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Sherri Willison
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Posted: Thu Apr 4th, 2013 05:13 pm
Attached is a larger size photo of the sole. Hopefully I did this correctly. To my knowledge, the shoe was applied without further trimming. Forwarding the X-Rays also

Attachment: DSCN1144.JPG


Sherri Willison
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Posted: Thu Apr 4th, 2013 05:14 pm
X-Ray of left front.

Attachment: DSCN1152.JPG


Sherri Willison
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Posted: Thu Apr 4th, 2013 05:15 pm
X-Ray of right front.

Attachment: DSCN1153.JPG


Sherri Willison
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Posted: Thu Apr 4th, 2013 05:15 pm
X-Ray of right heel.

Attachment: DSCN1154.JPG


Sherri Willison
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Posted: Thu Apr 4th, 2013 06:34 pm
Hi Dr. Deb! Thank you so very much for this forum and your expertise. I will try my best to address each item of your last post.

My husband purchased Apollo for me as a 2 year old. At that time, none of us (ie, vet, farrier, etc) mentioned, noticed or diagnosed any weakness or crookedness. When Apollo was three, prior to putting him in Boot Camp, the trainer requested shoes. Our farrier, at that time, put shoes on which resulted in Apollo pawing the ground with his right foot, noticable pigeon-toed stance, and noticable incorrect angles. We terminated the relationship and have had the same farrier since that time. Although no one else felt or would admit it was severe, I have long thought it had something to do with the trouble. At no time has Apollo gone without trim and shoes greater than 6 to 8 weeks since we have had him.

We notice Apollo stands oddly with his right front hoof approx. 2 1/2 feet in front of his left eating from his feeder at almost ground level. We have re-positioned his feeder 2 1/2 feet above ground and now Apollo is standing square when he eats from his feeder.

Apollo and his stable mates spend approx 16 hrs in their 24 X 24 open-air stalls. The stall ground is firm dirt, no deep sand. They are turned out daily 6 to 8 hours on approx. 1/2 acre flat groomed dirt. In addition to the flat area, there is a hillside of approx 1/4 acre(which we plan to fence off as the horses like to run up and down it). When Apollo is turned out, he runs, bucks and acts like he has no pain or other issues.

I have rarely ridden Apollo since the cracks began. Under saddle, he bobs his head slightly at the trot. More so to the left (maybe 6"). Nothing noticeable at the walk. I am not sure how to describe the canter other than it seems he really has to work at it - a lot of up and down front end movement. He is like driving a car with 4 flat tires.

I do not know how long Apollo has had the ringbone.

Let me know if I have not addressed something or if the photos I sent need to be better. Dr. Deb, this forum is a wonderful service you and others donate to the public and industry. I do support it and am reading The Birdie Book and the Inner Horseman. Sherri
adamsfam
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Posted: Thu Apr 4th, 2013 06:51 pm
Dr. Deb, It appears by this radiograph that sheared heels are at least part of the problem causing this horse some grief.
Jeannie
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Posted: Mon Apr 8th, 2013 03:51 am
 A TWH  I knew developed a crack after the owner hired a farrier who claimed gaited horses needed a different trim than regular horses. Even after she stopped using him, the crack,which went all the way through, stayed. He was moved, so I don't know the outcome. I hope Apollo gets some relief.
                                       Jeannie

DrDeb
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Posted: Mon Apr 8th, 2013 07:44 am
Ahh, yes, Sherri, Adamsfam is quite right. The XRay clearly shows that the horse's heels are of unequal height. The stresses that this forces the foot to endure are the main factor maintaining the deep crack. This was my initial suspicion, but the photos do not demonstrate it nearly so well as does the XRay.

Sherri, I am also thinking throughout this that this may be your first horse, or that you haven't got a whole lot of experience with horsekeeping. Or, if you have been in the game for years, then I have to assume that you're not too much of an avid student, so that you simply haven't read the commonly-available materials that explain what a good trim consists of.

You also seem to have a kind of hangup or overfocus on the pigeon-toes. I am telling you again: pigeon-toes are NOT a problem, and in fact if this is the horse's usual and normal stance they are probably a conformation "plus".  

