ESI Q and A Forums Home
 Search       Members   Calendar   Help   Home 
Search by username
Not logged in - Login | Register 

Navicular Issues
 Moderated by: DrDeb  
 New Topic   Reply   Print 
AuthorPost
Alex
Member
 

Joined: Mon Jul 2nd, 2007
Location:  
Posts: 27
Status:  Offline
 Posted: Sun Jul 12th, 2009 04:04 am
 Quote  Reply 
Hi Deb,

I finally find myself with a Sunday in front of the pc and enough time since I last saw you to tell you how things are going with Arwen.

Since we saw you in April we have had xrays of both her stifles and front feet.

The good news is that the stifles were clear of any issues on x ray and a visit by a veterinary chiro (recommended by Liz Sugar) very quickly stopped her stifles locking. This has had a good overall effect on how lame she appears and has eliminated the sudden waddling lameness that she had at times.

The front feet were a different story. The vet describes a spur like lesion on the caudal aspect of the navicular and mild evidence of arthritis on the middle phalanx in the right fore. In the left fore there is osteoarthritic changes in the proximal interphalangeal joint. In both navicular bones there is "poor distinction between the cortical and medullary bone, indicative of degenerative change" with the left being less severe than the right. There is no evidence of laminitis or pedal osteitis in either foot.

Since we had the xrays done I have taken myself off to several hoof trimming clinics with some of your students from the Melbourne dissection clinics. I found their clinic very helpful and part of the clinic was to film our horses in slow motion. For Arwen this showed a marked prevalence for toe first landing with her front feet. We filmed her in boots and this started her on heel first landing. I found it very helpful to view the cadaver legs they had and to see the difference in the movement of the joint between a simulated toe first landing and a heel first landing.

Our plan of attack with all of this has been:

Shorter toes, boots with pads for 12 hours of the day. Since we have started this plan of attack she has had some increased frog growth and decreased heel pain. She is able to trot far more comfortably in boots in the paddock and when ponied and the rhythm of her footfalls is almost correct. (She has been doing a running walk previously with a 1, 2 - 3, 4 kind of a sound). If unbooted she is slightly worse at a trot but still an improvement from where we were months ago.

Yesterday I had my second only ride since I saw you she walks fine straight forward and to the left but as soon as you ask her to turn right she limps. I find this odd because when she is walking forward she feels relatively even (that is she seems to be weighting her feet fairly evenly) but it is like as soon as you open the rein and connect it down to that right foot and ask for the weight to go over into it for the turn it hurts, sharply. I know this is a bit esoteric a description but I think you will understand!

I have attached one of the views of the x rays of each foot. I have the full suite if you would like to see more.

Do you have any other suggestions for how Arwen might continue to improve?

All the best,

Alex

Attachment: Arwen0012.jpg (Downloaded 284 times)

Alex
Member
 

Joined: Mon Jul 2nd, 2007
Location:  
Posts: 27
Status:  Offline
 Posted: Sun Jul 12th, 2009 04:05 am
 Quote  Reply 
The view of the right foot seems not to have attached.......

Attachment: Arwen0007.jpg (Downloaded 288 times)

DrDeb
Super Moderator
 

Joined: Fri Mar 30th, 2007
Location:  
Posts: 3316
Status:  Offline
 Posted: Tue Jul 14th, 2009 07:13 am
 Quote  Reply 
Alex, I'll tell you what, this is a great example of how a set of X-rays can set everybody straight. As you recall, I was advising you that Arwen was likely laminitic, this based on the fact that she is obviously sore on her feet -- so much so that all her gaits are wierd and with reluctance to move with any 'bounce'; on eyeballing and palpating the hoof walls, looking at the contracted appearance of her feet; and the fact that she is pretty fat and also of a breed that is prone to be cresty and prone to run to fat.

All of these things are good evidence of a horse that is founder-prone. But the veterinarian's diagnosis is otherwise; she says navicular, and now that I see the X-rays it is plain that Arwen isn't rotated or sunk at all. And this is a relief, even if we have to trade it for the navicular.

