New navicular case study

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

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



 

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

Viewing from front of hoof with navicular bone flipped up to expose the flexor (back) surface of the navicular bone in which the tendon glides over then attaches to coffin bone.

Note the two adhesions on flexor surface.  These where cut away from tendon 

This drawing shows the DDFT in green and adhesions in red

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

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

The grey are aka "the hoof" article

The Grey area aka the hoof

            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. 

            Below are four basic guidelines for successfully maintaining healthy hooves and approaching hoof lameness issues. 

1.     

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.

2.      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.      

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            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. 

3.      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. 

4.      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.

           

            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. 

Further reading and resources: 

1.      Dr. Redden's website, www.nanric.com, numerous articles regarding evaluation and treatment of many common foot ailments and soft tissue parameter measurement illustrations and articles.

2.      My website and blog, www.innovativequinepodiatry.com and www.innovativeequinepodiatry.blogspot.com

Theory of two major loads article

Theory of Two Loads

            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. 

             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.

                                                             

                                              Figure 1 short rope/high pa/club

                                                         

                                            Figure 2 Longer Rope/low pa/slam dunk

           

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.

.              

Figure 3 bone remodeling on tip of coffin bone

            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. 

         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.

       

                                     Figure 4Low Pa bone remodeling/low ddft tension

           

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.   

                                    

                                                                 Figure 5 Grade 3 club

    

              Figure 6 Grade 3 club with Rocker Rail

 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. 

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.

                          Figure 7 laminitis with rotation

Figure 8 Post tendon cutting and derotation shoeing  

Figure 9Acute laminitis venogram

 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. 

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.

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

Some random videos I have.  Enjoy your Memorial day weekend!

Navicular case in a rocker rail to relieve load applied to navicular bone by the deep digital flexor tendon

The Before video

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. 

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. 

Follow up on the Severe White line Disease case 7/22/2011

Hope everyone is staying safe in this record warm weather here in the US.  For those of you not suffering from the heat, your lucky.  Well the horses don't care how warm it is they still need there hoof care!  I revisited the white line disease case this past Friday.  We have continued accelerated hoof wall growth without cracks.  The Right front which is the more upright still has signs of fungal invasion despite mechanical unloading noted by the lucent zone in the Horn component of the H/L zone.  This would likely suggest the pathogen is invading new growth.  Left front shows continued improvement in all aspects with good hoof wall growth and sole depth recovery.  Sole growth has been slow to recover but is measurably increasing at this point.  I feel that higher scale mechanics (ie more rocker or deep digital tendon release) will be required for continued success in the right front due to this being the more upright foot and is under more deep digital flexor muscle pull.  At the last visit I instructed the owner to place on a weight control program with only enough alfalfa pellets to get the 100mg biotin and vitamin and minerals in.  Significant weight loss has occurred and will help the overall success of this case as the obesity could increase insulin and decrease the amount of circulation to the lower limbs further decreasing hoof quality and quality.  A great improvement is noted in hoof structure with loss of flares and a tighter new growth coming down.
    I elected to remove more dorsal hoof wall in area's that cavities existed and pack with a mixture of pine tar and oakum versus cleaning and packing with white lighting gel.  Below are updated photos and radiographs.  Read the captions for further information regarding individual images.

Increased sole depth but lesions from fungal invasion have remained

Very first radiographs

Good improvement in sole depth and new growth without fungal invasion

right front with 1/3 of new hoof growth.

Left front with almost half of new hoof growth without cracks.

Shoes are attached with a few nails into hoof wall then 3-4 next to hoof wall and superfast adhesive is used to glue  nails to hoof wall.  A band of superfast is added across the front to attach the two sides.  This has been one of my tougher cases and I appreciate the opportunity to work on this difficult case and the commitment the Owner has made to her equine companion.  We still have several months to go but I feel we have made significant improvement.


    We have two cases in the barn right now that we have been working with and plan to post them here on the blog as soon as time will allow to put together all the images, time lines and thought processes.  One is a fractured second phalanx (short pastern) named Lila that is recovering nicely and the second is a newly acquired laminitis case that was acutely laminitic about 6 weeks ago.  We will be posting those soon so keep checking back.  I am also excited about attending Dr. Redden's In depth podiatry 201 course August 8-12 in Versailles, Ky with farrier and friend Brendan Frost.

CHECK OUT WWW.HEARTLANDHORSE.COM FOR THE ONLINE VERSION OF THE HEARTLAND HORSE TRADER FOR MY FIRST ARTICLE EVER PUBLISHED!!  Look for it in all your local feed stores, tack shops and shows.

Stay cool, but most importantly Stay Fresh,,,,in your knowledge.

Backyard mare project update with venograms

Well it has been a while since we looked in on our backyard mare project.  We found some time to radiograph and update her venogram.  She has grown to a little over 17mm of sole depth and a notable return in solar papillae.  She has just been in the rockered 4pt shoe and maintained on pasture and trailriding.  I have placed her back in a more traditional flat steel shoe and placed in a fashion that would commonly be applied.  I theorize that this breakover is too long even on the day I placed it and will be growing ever longer throughout the shoe cycle.  The flat shoe will once again solidly engage the deep digital flexor tendon in which will begin to compress the solar corium and decrease sole depth over the next 2-3 months.  We will continue to radiograph and follow to see what happens.  

Very first venogram 3 1/2 months ago, for comparision

Note the return of the solar papillae with added foot mass.  This is the reason that Dr. Redden  claims 15mm is an adequate sole depth, as is requires 15mm to have a normal healthy venogram with good vascular depth and these papillae.  There is a peculiar absence of contrast that is there from an unknown cause, maybe an abscess brewing creating internal pressure, pushing the contrast out????

Very first raidograph, note the very thin soles.  

Here is a shot just before the removal of the shoe and venogram.  Note the massive increase in sole depth since we began.

Here is a shot after venogram and I placed her in a more common flat steel shoe in a manner in which I would have placed prior to a changing of my mind of how forces interact in the foot.  The DB (digital breakover) is 30 mm. This will continue to lengthen over time and reaching a likely 40-45mm by the next shoeing cycle, possibly.  I also surmise that a gradual reduction in sole depth will also occur due to the long and every increasing DB and increasing forces from ddf on solar corium and dorsal hoof    decreasing the circulation.

solar shot of flat steel shoe.

lateral view of flat steel shoe.  For those of you who know me, know that this was very difficult for me to do.  HEHEHEHEHEHe

Keep checking back for further updates on all our cases and a new one still to come is project Lilla.  She is recovering nicely from a fractured short pastern bone.  I will post here case study as soon as time will allow.  Please feel free to contact us here in Tulsa, Ok via text/call at 918.235.1529 or email at innovativeequinepodiatry@hotmail.com.

We are getting prepared for several upcoming events such as:  July 9th a reduced cost coggins clinic at animal health supply in Tulsa Ok, Aug 8-12th Dr. Redden's 201 podiatry course at International Equine podiatry center in Versailles Ky, 1-2 local demonstrations of radiological and external exam of the hoof and soft tissue parameter measurements, and of course the In depth podiatry lecture and demo with Dr. Redden here in Tulsa October 14th and 15th.

We thank you all for your support.