There is no inward twist affecting your horse's ankles; therefore, the source of the toed-in stance is his shoulder joints. It is unwise and damaging to try to crank the stance "straight" when every bone and joint of the forelimbs is telling you otherwise. You would know all about this if you had read any of the following: (a) My "Principles of Conformation Analysis", which has been available since 1989; (b) the 2003 back-issues disk of my newsletter, "The Inner Horseman", which deals with farriery; (c) any of several articles I've done over the years on this subject for Equus Magazine, but especially the recent conformation series spanning the last three years; or (d) any of the threads in this Forum where the same subject has been discussed (and illustrated: I have posted the relevant drawings in addition to text).

So, the first thing I think you need, Sherri, is to avail yourself of this material so as to cause yourself to become a more adequate supervisor and boss of the farrier you employ. In my world, the one who pays the bills is the boss, and a good boss must know enough about the job to know when a good job is being performed. A "good" job is not defined as being merely "neat and clean", but rather as serving the horse's actual orthopedic needs.

Your current farrier is "trying to give the horse some help" -- in other words trying to force the horse to stand with its toes facing forward. It may be that he would have done this on his own, or it may be that your own obsession with the pigeon-toed stance has caused you to ask him to do it. You and he must stop doing it, however. The horse must be allowed to stand in whatever manner the joints of his limbs above the feet dictate. This will involve finding a farrier who will trim the heels so that both of the heels (i.e. the medial and lateral buttresses of each fore hoof) are the same height, making no effort whatsoever to try to "crank" the foot by trimming the heels to different heights.

As soon as you find a new farrier who will do a proper job -- or as soon as your old farrier becomes willing to do as I say -- then you will soon see the hoof above the top of the crack growing down whole, so that there is no new cracking developing.

I want you to engage in this process also with your veterinarian, Sherri, because I cannot tell you here, and would not under any circumstances be able to say merely from photographs, at what point you can take the shoes completely off the horse. While the foot is unstable, the shoes should be left on, for without them to stabilize the sheared foot, the problem might get worse; because, you see, "shearing" does not affect just the horn of the hoof, but the shear goes right through the entire inner flesh that composes the foot, affecting bone, cartilage, tendons, ligaments, and circulation.

Because a sheared foot is a rather serious matter, it may thus take one, two, or five re-sets before your vet gives you the OK to take the shoes off. As soon as he says you can take the shoes off, the horse should then go barefoot. While the shoes serve a vital purpose on a sheared foot, once they are no longer needed for stabilization they should be removed so as to allow the horse's hoofs more freedom and flexibility, which will speed the process of healing.

You understand that you won't be able to ride the horse when the shoes come off; he'll be tender for a while, and this would not, in any case, be a time to stress his feet. When the shoes come off you'll arrange to have him in a paddock of moderate size, so that he can walk around or graze, but small enough to discourage big gallops. From there, in a few months, he can probably graduate to living in a field where he can move around at any gait with herdmates.

As to your observation that the horse prefers to graze with a certain foot always forward -- most horses do this, and it is because they have been carrying themselves crooked since they were foals and maybe even before birth. The whole matter relating to crookedness/straightness is basic reading in our school, which you will find by going to our main website at http://www.equinestudies.org, clicking on "Knowledge Base", and then downloading the following three papers:

-- Lessons from Woody

-- True Collection

-- The Ring of Muscles

All students in our school are asked to download and study this material, and you will find it directly relevant to your situation with this horse.

The animal was meant to be perfectly useful; he was, I mean, born to be sound and useful, and his body would therefore like to heal out of its present lameness, and is quite capable of doing so if only you will stop doing things that maintain him in lameness. When you get the sheared feet fixed up, I expect the ringbone will probably resolve too. If it doesn't, as I said there are some ideas for that condition also that may help. But first things first. If your vet said nothing about the unequal buttresses, then you also need to go find a new vet, Sherri -- one who knows something about horseshoeing and lameness. Let us know when you've made new arrangements in both the farriery and the vet departments, and you may post new photos at any time showing your horse's progress. Good luck to you as you begin the course of reading and study which I have suggested. -- Dr. Deb

 

AdamTill
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Posted: Mon Apr 8th, 2013 08:39 pm
DrDeb wrote: Ahh, yes, Shirley, Adamsfam is quite right. The XRay clearly shows that the horse's heels are of unequal height. The stresses that this forces the foot to endure are the main factor maintaining the deep crack. This was my initial suspicion, but the photos do not demonstrate it nearly so well as does the XRay.

Hi Dr Deb,

I don't want to post much in case you're intending this to be a learning experience for Sherri, but could you please indicate which film you're seeing the imbalance in?