I think now that what you're going to get is a good resolution. The arthritic changes will retreat now that you've got the toe-striking under control, for it is the toe-striking that is causing those. Navicular disease sometimes does not fully resolve; it depends upon how far along the horse is with it before treatment is started. So all we can do there is go ahead and treat her and then re-X-ray every few months and keep monitoring how sore she is of course.

As to why she's sore when she turns, there are two possibilities -- one is that this is related to the spurring and/or erosions on the navicular bone of the right fore being worse on the lateral side, so that in other words, the pain is coming from the navicular area and/or the tendon of the deep digital flexor muscle that overpasses it.

The other possibility is that she has "pushups" in the quarters. To detect this, you look at the line of the coronet band directly from the side -- put your eyeball or your camera lens right down at the level of the ground and take some photos of the lateral sides of both forefeet. If you see that the coronet band has a markedly arched shape, you have pushups.

Sometimes, as in Arwen's case, the arch of the pushup is made more prominent also by the fact that the heels are run-under -- actually not so much "run under" as that the buttresses are displaced forward. To detect this, pick up the foot and look at the bars -- are the bars warped, so that the edge of the bar has a "curly" shape? An ideal bar would be perfectly straight.

As your farrier works with reference to the X-rays and in a team attitude with you and your veterinarian, he will be working to move the buttresses back. This will take at least one year, but if you consistently go after keeping the heels moved back -- as well as shortening the toe -- not only will the "run under" or too-horizontal appearance of the heel tubules gradually improve, you will also see that this has the effect of causing the horse to widen its own heels. This, in turn, will greatly help to alleviate the navicular pain -- the narrower or more "contracted" the heels are, the more the hoof capsule acts to pinch all the underlying structures.

You do also, however, need to encourage your farrier to rasp out the quarters. Most farriers are trained to plane the foot (particularly if the trim is to be followed by a shoe or other orthotic appliance). However, if you notice flares in the quarters, or that the hoof walls seem to want to separate from the sole in the quarters, or if you see pushups, then the horse is telling you that he is growing more hoof in the quarters than he can wear off or break off, and he is asking you to help him. So what you do is you rasp out the quarters, leaving him to stand primarily on the frog, sole, and the four higher-density points of the hoof capsule, which are the two pillars and the two buttresses. But you take all the pressure off of the toe (between the pillars), and you take all the pressure off of the quarters (between the pillar and the buttress on each side).

Now when you do this, what you will likely find is that the horse almost "hyper-erupts" wall. In other words, you will rasp the toe back so that you rocker it up out of contact with the ground, and you rasp the quarters up also; and if you do this on a Monday, by Thursday you pick up the foot and you will see he needs to be rasped again, because the bloomin' thing has "let down" all around! This is the very measure of how "stuffed up" the hoof capsule has become -- it has, in essence, been "growing backwards" -- actually the growth has been "reflecting" upwards -- for perhaps a year or more, and you are thus going to be trimming off two years' worth of hoof in the space of a single year. If you can keep up with this, never doing more than the horse actually needs, but always doing enough so that his quarters and the toe are continually relieved, you will find Arwen getting sound.

I am currently dealing with Ollie wanting to spit quite a bit of wall down. He too has been sore off and on this past month, sometimes too sore to be ridden. I have foam-bootied him and learned from that temporary experiment that an hour of foam booties doesn't mean that much to him but two weeks of it certainly does. It's a total pain in the butt to have to put the duct tape on every day (because he wears it off pretty fast), and about every three or four days you have to totally rebuild the bootie, because he just shreds 'em. However, the way he moves the foam disks and the way he squashes them tells you volumes about where he wants that padding to be.

I've been using one inch thick, very high-density, very durable type of foam. This stuff is so thick that for up to two days when he's taped up, he has no contact at all between the hoof wall and the ground. And what I learned from this is, every time you go to rebuild the bootie -- so you are taking the old bootie off entirely -- then when he's standing there waiting for his new booties to be put on, you might as well have your rasp handy, because there's going to be some work for that rasp at that time.

