Follow up on the Severe White line Disease case

Hello readers, I hope this finds you well.  It has been a very dry Spring here in Oklahoma and fires are really causing troubles in many areas.  We definitely keep the firefighters in our prayers.  We had a busy weekend in the podiatry world.

On to the Case.  A very good response is noted since our last visit.  I consider a good response in a severe white line disease to be new hoof growth without fungal invasion.  The hoof defect noted in the soft tissue lateral radiograph is growing down.  The left front has 13mm  of new hoof growth with out cracks.  There is still  uneven growth rings from toe to heel but greatly improved.  Sole depth has increased but is still considered severely thin soled.  If you look at the upper portion of the barium paste you can see the new hoof wall growth that is growing down more parallel to the front/face of coffin bone/P3.  Patient has been in a small paddock and fed Biotin 100 from nanric.com daily.  I will be posting photos and radiographs from first visit and this recent visit.

first day pre shoe

first day post shoe

Before glueing 5weeks after initial visit.  Added a little more mechanics/belly/rocker to shoe.

With Superfast,  Due to poor quality walls I like to add a little extra holding power.  I drove nails but left long and create loop in end for glue to attach to

Initial visit post shoeing radiograph

Recent visit 5 weeks later, Notice the hoof wall defect growing down without fungal invasion and more parallel to front of coffin bone.  I also added a little more rocker to shoe to increase mechanics that allow further unloading of deep digital flexor tendon.  This image is after reset of shoe.

Left front day one

reset Note new growth without cracks in the upper hoof wall 

Now on the Right Front.....................................................................................................................................................

Day one

day one right front

Post Shoe day one with superfast.

Post shoe at 5wk reset.

5 week reset pre superfast.

After super fast

Day one post shoe radiograph

5 week post shoe radiograph.  Notice new growth at upper coronary band that is growing more parallel with front of coffin bone/p3

 So to restate the purpose of the use of the Rockered Rail shoe.  The Rails give us 5-7 degrees of heel elevation and the added rockering adds a self adjusting air wedge to allow further unloading of the tension in the Deep digital flexor and decreasing the pull at the inner layers of the horn wall.  The rocker action is also thought to increase the circulation of the entire foot which will enhance hoof growth and quality.  With the rocker action Digital breakover is greatly reduced.  I also added in a positive pressure frog bar to help prevent buttress/frog prolapse and spread weight distribution across the back of the hoof.

The most important aspect of why the rocker shoe is successful is it's ability to greatly reduce the action of the deep digital flexor tendon.  The deep digital tendon and it's action is the "big dog" force in the Hoof.  You must consider it's action and the forces it applys to the coffin bone and the space around it.    It pulls tension on the bone to hoof connection and a downward compression force on the solar corium below the tip of the coffin bone.  We must always first consider the action of DDF  and all other aspects of shoeing will be secondary to that.  I like this approach versus wedging alone as it can be difficult to acheive this much DDF tension release and breakover reduction with wedges.  Additionally the rocker motion greatly enhances the healing environment and speeds up recovery.  The addition of the superfast  at the quarters and over the toe adds stability  and connection of the whole hoof once again.  I do not feel it is required but does help hold the shoe longer.

Just Got off the phone with Dr. Ric Redden and things are coming together for the October lecture and demonstration.  I will have brochures ready within the next week.  October 14 will be an all day lecture and then on the 15th will be a demonstration at the 181 ranch in Bixby Oklahoma.  It will be a very informative seminar and hope you can make it.

Thanks for reading,                    Sammy L. Pittman DVM

Follow up Venograms and Radiographs of the Backyard Mare project.

. Hello everyone, I hope you are enjoying this site and potentially learning something as well.  Please feel free to ask any questions in the comment segment.  So we are just a little over four weeks into this shoe cycle with the low score mechanical rocker shoe.  In the plain film soft tissue farrier friendly radiograph we can measure right at 14 mm of sole depth in the left.  We started with 8mm of sole depth when we pulled her out of the pasture with bare feet and slightly tender on the rocks.  She has been ridden fairly regular which does slow down foot growth.  Again, what I am attempting to demonstrate is how the rocker shoe application enhances the  foot mass noted by increase in sole depth and the accompanying venogram changes. In my experience and the experience of many others, the rocker shoe is the fastest method available to regain foot mass and quality.  We are getting close to normal sole depth  of 15mm after 4wks in the rocker shoe.  I find that many foot ailments and lameness' improve drastically with added foot mass.

 The first image is today's and the second is the initial radiograph March 8, 2011.  Notice the great improvement in sole depth.

The Most notable change here is the terminal papillae are getting longer.  These are the little finger like projections.

In this view the terminal papillae continue to become longer and  more robust.  This will continue as sole depth increases.  When we achieve a healthy sole depth of closer to 20 mm we should have a very prominent terminal papillae and a vascular depth of around 10 mm.  

Below I am going to post a recent venogram on a chronic laminitis case.  This gives something to compare to.  Note the severe lack of contrast over to face of the coffin bone and below the apex of the coffin bone.  Just to refresh the memory the white tree branch like things you are seeing are the arteries and veins within the hoof.  In the image below there is no blood flow below the coronary band in the front (to the left).  There is still slight filling of the terminal arch which is supplying the coffin bone its nutrients and is keeping it from completely dying.  There is considerable bone resorption as almost 1/2 of the coffin bone is gone due to the lack of normal blood supply.  

 Keep checking the blog as next week I will be rechecking the Severe white line disease case that I have already posted.  We will be repeating radiographs and evaluating response to the rocker rail application. 

We hope everyone is enjoying the Spring.  

We are in the planning stages of hosting Dr. Ric Redden of International Equine Podiatry Center of Versailles, Ky for a 2 day lecture and live demonstration on October 14 and 15.  I will post the details when we get them nailed down.  

We will also be traveling to Magnolia, Tx to help renowned farrier Jimbo Stewart put on a clinic demonstrating radiographic technique, how to treat common foot problems and to read radiographs.