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Digital Cushion
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Pauline Moore
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 Posted: Thu Apr 8th, 2010 09:44 pm
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Dr Deb - I've started this as a new topic so we can leave the other one for Megan's horse specifically, and have copied your questions on to this thread.

I would also like to ask for a clarification as to what you said you'd heard at the Bowker seminar. What does he mean by 'half the length of the coffin bone'? In other words, does he mean half the length of the coffin bone as measured parallel to the solar plane? And then, exactly from what point to what point are we to compare this half-length? From the posterior apex of the coffin bone to the most posterior point of the bulb of heel (i.e. horizontally, straight backwards?) Or from the most posterior point of the coffin bone to the apex of the buttress (i.e. on a diagonal line downwards and backwards?).

I did send my seminar notes to you a couple of weeks ago plus photos of changes in the digital cushion depth of one of my own horses - perhaps you did not receive them or have not had time to look closely?

On both occasions I have attended seminars with Prof Bowker (RB), he has stressed the importance of a well-developed 'back of the foot', i.e. digital cushions and ungal cartilages that have developed beyond those of a 4 - 5 yr old horse.   After this age a 'good footed' horse will continue to develop strong, elastic fibrocartilage in the DC which differentiates him from the 'bad footed' horse whose DC and UC do not develop any further.  This development is not genetically governed, it is dependent on environment and how the horse uses his feet - fibrocartilage in the DC and lateral/medial cartilages will develop at any age given the right conditions.  One of my own horses, a 19-yr old TB with Cushings has proved this point - I'll try to attach comparative photos below separately.

The larger the back of the foot in relation to total size of the foot, the better.  RB likes to see a ratio of 2:2 or even 2:3 but 2:1 is the bare minimum needed for a functional foot.  This is measured on radiograph images by a straight line that runs from the anterior apex of the coffin bone (point of the toe), more or less parallel with the sole, extending past the wings of the bone out to the furthermost visible edge of the heel bulbs.  The distance along that line from the coffin bone wing to the heel bulb edge is considered to be 'the back of the foot'.  In an ideal 2:2 ratio the length of the coffin bone from toe tip to wing edge is the same length as that from wing edge to heel edge.  Another way to think of this is that the coffin bone should occupy no more than 2/3 of that line - the closer to 1/2 of the length of the line the better.  The absolute measurements are not important, it is the proportions that are important. 

The radiograph of Megan's horse is harder to measure accurately because of the steepness of the bone angle - however it can be seen the area occupied by the digital cushion is not large in comparison to the size of the bone.  Other images can be confusing where the palmar processes have become elongated on one side or the other - this happens when the horse's body is trying to provide more support to compensate for an underdeveloped back of the foot.  In any case, radiograph measurements are indicative only as they cannot show fibrocartilage or assess texture of the DC.  I think it is more meaningful to do a 'squeeze test' between thumb and forefinger (photo below) as size alone does not define a good DC - a good thick DC will feel like high-density foam, firm but 'giving'.  A poor DC will feel soft like low-density foam (bath sponge) if it has some depth, or hard, leathery if it is thin.  It is best to feel for this closer to the pastern if the heels are contracted as the squashed ungal cartilages at the heel bulbs can give a false feeling of firmness.  As an example, Megan tells us her horse has good, wide, healthy frogs and heels but I would take a guess that there is little DC development - I would expect to see a deep cleft between the UC that would feel soft when squeezed.  Perhaps she will let us know.

I think it would be great if Adam could draw some more lines for us and then have estimates of DC & frog thickness, and texture, alongside.

Once you help us by specifying where Bowker says we are to be measuring to estimate digital cushion thickness, I want to start by looking at that on Megan's X-Rays but also on Ollie's, because I know that Ollie is (at the present time, so far) not at all reluctant to strike on the heel.

