuFJW_YafVLy6U8JgdGpzzUSzXnMauS1pfE-jNprlSFu2w1jS8rlRj2xcN91s7gKblLVyITFU8pNlum7lo/s1600/2013-05-23_16-30-10_416.jpg" height="360" title="6 weeks post resection" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX7kZEx-71AYCcqTC9DGpvLIgIUgbWuCTSfHrOsIRXW7NzqwUfS99DwmVEETXFqgGILYvH-xKg9tB5XK9-6Ayc8VZqMWZrauXqfVFoCyhfJEiV2hAB9axuJNXtqYH62STfzb8c6h0l0Ao/s1600/2013-05-23_16-30-54_448.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX7kZEx-71AYCcqTC9DGpvLIgIUgbWuCTSfHrOsIRXW7NzqwUfS99DwmVEETXFqgGILYvH-xKg9tB5XK9-6Ayc8VZqMWZrauXqfVFoCyhfJEiV2hAB9axuJNXtqYH62STfzb8c6h0l0Ao/s1600/2013-05-23_16-30-54_448.jpg" height="360" title="6 weeks post resection" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3En0COdU6VQ34098kBi2rqxPKH3nxKWHMDgCrAnWQdpScZ5Gq4Eqk5a8Khhe9P_iU3FeS3VMhIzId9mnBXfses2ldXbPQVnofTDZOn1Z52NlF9p343fynXza4nX5YiQF0rF4t7MlKsRU/s1600/2013-05-23_16-31-16_907.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3En0COdU6VQ34098kBi2rqxPKH3nxKWHMDgCrAnWQdpScZ5Gq4Eqk5a8Khhe9P_iU3FeS3VMhIzId9mnBXfses2ldXbPQVnofTDZOn1Z52NlF9p343fynXza4nX5YiQF0rF4t7MlKsRU/s1600/2013-05-23_16-31-16_907.jpg" height="360" title="6 weeks post resection" width="640" /></a></div>
Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com04181 North Osage Drive, Tulsa, OK 74127, USA36.2143151 -96.009206510.6922806 -137.3178005 61.7363496 -54.700612500000005tag:blogger.com,1999:blog-6147842232488271378.post-42075456933115773492013-05-30T11:58:00.000-05:002013-05-30T11:58:15.719-05:00New 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. <br />
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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. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-Irzm8xfXLTMz6jZCu545MUQqftrgk2JzAUmagXT9GdkVlqIw7mASz1Mo4qMHlxZ8ZbWUhFVhRXVUbMFdUNByR3CLe7XgtAZS4Y4RPNXX1-sPsU91HC4zLPymGOM2eNXG3r0d9oqV33A/s1600/HI+beam+DPlf.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-Irzm8xfXLTMz6jZCu545MUQqftrgk2JzAUmagXT9GdkVlqIw7mASz1Mo4qMHlxZ8ZbWUhFVhRXVUbMFdUNByR3CLe7XgtAZS4Y4RPNXX1-sPsU91HC4zLPymGOM2eNXG3r0d9oqV33A/s1600/HI+beam+DPlf.jpg" height="640" width="496" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH5ktVQfVZNefzR9TLWQEUKXfgh_pgAbHU_pnRQ6MWVUv44y8xIPeASWLAfteirmZlLxEh6pnAOW6O0ppI4d844n8w6P23YAswgCDFm8gprqEMjl93UxFRKIBG_R6Z2u9m72IPcl3pcQg/s1600/65+DP.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqlMcXhlIVpxFAI75yvEpTKtbvRUaMzgxiPBoqHBbjH47oPC2DiI0jjOoN8E-Nk_YlH8oi1qrGAozuC0vKgYNRN0OljDC2a0YIpz3sV5TwLEUFYDKVJpwpovfJ0afDsQu-mX7MsIjp9LE/s1600/65DPLF.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqlMcXhlIVpxFAI75yvEpTKtbvRUaMzgxiPBoqHBbjH47oPC2DiI0jjOoN8E-Nk_YlH8oi1qrGAozuC0vKgYNRN0OljDC2a0YIpz3sV5TwLEUFYDKVJpwpovfJ0afDsQu-mX7MsIjp9LE/s1600/65DPLF.jpg" height="640" width="482" /></a><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH5ktVQfVZNefzR9TLWQEUKXfgh_pgAbHU_pnRQ6MWVUv44y8xIPeASWLAfteirmZlLxEh6pnAOW6O0ppI4d844n8w6P23YAswgCDFm8gprqEMjl93UxFRKIBG_R6Z2u9m72IPcl3pcQg/s1600/65+DP.jpg" height="640" width="482" /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl0VUZxaeQkAvxFi_WXK5h_lcN2t5ezHSjlwWOs6TXNGZIjJbWHrTUx-Oj6a88kwGy_l4q_3yr7OTseSpZ7rbFp0wFg6-uM7PHmWsoZVG3N_KlejOODtcADImg0ZCPjZ8iegE3MSFyzMs/s1600/HI+beam+RFDP.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl0VUZxaeQkAvxFi_WXK5h_lcN2t5ezHSjlwWOs6TXNGZIjJbWHrTUx-Oj6a88kwGy_l4q_3yr7OTseSpZ7rbFp0wFg6-uM7PHmWsoZVG3N_KlejOODtcADImg0ZCPjZ8iegE3MSFyzMs/s1600/HI+beam+RFDP.jpg" height="640" width="510" /></a></div>
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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.</div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgodI2pufErjYB6NhxhMnnEitRows61oB7PzlRd5Xr5SyYPcqPNEqnKTB5MKJur_faCbOwy4WoOwkxZbPmnEPkUyiof4zd7dQ2ExjWzeFMru1sLViA3bgvVsHnb4CpZGip2OcxX-R46srI/s1600/2013-05-29_17-51-07_742.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgodI2pufErjYB6NhxhMnnEitRows61oB7PzlRd5Xr5SyYPcqPNEqnKTB5MKJur_faCbOwy4WoOwkxZbPmnEPkUyiof4zd7dQ2ExjWzeFMru1sLViA3bgvVsHnb4CpZGip2OcxX-R46srI/s1600/2013-05-29_17-51-07_742.jpg" height="360" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">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.</td></tr>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhANhntU-JrRT-NfLz5TQCBGGOJFtu62ry5oEuPYDZdwfI2ga8Q_x3QUoJOyhit-K_MqESXapyOfRjfzmZee0pdN_8Z5-Q2PspUAHdX1EfHkC6Kas1eZl7bfWnVUfttLh6MgiTltm3DOIQ/s1600/2013-05-29_17-52-06_945.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhANhntU-JrRT-NfLz5TQCBGGOJFtu62ry5oEuPYDZdwfI2ga8Q_x3QUoJOyhit-K_MqESXapyOfRjfzmZee0pdN_8Z5-Q2PspUAHdX1EfHkC6Kas1eZl7bfWnVUfttLh6MgiTltm3DOIQ/s1600/2013-05-29_17-52-06_945.jpg" height="640" width="360" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Note the two adhesions on flexor surface. These where cut away from tendon </td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEierBiQuesPmk8pEffnNGzAS8SDvXF1CXAAjDiWpbn3lase4VCkk1bM56Gpisaa1Va3XLLtL3CFX7GanEJMBFNj1u_rG0HQLzQN1xfwQYkRKSLMgpA6oAQPrmPInfy0cV9HHZY5pzivNls/s1600/Tracing.with+tendon+attachments.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEierBiQuesPmk8pEffnNGzAS8SDvXF1CXAAjDiWpbn3lase4VCkk1bM56Gpisaa1Va3XLLtL3CFX7GanEJMBFNj1u_rG0HQLzQN1xfwQYkRKSLMgpA6oAQPrmPInfy0cV9HHZY5pzivNls/s1600/Tracing.with+tendon+attachments.jpg" height="640" width="518" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This drawing shows the DDFT in green and adhesions in red</td></tr>
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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.<br />
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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.<br />
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com1tag:blogger.com,1999:blog-6147842232488271378.post-77424470416357736502013-03-25T21:45:00.000-05:002013-03-25T21:47:08.579-05:00Acute laminitis case showing the value of the venogram<div dir="ltr" style="text-align: left;" trbidi="on">
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This is an acute laminitis case that was initially painful and exhibiting the typical founder stance on December 16 2012. No known cause but a mild colic episode had occurred 3 days prior. I was able to perform venograms on what I would consider Day one of laminitis. These plain film radiographs and venograms create a baseline in which to compare follow up venograms. This allows assesment of the mechanical therapy applied and severity of compromise in the days to follow. Venograms 5 days later show moderate compromise already. Consider the amount of compromise present while treated with mechanics. Unloading the Deep flexor tendon, its forces applied to the dorsal lamellar zone and sole directly below tip of coffin bone via raising the palmar angle. <br />
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There is no measurable displacement of the bone but significant change has occured within the vascular network as early as five days. Some financial constraints existed and it was decided to wait 30 days and repeat venograms to evaluate if the mechanics applied would be enough. I warned the client at this point that a deep flexor tenotomy may need to be performed as this rapid progression is very concerning. Ideally a repeat venogram in another 4-7 days would have been best but finances limited to a 30 day check. Knowing what I know now about this case I would have cut tendons on day five and never looked back. Below is the Day one venogram on the left compared to the Day five Venograms on the right side. Focus your eyes on the circuflex artery, terminal papillae and the vasculature directly below the tip of coffin bone. Moderate compression and diplacement of these vessels five days into the syndrome. Remember that no measurable rotation, increase in h/l zones, loss of sole depth has occured.<br />
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After applying the modified ultimates on day one the horse began to make a clinical improvement noted by moving around in stall better and better appetite. He no longer rocked back to make turns. This is important to consider as clinical signs alone are not good indicators of how the case is going. The horse will lie to you when comes to laminitis. </div>
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<tr><td class="tr-caption" style="text-align: center;">Right Front venogram comparson Day one to Day five</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiroBRVFBv5XDRVCHnKqOh6y5Ery5WvCmtUsm7G7QpKt7gSz8qy8lj3kKnuLweB3tad68-6vnszzmhq2n5c6KZuFhT8zSTN5-XXQGqepk-ZEXfQmIlOcHWXOb-Hsl8_Rqx69aKTwkY9UGY/s1600/Geronimo.Blackie.10-19-Jan-2013.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="408" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiroBRVFBv5XDRVCHnKqOh6y5Ery5WvCmtUsm7G7QpKt7gSz8qy8lj3kKnuLweB3tad68-6vnszzmhq2n5c6KZuFhT8zSTN5-XXQGqepk-ZEXfQmIlOcHWXOb-Hsl8_Rqx69aKTwkY9UGY/s640/Geronimo.Blackie.10-19-Jan-2013.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Left Front Venogram comparsion Day one to Day five.</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Day 5</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNPt1625yR2cbE3ddg_INLmcBUqi6HvnCooPlXirUGHOiqNisEt2vTCfFfnfyjmHZ0zDDmAkcIF4-T7hNQnJgD0FOgQ9e27ppXek7UvEZZiczYO6iMeM3Fdg-HL8CjYHA248BM_cOiySo/s1600/Geronimo.Blackie.1-21-Dec-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNPt1625yR2cbE3ddg_INLmcBUqi6HvnCooPlXirUGHOiqNisEt2vTCfFfnfyjmHZ0zDDmAkcIF4-T7hNQnJgD0FOgQ9e27ppXek7UvEZZiczYO6iMeM3Fdg-HL8CjYHA248BM_cOiySo/s640/Geronimo.Blackie.1-21-Dec-2012.jpg" width="496" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Day five</td></tr>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqZCrZLXrK58d54x2W1F5d5I5zzYFLP15IO4qxSqHe0xlXwtvgRV1oaHx0aN1Syy-T0Sj6GU-ZyCY2TwUL3jCfQVuLtgyO9A2E5N6AtCCsq2ckmLlbQLywJkMCYMut6dXSmdscLHSyWsw/s1600/Geronimo.Blackie.2-21-Dec-2012.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqZCrZLXrK58d54x2W1F5d5I5zzYFLP15IO4qxSqHe0xlXwtvgRV1oaHx0aN1Syy-T0Sj6GU-ZyCY2TwUL3jCfQVuLtgyO9A2E5N6AtCCsq2ckmLlbQLywJkMCYMut6dXSmdscLHSyWsw/s1600/Geronimo.Blackie.2-21-Dec-2012.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqZCrZLXrK58d54x2W1F5d5I5zzYFLP15IO4qxSqHe0xlXwtvgRV1oaHx0aN1Syy-T0Sj6GU-ZyCY2TwUL3jCfQVuLtgyO9A2E5N6AtCCsq2ckmLlbQLywJkMCYMut6dXSmdscLHSyWsw/s1600/Geronimo.Blackie.2-21-Dec-2012.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqZCrZLXrK58d54x2W1F5d5I5zzYFLP15IO4qxSqHe0xlXwtvgRV1oaHx0aN1Syy-T0Sj6GU-ZyCY2TwUL3jCfQVuLtgyO9A2E5N6AtCCsq2ckmLlbQLywJkMCYMut6dXSmdscLHSyWsw/s1600/Geronimo.Blackie.2-21-Dec-2012.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqZCrZLXrK58d54x2W1F5d5I5zzYFLP15IO4qxSqHe0xlXwtvgRV1oaHx0aN1Syy-T0Sj6GU-ZyCY2TwUL3jCfQVuLtgyO9A2E5N6AtCCsq2ckmLlbQLywJkMCYMut6dXSmdscLHSyWsw/s1600/Geronimo.Blackie.2-21-Dec-2012.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"> </a><br />
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Below are venograms that are 30 days post laminitis of the left front. Note the circumflex is several milimeters above the tip of the coffin bone and no papillae are present. I again recommended deep flexor tenotomy as the modified ultimates are not providing enough mechanical relief, through unloading the force of the deep flexor. The tenotomy abolishes all forces applied to the bone to hoof attachments and solar corium directly below tip of coffin bone. Finances prohibited the Owner from going the surgical route and horse was actually improving with regard to pain and we decided to wait another thirty days. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTzR7s2J12xI5eZamy03nv8mBM2G3i0XI02cbWY-uvIaJAPKm0M6Io_QX0A12nbtbkimWINkwEACG3kjvHAYy03_i7ekXiTLSrJ_-jfb-41XC5dbxLlgkthLY54vERiNNVBzGgNwwfbns/s1600/Geronimo.Blackie.12-19-Jan-2013.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto; text-align: center;"><img border="0" height="412" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTzR7s2J12xI5eZamy03nv8mBM2G3i0XI02cbWY-uvIaJAPKm0M6Io_QX0A12nbtbkimWINkwEACG3kjvHAYy03_i7ekXiTLSrJ_-jfb-41XC5dbxLlgkthLY54vERiNNVBzGgNwwfbns/s640/Geronimo.Blackie.12-19-Jan-2013.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">30 Days Post. The Circumflex artery is displaced several mm above the tip of the coffin bone and the solar vasculature is tightly compressed below the tip of the coffin bone.</td></tr>
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Below are 60 day post radiographs. Note the increased C/E distance, diverging H/L zones (rotation),and loss of sole depth, especially on the Left. No growth is noted on examination of the dorsal hoof wall and about 1/4 in at the heels is noted. Just to recap, we have no measurable displacement of the bone until 60 days into the syndrome but significant vascular changes on day five that continues to fail despite mechanical therapy. If you are waiting to diagnose laminitis based on rotation you are 60 days late in this case. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrBv0BwVvDsjPAZEBN28nqvGDBGoaqpn5hc0e7D9c9LAvlFUvsrEh-7EHtP6cXuD39GSfqp_jQ0av8dTpPFbOMasRFeEtkcj2hscPcFaOPwBEgNy73LQYCKbxwEVJkIspnCLV06sT1vbs/s1600/Geronimo.Blackie.1-24-Feb-2013.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrBv0BwVvDsjPAZEBN28nqvGDBGoaqpn5hc0e7D9c9LAvlFUvsrEh-7EHtP6cXuD39GSfqp_jQ0av8dTpPFbOMasRFeEtkcj2hscPcFaOPwBEgNy73LQYCKbxwEVJkIspnCLV06sT1vbs/s640/Geronimo.Blackie.1-24-Feb-2013.jpg" width="504" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">60 day post insult radiograph. Note changes in ce, hl zones and sole depth.</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjPo5Fa56zMhju-h2Wa85pW32MjU2WTINJlLSd_taB7pN6rXZpnMc1vm_MkFIQOCFcFdygAmK9tj8DcAVfJdujzI5hJik8WtBG3z0h0puEIiV6Wi_TMhRRCD7ZqYpHZkgC_8cfR-wnNmA/s1600/Geronimo.Blackie.2-24-Feb-2013.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjPo5Fa56zMhju-h2Wa85pW32MjU2WTINJlLSd_taB7pN6rXZpnMc1vm_MkFIQOCFcFdygAmK9tj8DcAVfJdujzI5hJik8WtBG3z0h0puEIiV6Wi_TMhRRCD7ZqYpHZkgC_8cfR-wnNmA/s640/Geronimo.Blackie.2-24-Feb-2013.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">60 Days post initial insult. Note diverging hl zones (some may call rotation) increased in ce and comparable decrease in sole depth. <br />