Thanks,
Adam

DrDeb
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Posted: Tue Apr 9th, 2013 02:39 am
The right heel view, obviously. You can confirm by running the image up into your Photoshop. First, level the shoe; this required a clockwise rotation of 1.6 degrees on my screen. Once the shoe is level, I obtain a difference in the heights of the heels of just shy of 1.0 screen units, using the measuring tool. Orienting the shoe level also creates an angular slope to the coffin joint of 3.5 degrees, which is fairly considerable.

The solar view, although Adamsfam rightly questioned where the buttresses had been dressed when the solar view was tiny and we couldn't see very well, in the larger view the buttresses have been moved back to about the right place. However, as the Xray shows, they are not level, and this doesn't show up at all in the solar photograph. This may imply that the entire foot is twisted, as indeed that is what I am saying: this is a sheared foot (there is really no such thing in any case as a horse ONLY having "sheared heels"; it always involves the entire foot, inside and out).

Look at the rear view photo -- either one of them -- showing the right forefoot and you can see the compression in the lateral bulb of heel. What isn't obvious is the upward twist, i.e. the shear, except in the XRay.

I would welcome your analysis of what we can see here, Adam, and your thoughts on any of the views. I'd like to get this lady some help so she can go about riding this horse, because he actually needs that. -- Dr. Deb

AdamTill
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Posted: Tue Apr 9th, 2013 04:10 pm
>The right heel view, obviously. You can confirm by running the image up into your >Photoshop. First, level the shoe; this required a clockwise rotation of 1.6 degrees on >my screen. Once the shoe is level, I obtain a difference in the heights of the heels of >just shy of 1.0 screen units, using the measuring tool. Orienting the shoe level also >creates an angular slope to the coffin joint of 3.5 degrees, which is fairly >considerable.

Hi Dr Deb,

I might be measuring incorrectly, but I'm not sure I can replicate this. Here is my attempt to do so.



I've tried a few ways of verifying the ground plane of the coffin bone, and they all show that the bone is sitting roughly level. Those are:

1) visually judged ground plane (green line). Tough to be clear on that one, but appears roughly level to the shoe plane (pink), if a touch high medially.
2) depth of collateral grooves (yellow) is approximately equal
3) line passed through the plantar foramina is roughly equal to ground plane
4) heel heights in the photo (ground to bottom of hairline) seem about equal.

There appears to be a substantial amount of remodeling of the right coffin bone ground plane as a result of long-term imbalance, but as it appears to be correctly setup on that plane at the moment.

The left foot appears to be substantially high on the medial heel (perhaps as an attempt to get the feet "equal" rotationally), but it's not sheared by the way I understand it. This would be a sheared heel, where there is a substantial imbalance between the heel heights:


This horse had substantial displacement of the joint spaces as well:


The correction in the plane of the heels above being approximately equal to the displacement of the joint spacing in the distal joint (the xray being pre-correction).

I don't see this in Sherri's horse when I mess with the brightness and contrast (joint spaces seem even).

DrDeb
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Posted: Wed Apr 10th, 2013 12:02 am
Adam, of course the solar plane of the coffin bone is level to the ground; we assume that the horse was standing on level ground when the Xray was taken, or anyway we make it so by rotating the image until the shoe is level on-screen, and then we judge our angles with reference to that.

The green line that you drew demonstrates about a 1.3-degree difference from the plane of the shoe, i.e. the foot is sitting unlevel in the shoe. This clearly shows on the Xray, i.e. that one heel is longer than the other. Is there a pad in this shoe, or some filler material or something, that we can't see in the heel view photographs? The animal is obviously standing "on" something above the shoe that is not radiopaque.

So what we get here in toto is a picture of every surface of articulation lying at a different angle as we go up: the shoe having been levelled, the coffin bone is sitting aslant by 1.5 degrees; the coffin joint above that aslant at about 3.5 degrees, and the higher joints the same. There is as you note no pathological widening or offsetting of the joints, and this is, of course, precisely because the animal stands pigeon-toed, which is how Nature meant him to stand.

So whether you like to call this type of foot "sheared" or not becomes a moot point, I think. Whether you call it sheared or not, it is unlevel in the heels; your nice analysis of the heel photos helps everyone to see it there, too, besides in the Xray; you can also see that the left foot (which is the one with the persistent crack) is worse than the right -- note that in the photo, even the line of the (compressed or contracted) central commissure slants in rear view.

