Images from the October clinic with Dr. Ric Redden.

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.  

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.  

This first case is a grade 2+ club cases used as western and english pleasure as well as some roping.  

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.

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.

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.

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.

Cyril's Hoof Spring

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.

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.

I placed in a custom steel rocker rail to fully load heels and maintain a self adjusting palmar angle with greatly reduced toe lever.

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.

Click here to shop Dr. Reddens products (shoes, ultimates and much much more) SHOP NANRIC

 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

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.

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.

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.

Enjoy your Summer and please call if I can be of any service to you and your equine companion.

All the best,


Sammy

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. 

     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.  
     Please call 918.235.1529 or email iepvs11@gmail.com to register as seating will be limited.  
     

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.  


     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.  
     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.  


Take some time and compare and contrast each radiograph for each case. 

Farriers reset

Post radiograph trim and shoe

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.  
     





   
   

Farriers reset

Post radiograph re trim and shoe

     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.  

     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.  

Take home message:  

1) Not all rocker shoes are the same.

2) Radiographs are a valuable tool in many difficult cases.  

  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.
  

Do not blame the anything but the mechanics!  Do you really know what they are? 

Note to Owners:  Yes radiographs can be the difference between your horse being sound or lame.

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.  

All the best,

Sammy

     

NANRIC Blog: Slideshow - Rockering a Rail Shoe

NANRIC Blog: Slideshow - Rockering a Rail Shoe: This slideshow of photos from Dr. Redden illustrates how to rocker a rail shoe.

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.

Have a great week.

Update On Lobo the Laminitis Case.

 Previous Post on Lobo.  Click on the link to the left for the first post.  Lobo is responding very well to the Tenotomy performed back in July.  He continues to grow hoof wall at an even rate toe to heel and continues to add good dense sole.  I would not consider success if those are not occurring.  In evaluation of your laminitis treatment if you are still growing more heel than toe then you are not effectively addressing the mechanical problem. ie more tendon release is needed either with an increase in Palmar angle or likely a tenotomy.

I placed Lobo in Rocker rails as he began to have upright pasterns indicating the need for more mechanics (increase in PA), and due to the affects of the tenotomy which removes most of the load on the dorsal lamellar attachments and solar corium at the apex of the coffin bone but increases load through heels.  The only load is distributed through the bone column through the palmar (back) aspect of the hoof which over time will add some heel crush.  This is best addressed with the rocker or the buttress trim.

I (and Lobo) liked the increase in palmar angle but I was not fond of how he could rock back in soft footing.  This being due to the lengthening of the deep digital tendon post tenotomy.  I moved him into an aluminum buttress with a five degree rail, which accomplished my goal of a higher palmar angle and ability to remove all crushed heel and load to widest part of frog.  The buttress shoe trim involves creating a positive palmar angle by trimming from the toe back with the rasp tipped at a 5-8 degrees.  This is continued approxiametly the wings of the coffin bone ideally.  The heels are then taken at an angle parallel to the palmar angle to the widest part of the frog.  The  buttress wedge bar is made of 1/2 by 1 inch aluminum bent in to a U - shape to fit the width of the heels.  Forge a wedge shape to fit your trim. Grinding or hammering a recess in the bar for the frog will necessary in most cases.    I really like this approach for my post tenotomy cases when added mechanics are needed to maintain good digital alignment.  This will occur in more severe cases when vascular and bone damage occur secondary to laminitis insult that was either not appropriately addressed  in a timely fashion or so severe that any mechanics would not have changed things sucha as in severe sinker cases.  Lobo did not receive the needed tenotomy until 6 wks post laminitis and the initial insult was severe creating compromise at the circumflex. This is noted in the venogram obviously but also in the shape of the tip of the coffin bone.  You can see flipped up circumflex starting to remodel around the apex.

 Maintained in tenotomy rail then a four point trim.  This is when we noted a need for more mechanics noted by upright pasterns.

 Initially placed in Rocker Rail to increase PA and removed crushed heels.

Note the still compromised solar vascular supply with lack of papillae but nice remodelling of the circumflex artery.  

 This is the Left series which shows similar improvement as the right.    Good remodelling around the circumflex b ut poor solar and terminal papillae.  I feel that even with even toe to heel growth and good sole depth that unless solar papillae return with more healing and regeneration time then any chance of a performace career will be limited.

Points to remember:  Evaluation of the vascular supply is paramount to determine success of the device you are applying.  Success should not only be measured by comfort of the patient but I cannot claim success without even toe to heel growth and addition of 7-10mm of sole depth every 30 days.  If this is not happening one must rethink their approach.  Note we did not have a natural increase in Palmar angle we created is due to upright pasterns.  The upright pasterns can be secondary to continued low grade bone pain or even some heel pain.  Achieving better digital alignment allows load be directed through the middle of the foot in the direction that the first phalanx is pointing.

Lobo is now getting 4-6 hours of paddock turnout after five months of stall confinement with the first three in firm wraps over tenotomy site to prevent excessive scarring and a tenotomy rail shoe to prevent toe from flipping up or undue strain on tenotomy site in soft stall bedding.

Please comment, email (iepvs11@gmail.com) or call (9182351529) if you have any questions.