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Below are comparative venograms of the left front. On the left is day one and on the right is 90 days after intial insult. Note the greatly altered circumflex architecture and the tip of the coffin bone is visualized below the solar vessels. Moderate thickening of the dorsal sublamellar zone and significant accumalation of contrast as the dorsal coronary band that is likely secondary to a septic process that is brewing. Horse still has not grown any sole or dorsal hoof wall in 90 days. Note the scallop like loss of bone that occurs just above the tip caused by displacement of the terminal papillae and circumflex artery. I can only assume the combination of local hydraulic pressure and possibly the redirected papillae in this area are to blame for this unique change in the shape. At this stage in the game many irreversible changes have occurred that will likely prevent this horse from returning to a previous level of competition. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhno6tgtzskmaSKg6vTKkcf-DYHWdfRU_z9S8XxXCMxjvlgwKUz4oHiIyB1M56GI9RrjtrmPRFAUwV1PLoAvDumYhy3ljNfdxQDEJsfObCPaWwZFQiNZBER5a3KPjFVnHPeEJGrEe9TFfA/s1600/Geronimo.Blackie.11-19-Jan-2013.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="412" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhno6tgtzskmaSKg6vTKkcf-DYHWdfRU_z9S8XxXCMxjvlgwKUz4oHiIyB1M56GI9RrjtrmPRFAUwV1PLoAvDumYhy3ljNfdxQDEJsfObCPaWwZFQiNZBER5a3KPjFVnHPeEJGrEe9TFfA/s640/Geronimo.Blackie.11-19-Jan-2013.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">90 days post comparison</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcLEDI4yHPoJqSCFwj-NMXl9AffRrNqOEmzjyejkOWQgO0RPFDGtp7fum6Kce8tCvjuXCSmKtomhJz7Y_yqC9ZP_pWltnk3ThIX26b21DpxP3mgMWpYLuDEuFobjPEUhcSpdZp-fo05_E/s1600/Geronimo.Blackie.14-19-Jan-2013.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcLEDI4yHPoJqSCFwj-NMXl9AffRrNqOEmzjyejkOWQgO0RPFDGtp7fum6Kce8tCvjuXCSmKtomhJz7Y_yqC9ZP_pWltnk3ThIX26b21DpxP3mgMWpYLuDEuFobjPEUhcSpdZp-fo05_E/s640/Geronimo.Blackie.14-19-Jan-2013.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">90 days post comparison . The right foot has suffered less but prominent and significant change/damage has occurred in the area of the circumflex artery and terminal papillae.</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6s5M1liwGCPsjlKaOY5U_UjDodRT_-pX84z_ZSjZysdcavowX7fxAJYoBe-8Nf9ZGGAjEwn2OhAuGZx8N7oQX1bDQCV561OUo7rrMHrz0zUlLhKJxp3Ygy1oNii62L2zVM_e6qO8s4fo/s1600/Geronimo.Blackie.11-22-Mar-2013.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6s5M1liwGCPsjlKaOY5U_UjDodRT_-pX84z_ZSjZysdcavowX7fxAJYoBe-8Nf9ZGGAjEwn2OhAuGZx8N7oQX1bDQCV561OUo7rrMHrz0zUlLhKJxp3Ygy1oNii62L2zVM_e6qO8s4fo/s640/Geronimo.Blackie.11-22-Mar-2013.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Left front Post tenotomy and derotation. </td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggw_h302VRs9gq1QiKqSJINReQCObolestydk_lE3_KrLOM2bGEpaXjs7Jqk-TmD92AQMyMN6i9_gd2GF9azPJHc1b1gbMw1uoRD3u-PSf2W5nyurOoTt1v2zQHSQYX13AewDc4xh57rY/s1600/Geronimo.Blackie.12-22-Mar-2013.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggw_h302VRs9gq1QiKqSJINReQCObolestydk_lE3_KrLOM2bGEpaXjs7Jqk-TmD92AQMyMN6i9_gd2GF9azPJHc1b1gbMw1uoRD3u-PSf2W5nyurOoTt1v2zQHSQYX13AewDc4xh57rY/s640/Geronimo.Blackie.12-22-Mar-2013.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Right Front post tenotomy and derotation.</td></tr>
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At the 90 day examination I advised the client that surgery was the only option for treatment and this late in the game I could only offer a guarded prognosis for any return to previous level of performance. The owner opted to donate the horse for a learning seminar. On March 22, 2012 a little over 90 days post initial insult a eager bunch of vet students and farriers performed venograms, applied derotation shoes and performed deep flexor tenotomies. In the days following the horse is moving much better. I will post followup radiographs in 30 days to evaluate the progress. I do feel recovery is still very likely. Ideally performing the tenotomy prior to irreversible damage and bone change would result in a better outcome.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNPt1625yR2cbE3ddg_INLmcBUqi6HvnCooPlXirUGHOiqNisEt2vTCfFfnfyjmHZ0zDDmAkcIF4-T7hNQnJgD0FOgQ9e27ppXek7UvEZZiczYO6iMeM3Fdg-HL8CjYHA248BM_cOiySo/s1600/Geronimo.Blackie.1-21-Dec-2012.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a>In conclusion I would like to re iterate the important points:<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNPt1625yR2cbE3ddg_INLmcBUqi6HvnCooPlXirUGHOiqNisEt2vTCfFfnfyjmHZ0zDDmAkcIF4-T7hNQnJgD0FOgQ9e27ppXek7UvEZZiczYO6iMeM3Fdg-HL8CjYHA248BM_cOiySo/s1600/Geronimo.Blackie.1-21-Dec-2012.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a></div>
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1) In hindsight a deep flexor tenotomy should have been performed on day five or very shortly after.</div>
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2) Improvement with regards to pain and movement are not good indicators of success in laminitis.</div>
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3) Radiographic measurements alone, early in the syndrome, may change very little if any and a venogram may be the only information alluding to the nature of the insult.</div>
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4) Aggressive early mechanical therapy did relieve a lot of pain but did not provide enough unloading of the Deep digital flexor to aid in unloading of the vascular supply and further unloading via deep flexor tenotomy would have likely given a better outcome if performed earlier.</div>
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Stay tuned!</div>
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com04181 North Osage Drive, Tulsa, OK 74127, USA36.2143151 -96.009206510.6922806 -137.3178005 61.7363496 -54.700612500000005tag:blogger.com,1999:blog-6147842232488271378.post-3857236682619477602013-02-05T14:14:00.000-06:002013-02-21T08:00:08.861-06:00My Take on barefoot management<div dir="ltr" style="text-align: left;" trbidi="on">
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I get this question alot and I thought it would be a good question to address. Let me start by saying I love managing horses barefooted and it would be wonderful if that is all it required to fix many hoof problems. The truth of the matter is that many horses need shoes to alter the mechanics to their advantage to maintain good sole depth and soundness. Many of today's horses have what I call genetic handicaps that prevent them from have the ideal foot and forces applied to it. Horses that can stay sound barefoot and compete will have the following parameters measured radiographically: sole depth of 15mm, bone angle 50 degrees, a positive palmar angle, a toe lever (measured from center of coffin joint articulation to the tip of coffin bone) that usually is not much more than 60 percent of overall coffin bone length, growth that is equal to or exceeds 7-10mm in 45 days and is even from to heel. <br />
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Change a few of these parameters and you start to identify mechanical handicaps that increase forces on growth centers and reduce blood flow hence reducing horn/sole growth. The most relevant difference I see is the bone angle, the toe lever and relative deep digital flexor tension/length. These are characteristics that a horse is born with. A lower bone angle and longer coffin bone (toe lever) often go hand in hand. This creates a longer lever arm acting against the flexor tendon and the bone to hoof attachment at the toe. On the other hand take a club foot with shortened muscle/tendon unit that overloads the toe area and this excessive force is responsible for the lack proper circulation and growth even with a shorter toe lever. Depending on the severity of these genetic handicaps and the goal for the horse will determine whether or not your horse will do good as a barefoot candidate. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWBcUEm4NjW_zQD8cgaowe36YyoqeVIiWA20rkDlfY-FJojOTccQg4IByOVz_yKDk1lctXWOTvAu_2nwpriYAeiuvo_sEbfX_Q7nHpybY_M7UPaSwwURF9F56XU7oRvq0xdCBVdFhJgTk/s1600/SHORT+TOE+LEVER.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWBcUEm4NjW_zQD8cgaowe36YyoqeVIiWA20rkDlfY-FJojOTccQg4IByOVz_yKDk1lctXWOTvAu_2nwpriYAeiuvo_sEbfX_Q7nHpybY_M7UPaSwwURF9F56XU7oRvq0xdCBVdFhJgTk/s640/SHORT+TOE+LEVER.jpg" width="506" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Note a short toe lever. When evaluated from COA to tip of coffin bone. This horse maintained good sole depth and hoof quality with minimal trimming. </td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXfu78N4d0l9cdxO03mryhNGos6eMoMK5JhAbRASjAa1MKqYfK17ZECtlMu3XBJ7ldPPjP6Rm-lotRyb2mvQ-6AzXmKivX5nP3w1CzWZO6eV7kMlSbgTi_x0rBlGRUzFq8GL7AeaWw9yc/s1600/LONG+TOE+LEver.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXfu78N4d0l9cdxO03mryhNGos6eMoMK5JhAbRASjAa1MKqYfK17ZECtlMu3XBJ7ldPPjP6Rm-lotRyb2mvQ-6AzXmKivX5nP3w1CzWZO6eV7kMlSbgTi_x0rBlGRUzFq8GL7AeaWw9yc/s640/LONG+TOE+LEver.jpg" width="494" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Note the long Toe Lever when evaluated from COA to tip of coffin bone. This horse would likely benefit from a shoe package that reduced the toe lever (rolled, rocker toe, rocker shoe, natural balance style) as an maintanence of genetic handicaps. This case was place in rocker rails for initial management then to a rockered keg shoe. </td></tr>
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Yes, sometimes a shoe can be detrimental to the hoof if attention is not given to recognizing these handicaps and altering the mechanics with the shoe application. For example a long toe lever and long coffin bone would benefit from a shoe application that reduced the toe lever. Examples are a rolled toe, rocker toe, natural balance or rocker shoe. This allows a reduction in the moment arm and reduces the force transmitted against the deep flexor tendon. This reduces subsequent tension force on the horn-lamellar junction, compression force at the solar corium and navicular bone tendon interface. </div>
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I feel that earlier recognition and management of the these handicaps will reduce many problems that our horses experience later in life. Horses are such amazing beast and able to adapt and overcome problems for many years to only be painful in their later years. I feel a reduction in these forces, once recognized and shoeing plan altered, prior to training would reduce the accumulated trauma over the lifespan of the horse. </div>
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So my overall stance is: If your horse has good external and radiographic parameters and no genetic handicaps or disease processes that require unloading then by all means manage with a good barefoot trim. However if there is problem such as thin soles, navicular bone disease, laminitis, arthritis or white line disease, application of a shoe to place the forces in the horse's favor may be required. Many cases require our modification of the forces to keep the horse doing its job. </div>
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I think shoeing horses often gets a bad reputation because we fail to recognize that maybe a perimeter fit, flat shoe may not be the best for every horse. I see many that would be better off barefoot as the shoe is creating an ever lengthening toe lever that may have the chance to wear off, if the horse was barefoot. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJOZSKtCqkTk1MI5Rx0wHT8or04-V1RUa2a-Jwun1uXv1DRoqDvnBP4wbkpCQnrHbuOwu39VWSj-vdUd9kj9I4hn8-gdUEn1vduls8wt0PFKCfrgVGvLqMnPk8m83k40gicbRq65sUn6g/s1600/2012-11-21_12-33-14_226.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJOZSKtCqkTk1MI5Rx0wHT8or04-V1RUa2a-Jwun1uXv1DRoqDvnBP4wbkpCQnrHbuOwu39VWSj-vdUd9kj9I4hn8-gdUEn1vduls8wt0PFKCfrgVGvLqMnPk8m83k40gicbRq65sUn6g/s640/2012-11-21_12-33-14_226.jpg" width="360" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This horse is nine years old and have never been trimmed. Note the load zones. This horse is maintaining his own four point trim. Not that no hoof care is good but this horse has a foot that is sound enough not only to go barefoot but has the right environment and proper mechanics to maintain itself.</td></tr>
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So when and if I can manage horses barefoot I prefer the four point trim. It's ability to reduce digital breakover greatly enhances the quality of and quantity of growth. I think the secret is "less is more" This approach allows maintaining a short toe and toe lever with maximizing sole depth. This trim is typically a rasp only trim with minimal knifing of the frog and sole only to clean up any ragged frog or bars that may trap debri. Below is a short video demonstrating a four point trim and some images demonstrating some of the important aspects as well. </div>