RB did not discuss where or how to measure DC thickness.  I came home from the seminar wanting to find some way of tracking progress in horses so decided to use calipers as a way of measuring - the top prong was placed centrally on the skin over the DC at the point where it changes direction to become the skin over the back of the pastern.  The lower prong was placed centrally on a line below that runs from heel buttress to heel buttress on their most posterior edges - the prong was not put down into the central sulcus of the frog.  (photo below separately).  Maybe you or Adam can think of a better way to measure, but again the value is in comparisons - whatever method is used should be consistent for that particular horse.  RB believes that once DC fibrocartilage has been developed fully, it never disappears but I'm not sure about this so regular measurements might be useful.

Also -- I know exactly what you're referring to as resulting from the use of foam-padded boots, having seen Dr. Jane's horse make such progress in Adelaide, for example. But....is this the only way that we can influence this? What have you observed regarding type of footing?


Can't definitively answer this question.  In theory the conforming sandy work surface you described should be enough to provide stimulation to the whole solar surface of the foot but you told me recently that you saw a difference when Ollie was wearing boots & pads so maybe the soft surface was not enough.  Maybe it has to do with amount of time spent on that conforming surface - is an hour (or whatever) per day when ridden/groundworked enough when compared with the amount of stall and turnout time?  Don't know, but would be interesting to find out.   I know of a horse here who lived on a soft, sandy surface 24/7 but did not heel-strike at a trot until he had padded boots.

Without a forceplate it is hard to tell visually just how much the horse is weighting his heels with each step, especially on a sandy surface.  Many horses will heel-strike at a walk but not a trot, some will heel-strike on soft ground but not on hard, and this can change from day to day - so many variables it is almost impossible to be certain what any one horse does or does not do.  Looking at the wear patterns of the wall and sole is the only way I can think of to have some idea of what a horse is doing, i.e. if I have to trim more heel than toe then I'm fairly certain that horse is predominantly toe-striking.  Also, I can't be sure what impact an unstable (wobbly) surface would have on the sensory and proprioceptor nerves in the frog and sole, don't know if this would interfere with the sensory-nerve mediated perfusion of the foot.  Any foot soreness from other issues such as laminitis would also impact.

Best wishes - Pauline







Pauline Moore
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 Posted: Thu Apr 8th, 2010 09:50 pm
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This is a photo of how I used calipers to estimate the thickness of the digital cushion and frog.

Attachment: Measuring thickness of DC & frog DSC01158.jpg (Downloaded 1050 times)

Pauline Moore
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 Posted: Thu Apr 8th, 2010 09:54 pm
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This is how I squeeze the digital cushion and frog to assess texture - in practice it is better to have my thumb on top but it was easier to do it this way when trying to take a photo one-handed while relying on my obliging horse to leave his foot on the crate.


Attachment: Feeling texture of DCushion DSC01153.jpg (Downloaded 1041 times)

Pauline Moore
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 Posted: Thu Apr 8th, 2010 09:59 pm
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This is a photo of my horse's right fore taken in July last year, the next photo was taken in March this year. (Sorry, don't know how to put 2 photos together).  It can be seen that the area between his medial and lateral cartilages has 'filled-in', increased in volume.  The texture is now like firm foam, it used to be thin, feeling like leather.

Attachment: Rory RF heels, DC 14.7.09 DSC00861.jpg (Downloaded 1040 times)

Pauline Moore
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 Posted: Thu Apr 8th, 2010 10:01 pm
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March 2010, same foot


Attachment: Rory RF heels, DC 4.3.10 DSC01139.jpg (Downloaded 1041 times)

ozgaitedhorses
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 Posted: Fri Apr 9th, 2010 04:56 pm
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Hi Pauline!
I asked a well known Australian barefoot blacksmith whether he thought that developing a stronger digital cushion was possible in an adult horse. His answer was that he hadn't seen it happen...
Glad to hear that your experience was a different one! But then again, you are probably more committed than 99% of horse owners!
May I asked what happened in the time between the July 2009 and March 2010 photos? Did the horse go to live on different ground? Did you ride him more? Change in diet? All of the above?
Also, in the 2009 photo, the foot has a 'pinched' look to it. Did the heels open up during that time?
Thanks for those photos, Pauline! Always a pleasure to read your posts!
Cheers,
Manu

Alex
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 Posted: Fri Apr 9th, 2010 07:58 pm
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Hi Pauline,

Thanks for posting all of that information. This sounds like a good measurements to take of Arwen's feet. For those who are not familiar with the story if you search her name you will be able to see the x rays from last year.

