The Horse

JAN 2019

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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42 January 2019 The Horse | TheHorse.com Pennsylvania School of Veterinary Medi- cine, in Kennett Square. Ultrasound can provide limited information about the soft tissues within the hoof capsule by imaging through the frog; however, she says, it is best used to examine lesions above the hoof capsule. Unfortunately, she adds, many lesions in the DDFT and collateral ligaments occur below this region. Focusing on Farrier Work Trimming and shoeing are some of the most important components of managing foot pain, says Vlahos. "I often tell clients that we can do an accurate job in diagnosis and treatment of equine foot pain, but nothing in our ar- senal is ultimately going to help the horse unless we first establish proper balance in the foot," he says. "We often see horses with severe misalignment of hoof-pastern and palmar angles (the angles of the pas- tern relative to the hoof wall and of the bottom of the coffin bone and the ground, respectively); many of these issues are manmade. I am a believer in the idea that most of the time horses don't need correc- tive shoeing but, instead, they just need correct shoeing. A competent farrier is an essential part of the team in managing hoof pain." Besides maintaining each foot's medial- lateral (side-to-side) orientation, the farrier should aim to improve breakover (how the horse's heel lifts off the ground and rotates over the toe during move- ment) to help relieve pressure on the cof- fin joint and supporting ligaments within the foot, while reducing the energy re- quired for the horse to pick up and move his foot forward. Some horses fare better with synthetic shoes, which dampen the impact of hoof concussion on the ground more than steel or aluminum. Some horses do better without shoes at all. Re- sults from one report by Willemen et al. suggest that horses with podotrochlosis experience 14% less force on the navicu- lar apparatus if barefoot than if shod with standard shoes. However, not every horse can go bare- foot without sole bruising. Boswell cautions against trimming barefoot horses too often. "The ground wears out the sole, and repeated trims remove more than a horse can grow and replace between trims," he says. "This results in a thin sole," a common cause of foot pain (more on page 44). Optimal sole depth is 18-20 mm, with deep bruising occurring if the sole gets thinner than 15 mm, says Boswell. He has radiographed the feet before and after a trim and found that even an ultracare- ful farrier might remove 6 mm of sole in a single trim. Providing Rest and PT If a horse hurts, give him a break. "Rest is not a four-letter word" in the taboo sense, says Vlahos. "For acute soft tissue injuries, it is often appropriate." Soft tissue injuries in the feet usually need six to nine months of rest to heal. Successive imaging exams help veteri- narians monitor healing. But even if the ligament appears full of collagen, which is a structural protein that's the main component of connective tissue, that doesn't necessarily mean it's mature and able to withstand going back to work, says Boswell. He attributes more than 50% of success (a horse being able to return to its origi- nal level or greater of work) to taking the time to implement appropriate physical therapy. He suggests leading the horse, if sound, at the walk, starting with 15-30 minutes a day. Then increase this to twice a day. Once the horse handles that well and is walking under saddle, introduce trotting for progressively longer periods if the horse accepts this challenge and re- mains sound. Next, increase duration and demand systematically to slowly work the horse back to its previous level. There is no one recipe for implement- ing a physical therapy program in a horse recovering from foot pain; much depends on the injury's severity, the horse's coop- eration, and the athletic endeavors you hope to pursue. Work with your veteri- narian to fine-tune this process. Controlling the Pain Of course, some types of foot pain are more severe and acute than others. Cryotherapy (application of extreme cold) is particularly effective for treating and managing acute laminitis, says Boswell. Cooling the tissues slows their oxygen and glucose requirements and reduces inflammation. Boswell says he fills empty 5-liter intravenous (IV) fluid bags with ice, places the feet inside them, and secures them with a wrap. Commercial ice boots are also available. Foot support (therapeutic shoes or boots) is critical for horses with laminitis and might be useful for those with deep bruising, he adds. Veterinarians commonly prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone (Bute), flunixin meglumine (Banamine), and firocoxib (Equioxx) to break the STEP BY STEP Ultrasound can shed light on soft tissue injuries, such as to the collateral ligaments of the coffin joint. PAULA DA SILVA A competent farrier is an essential part of the team in managing hoof pain." DR. TED VLAHOS

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