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<object class="BLOGGER-youtube-video" classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0" data-thumbnail-src="http://i.ytimg.com/vi/h_bHjqVddkw/0.jpg" height="266" width="320"><param name="movie" value="http://www.youtube.com/v/h_bHjqVddkw?version=3&f=user_uploads&c=google-webdrive-0&app=youtube_gdata" /><param name="bgcolor" value="#FFFFFF" /><param name="allowFullScreen" value="true" /><embed width="320" height="266" src="http://www.youtube.com/v/h_bHjqVddkw?version=3&f=user_uploads&c=google-webdrive-0&app=youtube_gdata" type="application/x-shockwave-flash" allowfullscreen="true"></embed></object><br />
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Points to remember:</div>
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1) Very good trimming approach to manage horse barefoot even with long toes and club as long as there is no other problems</div>
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2) Get paid for what you leave on the horse not what you are taking off. </div>
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3) When transitioning from shoes to barefoot, Take baby steps in applying any trim unless you have a ton of foot. Consider trimming every 2-3 weeks for 3 trims until you get the foot toughened. </div>
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4) I see great benefit from the use of Keratex hoof hardener and hot searing (Propane torch) my barefoot cases</div>
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5) Leave a nice round radius to the hoof wall and the hoof wall will be less likely to chip and more likely to self maintain.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL98jIdEO47EWEYKdLvgCRq1sAuTtcYsfk6HW7Hn4IZPvS2wpbO99ttym7aQp3IITvu9fyHfB4xVgNxbLcuucr3xjdsj8Eq751VhUsAfcbDqpOI1rNzswP8Flc1TIplOVduehfho8ipok/s1600/IMG_6246.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL98jIdEO47EWEYKdLvgCRq1sAuTtcYsfk6HW7Hn4IZPvS2wpbO99ttym7aQp3IITvu9fyHfB4xVgNxbLcuucr3xjdsj8Eq751VhUsAfcbDqpOI1rNzswP8Flc1TIplOVduehfho8ipok/s640/IMG_6246.JPG" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Angle of Rasp for toe trim varies according to sole depth.</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTbyP7lGDNRHpyjz9JzQg5fzBkTBiKKZ3M7dieIK26CnsKRpjdG1MlBMKHjik608huagVs3SjYQxlv24gY2yeff8k7RBRTzHA3lEHyvTx5-SdrmR_jb42arSRdn54xLSeF22On9mkQyKI/s1600/4pt+trim+with+markup.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTbyP7lGDNRHpyjz9JzQg5fzBkTBiKKZ3M7dieIK26CnsKRpjdG1MlBMKHjik608huagVs3SjYQxlv24gY2yeff8k7RBRTzHA3lEHyvTx5-SdrmR_jb42arSRdn54xLSeF22On9mkQyKI/s640/4pt+trim+with+markup.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Demonstration of the load zones with a four point trim</td></tr>
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-38234396860102128562013-01-13T16:44:00.001-06:002013-01-13T16:45:59.200-06:00The grey are aka "the hoof" article<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><u><span style="font-size: 18pt;">The Grey area aka the hoof<o:p></o:p></span></u></b></div>
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<b> As horse owners, farriers, trainers and vets we all know about the ever increasing foot ailments that horse's endure. We have all heard the saying, “No foot, No horse”. Do we really live that approach in our day to day lives with our equine companions? Have we really obtained all the information possible about our horse's hoof dynamics? The majority of hoof lameness' and even upper limb lameness' are a mechanical diseases that can benefit from a well developed mechanical solution based on evaluation of the forces at play within the hoof combined with accurate diagnosis and medical therapy. The hoof is often times overlooked as many of the people involved in the care of horses do not have all the information necessary to help maintain a healthy foot. Farriers have good working knowledge of trimming, nailing, using various tools in there day to day job but many lack knowledge of internal anatomy, radiographic anatomy and physiology. Veterinarians have a good understanding of anatomy, physiology and diseases but lack many of the hands on skills, knowledge of external hoof characteristics and techniques that a farrier takes for granted. The grey area is birthed from neither profession has enough information to communicate on the same level. As a veterinarian I was not educated on bio-mechanics, how to take farrier friendly radiographs, or how to evaluate lower limb mechanical forces. There just isn't enough time to completely cover all aspects of the horse while in veterinary school. Most veterinarians base their therapeutic recommendations on findings in veterinary lameness text or based on empirical personal experience and not a well designed mechanical plan based on radiographic findings. I know this because that was my approach upon graduating veterinary school. I find in my everyday practice that many hoof care professionals are unaware of a more in depth approach to evaluating and treating hoof disease and lameness. When we combine the knowledge of both professions with egos aside and develop a plan from that combination more success will arise. Many foot ailments can be a financial and emotional drain and require aggressive, quick and precise mechanical and medical treatments to be successful. I have been fortunate to learn from a pioneer in the podiatry world, Dr. Ric Redden of Versailles, Ky. Through his practical and innovative use of venograms, serial podiatry style radiographs and new mechanical devices, many horses are relieved of unnecessary pain and suffering. <o:p></o:p></b></div>
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<b> Below are four basic guidelines for successfully maintaining healthy hooves and approaching hoof lameness issues. <o:p></o:p></b></div>
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<b>Nutrition- We are all aware that skinny horses do not typically grow good hooves, but did you know that research has shown that added biotin at a rate of 100mg per day will increase hoof quality. Common hoof supplements that are commercially available only supply 10-20 mg daily. Biotin is long been noted to aid in hair and hoof growth. All of my hoof cases that have poor quality hoof, thin soles, slow growth or laminitis (founder) are started on 100 mg of Biotin daily.<o:p></o:p></b></div>
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<b>2.<span style="font-size: 7pt; font-weight: normal;"> </span></b><b>Balanced mechanical forces- This information is obtained from careful and in depth examination of external hoof characteristics combined with information based on measured soft tissue parameters from a farrier friendly radiograph. Radiographs must be taken in a consistent manner to obtain results that can be compared between radiographs. Radiographic measurements that are important to evaluate are: Coronary band/Extensor process distance (CE), proximal (top) and distal (bottom) horn lamellar zone (H/L), digital breakover (DB), sole depth (SD), and palmar angle (PA). Accurate assessment of these parameters will give you an idea if the horse's hoof is within a healthy range or not. To be successful in many common foot ailments, such as laminitis, navicular syndrome, caudal heel pain, long toe/low heel and club feet, it is paramount that precise radiographic evaluation of the forces at play is accomplished. The basis for all my therapeutic recommendations comes from these measurements. Below is a diagram of soft tissue parameters commonly utilized. </b></div>
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<b> Farriers are often given a very vague prescription such as wedge the heels and back the toe up, but how much wedge and where should the toe be backed up to. A more precise prescription might include: DB at 0 mm, PA increased from 0 degrees to 10 degrees and use of aluminum rail shoe rockered mid shoe attached with glue and fit with a positive pressure frog plate. In order for a prescription like this to be given and received both farrier and veterinarian must speak and understand the same language, which also means that both individuals have pursued a higher level of understanding of the equine hoof. <o:p></o:p></b></div>
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<b>3.<span style="font-size: 7pt; font-weight: normal;"> </span></b><b>Preventive hoof care programs- Many equine hoof ailments are results of long standing minor mechanical imbalances and predisposing genetic traits. Many of these can be identified early in life and monitored on annual basis via farrier friendly radiographs. For example, if your horse as a yearling has long pasterns, zero degree pa and a 30 mm breakover then you can assume that as an adult he will be predisposed to crushing his heels, maybe have thin walls and sole. However since it has been identified at an early age a maintenance program for the farrier can be developed that may differ from a basic perimeter fit steel shoe or traditional trimming. Many horses these days are not blessed with perfect feet and many would benefit from minor modifications in shoeing approach early in life to help delay or prevent the onset of hoof disease. A preventive hoof care program should involve a yearly podiatry style exam with radiographs that could be easily included into your yearly vaccination and wellness exam. Foals should be evaluated within the first week of life and every month for the first year of life. Radiographs can be taken any time along the way but definitely prior to entering training as to develop a hoof care plan. We as hoof care professionals need to be focused on maintaining hoof mass and quality instead of pretty and appealing to the eye. We can find minor changes in the measured soft tissue parameters long before bone changes occur and before the horse will exhibit pain or discomfort. <o:p></o:p></b></div>
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<b>4.<span style="font-size: 7pt; font-weight: normal;"> </span></b><b>Regular and consistent farrier visits- It is very important to have shoeing/trimming intervals that are appropriate for the individual horse as mechanical properties and soft tissue parameters change early in the shoeing interval. Often times by the end of the shoeing period, especially if overdue, the soft tissue measurements such as palmar angle and digital breakover have entered into an unhealthy zone. Using the podiatry style radiograph to design a healthy protocol that may maintain a healthier palmar angle and digital breakover longer in the shoeing cycle is another added benefit for preventive hoof care programs.<o:p></o:p></b></div>
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<b> In conclusion, I would like to see veterinarians and farriers alike adopt this similar language and radiographic techniques to evaluate the equine hoof. Without regard to consistent technique and a detailed evaluation of the mechanical formula there is an inherent risk of not obtaining the level of success that one may desire. What we do, and more importantly what we do not do to the hoof, not only has an affect today but in the future as well. We all need to recognize that a perimeter fit flat steel shoe may not be the best option for every horse, as simple modifications may prolong the health of the foot and prevent problems down the road. <o:p></o:p></b></div>
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<b>Further reading and resources: <o:p></o:p></b></div>
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<b>1.<span style="font-size: 7pt; font-weight: normal;"> </span></b><b>Dr. Redden's website, </b><a href="http://www.nanric.com/">www.nanric.com</a><b>, numerous articles regarding evaluation and treatment of many common foot ailments and soft tissue parameter measurement illustrations and articles.<o:p></o:p></b></div>
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<b>2.<span style="font-size: 7pt; font-weight: normal;"> </span></b><b>My website and blog, </b><a href="http://www.innovativequinepodiatry.com/">www.innovativequinepodiatry.com</a><b> and </b><a href="http://www.innovativeequinepodiatry.blogspot.com/">www.innovativeequinepodiatry.blogspot.com</a></div>
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-79872348761280226392013-01-13T16:41:00.000-06:002013-01-13T16:41:25.226-06:00Theory of two major loads article<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="font-size: 18.0pt;">Theory of Two Loads<o:p></o:p></span></b></div>
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<b> I have
struggled with what forces are involved in the hoof and how they changed with
different palmar angles and varying degrees of deep digital flexor tension
(DDF). So to aid in my understanding I consider two extreme examples to help
describe my simplified idea of two major loads within the hoof capsule. First I will describe tendon load (TL) and
the extreme example to be used is a high grade club. Next we will discuss bone load (BL) or ram
load with the extreme example of a post ddf tenotomy laminitis case. <o:p></o:p></b></div>
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<b> I think we can all agree that there is a
significant pull from the DDF in club foot cases. Lets consider the action of the DDF. As weight is applied to the limb or the DDF
muscle contracts the pulling force is
transferred to the coffin bone via the semilunar crest at the DDF tendon
insertion. This pulls the coffin bone
around its articulation with the distal end of the second phanlanx (P2) and the
DDF tendon also is pressed against the flexor surface of the navicular bone. Extraction forces are apparent at the
horn-lamellar interdigitation and compression forces on the solar corium
directly beneath the apex of the coffin bone.