Since last year we have been using glue on boots and we are having a gradual success. She walks out very well in the boots and is far more inclined to trot and even gallop whilst in them. If they come off she is less inclined to move in the paddock.

The structures of her feet are interesting to watch from booting to booting as we can have a big change in the amount of frog tissue depending on how much moisture is around and we worked out that more glue inside the boots seems to be better at either keeping the moisture out or keeping the pressure on the tissues or both.

Anecdotally I would have said that she has developed a depth through the heel tissue, there is certainly much less pain in the area. She is walking in a better heel first movement. 

I look forward to hearing more.

Cheers,

Alex



 

Pauline Moore
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 Posted: Sat Apr 10th, 2010 01:40 am
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Hello Manu & Alex

The thing I'm really excited about is that there has been only one change in the past year that could account for the increased fibrocartilage in this horse's digital cushions.

In December 2008 we moved to another property in the same area; I was concerned about how this horse would cope with the abundance of grass - some native grasses but also paspalum, kikuyu and other less desireables.  Although it was a dry summer, for the first few months he did not cope well, abscessing in one hind foot, toe-landing, accelerated wall growth, then he tweaked a front tendon so I left him alone for the rest of the year, devoting my limited horse time to the two younger horses.  All 3 horses live out together 24/7 as they have for years, so he had no increased movement during this past year, if anything - less.  No riding or groundwork, just the normal everyday pottering about in a large paddock - the more grass, the less they move around.  As you know, we've had a lot a rain in the last few months, they're up to their knees in grass so do not bother to walk around to find another tasty patch, it's right there at their feet.   They live peacefully, only occasionally stirring themselves into a fast canter when coming up for a feed but this is not everyday, and was their same habit at the previous property also. 

There has been no change in basic diet - I still give them the same copra, oat chaff and various supplements that I have used for years and spoken about here on the forum from time to time.  The only difference is that I have added chromium to their diet.  Early in 2009 I started reading about chromium and how it is useful for people with blood sugar disorders such as diabetes.  Believing that laminitis is primarily a blood sugar disorder and that a healthy, functional foot must have a good glucose supply I thought it would be worth experimenting with chromium.  Took a while to establish if this would be safe for horses and to find a supplier, so did not start giving it to the horses until mid-March 2009.

The first change I noticed was a decrease in hoof growth rate compared to previous years at the same time.  Anecdotal accounts from farriers around the world agree that laminitic horses grow hoof wall at a faster rate than normal regardless of season.  I saw this change on all 3 horses even though the 2 younger ones have never had laminitis problems. The other change has been a shortening of the overall height of the hoof capsule on all 3 horses (north:south) - I think this has been due to the bone being held higher up, the sole following the bone, resulting in a shorter hoof wall.  The older chestnut horse no longer has a soft slight swelling around the coronet, often associated with the bone within sitting too low.

I think the chromium has been the final missing link that, added to the other supplements they get such as magnesium, has allowed this horse to deal with 24/7 access to grass sugars.  All remnants of any low-grade laminitis has gone so he has been comfortable enough to weight his heels with each step - this in turn has provided the necessary stimulation for development of fibrocartilage within his digital cushions.  I've not had to trim more heel than toe at any time during the last 10 months or so, mostly even growth all round.