This certainly makes me appreciate the work my farrier goes to, and all farriers; it's a pretty sweaty job holding those feet up and working that rasp. One thing that makes it much easier is that I can have Ollie stand up on his circus drum while I work on him. In the first place, he's higher up so I don't have to bend over very far, and I don't have to put his foot between my knees. And, it's easy to get him to put his foot down anywhere on the drum, so when it's time to rasp the toe then I have him put his foot right at the front edge of the drum, so that the toe hangs over, and that makes rasping down on it very easy. So if you haven't gotten Matt to build you a drum yet, now's the time, and a great reason for you to work on making that the happiest and calmest place in the world for her, so that it gets to where no matter what you need to do with her, so long as she can stand on that drum while you're doing it, it's cool with her. Mighty handy for giving shots too, by the way.

Not to digress, though -- back to Ollie's booties. So after booty-ing him and seeing what relief that provided, but also as I said it's a lot of work to keep doing it and a pain in the butt (not to mention expensive: good duct tape is $11 per roll up here these days), I decided to phone Gene Ovnicek and ask him if he knew of anything I could put on there that would work similar to the foam but that could be applied either with nails or glue and be durable enough to stay on for at least a month at a time. And what we settled on for a first go is a product invented by a vet in Texas that is called 'clogs'. They are made of tough, but moderately soft, green plastic that is shaped like the foam pads, i.e. it applies pressure to the sole and frog but not very much to the walls. Nailed on, they'll stay as well as shoes. They are not only good for the chronically laminitic horse or the "sinker", but they also relieve the soreness that you get in the coronet over the quarters in the horse that has chronic pushups, so that they quit limping or wincing when you turn the horse to one direction or the other. So, I'm going over tomorrow to pick up the package -- it came in while I was out of town this weekend -- and then we'll be putting those on, and I will let you know how that works for Ollie. It may be that this could help Arwen, also, and your vet will want to know about it.

Meanwhile, I'd love it if you get a little time to go take some photos of her feet to go with the X-rays you have already provided. Those are beautiful X-rays too, by the way, extremely clear; my compliments to the vet or technician who took them. Thanks for sharing the update with us, Alex, and I'm happy to know that you now have a diagnosis and a treatment plan. Cheers -- Dr. Deb

AdamTill
Member
 

Joined: Tue Mar 27th, 2007
Location: Calgary, Alberta Canada
Posts: 289
Status:  Offline
 Posted: Tue Jul 14th, 2009 03:15 pm
 Quote  Reply 
Coffee break markup:



Will write more later, but for now, pls. note 20% greater distal decent on right. All measurements are relative, not absolute.

AdamTill
Member
 

Joined: Tue Mar 27th, 2007
Location: Calgary, Alberta Canada
Posts: 289
Status:  Offline
 Posted: Tue Jul 14th, 2009 05:23 pm
 Quote  Reply 
Quick lunch thoughts (just an opinion):

-sorry, when I said "on the right" above I meant the photo...which is inevitably of the LEFT foot.

-top blue line shows the relative line at the "extensor process", so to speak, of the proximal joint. Note that these are roughly aligned, but that the distal joint (marked by the lower blue line) is not aligned (left coffin bone sitting lower in the capsule). That says to me that the horse was standing properly for the rads, but that there is some compensation and/or imbalance between the legs.

-note difference in breakover between the two feet. The left needs the breakover brought back towards the tip of the bone more, but both feet could do with it being at least brought to the intersection of the light blue line and the ground (further still, by NB guidelines, but easy goes it at first).

Questions

In a turn is the limp when she weights the right foot, or when she pushes off with the left?

Is there an attempt being made to "correct" the pastern alignment by leaving more heel on the left foot? (If so, please stop...trust me).

I don't see the shadowing in the proximal joint on the left? Is it in another view?

Comments:

Would be great to see some photos.