Club feet are affected by a shortened musculotendonous unit via
increased neurologic stimulation of the flexor muscle. This tranfers load to the apex of the coffin
bone and the horn-lamellar interface at the toe. So for simplicity sake consider two lengths
of rope both attached above carpus and at the semilunar crest of coffin
bone. The shorter length will transfer
more load to the apex than the longer when weight is applied to the limb. <o:p></o:p></b></div>
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Figure <!--[if supportFields]><span style='mso-element:field-begin'></span><span
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<b>These forces and the changes
implied are noted on radiograph's of club feet, as a remodeled tip of coffin
bone, a small bump midway down on the face of P3 and often smaller,and a less
dense navicular bone. These changes
follow Wolfes law of bone remodels along lines of tension and compression. Now consider the external characteristics of
this extreme example: Atrophied frog,
deep central sulcus, wider growth rings at heel than toe, bulging or flat sole
at and around apex of frog. These
characteristics are created by the excessive DDF tension which allows for an
unbalanced load distribution between tendon load and bone load. This excessive TL prevents loading and
stimulation of the palmar portion of the hoof and leaves the frog and heel
suspended in the air.<o:p></o:p></b></div>
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<b> The
second load to consider is bone or ram load (BL). This is the weight that is transferred
through the bony column directly to the ground.
If no DDF was present then all load is distributed through this manner
and forces are increased in the heel region.
Consider the case of a post deep digital flexor tenotomy when all TL has
been negated due to severing of the DDF tendon. All weight and forces are concentrated in the heel region
and has more of a table leg distribution of forces. I feel that many of the crushed heel, low to
negative palmar angle hooves have a
similar situation. Just as the club foot is born with shortened musculotendinous
unit the low Palmar angle/crushed heel or slam dunk foot may have a longer than
ideal musculotendinous unit allowing a greater bone load that will allow more
weight or load through the bony column to the palmar/plantar aspect. I think it is possible to create a negative
palmar angle and crushed heels with poor mechanics in many of our everyday
shoeing practice that could possibly take a normal healthy foot with good sole
depth and palmar angle to thin soles and negative palmar angle, however many
are destined for that path from a very early age due to conformation. It is impossible to take a club foot
caused by shortened musculotendinous unit and create a negative palmar angle
and the same may be true for the slam dunk foot as many will revert back to
crushed and under run heels once orthotic devices have been applied to increase
hoof quality, sole depth and aid in treatment of lameness. <o:p></o:p></b></div>
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<b> Consider a
heel sore horse that is landing toe first, this is evidence to me that the
horse can use the tendon to transfer load to the front of the foot to unload
the painful buttress, digital cushion and many related soft tissue
structures. Many horses compensate quite
well by transferring load to the front of the foot via DDF with initial heel
soreness but it is not long until the extra workload by the tendon creates inflammation
within the tendon itself and many of soft tissues and ligaments associated with
the palmar/plantar aspect and fatiguing the flexor muscle group. This is when
a trip to the vet usually occurs as they are now unable to effectively transfer
load to a non painful region and show obvious signs of lameness. The increased load transferred to the front
by the toe first landing and often long digital breakover in these cases
decreases blood supply to vital growth centers and adds to the further compromise
of hoof and sole quantity and quality.
Radiographs would show very thin soles below wings of coffin bone, low
to negative palmar angle, a very low tendon surface angle, as scallop of bone
remodeling in palmar/plantar aspect of solar margin of coffin bone and upright
pasterns. External characteristics noted
are: Wider growth rings at toe than
heel, flat and thin soles, 2-3 sets of nail holes, wide robust frog, and under
run heels.<o:p></o:p></b></div>
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Figure <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->4<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->Low Pa bone remodeling/low
ddft tension<b><o:p></o:p></b></div>
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<b> <o:p></o:p></b></div>
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<b>For
further understanding let us consider treatment of these two scenarios and why
they are successful l in
increasing soundness and quality of hoof mass.
For the club foot syndrome, lower grades that are not surgical
candidates, increasing palmar angle and lengthening the heel base will allow
more BL and less TL. Decreasing the TL
will decrease the amount of load being transferred to the toe and allow more
bone or ram load to push into the heels.
The easiest and most successful approach I have found, is using rocker
shoe mechanics. The heels are trimmed to
the widest part of the frog parallel to the wings of the coffin bone and toe is
trimmed perpendicular to the frog axis at a low rocker toe style angle. <o:p></o:p></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWTzT-tvJbebfiC-dhU-gJIMGeJwUapgcnbXOsmIsTPhafI_zSytEamigyZJGK9od1fFqRQeEKczot9gMwD3HMtRsQv_2Jkyg21O6nj9kPO-cZWnKolE1bIU-FTdph3-1pShXpLsj5riQ/s1600/2012-10-05_12-56-26_869.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWTzT-tvJbebfiC-dhU-gJIMGeJwUapgcnbXOsmIsTPhafI_zSytEamigyZJGK9od1fFqRQeEKczot9gMwD3HMtRsQv_2Jkyg21O6nj9kPO-cZWnKolE1bIU-FTdph3-1pShXpLsj5riQ/s320/2012-10-05_12-56-26_869.jpg" width="320" /></a></div>
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Figure <!--[if supportFields]><span style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->5<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> Grade 3 club</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAa5xWdgjUGTyjzgLMvHNFBiSvoIynhDKuBgwsVveVyRP5983IOXlcyRU4_M6UsD3J5e-LF-42VLz2ZF12dFxyWFKbW2N92EwuPlC3LrPKHEFRa6lQhycxjbIOQoic0vFKQ5P8L8ARpxI/s1600/G3+club+with+RR.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAa5xWdgjUGTyjzgLMvHNFBiSvoIynhDKuBgwsVveVyRP5983IOXlcyRU4_M6UsD3J5e-LF-42VLz2ZF12dFxyWFKbW2N92EwuPlC3LrPKHEFRa6lQhycxjbIOQoic0vFKQ5P8L8ARpxI/s320/G3+club+with+RR.jpg" width="253" /></a></div>
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Figure <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->6<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> Grade 3 club with Rocker Rail<b><o:p></o:p></b></div>
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<b> The trim will vary based on such parameters as
palmar angle, sole depth and digital breakover but the basic approach will stay
the same. The next step is to determine
what shoe to shape to fit our specific needs.
In general low grade clubs will do fine in a rockered flat shoe as
higher grade clubs may require starting with a wedged shoe that has greater
mechanical potential. Consider a flat
shoe that is rockered can alter pa 2-4 degrees and a 5 degree rail shoe is
starting with 5 degrees, so any added rocker will increase potential to alter
palmar angle. So the question to be
answered is how much PA increase do I need to create less tendon load and more
bone load? Low grade clubs require less
than higher grades. This approach will
allow more ram or bone load, more heel loading that will result in less atrophy
of the frog, decreasing depth of the central sulcus, increased sole depth below
the tip of coffin bone and more even toe to heel growth patterns. With less TL comes less H/L zone extraction
force and less solar corium compression.
<o:p></o:p></b></div>
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<b>Now consider a case of acute
lamintis with extensive H/L detachment and venogram shows decreased perfusion
at the coronary waterfall, compromised vasculature down face of the coffin
bone, tip of coffin bone has displaced 3
mm below the circumflex artery, and terminal papillae are horizontal versus
being in normal orientation with the face of p3. This gives us a picture of severely
compromised dorsal portion, including the horn-lamellar attachment and solar
corium below the tip of coffin bone. A
DDF tenotomy may be indicated in many cases such as this. This will completely
unload the forces of the DDF and allow all weight to be transferred down
through the bony column into the palmar/plantar region of the foot and unloading
much of the compromised areas in dorsal aspect. This can be shown by post tenotomy
radiographs and venograms. This
release and increased load now through the bony column to heels will often push
the coffin bone up closer to its original placement prior to laminitis episode
and displacement and radiographs will show measurable decrease in distal h/l
zone and increase in sole depth just from the unloading that occurs from
complete release of DDF.<o:p></o:p></b></div>
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Figure <!--[if supportFields]><span style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>SEQ Figure \* ARABIC <span style='mso-element:
field-separator'></span><![endif]-->7<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> laminitis with rotation</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM-u4i5VODez3BEOmWKfXT1zZEEzSLyxBgUXLWRyA2ARNlwLcm35Re22Khe_cHMrop3RdFSRe8adCSABwc7khmNCjcd1sAbWmbs2T1HrginkFisFeJq8ElX6cwd0jvRcOlxAbmofltZds/s1600/POst+tenotomy+drawing.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM-u4i5VODez3BEOmWKfXT1zZEEzSLyxBgUXLWRyA2ARNlwLcm35Re22Khe_cHMrop3RdFSRe8adCSABwc7khmNCjcd1sAbWmbs2T1HrginkFisFeJq8ElX6cwd0jvRcOlxAbmofltZds/s320/POst+tenotomy+drawing.jpg" width="175" /></a></div>
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<span style='mso-element:field-separator'></span><![endif]-->8 <!--[if supportFields]><span style='mso-element:
field-end'></span><![endif]-->Post tendon cutting and derotation shoeing<b> <o:p></o:p></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2NY8_Ng8mJBNh_M78JMOrgq7gz5jl4ujHXQxtg0Eood1bgirzpHHm2WG4Y9hd9oY1c_wr9U4apufz3OQzizmVwgh4mDZkMGTWp8QZN58f6ug_1tqLpWxyZ154AB0gdmYaGn4Oku9uq7g/s1600/acute+laminitis+post+teno+veno.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjofpXVCHg19Ibr3wsOueJsAdNHTlIew8MyzDp9ApY2ysz42hSE-gqXkx_bWbOSOnSdXBtgV3D7NYPNtr11JXJvgI_L4fmg2gcqvC04pxFpzWGxJ6ay8xznAjT6p85pMLUEyd4xaCFkj5I/s1600/ACUTE+LAMINITIS+VENO.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjofpXVCHg19Ibr3wsOueJsAdNHTlIew8MyzDp9ApY2ysz42hSE-gqXkx_bWbOSOnSdXBtgV3D7NYPNtr11JXJvgI_L4fmg2gcqvC04pxFpzWGxJ6ay8xznAjT6p85pMLUEyd4xaCFkj5I/s320/ACUTE+LAMINITIS+VENO.jpg" width="249" /></a><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2NY8_Ng8mJBNh_M78JMOrgq7gz5jl4ujHXQxtg0Eood1bgirzpHHm2WG4Y9hd9oY1c_wr9U4apufz3OQzizmVwgh4mDZkMGTWp8QZN58f6ug_1tqLpWxyZ154AB0gdmYaGn4Oku9uq7g/s320/acute+laminitis+post+teno+veno.jpg" width="254" /></div>
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Figure <!--[if supportFields]><span style='mso-element:
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<span style='mso-element:field-separator'></span><![endif]-->9<!--[if supportFields]><span style='mso-element:
field-end'></span><![endif]-->Acute laminitis venogram</div>
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<b> In the above drawings (Figure 7 and 8) shows
the pull of the tendon with detached bone to horn attachments and a post
tenotomy with derotational shoeing.
Without a healthy lamellar attachment there is no antagonistic force to
counteract the pull of the ddft (TL) and the coffin bone rotates around its
articulation compressing solar corium at the tip of the coffin bone. Figure 9 shows an acute laminitis case in
which the bone is compressing the blood supply at the tip of coffin bone due to
lamellar detachment. You can see the tip
of coffin bone below the circumflex artery.
This area is heavily loaded secondary to the TL and loss of the bone to
horn attachment. The image on the right
is of the same horse 2 weeks after derotational shoeing and deep digital flexor
tenotomy. The tenotomy negates all TL
and its forces applied to the damaged areas (lamellar zone, sole under tip of
p3) and heavily loads the palmar/plantar aspect of the hoof through BL only. Note the restructuring of the blood vessels
under and around the tip of the coffin bone in this short 2 week period. <o:p></o:p></b></div>
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<b>I have always considered that
anytime we raise the palmar angle via wedges or rocker shoe mechanics that we
increased the load on the heels but it really wasn't clear why until
considering these two loads. These
examples are two extreme versions and most feet will fall somewhere in between.