The challenge he has given me doesn't get much harder - large horse, small, poor-quality feet that couldn't keep a shoe on, Cushings Disease, highly susceptible to laminitis - at 19 he's now the best he has been in a very long time.  I'm so happy for him, but also optimistic that if he can improve so much at his age, then so can most other horses living in similar conditions.  I've felt for a long time that diet is responsible for 90% of a horse's soundness, this horse is the living proof. 

The photo from July 2009 was taken without any thought of digital cushions, in fact can't remember why I did take that photo.  I had long stopped expecting any further improvement in the TB's feet.  As a 6-yr old his front feet were contracted, his heels progressively widened over time to the same point as shown in the July 2009 photo.  There has been no discernible widening of his heels since then, but the 'filling-in' of the area between the lateral and medial cartilages with fibrocartilage has pushed the lateral and medial cartilages apart, reducing the 'pinched' look that you noticed, Manu.  It is also probable that the lateral and medial cartilages themselves have widened and strengthened.  I'll be interested to see if there is any further improvement on this horse or if we have already reached maximum - just wish I'd thought to do measurements last July.

In a nutshell, this 19-yr old Cushings horse has grown a good, functional, back-of-the-foot purely through getting his diet right with no boots, pads or miles of exercise.

Best wishes - Pauline





DrDeb
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 Posted: Sat Apr 10th, 2010 02:57 am
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Pauline -- I'm very interested in this conversation too -- so much so that I delayed replying until I'd had time this afternoon to go out to the ranch and take some photos of Ollie's feet. I post these here for your comments along with a recent X-ray lateral view of the left fore.

Adam, you will be gratified to see that, although my vet did not put a radiopaque marker at the coronet, you can clearly see where it is.

Everyone may benefit in several ways, I think, from looking at Ollie's X-Ray. You can dub it out and put it up, along with Megan's X-Ray of her Lipizzaner from the other thread, and the pair will then highlight a number of comparisons.

Megan, I suggested to you previously that your horse's coffin bone may be detaching from the laminae at the top. With further study I am more certain this is so, for again despite there not being a hairline marker on your photo, we can be certain within a fairly small range of where the top of your horse's capsule is, and when you compare this to the height of the top of his coffin bone, there is no doubt but what your horse is a "sinker".

The wryly humorous part of all of this is that I was sure -- based on Ollie's history of periodic lameness and founder-like symptoms -- that HE was a sinker. You can see from the XRays, however, that he certainly is not a sinker! So when we took the XRays I got a lesson -- which was -- you need XRays! Especially when as in your horse's case and also in Ollie's case, the capsule itself is not showing a dish or any strong founder rings -- it generally looks normal. You can safely deduce much more about what's going on inside from an abnormal-appearing capsule, but the lesson is that just because the capsule appears normal does not mean that everything inside is normal.

In Ollie's case, everyone, you can see what the MAIN problem is: he has 'spicules' or 'exostoses' or 'osselets' -- prickly, rough bony growths -- on the anterior face of the short pastern. He also (more subtly) has diffuse 'snowy'-looking calcination of the cartilages and a little bit of extension and roughening of the wings of the coffin bone that support the cartilages, i.e. very early incipient sidebone.

As Pauline mentions with her horse, I am still controlling Ollie's diet, because I still believe that he DID have at least one episode of severe laminitis in his life. I got the horse from Yvonne Miller, who is one of our recommended clinicians, an occasional correspondent here, and a very fine practicing farrier. She in turn received the horse from the owner who allowed him to overfatten and founder. After getting the XRays I wrote Yvonne and thanked her again, because it is obvious that her immediate, persistent and dedicated intervention (two solid weeks of HD foam and duct tape) saved not only his life but allowed the laminae to fully re-attach, so that there is no evidence at all on XRay at this point of any sinking or rotation.

