Ric Redden, DVM follow up clinic 6wks rechecks

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.

 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.  October clinic images link



White line disease Case:  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.

6wks post intial rocker rail note 4mm increase in sole depth in a horse that hasn't grown any sole in years.

Reset image

First image Oct 6 pre shoe

Hoof wall resection to allow cleaning and oxygen to penetrate

Club foot case:  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.

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.

Pre shoe radiograph Oct 5

Left front shoe that regular farrier had replaced with flat keg shoe for protection

Rockered keg shoe

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 

Chronic Lamintis case:  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.

Pre Rocker shoe oct 6

6 weeks post rocker rail with addition of 4mm of sole and less bulge of sole at apex of frog.  

Oct 6th pre rocker 

Left front 6wks post rocker rail.  Rocker shoe was removed prior to getting a radiograph.  Added 5mm of sole

Nov 17th reset with rocker rail.  

Post nov 17th reset rocker rail.

Navicular case:  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.

RF pre reset on nov17th

Post shoe nov 17th

Post shoe nov 17th

Pre shoe reset on nov 17th

6 month chronic laminitis case:  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. 

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.

Immediately post derotation and deep flexor tenotomy oct 6

Note the rapid growth of sole at dorsal portion of hoof and loss of palmar angle.  addition of 10mm of sole

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 

Immediately post derotation and deep flexor tenotomy on oct 6

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.

New navicular case

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

 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.

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.

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.

Below are images of the navicular bone, pre and post shoe podiatry radiographs and digital photos of the patient.

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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.

Thanks for looking.

Upcoming Clinic with Dr. Ric Redden

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

Update on Severe White line disease case

It has been a while since my last post.  I am writing this as we are driving down the road headed to visit family on Thanksgiving Day.  We had a great clinic in October with Dr. Ric Redden.  I plan to post images from the clinic. We had an interesting mild laminitis case in which we performed venograms the day of the clinic and we did follow up venograms about 2 weeks later.

The case below is one we have been working with for several months and it is coming along very well.  We had our most dramatic increase in sole depth this last cycle and we now are very close to what I would consider a normal sole depth for this size of horse.  The fungal invasion noted by defects in the hoof wall on radiographs and visual inspection is no longer present.  We reset the rocker rails with positive pressure frog bar and plan to have the next visit in conjunction with regular farrier and turn it back over for 2-3 cycles.

Please look back at previous post for comparative photos and radiographs.

We reset the rockers using nails against the hoof wall and superfast adhesive to attach nails to hoof wall.  One roll of 2 inch casting tape was then applied over that.

HAPPY THANKSGIVING!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Backyard mare Project, Updated radiographs after returning to Flat perimeter fit shoes. Please look back at previous Post for serial podiatry style radiographs and venograms

Hello again, I hope this finds you and yours healthy and safe.  Kellee and I have been very busy and enjoying meeting many new clients and horses.   We are now focused on getting ready for Dr. Reddens In depth podiatry clinic in October and hope to see many of you there.  For more information on that go to our website at www.innovativeequinepodiatry.com and click on the Nanric link. 

I am posting some radiographs of Susie Q which is my old faithful trail horse that I have placed back into to a more traditional perimeter fit steel shoe after being in a rockered four point shoe and obtaining 19mm of sole depth.  Please look back at the other post that contain the previous radiographs and venograms.  I will post below radiographs from June 20 when the steel flat perimeter fit shoes where applied and today's radiographs.  A good ole 8 week cycle.  She did lose one shoe at 2 weeks in and I replaced.  Note the toe clip on the Left front.  Notice the loss of sole depth in both fronts and gain of nearly 10 mm of digital breakover.  She did grow hoof wall which elevates digit from the shoe but true dense sole depth, measured from the tip of the coffin bone to the noticeable dense sole, is diminished by a few millimeters. 


You would expect an 8 week cycle to have a ton of sole depth but this is where we are wrong many times.  If you take these hooves and reset while cleaning and cupping the sole you may have as little as 10 mm of sole when finished.  If this horse remains in this similar package another 8 weeks and we are lucky and maintain that 10mm of sole we are still below the healthy sole depth of 15 mm required to have a healthy vascular supply and protection noted on the venograms.   Digital breakover has increased almost 10mm.  This had increased the effective lever arm to a whopping 15-20mm past what would be considered ideal of 20-25mm.  The shorter breakover and self adjusting palmar angle is what allowed this mare to obtain better than adequate sole depth of 19mm.