When a healthy balance between TL and BL
exist we find good feet that are easy to
maintain with adequate sole depth and a positive palmar angle but when loads
sway more to one side of spectrum to overloaded portions become unhealthy and
need our assistance in balancing the load via a well designed protocol based on
and monitored by serial podiatry style radiographs and venograms.<o:p></o:p></b></div>
</div>
Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com24181 North Osage Drive, Tulsa, OK 74127, USA36.2143151 -96.009206510.6922806 -137.3178005 61.7363496 -54.700612500000005tag:blogger.com,1999:blog-6147842232488271378.post-4159711031416056582012-12-05T13:28:00.003-06:002012-12-05T13:28:39.435-06:00Ric Redden, DVM follow up clinic 6wks rechecks<div dir="ltr" style="text-align: left;" trbidi="on">
We had a great day resetting and rechecking many of the cases we used as demo's during Dr. Ric Redden's in depth equine podiatry lecture and demonstration. We had some return students and some new ones attending. I want to thank Clyde Brown and Animal Health Supply for allowing us to congregate at their place of business.<br />
<br />
Below is several follow up images and short discussion of each case. Also look back at the previous blog entry for initial images and therapeutic shoe applied. <a href="http://innovativeequinepodiatry.blogspot.com/2012/10/images-from-october-clinic-with-dr-ric.html" target="_blank">October clinic images link</a><br />
<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3VOSSPov4YenwPddmiiHL8WYeVD6V8RcORs3HmLEEY_l449SZrnUwGK_fW36gyTXrXMkThCJWUoBhZj_HRkHTldAHCk5Xl7YJ8E7FZAiEdCcDB4VcWO8QfrccD85B-v5hIrbcizkRl-E/s1600/G3club+RF+pre+rocker+oct.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br /></a><span style="font-size: large;">White line disease Case: </span> Sole depth improved by 4mm but white line lesion failed to grow down at same rate and decision was made to remove hoof wall to expose oxygen and allow cleaning. Owner reports that he is running around like a youngster again and is more comfy than is has been in a long time. <br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgycMp_lUcL5_EEjk5wd_5FfBrVHlUJ_v-5JCe8UburKQyq0Ew92XMe493PlbnPFAn3c8QmtNHyQ5J2_hhPZVB8_wZnD5c7PD0hjFWpbzOozHBA24PR2CWktRvN15p2nOO4AP-Qwr-pwDg/s1600/Choctaw+WLD+LF+pre+shoe.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgycMp_lUcL5_EEjk5wd_5FfBrVHlUJ_v-5JCe8UburKQyq0Ew92XMe493PlbnPFAn3c8QmtNHyQ5J2_hhPZVB8_wZnD5c7PD0hjFWpbzOozHBA24PR2CWktRvN15p2nOO4AP-Qwr-pwDg/s640/Choctaw+WLD+LF+pre+shoe.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">6wks post intial rocker rail note 4mm increase in sole depth in a horse that hasn't grown any sole in years.</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXgluqgNx7shcWG-dhE9l-0Ao20ngtgLpPJVETFb6caoTXL9bR_cshBDvD84Wh1T0gLUsZJCrbbsaPx_8pzJIG3mlTRP5BOPjD7iO-ZKXEjhdrkuUe2W2xxuDIhE20WkwTROwuE-_nB-g/s1600/Choctaw+WLD+LF+post+shoe.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXgluqgNx7shcWG-dhE9l-0Ao20ngtgLpPJVETFb6caoTXL9bR_cshBDvD84Wh1T0gLUsZJCrbbsaPx_8pzJIG3mlTRP5BOPjD7iO-ZKXEjhdrkuUe2W2xxuDIhE20WkwTROwuE-_nB-g/s640/Choctaw+WLD+LF+post+shoe.jpg" width="498" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Reset image</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhl6XzAG34g8YTV0IZs_KcQLv6chYM9efIbDRlhnV3YHPMW7K2ihiN5UpHV94e_iP7Uxh0nyTXFT3lxLY7QiOz1oWYNozcX5Nc-k948okXAlZhytyzeEcQnO5m_IpDDNizNstoVC-h_cmo/s1600/WLD+LF+PRE+SHOE+OCT.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhl6XzAG34g8YTV0IZs_KcQLv6chYM9efIbDRlhnV3YHPMW7K2ihiN5UpHV94e_iP7Uxh0nyTXFT3lxLY7QiOz1oWYNozcX5Nc-k948okXAlZhytyzeEcQnO5m_IpDDNizNstoVC-h_cmo/s640/WLD+LF+PRE+SHOE+OCT.jpg" width="500" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">First image Oct 6 pre shoe</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitUcdp9OC7ag6n09U2uYNJHn8DWcKltx9CJi7SKB8S-uRi9fMnLdjPYnt2lzryS4dHXycJz1bDaVISxz1B0HHz7REhKv4NHArh3sWTZ0QTRSCQYAD5AV5Pk5ldrAGdAsVgZ94t3V7HBXE/s1600/2012-11-17_12-37-43_300.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitUcdp9OC7ag6n09U2uYNJHn8DWcKltx9CJi7SKB8S-uRi9fMnLdjPYnt2lzryS4dHXycJz1bDaVISxz1B0HHz7REhKv4NHArh3sWTZ0QTRSCQYAD5AV5Pk5ldrAGdAsVgZ94t3V7HBXE/s640/2012-11-17_12-37-43_300.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Hoof wall resection to allow cleaning and oxygen to penetrate</td></tr>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkqa6LIZcdYp6urm5_P042iZ9GtuUWQoO74dpHLaZoC-q4GXuL19QzIlw6Kdnbetn4H_VeMmylI-wUBqsyLWoso8Qh7qjq08Zx4g38Ub40_zYMG_2UWloufIUo3zGWqv1ETw1F-z4ZOLY/s1600/2012-11-17_12-40-24_251.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkqa6LIZcdYp6urm5_P042iZ9GtuUWQoO74dpHLaZoC-q4GXuL19QzIlw6Kdnbetn4H_VeMmylI-wUBqsyLWoso8Qh7qjq08Zx4g38Ub40_zYMG_2UWloufIUo3zGWqv1ETw1F-z4ZOLY/s640/2012-11-17_12-40-24_251.jpg" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvx6V2s_CAzvVf3Y9m5XPNOObVnrEtiaVU_2yVRf21VbXGCR14zx056MZNRlAcjpYudUUQ_ERd9TEcsraNQF8Odn-6W7fTjtxC-vP_HDT2x362267d5lExmzZu5KwLOl8t__3PfCxT8Gw/s1600/2012-11-17_12-44-15_651.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvx6V2s_CAzvVf3Y9m5XPNOObVnrEtiaVU_2yVRf21VbXGCR14zx056MZNRlAcjpYudUUQ_ERd9TEcsraNQF8Odn-6W7fTjtxC-vP_HDT2x362267d5lExmzZu5KwLOl8t__3PfCxT8Gw/s640/2012-11-17_12-44-15_651.jpg" width="640" /></a></div>
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<span style="font-size: large;">Club foot case: </span> This horse lost the rocker rail shoe applie to the foot opposite the grade 3 club (which is also a club) and regular farrier applied a flat steel keg shoe to keep foot protected. Note the horn lamellar zone divergence. One could call this rotation which would be non specific. The divergence is created by the club syndrome stretching to lower horn to bone attachments. This is confirmed by evaluating the dermal-epidermal junction and measuring the horn zone compared to the lamellar zone. If the lamellar zone was larger than the horn zone one could conclude a laminitis as this is lamellar swelling. In this case it is chronic stretching of the lamellar bone secondary to the constant pull of the deep digital flexor unit. <br />
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The Grade 3 club grew more sole in the rocker rail than did the lower grade club in a flat shoe. This information tells us that placing the tendon sling in freedom with the rocker shoe allows better nutrient and blood circulation through unloading of the sole via reduced deep flexor tension. We placed the grade 2 club (Left Front) in a rockered trim with rockered steel keg shoe to also place the tendon sling in release. We will be to see a more rapid sole mass recovery in this hoof as well at the next reset. Owner reports excellent comfort and has adjusted very well to the new shoeing approach.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3VOSSPov4YenwPddmiiHL8WYeVD6V8RcORs3HmLEEY_l449SZrnUwGK_fW36gyTXrXMkThCJWUoBhZj_HRkHTldAHCk5Xl7YJ8E7FZAiEdCcDB4VcWO8QfrccD85B-v5hIrbcizkRl-E/s1600/G3club+RF+pre+rocker+oct.jpg" imageanchor="1" style="clear: left; font-size: medium; margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: left;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3VOSSPov4YenwPddmiiHL8WYeVD6V8RcORs3HmLEEY_l449SZrnUwGK_fW36gyTXrXMkThCJWUoBhZj_HRkHTldAHCk5Xl7YJ8E7FZAiEdCcDB4VcWO8QfrccD85B-v5hIrbcizkRl-E/s640/G3club+RF+pre+rocker+oct.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Pre shoe radiograph Oct 5</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNjbzLkzxKgqDBUdC9aLuOPbwjGq29GXLNLPZ9mpYRUYzHDW-bdUo15uE-esGtSmDi34UpgnmL60Uh-jPV0mcZ2h5bUwmo67FPVYMSKi6d0_QldJUWOQdVW_WZrCeZi-90e4KAWGEqpgg/s1600/Oct+chronist+left+preshoe.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNjbzLkzxKgqDBUdC9aLuOPbwjGq29GXLNLPZ9mpYRUYzHDW-bdUo15uE-esGtSmDi34UpgnmL60Uh-jPV0mcZ2h5bUwmo67FPVYMSKi6d0_QldJUWOQdVW_WZrCeZi-90e4KAWGEqpgg/s640/Oct+chronist+left+preshoe.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Left front shoe that regular farrier had replaced with flat keg shoe for protection</td></tr>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3bfzoApgXEhuxQCR0NUDeYNvdzhsZyEO7fLYZMS4mys0lLBc0khtZdpVJMj9hHwMMBZk6kSV-CFZ-OOAaMCEmQEeIKPb4AcxRfsKwZnJYibsQ2c-uS9PjUpBBbf-1Etf-oJHHgU8fq4M/s1600/OCT+chronister+LF+post+shoe.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3bfzoApgXEhuxQCR0NUDeYNvdzhsZyEO7fLYZMS4mys0lLBc0khtZdpVJMj9hHwMMBZk6kSV-CFZ-OOAaMCEmQEeIKPb4AcxRfsKwZnJYibsQ2c-uS9PjUpBBbf-1Etf-oJHHgU8fq4M/s640/OCT+chronister+LF+post+shoe.jpg" width="500" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Rockered keg shoe<br /><br /></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkYn8VyZu6zX5gz_QVtcB5uGN-MrszemGRUa-NExQTCALoiZQ5RQLGCCazV3OO4x5iqv4QmPocze2kmce0RdmyfAbpODHo8zl2pGRnvKvqg6RU3wu5m374DEC7WMISxJfVaKqRvlWVf-M/s1600/October+clinic+2012.Chronister.2-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkYn8VyZu6zX5gz_QVtcB5uGN-MrszemGRUa-NExQTCALoiZQ5RQLGCCazV3OO4x5iqv4QmPocze2kmce0RdmyfAbpODHo8zl2pGRnvKvqg6RU3wu5m374DEC7WMISxJfVaKqRvlWVf-M/s640/October+clinic+2012.Chronister.2-17-Nov-2012.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">6 wks post rocker rail application additional 4mm of sole and cup starting to form. All this due to unloading of the deep flexor pull </td></tr>
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<span style="font-size: large;">Chronic Lamintis case:</span> Farrier was a student and he reports horse is moving very nice. Horse was able to stand comfortably for each shoe reset. Turning and moving very nicely.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsWwcMO08UFcTI56DvtZluhQMwcdcRohqrRsj6ap0machausg96puWkJ0FZ0fnGwLeG-a3UfeROqOV_5AA8OmSJgVPs4ccnzWBviKtKTSKlch_COY_GNjot-k9HVRHVudVlm5MYq9E72U/s1600/October+clinic+2012.Munger+%252C+mark+chronic+lami+case.4-6-Oct-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsWwcMO08UFcTI56DvtZluhQMwcdcRohqrRsj6ap0machausg96puWkJ0FZ0fnGwLeG-a3UfeROqOV_5AA8OmSJgVPs4ccnzWBviKtKTSKlch_COY_GNjot-k9HVRHVudVlm5MYq9E72U/s640/October+clinic+2012.Munger+%252C+mark+chronic+lami+case.4-6-Oct-2012.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Pre Rocker shoe oct 6</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix8ak9fvr7_ilhDbo36Ic1U2L7hCFDrQjq5ZcQA-3RAGQK57prhFV67DvnIVfmC_tEoT4gNi41iGtbxaZ4eKdKbYy9mMCrRZ55nymSN7Ijv61u9wTOJQP-2l3ZsBeRYmq5RgbOzRo16Vw/s1600/October+clinic+2012.Munger+,+mark+chronic+lami+case.1-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix8ak9fvr7_ilhDbo36Ic1U2L7hCFDrQjq5ZcQA-3RAGQK57prhFV67DvnIVfmC_tEoT4gNi41iGtbxaZ4eKdKbYy9mMCrRZ55nymSN7Ijv61u9wTOJQP-2l3ZsBeRYmq5RgbOzRo16Vw/s640/October+clinic+2012.Munger+,+mark+chronic+lami+case.1-17-Nov-2012.jpg" width="504" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">6 weeks post rocker rail with addition of 4mm of sole and less bulge of sole at apex of frog. </td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaqB6RtnGhqyia09EjAgnkdVvAkxWXzOIbKNbpRWfUR4hTbflaIBQYah1Gt3fZE47XbW99mFKF-_ICLXJP0CA9lYrD72xsFxe2ueS4kr-TnypguU4cKIyZ7q1JgiQTyCjzcyRGWOBs3gU/s1600/October+clinic+2012.Munger+%252C+mark+chronic+lami+case.1-6-Oct-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaqB6RtnGhqyia09EjAgnkdVvAkxWXzOIbKNbpRWfUR4hTbflaIBQYah1Gt3fZE47XbW99mFKF-_ICLXJP0CA9lYrD72xsFxe2ueS4kr-TnypguU4cKIyZ7q1JgiQTyCjzcyRGWOBs3gU/s640/October+clinic+2012.Munger+%252C+mark+chronic+lami+case.1-6-Oct-2012.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Oct 6th pre rocker </td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIyyLIsu1ztsCPpfh73Y18g6aNS2nXO3pow074qmCO-Z-ZNJGXo84EfzykfH6XjZSENP7ap3QL7Bm_lKGn2lSrm9wGSSGI9RqmH-hL5stKpIEImQCOvVMqG5Ur3Q_oynHpscOmV28ds-o/s1600/October+clinic+2012.Munger+,+mark+chronic+lami+case.2-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIyyLIsu1ztsCPpfh73Y18g6aNS2nXO3pow074qmCO-Z-ZNJGXo84EfzykfH6XjZSENP7ap3QL7Bm_lKGn2lSrm9wGSSGI9RqmH-hL5stKpIEImQCOvVMqG5Ur3Q_oynHpscOmV28ds-o/s640/October+clinic+2012.Munger+,+mark+chronic+lami+case.2-17-Nov-2012.jpg" width="498" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Left front 6wks post rocker rail. Rocker shoe was removed prior to getting a radiograph. Added 5mm of sole</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtBfQD7SfUuajIONdTJL4VwGW4uQK6vTuPxYxvQoK4Oavlm7HPuWyooGbjSLMBoonPBGXXa3eokRYF6u7oTYH8CcBiV4_GntU1f-xl7p4mkDyRg1xiloThsu2lQIcyS8hpxZEPLsFeS0w/s1600/October+clinic+2012.Munger+,+mark+chronic+lami+case.3-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtBfQD7SfUuajIONdTJL4VwGW4uQK6vTuPxYxvQoK4Oavlm7HPuWyooGbjSLMBoonPBGXXa3eokRYF6u7oTYH8CcBiV4_GntU1f-xl7p4mkDyRg1xiloThsu2lQIcyS8hpxZEPLsFeS0w/s640/October+clinic+2012.Munger+,+mark+chronic+lami+case.3-17-Nov-2012.jpg" width="494" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Nov 17th reset with rocker rail. </td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyfRm68mE2E5jy3J6x8_v0l4gEkUpHG4oI5Lf8xtO8N9OIv1qwTjFQPnNxBsjT3jHHEBThB-7b87jO_Jxz3OJtNAf81yc5G4mmOCeh6o51r-lYsaQIji6HpreHBfCYbc28MlHoX4eTq7s/s1600/October+clinic+2012.Munger+,+mark+chronic+lami+case.4-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyfRm68mE2E5jy3J6x8_v0l4gEkUpHG4oI5Lf8xtO8N9OIv1qwTjFQPnNxBsjT3jHHEBThB-7b87jO_Jxz3OJtNAf81yc5G4mmOCeh6o51r-lYsaQIji6HpreHBfCYbc28MlHoX4eTq7s/s640/October+clinic+2012.Munger+,+mark+chronic+lami+case.4-17-Nov-2012.jpg" width="504" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Post nov 17th reset rocker rail.</td></tr>