I keep my set of boots and a supply of HD foam, I continue to have Ollie's hay soaked to lower the sugar content, I continue to feed him Mg and Cr supplements, and I also have him on a locally-manufactured pelleted low NSC bellyfiller that eliminates the chronic diabetic "munchies" and makes him a mellow happy performer. I have him also on IM polygluconate (glucosamine hydrochloride, chondroitin & MSM mix prescribed by my vet) and since we started that in February the horse has not taken a single lame step. As IM glucosamine totally reversed Painty's ringbone, I am hoping it will, over time, do the same for Ollie's. We were out there tonight practicing half-pass at the "trot" (that is to say at the pace, in Ollie's case).

Now as to the discussion in this thread: awp, Pauline, there is no way that I know of either to post more than one photo in any one post, unless you hook the photos together in Photoshop beforehand and put them in as a single file. I have four to post here so y'all will just have to scroll down to see them.

1. Ollie's February XRay, left fore, lateral view. I use the Photoshop measuring tool (an alternate function under the eyedropper tool), which is very accurate, and I get a measurement of 15.108 units for the total straight-line distance from the toe of the coffin bone to the furthest posterior bulge of the heel. I then get a measurement of 5.661 units for the distance from the posterior lateral "wing" of the coffin bone to the posterior bulge of the heel. Measured this way, the DC is 37.4% of the length of the coffin bone. Measuring Megan's Lipizzan in the same way, her numbers are 7.243 units total coffin bone length, 2.187 units for the DC, yielding a ratio of 30.1%. According to what you report from Bowker, Pauline, both my horse and Megan's would be seriously below the critical minimum....and yet Ollie is not lame, does not have heels that are collapsed forward to shorten the back of the foot, and does strike on the heel both at the walk and at the pace and canter. Maybe I still have not correctly understood how to measure?

2. Photo of left forefoot showing width between the bulbs and the depth of the DC. I can't take a photo with one hand and also hold the fetlock hairs up and also caliper the heels all at once, so I'll just tell you that the calipered depth is about an inch and three-quarters (4 cm). The texture is firm, firmer than HD foam, but not leathery. The left foot has been Ollie's "more lame" foot, i.e. when he is lame he's always lamer on this side.

3. Photo of right forefoot, same view as no. 2. Calipered depth of DC is about 5 cm (two inches).

4. Photo of left hind foot, same view as nos. 1 and 2, with calipered DC depth of only an inch (2.6 cm)! Pauline, you report Bowker said that the DC on the hind feet is almost always greater than that in the forefeet, but this is certainly not the case with Ollie! Yvonne suggested to me also that perhaps Ollie's reluctance to trot and to canter under saddle might relate to a hind limb issue. Perhaps this will now prove to be so; but I wonder also if this is not another chicken-and-egg deal, because I also know for a fact that the man who bred my horse and started him under saddle 14 years ago believed that gaited horses destined for the show ring should not canter under saddle. Ollie still tries to tell me I'm breaking the law when I ask him to canter, even though he can canter perfectly well. So as with the horse that is confined to a stall and therefore fails to move and to develop a thick DC, perhaps the horse that is not REGULARLY ASKED to pick up a canter under saddle from a walk or halt finds it uncomfortable to do so, not merely because that's heavy lifting for the muscles and joints.

All entirely fascinating and helpful -- your comments are welcome. -- Dr. Deb

 

 

Attachment: Forum Oliver DC thickness Lt fore XRay 2-2010.jpg (Downloaded 980 times)

DrDeb
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 Posted: Sat Apr 10th, 2010 02:58 am
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Left fore photo showing heels

Attachment: Forum Oliver DC thickness Lt fore 4-2010.jpg (Downloaded 982 times)

DrDeb
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 Posted: Sat Apr 10th, 2010 02:59 am
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Right fore photo showing heels

Attachment: Forum Oliver DC thickness Rt fore 4-2010.jpg (Downloaded 984 times)

DrDeb
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 Posted: Sat Apr 10th, 2010 03:01 am
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Left hind showing heels

Attachment: Forum Oliver DC thickness Lt hind 4-2010.jpg (Downloaded 981 times)

Charlotte
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 Posted: Sat Apr 10th, 2010 12:07 pm
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Thank you Pauline, I'm reading with great interest  - spring seems to finally have sprung here in the UK and I'm pulse-checking in earnest. I'm already feeding mag, salt and toxin binder.