What, then, shall we say? That whether Sherri thinks so or not, somebody allowed this horse's heels to overgrow so badly that at some point they rolled under, and that this is what tore the quarter in half? Shall we say that torque forces due to the unlevel heels, which are even at this moment passing through the foot on some kind of fore-aft plane, are destabilizing the coronet band enough to produce and preserve a separation of the generative cells there, so that they can't produce a continuous quarter, so that it must grow out in segments with a space (which Sherri calls a 'crack') between?

Whatever we say, we know this: the heels have to be made equal, so that the coffin bone is dead plumb to the ground; and that no attempt must be made to 'help' quote-unquote the horse to stand in any particular manner, other than in the particular manner of standing with its joint surfaces parallel to the earth. And let the orientation of the toes be, relative to the sagittal plane of the body, where the joints of the limb say they must be!

Now we might also interview Sherri on another idea: that somewhere in this horse's history there has been a time when he got both forelimbs caught in a fence or between the rails of a pipe panel, and struggled, and somehow tore or sprained both anterior sets of pectoral muscles, i.e. left and right. Whence thereafter he has abnormally low tonus (or no tonus, because the muscles are ripped right off) in the pectorals and hence stands with elbows-out, and hence toes-in. This is a wild and crazy idea, a highly unlikely scenario -- so what I have been thinking instead is that Sherri simply failed to notice that the animal stood with toes-in all the time, which is why I say this is how Nature intended him to stand; it's how his shoulder joints are formed.

When this is the case, obviously breakover in the forefeet is always going to be at about 1:30 or 2:00 on the right forefoot and at about 10:00 or 10:30 on the left forefoot; the horse will 'roll over' the lateral pillar rather than the toe. This, however, should have no effect on warping the quarters, which are much farther toward 6:00 on the dial.

So, Adam, you can certainly put your spoke in here specifically as to what you think should be done in terms of trimming, i.e. the particular steps to take. It will be helpful to get the horse to the point where he can come out of the support shoes, because only then are we going to get significant progress on decontracting the heels. He has currently three good reasons to be lame: one, the contracted heels which are pinching and inhibiting the ciruclation; two, the ringbone; and three, the unlevel distal limb joints. We need to create a plan that addresses all three if possible. -- Dr. Deb

 

 

 

Sharon Adley
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Posted: Thu Apr 11th, 2013 10:10 pm
Am studying this thread with some interest, as one learns as much what NOT to do as what to do with problems of this type.  But can we clarify one point?  I thought the crack was on the medial quarter of the right fore foot because Sherri mentioned the horse striking himself on the coronary band as a possible cause.  Unless the original photo of the crack is reversed, this has to be a view either of the right medial quarter or the left lateral quarter and it would be impossible for him to strike his own coronary band on the left lateral quarter unless he did it with a hind foot (unlikely).  Correct?

AdamTill
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Posted: Fri Apr 12th, 2013 03:17 pm
>Adam, of course the solar plane of the coffin bone is level to the ground;

As much as I'd like to, I've seen a lot of x-rays where "corrective action" has resulted in a coffin bone angled by a fair amount on that plane. Here that doesn't seem to have been the case.

>The green line that you drew demonstrates about a 1.3-degree difference from the >plane of the shoe, i.e. the foot is sitting unlevel in the shoe.

Odd that it's on the medial surface. I can't substantiate it, but the coffin bone seems to be showing the effects of a long-term attempt to correct a toeing-in stance by raising the medial heel.

>This clearly shows on the Xray, i.e. that one heel is longer than the other. Is there >a pad in this shoe, or some filler material or something, that we can't see in the >heel view photographs? The animal is obviously standing "on" something above >the shoe that is not radiopaque.

I can't see anything in the photos either, but either the heels were much longer when the xray was taken, or it's an older film where a wedge pad was in place.

>you can also see that the left foot (which is the one with the persistent crack) is >worse than the right -- note that in the photo, even the line of the (compressed or >contracted) central commissure slants in rear view.
>What, then, shall we say? That whether Sherri thinks so or not, somebody allowed >this horse's heels to overgrow so badly that at some point they rolled under, and >that this is what tore the quarter in half?



The lateral and medial walls are over-straight at the moment, which is either a result of or contributing to a substantial amount of heel contraction. Intentionally leaving the medial heel high is the largest contributor to this from what I can see on the left foot above, and the same seems to be being done on the right foot below:



>  Shall we say that torque forces due to the unlevel heels, which are even at this >moment passing through the foot on some kind of fore-aft plane, are destabilizing >the coronet band enough to produce and preserve a separation of the generative >cells there, so that they can't produce a continuous quarter, so that it must grow out >in segments with a space (which Sherri calls a 'crack') between?