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<span style="font-size: large;">Navicular case:</span> Owner reports she was able to work a pattern for the first time in 2 years. The Owners farrier was present and we helped him reset the rocker rails. We plan to maintian the higher palmar angle for the next shoe cycle then began to lower the mechanics/palmar angle. I expect to achieve similar comfort with lower mechanics as the horse remained comfortable even with losing a few degrees of palmar angle secondary to growth. The history is very important here. If horse became more lame at the end of the cycle as the palmar angle decreased, this tells us the hot spot becomes loaded at the lower palmar angle and may require a longer period of higher mechanics.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAZnE6TcprWVP7D-2Oq-KyKoOGJVVnRpE_k8V7SftConjE9zFDMKH-UwBvrz6f79jsy9sT_cQxEIcV_z3UiuWw3r6u-uLrSLPZwR_lUmDklVojutGKYMBtpnNXoD0UFbOmROLwu-7Rlls/s1600/October+clinic+2012.cool.1-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAZnE6TcprWVP7D-2Oq-KyKoOGJVVnRpE_k8V7SftConjE9zFDMKH-UwBvrz6f79jsy9sT_cQxEIcV_z3UiuWw3r6u-uLrSLPZwR_lUmDklVojutGKYMBtpnNXoD0UFbOmROLwu-7Rlls/s640/October+clinic+2012.cool.1-17-Nov-2012.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">RF pre reset on nov17th</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJCJkHct_1T7KdeOHrnOQqPBPdMjrybqS-qOh1A6CGWAiZZguRmM0dVF-ZBXJvbScaLTCe0bCHgYel4FFa04YVOZt1HwvsG7AMuKlnNxzhSbPRiniumjv_jEweWJURlgK1q9cK0-qsGSE/s1600/October+clinic+2012.cool.3-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJCJkHct_1T7KdeOHrnOQqPBPdMjrybqS-qOh1A6CGWAiZZguRmM0dVF-ZBXJvbScaLTCe0bCHgYel4FFa04YVOZt1HwvsG7AMuKlnNxzhSbPRiniumjv_jEweWJURlgK1q9cK0-qsGSE/s640/October+clinic+2012.cool.3-17-Nov-2012.jpg" width="496" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Post shoe nov 17th</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEDNTX_Rw0BELuA7J6q-ygooXZ0yHrbxoBx2XzOacnl-X7NPzU5KzX64AqvqZiiIPB9Lahho6L_Rb1AkqhPGgdX4xSEjX8mZvOBXZ8q5YZK5vP2gt3t-A4ypD76pdY9ff9I7UhV_C8rxY/s1600/October+clinic+2012.cool.4-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEDNTX_Rw0BELuA7J6q-ygooXZ0yHrbxoBx2XzOacnl-X7NPzU5KzX64AqvqZiiIPB9Lahho6L_Rb1AkqhPGgdX4xSEjX8mZvOBXZ8q5YZK5vP2gt3t-A4ypD76pdY9ff9I7UhV_C8rxY/s640/October+clinic+2012.cool.4-17-Nov-2012.jpg" width="492" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Post shoe nov 17th<br /></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivCtWFVRCfYnRvVlpWk3dZImUqQQ1gOmtm1vA0HHS_lEmV8Ih0mVON1eFhInk5u0RRXWmkv7BxamrcoWE_ILobYGXyRGQTLD2J8sENprgwm75PBAYaNxfU4A_CDZAM7fHjzCscv02KluE/s1600/October+clinic+2012.cool.2-17-Nov-2012.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivCtWFVRCfYnRvVlpWk3dZImUqQQ1gOmtm1vA0HHS_lEmV8Ih0mVON1eFhInk5u0RRXWmkv7BxamrcoWE_ILobYGXyRGQTLD2J8sENprgwm75PBAYaNxfU4A_CDZAM7fHjzCscv02KluE/s640/October+clinic+2012.cool.2-17-Nov-2012.jpg" width="494" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Pre shoe reset on nov 17th</td></tr>
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<span style="font-size: large;">6 month chronic laminitis case:</span> Owner reports horse is very comfortable, has a much better appetite and very willing to move freely. This case demonstrates the importance the deep digital flexor tendon force applied to a failed lamellar bone. With the loss of the lamellar suspension of the coffin bone, it is allowed to compress the sole at the apex of coffin. No blood, No growth and recurrent abscessation as has occurred in this case. The fragile rim of the coffin bone becomes loses its blood supply and acts like a foreign body. I haven't been able to achieve this level of success with any other approach. Doubling sole depth from 10mm to 20 mm in a matter of 6 wks in chronic laminitis is astonishing. </div>
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I do not recommend a tenotomy for every laminitis case and only do so if the venogram shows the circumflex artery at or above the level of the tip of the coffin bone as described by Dr. Ric Redden. However I do recommend considering the forces applied by the ddft to the coffin bone and often use "mechanics" (rockering/wedging) to lesson the tension on a failing system to aid in re-establishing vascular supply.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1p4WPL4cQGu1tQ1ZBf9h6ebGU4BvUrBjUVHPiCCflIwucY8PZS-IKcXC_Rg2gsn-UOi_akgXf1zPdDJNsMZDJAGthPuvaNeKwVOM-1jR_T88t9jx0OyLNcmV8KRiSDTGgSVVgPEgemcc/s1600/ROSE+POST+TENO+LF.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1p4WPL4cQGu1tQ1ZBf9h6ebGU4BvUrBjUVHPiCCflIwucY8PZS-IKcXC_Rg2gsn-UOi_akgXf1zPdDJNsMZDJAGthPuvaNeKwVOM-1jR_T88t9jx0OyLNcmV8KRiSDTGgSVVgPEgemcc/s640/ROSE+POST+TENO+LF.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Immediately post derotation and deep flexor tenotomy oct 6</td></tr>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9zEspM1a7GWGs1LZ44XEaIDaxUck_Bwj4sgASlT18GswwOgnOngExhiGX_u8fL-UeSXJ3Pf60U2ucsx4Gi_2iTBh249CA91InjoIxo23WNV22hhv0_VGrrMwEN952Mby7bshagancxko/s1600/ROSE+POST+TENO+RF.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br /></a><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF1auXfOib16_7USt5x881X_wPN86ATC2O2jKnZb8yHElFh3d6ZcV0V02MpldfIXVv8w3sdHhub1grOeJv85qiOIh8scutemtw8n-CBkgK5qn4qmf9_fB9uuPiv2d6wmw_8X6JDf9l1rY/s1600/Rose+6wks+post+tenotomy+LF+pre+shoe.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF1auXfOib16_7USt5x881X_wPN86ATC2O2jKnZb8yHElFh3d6ZcV0V02MpldfIXVv8w3sdHhub1grOeJv85qiOIh8scutemtw8n-CBkgK5qn4qmf9_fB9uuPiv2d6wmw_8X6JDf9l1rY/s640/Rose+6wks+post+tenotomy+LF+pre+shoe.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Note the rapid growth of sole at dorsal portion of hoof and loss of palmar angle. addition of 10mm of sole</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgheg0BpbE3Jq5PVFbttHLhHiZFnczjU2-HIXRvJnDWIp9Do3oEZFYcI617TrPlhLNhfgfTVkD9m4EzhRi9XgeSSCixDdBxr7X7bbUltjyMfbvw8sNgZ7CUUVXNU3b_nMJHtrsjUecrx4c/s1600/Rose+6wks+post+tenotomy+LF+post+shoe.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgheg0BpbE3Jq5PVFbttHLhHiZFnczjU2-HIXRvJnDWIp9Do3oEZFYcI617TrPlhLNhfgfTVkD9m4EzhRi9XgeSSCixDdBxr7X7bbUltjyMfbvw8sNgZ7CUUVXNU3b_nMJHtrsjUecrx4c/s640/Rose+6wks+post+tenotomy+LF+post+shoe.jpg" width="494" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Post reset to re establish a zero palmar angle with the shoe. This is necessary to prevent over correction resulting in a negative palmar angle </td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9zEspM1a7GWGs1LZ44XEaIDaxUck_Bwj4sgASlT18GswwOgnOngExhiGX_u8fL-UeSXJ3Pf60U2ucsx4Gi_2iTBh249CA91InjoIxo23WNV22hhv0_VGrrMwEN952Mby7bshagancxko/s1600/ROSE+POST+TENO+RF.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9zEspM1a7GWGs1LZ44XEaIDaxUck_Bwj4sgASlT18GswwOgnOngExhiGX_u8fL-UeSXJ3Pf60U2ucsx4Gi_2iTBh249CA91InjoIxo23WNV22hhv0_VGrrMwEN952Mby7bshagancxko/s640/ROSE+POST+TENO+RF.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Immediately post derotation and deep flexor tenotomy on oct 6</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbKrGGFOq3l_0aVAcDrJk2QM0227XVp97K7vMocSFCTzpB02kgOrZI0H1lKzNOlTUhx-fMurqexzfroC-u-6LJEcA0xYSh0n0RSt7enkbSS3fdVhO9MnfK2qbrPFKfsxn_anprqOx2Z7w/s1600/Rose+6wks+post+tenotomy+RF.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbKrGGFOq3l_0aVAcDrJk2QM0227XVp97K7vMocSFCTzpB02kgOrZI0H1lKzNOlTUhx-fMurqexzfroC-u-6LJEcA0xYSh0n0RSt7enkbSS3fdVhO9MnfK2qbrPFKfsxn_anprqOx2Z7w/s640/Rose+6wks+post+tenotomy+RF.jpg" width="502" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">6wks post derotational shoeing and deep flexor tenotomy. No reset required as even sole growth is occuring and resetting the shoe does not add any benefits mechanically.</td></tr>
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-31033094484345245472012-10-26T13:52:00.004-05:002012-10-26T14:05:53.063-05:00Images from the October clinic with Dr. Ric Redden.<div dir="ltr" style="text-align: left;" trbidi="on">
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Hello, I wanted to thank all the attendees to the in depth equine podiatry lecture and demo with Dr. Ric Redden of International Equine Podiatry Center. We had some very good cases in which to apply a sound and methodical radiographic and external evaluation. Using this evaluation a therapeutic shoe was apply to aid in rehabilitation of each case. </div>
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We are planning a follow up clinic November 17th to recheck and reset each case. This will be a great opportunity to see the response radiographically. </div>
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This first case is a grade 2+ club cases used as western and english pleasure as well as some roping. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWTzT-tvJbebfiC-dhU-gJIMGeJwUapgcnbXOsmIsTPhafI_zSytEamigyZJGK9od1fFqRQeEKczot9gMwD3HMtRsQv_2Jkyg21O6nj9kPO-cZWnKolE1bIU-FTdph3-1pShXpLsj5riQ/s1600/2012-10-05_12-56-26_869.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWTzT-tvJbebfiC-dhU-gJIMGeJwUapgcnbXOsmIsTPhafI_zSytEamigyZJGK9od1fFqRQeEKczot9gMwD3HMtRsQv_2Jkyg21O6nj9kPO-cZWnKolE1bIU-FTdph3-1pShXpLsj5riQ/s640/2012-10-05_12-56-26_869.jpg" width="640" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUOIT44JEWKfsxWkjjMKWZ2fktE6BvehcR_aWbj5-NHtEB6_vG3uMYtEQvslFWV1fMWS15Iv7JtDc7m4nag9wbhDHsDkUZlkpllT0-FiNrX4Ql1z_bzQM3hAjKrd5giMEbOF0_LcG4TIM/s1600/2012-10-05_13-48-14_940.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" height="356" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUOIT44JEWKfsxWkjjMKWZ2fktE6BvehcR_aWbj5-NHtEB6_vG3uMYtEQvslFWV1fMWS15Iv7JtDc7m4nag9wbhDHsDkUZlkpllT0-FiNrX4Ql1z_bzQM3hAjKrd5giMEbOF0_LcG4TIM/s640/2012-10-05_13-48-14_940.jpg" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi16F4xhVrcMBtiD2mxLxNfYntjjU7W7_v_kIYPz7YfISDUo5VuHO4ILTLBUvPZzId0H2hHxpVRhA6K2xfs2YQpuw_-CCvO3DWruXjenbSZ5RyYal5T7roBYB7w7VKjuABrxQvXWtIjM8U/s1600/October+clinic+2012.Chronister.1-5-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi16F4xhVrcMBtiD2mxLxNfYntjjU7W7_v_kIYPz7YfISDUo5VuHO4ILTLBUvPZzId0H2hHxpVRhA6K2xfs2YQpuw_-CCvO3DWruXjenbSZ5RyYal5T7roBYB7w7VKjuABrxQvXWtIjM8U/s640/October+clinic+2012.Chronister.1-5-Oct-2012.jpg" width="640" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioCpZVJH-GwYfa6yStnLkf6VpdvBR2YbgUEqILNO2eJWsSbYMoxqqCPIiAvmbtnhC7FVLujbYMmiijfh8GSfXrnOdT-u3lVsQy1N22t4zSR8Hkcu_eBpjR_c6MVBMxV7RkW-64qxO28Bo/s1600/October+clinic+2012.Chronister.2-5-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioCpZVJH-GwYfa6yStnLkf6VpdvBR2YbgUEqILNO2eJWsSbYMoxqqCPIiAvmbtnhC7FVLujbYMmiijfh8GSfXrnOdT-u3lVsQy1N22t4zSR8Hkcu_eBpjR_c6MVBMxV7RkW-64qxO28Bo/s640/October+clinic+2012.Chronister.2-5-Oct-2012.jpg" width="480" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWvmyZStUUVdYllKMz1N-pDgYRSURGD5GECi6j48lE-ZeM6VAyhsOayryY_UrFiPCdaUmPoHP0Th87bSFhcE51g3_JfzV0C6z973R6squ1f7Eoa50piONxeH3-hWB90cmX0kJJwBXy2Bk/s1600/October+clinic+2012.Chronister.3-5-Oct-2012.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWvmyZStUUVdYllKMz1N-pDgYRSURGD5GECi6j48lE-ZeM6VAyhsOayryY_UrFiPCdaUmPoHP0Th87bSFhcE51g3_JfzV0C6z973R6squ1f7Eoa50piONxeH3-hWB90cmX0kJJwBXy2Bk/s640/October+clinic+2012.Chronister.3-5-Oct-2012.jpg" width="640" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuvQnlsPLjy3ZvUpEDZ4Mw7DzX280fEJdpXlebKR_aF7VgODK4p1BeaY2NZojYfyypgqgbDpUFXS5YWR4uUW1GJzfb308Wjt_Vu7uMX6R7t8j_YeDGk5sxbWkPGGMTkscD81hA9z3xmQw/s1600/October+clinic+2012.Chronister.4-5-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuvQnlsPLjy3ZvUpEDZ4Mw7DzX280fEJdpXlebKR_aF7VgODK4p1BeaY2NZojYfyypgqgbDpUFXS5YWR4uUW1GJzfb308Wjt_Vu7uMX6R7t8j_YeDGk5sxbWkPGGMTkscD81hA9z3xmQw/s640/October+clinic+2012.Chronister.4-5-Oct-2012.jpg" width="640" /></a></div>