Also notice the decrease in Palmar angle.  This is the reaction to the lengthening digital breakover and the base of support migrating forward allowing more load and crush to the palmar aspect of the hoof. This will overload the digital cushion and deep digital flexor tendon and overwhelm it's capability to suspend the coffin bone at a higher palmar angle.  I believe the deep digital flexor muscle continues to get stretched and has difficulty returning to home base with maximum contraction capability and cannot pull the palmar angle back up to a more positive angle.  The long digital breakover is antagonizing the ability for the flexor muscle be an affective suspension apparatus and hold the better palmar angle.  At the same time with extra antagonism against the flexor tendon we are adding additional compression of the solar corium below the tip of the coffin bone which in turn compresses the blood supply and reduces production of horny sole and the measurable distance from the tip of coffin bone to the cup of the foot which is the black air space between sole and shoe.  It is this response that suggest to me that many horses should not be maintained in traditional perimeter fit shoes but in a package that will at least maintain a better digital breakover longer in the cycle.  This approach obtained through natural balance shoes, mustad equilibrium, kerkhart comforts, four point shoe, or by simply forging a roll in the toe of a plain steel shoe, will allow better maintanence of sole depth, tendon tension, palmar angle and overall health of the entire limb.

 Reducing these forces should also reduce hyperextension forces in fetlock and carpus (fetlock and knee) and may help in reducing arthritic conditions in aged performance horses if started and maintained in this manner early in life.  Podiatry style radiographs early in life will help determine which horses may benefit from shorter digital breakover shoes and aid in maintaining better hoof  and limb health.  Many times shortened digital breakover is only part of the equation to institute better blood supply and foot mass recovery.  I suggest the above as a bare minimum for maintaining a sound horse.  If we are not obtaining the goals we set forth, we must also consider palmar angle adjustment especially in unsound horses with diagnosed lameness issues.  Susie Q is not lame but is beginning to stumble with this long breakover.  I can only surmise that if I where to continue the flat shoeing approach coupled with a performance career for several years that this will lead to certain pain and inflammation in many possible areas. 

I plan to reset the flat steel shoes and continue to monitor over the next 4-6 weeks. 

This is first flat shoe after rocker

8 Weeks in flat shoe, note loss of sole depth and increased digital breakover.

First flat shoe after rockers

8 weeks in flat shoe, note loss of sole depth and very lengthening of digital breakover and loss of palmar angle. 

Pictures from the 5 day Podiatry class with Dr. Ric Redden

Well it was an exciting and educational week spent at Dr. Ric Reddens equine podiatry 201 clinic in Versailles Kentucky.  Attendees where largely international with teams from Switzerland, Germany, Costa Rica, Texas and of course Oklahoma.  Dr. Redden, his wife Nancy and his staff create a hospitable, laid back environment for easy learning.  We had several cases ranging from club feet, acute and chronic laminitis and navicular cases.  Mornings where spent in lecture covering topics with great detail that where relevant to the afternoon cases.  Dr. Amy Rucker of Midwest Equine in Columbia, Mo a long time student of Dr. Redden's, and popular lecturer regarding laminitis treatment and venogram study was also present assisting in the educational process.  It was very exciting to see the world wide interest that Dr. Redden has inspired through his multiple lectures across the world.  I plan to post several pictures in which more information will be in the caption below.  A special thanks to my team members, Frank the German Brendan Frost from Stillwater Ok.  It was a great pleasure meeting everyone and getting to spend valuable time with Dr's Redden and Rucker.  

Large Draft with grade 3 club and white line disease.  Slight rockered flat shoe handmade by the Swiss Team

Grade 3 Club with a toe crack.  We placed a rockered full rocker and a toe band while the foot was unloaded to prevent pinching of underlying laminar tissue.

After class play in Dr Reddens self made log blacksmith shop.

Rockered Rail shoe for a Navicular horse

Frank the German and myself.  This is the first time for Frank to drive a bid Dodge diesel.

Dr. Redden demonstrating his quarter crack lacing technique to Kyle from Texas and Jorge from Costa Rica in Brandon O'neals Purdy Built F3 trailer.

P3 Fracture in a weanling

Walking horse with contracted DDF and SDF and very thin soles.  Rocker rail placement to facilitate better sole mass and comfort

Steffan from Switzerland, European style with an assistant to hold the leg for you.  I tried it and I would have to relearn how to trim and nail!

Rocker rail for navicular case to release deep digital tendon pressure.

Finished rockered full rocker and toe band



Don't miss your chance to learn an in depth approach to many common ailments from Dr. Ric Redden, DVM we all see and deal with this October 14-15 in Tulsa Oklahoma.  For more information contact me a 918*235*1529