Certainly. A horse that naturally toes in will tend to overload the lateral wall anyway, but there is far too much toe flare in this horse anyway as can be seen below or in the blue line on the heel photo. I haven't seen the horse move, but a tendency to land on the outer toe quarter will likely be exaggerated by a high medial heel, which will tend to "catch" just prior to landing (and in so doing torque the foot and contribute to ossification of the lateral cartilages and tendon attachments).


Note in the above photo that the line of force through the crack is resulting in a bulge in the hairline. This is because the quarters are buckling because they were not relieved prior to the shoe being applied. Since the crack doesn't originate at the hairline, it's a result of mechanical stress on the hoof rather than trauma to the coronet.

The stresses on the joints will also be increased by a breakover that is too far forward as well. The edge of toe callus is visible in yellow in the solar photo, and that would be closer to where breakover should likely be set (unless the heels are sensitive, which is a likely scenario with heel this contracted). Breakover should eventually be something like this:


...but how quickly this can be achieved is a function of when the back of the foot can be brought into proper function.

>Whatever we say, we know this: the heels have to be made equal, so that the >coffin bone is dead plumb to the ground; and that no attempt must be made to >help' quote-unquote the horse to stand in any particular manner, other than in the >particular manner of standing with its joint surfaces parallel to the earth. And let the >orientation of the toes be, relative to the sagittal plane of the body, where the >joints of the limb say they must be!

Exactly. In a nutshell, the mechanics of movement need to be prioritized over the appearance of stance, which are at opposite ends of the priority spectrum here. The corrections being attempted are at odds with the requirements of movement. A farrier I respect once told me that horses never go lame standing square on concrete, after all.

>So, Adam, you can certainly put your spoke in here specifically as to what you think >should be done in terms of trimming, i.e. the particular steps to take. It will be >helpful to get the horse to the point where he can come out of the support shoes, >because only then are we going to get significant progress on decontracting the >heels. He has currently three good reasons to be lame: one, the contracted heels >which are pinching and inhibiting the ciruclation; two, the ringbone; and three, the >unlevel distal limb joints. We need to create a plan that addresses all three if >possible. -- Dr. Deb

Step 1: buy boots that fit, along with a variety of foam and wedge materials
Step 2: Pull shoes and trim heels to equal length according to the depth of the collateral grooves. Bring breakover to the inside edge of the wall at the toe.
Step 3: Shear heels by hand to see if one bulb can be moved in relation to the other. In a healthy horse, this is not possible by hand, but in a horse looking like this it is likely. Palpate digital cushion to check for development of appropriate fibrocartilage. Check to see if the horse is sensitive to a hoof pick in the frog cleft. Check to see any odour is detectable here, or if white flaky material is present. Treating heels this deep with a one-time dose of non-necrotizing anti fungal soak is rarely wasted, along with a daily topical mixture of 50% Neosporin (or generic) triple antibiotic cream with 50% athlete's foot cream (1% Clotrimazole) . The soaks and creams will also treat anything that's taken up residence in the wall crack as well.
Step 4: Check the horse's stride to see if it's landing heel-first. If so, horse can be turned out later without protection. If landing toe-first, protection for turnout will require hoof casts or boots or no meaningful progress will be made.
Step 5: Rasp breakover on boots back as far as practical.
Step 6: Check stride in boots. If the horse is still landing toe-first, experiment with different pad materials to see if this can be corrected (in rare cases, wedge pads can help).
Over time: Slowly adjust breakover and heel height in alternate trims. Don't overexpose the heels of the horse to force, or it won't matter where breakover is set because the horse will be landing on it's toes anyway. Don't address flare higher up the wall than 1/3 of the total height.

I'm not adverse to working with shoes instead, but it's a much longer process and makes the experimentation phases above far more challenging.

adamsfam
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Posted: Fri Apr 12th, 2013 09:09 pm
Adam, for what it's worth I agree with most of your assessment of this horse's problem. The trimming to collateral groove depth would have served this horse well and I think still can. If a person is trying to "correct" a toed in conformation one would, if anything, want to lower the medial wall/heel. Leaving the horse barefoot with boots would I agree be best so you could tweak things as needed.



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