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This is a case with navicular bone changes that had responded to increase in palmar angle and reduction in digital breakover but was not consistently going sound. Dr. Redden applied an aluminum rocker rail. Look at the TSA and the distance the navicular is from the proximal p2 between the pre and post shoe radiographs. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDhS398MJH3y_-2KaoX5uabGjPcyRui1C4nr0adCgTHBXgzX0XLl1wvbbGvxJ8eDCVOSCcWARuMCGohJsFPCdbjD-Z08vwbf0v9RYstcHjvVRXT4EHeD0U_yAglk_EqnnhBHxpcxgAKOY/s1600/October+clinic+2012.cool.1-5-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDhS398MJH3y_-2KaoX5uabGjPcyRui1C4nr0adCgTHBXgzX0XLl1wvbbGvxJ8eDCVOSCcWARuMCGohJsFPCdbjD-Z08vwbf0v9RYstcHjvVRXT4EHeD0U_yAglk_EqnnhBHxpcxgAKOY/s640/October+clinic+2012.cool.1-5-Oct-2012.jpg" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhivjS8plZteygwAmJ0vqniejpv9Zr9zDPrACl6E9rnGqkq-7m2GgqR7cZ_MpIS225OA9rsVW1_sYsAc3PYqmTgaTI_jYgzRwWHGmyiB69EDsB69FVwDbL2JtdzjOJ-Smox3-zt0wguzfI/s1600/October+clinic+2012.cool.3-5-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhivjS8plZteygwAmJ0vqniejpv9Zr9zDPrACl6E9rnGqkq-7m2GgqR7cZ_MpIS225OA9rsVW1_sYsAc3PYqmTgaTI_jYgzRwWHGmyiB69EDsB69FVwDbL2JtdzjOJ-Smox3-zt0wguzfI/s640/October+clinic+2012.cool.3-5-Oct-2012.jpg" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS5hL7XsPp3XlHGlVU6PQgmGq6m0IeHoE2RL-uoWxqKR5KtbtxJSM3Zo47hP8yTAiSL5eQQV91oFBcF0w-UzZEXGlZ1_3rjGh3LEQ3Juabw2CLkDvn9B_p-6ZWWFSEDS0_OYpgGK1CuW0/s1600/October+clinic+2012.cool.2-5-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS5hL7XsPp3XlHGlVU6PQgmGq6m0IeHoE2RL-uoWxqKR5KtbtxJSM3Zo47hP8yTAiSL5eQQV91oFBcF0w-UzZEXGlZ1_3rjGh3LEQ3Juabw2CLkDvn9B_p-6ZWWFSEDS0_OYpgGK1CuW0/s640/October+clinic+2012.cool.2-5-Oct-2012.jpg" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFP1grCCwPTYtYBGtB2-ahKOzrjNCOC_A7wwEJAcB75lNixUEq1eFFVWP9n-JGzNfnV-j8y_36iMO152kj8e9eOuXJ6q8_BQ2sPrMU-frRZWdvLnPuVTGZM3Q-EoeUPUh9kgvrjbOi_Wc/s1600/October+clinic+2012.cool.6-5-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFP1grCCwPTYtYBGtB2-ahKOzrjNCOC_A7wwEJAcB75lNixUEq1eFFVWP9n-JGzNfnV-j8y_36iMO152kj8e9eOuXJ6q8_BQ2sPrMU-frRZWdvLnPuVTGZM3Q-EoeUPUh9kgvrjbOi_Wc/s640/October+clinic+2012.cool.6-5-Oct-2012.jpg" width="640" /></a></div>
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This patient has had some undiagnosed recurring lameness. Today no in depth workup was performed but a shoe to enhance foot mass recovery and increase sole depth was applied. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH92GR7kjEqIULe5d3uO42BKn4U-LZkUwsLzCTTfx6_X4Yla1kPA48gnMuFB1pR5lFup5gjuqt0umtwMoPv4q1MoniS74eks9RwVJnbk9TBUnRqP1m-duTc2gBLkluap1B0-1GzwjynIM/s1600/October+clinic+2012.Luke+Davis.4-5-Oct-2012.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH92GR7kjEqIULe5d3uO42BKn4U-LZkUwsLzCTTfx6_X4Yla1kPA48gnMuFB1pR5lFup5gjuqt0umtwMoPv4q1MoniS74eks9RwVJnbk9TBUnRqP1m-duTc2gBLkluap1B0-1GzwjynIM/s640/October+clinic+2012.Luke+Davis.4-5-Oct-2012.jpg" width="640" /></a><br />
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This is a many year chronic laminitis. Goal with the rockered aluminum rail is to decrease DDFT tension unloading the apex of the coffin bone and the tension forces at the horn/lamellar zone. This places breakover in the center of articulation. This will improved compromised circulation in the dorsal region of hoof and a more even hoof growth from toe to heel is expected as well as improved sole depth.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4K8Tc94LDPIvHNYD0FHO0-bu3h2ar1Bj8jkdK-uq_vS4S5ISwSwbeLAvvRDcch63L9u1OEO5w_pNnbLeHGuHJeZcae3Y3ukIuWXE7zyCrVj-6A2D-j87VJq3mKTDGxM2Zk98iuKRc5rM/s1600/IMG_6087.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4K8Tc94LDPIvHNYD0FHO0-bu3h2ar1Bj8jkdK-uq_vS4S5ISwSwbeLAvvRDcch63L9u1OEO5w_pNnbLeHGuHJeZcae3Y3ukIuWXE7zyCrVj-6A2D-j87VJq3mKTDGxM2Zk98iuKRc5rM/s640/IMG_6087.JPG" width="640" /></a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaqB6RtnGhqyia09EjAgnkdVvAkxWXzOIbKNbpRWfUR4hTbflaIBQYah1Gt3fZE47XbW99mFKF-_ICLXJP0CA9lYrD72xsFxe2ueS4kr-TnypguU4cKIyZ7q1JgiQTyCjzcyRGWOBs3gU/s1600/October+clinic+2012.Munger+,+mark+chronic+lami+case.1-6-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaqB6RtnGhqyia09EjAgnkdVvAkxWXzOIbKNbpRWfUR4hTbflaIBQYah1Gt3fZE47XbW99mFKF-_ICLXJP0CA9lYrD72xsFxe2ueS4kr-TnypguU4cKIyZ7q1JgiQTyCjzcyRGWOBs3gU/s640/October+clinic+2012.Munger+,+mark+chronic+lami+case.1-6-Oct-2012.jpg" width="640" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiv87E6QjDNz1BU8gwJ95J4riGKBWtAGBe6a1KWQkyXBl7S2mCqlQxK0CpuhKauPHjM0E1kt4HL9LdklX62YezwIGj8sifRMdNkUD4WrnI1wB7FsTvB-ngjavkrbLmJcPIPM-QJmYO-FE/s1600/October+clinic+2012.Munger+,+mark+chronic+lami+case.3-6-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiv87E6QjDNz1BU8gwJ95J4riGKBWtAGBe6a1KWQkyXBl7S2mCqlQxK0CpuhKauPHjM0E1kt4HL9LdklX62YezwIGj8sifRMdNkUD4WrnI1wB7FsTvB-ngjavkrbLmJcPIPM-QJmYO-FE/s640/October+clinic+2012.Munger+,+mark+chronic+lami+case.3-6-Oct-2012.jpg" width="640" /></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDL4Og0griSRrY8LIMXuXiDrzgDvAE_eGp7h_62w55qp04JNRHlxorPBV8kWfrmUOonXBCzpVb9S8DQWDINJc6alsf12DTFIaUthnTeR6kcmx4GlsoeHly-_g2ef1NBeyyU7ZqRSY4DmQ/s1600/IMG_6089.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDL4Og0griSRrY8LIMXuXiDrzgDvAE_eGp7h_62w55qp04JNRHlxorPBV8kWfrmUOonXBCzpVb9S8DQWDINJc6alsf12DTFIaUthnTeR6kcmx4GlsoeHly-_g2ef1NBeyyU7ZqRSY4DmQ/s640/IMG_6089.JPG" width="640" /></a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIj5qjYrS6XdRu-kQVsliww6SE2UNVZ7caRIR3dB31NldkRxHW9U8jHQFQsw4zLehLRZeRHeub9bZPuXU1tqaEDTNliLyQO5bksYvrK8U8qbo0yVX6i4Nq_f5P220-1hNyBRADlsVg94o/s1600/IMG_6086.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIj5qjYrS6XdRu-kQVsliww6SE2UNVZ7caRIR3dB31NldkRxHW9U8jHQFQsw4zLehLRZeRHeub9bZPuXU1tqaEDTNliLyQO5bksYvrK8U8qbo0yVX6i4Nq_f5P220-1hNyBRADlsVg94o/s640/IMG_6086.JPG" width="640" /></a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsWwcMO08UFcTI56DvtZluhQMwcdcRohqrRsj6ap0machausg96puWkJ0FZ0fnGwLeG-a3UfeROqOV_5AA8OmSJgVPs4ccnzWBviKtKTSKlch_COY_GNjot-k9HVRHVudVlm5MYq9E72U/s1600/October+clinic+2012.Munger+,+mark+chronic+lami+case.4-6-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsWwcMO08UFcTI56DvtZluhQMwcdcRohqrRsj6ap0machausg96puWkJ0FZ0fnGwLeG-a3UfeROqOV_5AA8OmSJgVPs4ccnzWBviKtKTSKlch_COY_GNjot-k9HVRHVudVlm5MYq9E72U/s640/October+clinic+2012.Munger+,+mark+chronic+lami+case.4-6-Oct-2012.jpg" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTv5NdJVnhigi0b_wu5cMydPzn4BjNy5caoMWP8F2fc99HACQVVppGvWvME-7dCCMrg6EqQiSubm-9Vg0nB-YRTTGK69rGQ2YxutqHBzNcy2FWlGekAucT_EdKj5K6WM7UQGqg4mFb82o/s1600/IMG_6088.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTv5NdJVnhigi0b_wu5cMydPzn4BjNy5caoMWP8F2fc99HACQVVppGvWvME-7dCCMrg6EqQiSubm-9Vg0nB-YRTTGK69rGQ2YxutqHBzNcy2FWlGekAucT_EdKj5K6WM7UQGqg4mFb82o/s640/IMG_6088.JPG" width="640" /></a><br />
This case had an acute bout of laminitis about 6 months ago. Venograms show that circumflex is above the apex of coffin bone and compressed tightly to tip of coffin bone as well. Dorsal lamellar zone on the right front is broken and a void of contrast is present at coronary plexus. No solar papillae are evident even at an increased to 20 degree palmar angle which should unload DDFT by 60 percent. Treatment included derotational shoeing followed by a deep digital flexor tenotomy. <br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXgqSQwMODCfuAaK34fC8XcrO1I8mpW6cQH7_wIsnobLKzJP2xokBX-juXCcMG-eIL-UTGlPAt0aiqthvttREUOlWW2P1TNcmTarBAEqIXESjaN0MdXtdKBIBG-ZM0THKhhRQLUS1KNJ8/s1600/October+clinic+2012.Rosie,+Kevin+George.11-6-Oct-2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXgqSQwMODCfuAaK34fC8XcrO1I8mpW6cQH7_wIsnobLKzJP2xokBX-juXCcMG-eIL-UTGlPAt0aiqthvttREUOlWW2P1TNcmTarBAEqIXESjaN0MdXtdKBIBG-ZM0THKhhRQLUS1KNJ8/s640/October+clinic+2012.Rosie,+Kevin+George.11-6-Oct-2012.jpg" width="640" /></a><br />
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-35030461203095917332012-09-03T16:22:00.000-05:002012-09-03T16:43:14.297-05:00Cyril's Hoof Spring<div dir="ltr" style="text-align: left;" trbidi="on">
This is a technique I learned from a farrier from Switzerland (Cyril Zuber) while at Dr. Redden's advanced equine podiatry class last month. This case experienced a severe heel bulb laceration about a year ago. All has healed up but a severe contraction secondary to loss of heel mass from injury and lack of full load bearing has occured. I can't say if the contraction component is related to any lameness but a more cosmetic hoof could be obtained. <br />
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Below is radiographs and photos of the hoof and spring application process. At the very end is a video of the spring being released showing the action that it is applying to the hoof capsule. <br />
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I placed in a custom steel rocker rail to fully load heels and maintain a self adjusting palmar angle with greatly reduced toe lever. <br />
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/zz25N94fAik?feature=player_embedded' frameborder='0'></iframe></div>
Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com04181 N Osage Dr, Tulsa, OK 74127, USA36.215890159939732 -96.0115170478820836.214288659939733 -96.013984547882075 36.217491659939732 -96.009049547882086tag:blogger.com,1999:blog-6147842232488271378.post-71610569151216691942012-08-31T10:36:00.000-05:002015-03-21T21:58:05.442-05:00New navicular case<div dir="ltr" style="text-align: left;" trbidi="on">
I have been too busy to post many cases in the last few months. Thanks to Isaac we are getting some rain which allowed me a few hours on the computer<br />
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The following is a case from this week. This is a 7 year old pleasure horse with a long term history of choppy gait and off and on head bob responsive to bute. <br />
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1/5 lame bilateral but 2/5 on left turn in a tight circle. Left front is a grade 1+ club and podiatry style films confirm healthy soft tissue parameters. My thought process is: With healthy sole depth and minimal remodelling of the apex of coffin bone on a club foot I want to next look at the navicular bone to evaluate for lesions. This case shows significant lesions in several views. This are most likely in the distal half of the flexor cortex of the navicular bone. I find these similar lesions in younger non lame patients but I do feel as they reach middle age they begin to create lameness. Dr. Redden feels that the navicular bone of the club foot does not recieve as much load from the tendon versus the lower profile foot and does not develop as strongly as the low foot. I am beginning to feel that these lesions are developmental and become more degenerative with age and use. If dissected out these lesions will be a slight depression in the flexor cortex with a roughened edge that likely causes some abrasiveness to the deep digital flexor tendon.<br />
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My treatment plan is to drastically increase palmar angel to reduce load on the painful area. This will allow some decrease in inflammation and likely a lower mechanical shoe in the future. I have also prescribed a 5 day course of bute to decrease pain and inflammation. I choose mechanical options first as it is a very low risk treatment and we can always resort to injections of the coffin joint and/or navicular bursa. However I find that most of my cases respond very well to mechanical enhancement alone. I will let you know about the response we obtain in this case. <br />
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Below are images of the navicular bone, pre and post shoe podiatry radiographs and digital photos of the patient. <br />
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Click here to shop Dr. Reddens products (shoes, ultimates and much much more) <a href="http://www.nanricstore.com/servlet/Catalog?affiliate_no=4" target="_blank">SHOP NANRIC</a><br />
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Note the better digital alignment the drastic change in palmar angle, tendon surface angle and reduced toe lever. This shoe changed PA by 12-14 degrees which will unload the tendons load on the navicular bone by 50 to 60 percent. <br />
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Thanks for looking.<br />