I'm wondering how much chromium you fed per bodyweight and did you give it in a specific ratio with the magnesium? Many thanks in advance.

Leah
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 Posted: Sat Apr 10th, 2010 12:26 pm
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Pauline-was there a change in weather from the first photo to the second? I assume there would be.

Could that also account for the changes?

Pauline Moore
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 Posted: Sat Apr 10th, 2010 09:25 pm
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Dr Deb:

This morning I spoke with my vet friend whom you know, a hoof 'n' tooth specialist who also attended both Bowker seminars as I wanted to be sure my understanding was the same as hers.

You have measured the coffin bone/DC lengths and arrived at proportions that are roughly the same that I got just using a ruler on the screen.  Yes, both Ollie and Megan's horse have DC lengths that fall short of Bowker's recommended minimum but Ollie is not lame.  The photos and depth measurements of his DCs also indicate that he does not have a well developed, substantial back-of-the-foot - he does not have collapsed or underrun heels, he does heel-strike on a sandy surface.

I heard Bowker say several times 'a sound foot is not necessarily a good foot' and was puzzled about what that meant - if a horse is sound what else could we want?  It became clearer after this last seminar.  The horse we look at today who is sound is less likely to remain sound throughout his life if he does not have well-developed DCs and ungal cartilages. The reduced capacity to absorb impact shock and reduced perfusion through the foot is likely to eventually result in one or more pathologies somewhere in the foot.  Bowker also repeated several times, particularly in discussions about navicular issues, that it is a 'whole foot' problem not just isolated to the heels - ditto most other foot problems. Regarding Ollie, what are your thoughts about why he has developed ringbone and maybe also the start of some sidebone?  The usual suspects are poor foot balance and/or crookedness but we know this cannot apply to Ollie - you are pedantic about hoofcare and you have made him straight as shown in some of the lovely photos you've posted recently - so, do you think it's possible that his weak DCs and UCs have not given him enough support, perhaps especially on the wobbly, sand substrate you've told us he was living on for some time?

My vet friend mentioned this morning something from the most recent Bowker seminar that I had totally missed but remained prominent in her memory as it puts a question mark on the suitability of sand arena surfaces.  Bowker has done a study which found that horses living on a soft, sandy surface have reduced perfusion through the pedal bone very similar to horses with peripherally loaded feet.   It would be very interesting to know if there is a higher incidence of bony changes in the feet of horses living/working on sand such as the area where Ollie used to live.

I do not remember Bowker making any comment about hind feet DCs being more developed than front feet - I think Adam mentioned something about this on the other thread but do not know if it came from Bowker.  Anyhow, I measured my own horses' hind feet DC depth this morning and like you, found they are all thinner in their hind feet.  Comparisons below:

Rory - 19 yrs
LF  55mm
LH  45mm

RF  51mm
RH  45mm

Sol - 6 yrs
LF  60mm
LH  52mm

RF  64mm
RH  51 mm

Gante - 12 yrs
LF  69mm
LH  60mm

RF  73mm
RH  60mm

The photo below is of the left forefoot of my 12-yr old horse who has a DC & frog depth of 69mm.  He has the best feet of the 3 of them, real 'rock-crushers' although Bowker doubts such horses exist.  The back of his foot is huge in comparison to overall size.  Just last week I met the person who bred this horse - she told me that for the first 17 months of his life he was running wild over rocky, mountain country - perhaps that explains his excellent feet.  When my vet has time to bring her x-ray machine over here, I'm intending to do all 3 of them - the 19 yr old to see how his pedal bones have coped with 18 yrs of less than ideal feet and the 12 yr old to see just how closely his internal measurements accord with Bowker's findings.

Best wishes - Pauline


 

Attachment: Gante LF 11.4.10 DSC01194a.JPG (Downloaded 940 times)


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