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Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-2641626587897767412012-07-24T12:06:00.000-05:002012-07-24T12:06:11.403-05:00Upcoming Clinic with Dr. Ric Redden<div dir="ltr" style="text-align: left;" trbidi="on">
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Come join us for a unique learning opportunity! Hope to see you there. If I can answer any questions regarding this lecture/demo please feel free to call 918.235.1529 or email at iepvs11@gmail.com</div>
Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-42333457877767351812012-06-26T22:52:00.000-05:002012-06-26T22:52:07.076-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
Hello everyone, I hope the heat is not treating you too badly. We have been very busy with many new cases and I hope to have time to post them soon. <br />
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I have redesigned the blog with pages representing some of the cases we deal with. It is by no means a complete discussion of each case but should give you some food for thought. <br />
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We are putting together another In depth equine podiatry clinic with Dr. Ric Redden of versailles Ky and hope that many of you will be able to attend. Put it on the calender for October 4 and 5 here in Tulsa Ok. I will be posting brochures for registration here and on facebook. <br />
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Enjoy your Summer and please call if I can be of any service to you and your equine companion.<br />
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All the best,<br />
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Sammy</div>Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-6892870819080672652012-05-26T16:56:00.000-05:002012-05-26T16:56:36.805-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
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Some random videos I have. Enjoy your Memorial day weekend!<br />
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Navicular case in a rocker rail to relieve load applied to navicular bone by the deep digital flexor tendon<br />
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The Before video<br />
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More Rocker Rail Shoe for navicular syndrome. I speak with people that have concerns of the foot rocking backwards and creating excessive load. If applied correctly that should not happen. </div>Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-39782035864887034742012-04-08T16:04:00.001-05:002012-04-08T16:04:43.142-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCurJjpSBOKGvCo0kxQUioU0_Ihrzb6raGiae33xk30UN3ELdg9naUN74JHd5LCGFtHNYSAnpE1HBtDWcf7tLGd3GZ3Qbd500A-Mh6BqBojwhrJrAWlcn_o_R43zzelcvAeov6moXKCAY/s1600/iepvs+flyer+4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCurJjpSBOKGvCo0kxQUioU0_Ihrzb6raGiae33xk30UN3ELdg9naUN74JHd5LCGFtHNYSAnpE1HBtDWcf7tLGd3GZ3Qbd500A-Mh6BqBojwhrJrAWlcn_o_R43zzelcvAeov6moXKCAY/s640/iepvs+flyer+4.jpg" width="483" /></a></div>
<span style="font-size: x-large;"> Come Join us for a great day of discussion! 9-5pm at Animal health supply (6939 E. 15th Tulsa, Ok). Lunch on your own. Free to horse owners, trainers, farriers, and veterinarians. Morning anatomy dissections and afternoon live demo. </span><br />
<span style="font-size: x-large;"> Please call 918.235.1529 or email iepvs11@gmail.com to register as seating will be limited. </span><br />
<span style="font-size: x-large;"> </span></div>Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0tag:blogger.com,1999:blog-6147842232488271378.post-70517024308914677532012-04-02T21:20:00.000-05:002012-04-02T21:29:43.581-05:00<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;">Hello out there in the horse world. We are off to a busy start with many new podiatry cases, vaccinations, floats and yearly wellness exams. </span><br />
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<span style="font-size: large;"> I wanted to post a couple of recent cases that drive home two very important points regarding therapeutic shoeing. Both cases are in rocker shoes. One because of crushed heels and poor foot mass and the second due to a low grade navicular bone lesion. Both cases where started in rocker shoes and have been sound. However after another farriers reset without radiographic guidance as per request of the Owner to help reduce cost both horses went lame. I ruled out any likelihood of close nails and horses are exhibiting only low grade lameness. </span><br />
<span style="font-size: large;"> After radiographs where performed and measurements taken the shoe and trim were slightly modified. Below are the differences in pre and post shoe measurements that seemed significant to me and could likely be the reason that both cases where not as sound as previously. </span><br />
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<span style="font-size: large;">Take some time and compare and contrast each radiograph for each case. </span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBgRBK77mh467CrODfZU3GBOqgs-gBmNxbjoc_vsZ0GFTsjvotQzWyrjHHrBTvJvFUiId99mVSoJfnrYQ5Rago5rpwmIzLXI_pYjzrGReA0daLDXvTd7k4FJuaWhuvg8-at5vOoqcXnQo/s1600/liav1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBgRBK77mh467CrODfZU3GBOqgs-gBmNxbjoc_vsZ0GFTsjvotQzWyrjHHrBTvJvFUiId99mVSoJfnrYQ5Rago5rpwmIzLXI_pYjzrGReA0daLDXvTd7k4FJuaWhuvg8-at5vOoqcXnQo/s640/liav1.jpg" width="510" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Farriers reset</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8wSORyKpxMcbYbwXoYfe6VuthCY39iG4WHwY-rNWdLKmgJ7_LP4ok8_bI31pSF-d-3sVmzAYI6dfS_TUlFNclYeQU-HFGSQrVn5TvMU49dNww7kYIFbkd2opxKitgVgdQsRxIrXO4leA/s1600/liav2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8wSORyKpxMcbYbwXoYfe6VuthCY39iG4WHwY-rNWdLKmgJ7_LP4ok8_bI31pSF-d-3sVmzAYI6dfS_TUlFNclYeQU-HFGSQrVn5TvMU49dNww7kYIFbkd2opxKitgVgdQsRxIrXO4leA/s640/liav2.jpg" width="488" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Post radiograph trim and shoe</td></tr>
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<span style="font-size: large;">Note the major differences in digital alignment, palmar angle, toe lever, tendon surface angle and suspensory ligament of navicular bone distance. The changes noted radiographically help explain why this horse would be lame. The mechanics governed by the trim, shape and placement of the rocker alter loads inside the foot. With the PA much lower a higher degree of tension can be expected within the deep digital flexor unit and more hyperextension applied to the coffin and pastern joint. A recent paper suggest that for every degree change in PA, pressure on the navicular bone changes 4%. We changed load on the navicular apparatus by around 24 %. Note the distance measured from the navicular bone to the origin of the suspensory ligament of the navicular bone. This changed 6mm and may also be another reason for increased comfort with higher mechanics. The last important aspect is the toe lever, measured from COA to where the shoe would leave the ground. This is the affective lever arm that gives the ground advantage to apply force to the flexor tendon apparatus. This number was greatly changed and subsequent reduction in force applied to DDFT is achieved. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR3CRLH2GKYZPTjduxiQ1VqoqXkbE2U2VKVOg1Lqej4NdwjwgcJ2HudI723za4So4Rs7Pa1o2cVhmNkzGwmv0XyzBWKfWh8wDOQ0F66cIzQdpwbt7Tw323w1tMj3kxuVULg87TmMxfAXY/s1600/snave.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR3CRLH2GKYZPTjduxiQ1VqoqXkbE2U2VKVOg1Lqej4NdwjwgcJ2HudI723za4So4Rs7Pa1o2cVhmNkzGwmv0XyzBWKfWh8wDOQ0F66cIzQdpwbt7Tw323w1tMj3kxuVULg87TmMxfAXY/s640/snave.jpg" width="504" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Farriers reset</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWONK5o6gv8K-WcHdMEM1frghfvLjJsLxIC1KynQXqbJpfU8o7t7DGyyMgluCyDdSxYOtR1wQlwFL5UFjfUb8w3EiQ3CQ4l8gjcB7BBK1q_TC9tad72ygm0yDWbdbX0WVWHS-lBkBx-N0/s1600/Snave2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWONK5o6gv8K-WcHdMEM1frghfvLjJsLxIC1KynQXqbJpfU8o7t7DGyyMgluCyDdSxYOtR1wQlwFL5UFjfUb8w3EiQ3CQ4l8gjcB7BBK1q_TC9tad72ygm0yDWbdbX0WVWHS-lBkBx-N0/s640/Snave2.jpg" width="505" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Post radiograph re trim and shoe</td></tr>
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<span style="font-size: large;"> This horse has mild navicular bone changes and has responded very nicely to the rocker shoe approach. The increased PA and reduced digital break over has this horse back in the show ring. This one has baffled me as after the farrier reset horse was just slightly off in soft footing and traveled almost normal on hard surface. On initial exam the PA and shoe placement appeared to be in good shape. However when in soft footing the horse would tend towards a rocking back approach, which I assumed to increase pressure on DDFT and navicular apparatus. </span><br />
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<span style="font-size: large;"> The measurable differences are a shortened toe lever and a much lower PA, however the Suspensory ligament distance and the TSA remained very similar despite the lower PA. This is very confusing and I will continue to try to wrap my head around this one. I think the key here was reshaping the rocker to place directly under center of articulation versus slightly behind and modification of the trim in the same manner. I feel with the belly/rocker to far back this forced a higher than needed PA and created a scenerio that allowed for rapid sinking of the heel in soft footing. Jogged sound in hard and soft footing after changes where made. </span></div>
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<span style="font-size: x-large;">Take home message: </span></div>
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<span style="font-size: x-large;">1) Not all rocker shoes are the same.</span></div>
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<span style="font-size: x-large;">2) Radiographs are a valuable tool in many difficult cases. </span></div>
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<span style="font-size: x-large;"> I feel that if radiographs where available, for the farriers that reset these shoes, this could have been avoided as there are obvious mechanical differences noted in the radiographs. Many times have I pulled a shoe and modified it after seeing the radiograph and I am thankful for that advantage.</span><br />
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<span style="font-size: x-large;">Do not blame the anything but the mechanics! Do you really know what they are? </span></div>
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<span style="font-size: x-large;">Note to Owners: Yes radiographs can be the difference between your horse being sound or lame.</span></div>
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<span style="font-size: x-large;">Note to farriers and veterinarians: Do not blame the rocker shoe, heartbar, egg bar, or whatever device applied without critical evaluation of the mechanics that the foot is subjected to. If something did not work try to figure out why. Through serial radiographic evaluation of every foot problem one can develop an enormous amount of information and detail that can allow such great success. </span></div>
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<span style="font-size: x-large;">All the best,</span></div>
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<span style="font-size: x-large;">Sammy</span><br />
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</div>Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com1tag:blogger.com,1999:blog-6147842232488271378.post-76791917724877994562012-01-23T07:37:00.000-06:002012-01-23T07:37:49.109-06:00NANRIC Blog: Slideshow - Rockering a Rail Shoe<a href="http://nanric.blogspot.com/2012/01/slideshow-rockering-rail-shoe.html?spref=bl">NANRIC Blog: Slideshow - Rockering a Rail Shoe</a>: This slideshow of photos from Dr. Redden illustrates how to rocker a rail shoe. <div><br /></div><div><br /></div><div><br /></div><div>Great slideshow of Dr. Redden Rockering a 4pt rail shoe which is used to treat many common fool ailments such as: chronic laminitis, navicular syndrome and thin soles. </div><div><br /></div><div>Have a great week.</div>Sammy L. Pittman, DVMhttp://www.blogger.com/profile/13148726141402659493noreply@blogger.com0