Also, to make these more useful for the farrier/trimmer, please get the vet to mark the frog tip with a tack, and mark the hairline with a radio-opaque marker of known length. Then the breakover and distal decent can be measured on the foot and rads with precision. As it stands, you can't do that with perfect accuracy with these rads.

Finally, forgive me if you already know this, but one of the bigger ahas that I took away from the 2003 Orthopedics disc was the realization of what the "bone spurs" are in a lot of hoof rads...namely, the ossification of a tendon attachment. The hoof is saying that it needs a "stronger" attachement at the insertion of the tendon because the forces are unnaturally high there, and thus the change from cartilage to bone. That's why fixing the flow of force through the limb will halt the degeneration, and sometimes lead to some reversal.

Cheers,

Adam

Indy
Member
 

Joined: Mon Aug 4th, 2008
Location: Pennsylvania USA
Posts: 145
Status:  Offline
 Posted: Wed Jul 15th, 2009 12:49 pm
 Quote  Reply 
Adam,
Thank you once again for providing the lines and an explanations. It is so helpful.
Clara

Alex
Member
 

Joined: Mon Jul 2nd, 2007
Location:  
Posts: 27
Status:  Offline
 Posted: Sat Jul 18th, 2009 03:27 am
 Quote  Reply 
Dear Deb,

Thank you for your reply. It has given me some more helpful things to think about.

With the two options regarding her lameness to the right, we can rule out pushups. I have my trimmer doing her feet every 5 - 6 weeks now and I do them 2 -3 weeks in the interim. We are both taking out the quarters and taking back the toe.

I chuckle to myself about asking Matt to build me a circus drum as I have had one on the 'shopping list' for quite a while now. The thing I have bumped up the list is a farriers stand. Gosh this trimming stuff is athletic!

As far as our boots go we have got an older style which allows you to insert different sorts of padding. Currently we have some dome shaped pads in there.

Adam, thank you for marking up the x rays and all you input.

Some answers to Adam's questions:

In a turn is the limp when she weights the right foot, or when she pushes off with the left?

I will have to look at this further, my "feeling" is that it is when she is pushing off from the right but I will investigate further.

Is there an attempt being made to "correct" the pastern alignment by leaving more heel on the left foot? (If so, please stop...trust me).

No, this is not something we have discussed. We did discuss bringing the heel down at one stage but they have been left roughly the way they were at x ray with the emphasis being on taking more off the toe and doing regular trimmings. She seems to really hate walking on any wall what so ever so for a long time now (at least 6 months) she has been trimmed every 3 weeks.

I don't see the shadowing in the proximal joint on the left? Is it in another view?

When the vet is saying the "proximal interphalangeal joint" I can interpret proximal meaning closest to the body (as opposed to distal, further away), interphalangeal meaning between the phalanges (fingers) but I am struggling to work out whether he means the joint between the cannon and the 1st phallanx or the first and second phallanx.

I will get some photos of her feet soon. Besides the side on view I am going to try and show the difference between the right and left feet from the bottom. We can certainly use them to think about the Woody paper. I just hope I can get a photo that shows what I mean. When you clean her feet out there is so much more depth in the foot either side of the frog compared to the other foot. We really do have a foot that doesn't like to bear weight.

More information soon......

Cheers,

Alex

DrDeb
Super Moderator
 

Joined: Fri Mar 30th, 2007
Location:  
Posts: 3316
Status:  Offline
 Posted: Sat Jul 18th, 2009 07:04 am
 Quote  Reply 
Alex, I think what Adam is (tactfully) asking is why is the left foot steeper, and its heels higher, than the right. You have answered this by saying 'we have one foot that really doesn't like to bear weight.' AT SOME POINT -- not necessarily immediately, but it should be in your sights -- you will need to work toward getting the feet to be a pair. You do this by 'encouraging' rather than 'forcing', which is also what Adam is implying. And you understand this, and I know you do, because you say, 'we will have to see what this means in terms of the Woody paper.' Right. So as we discovered in our last riding session, the little mare isn't really broke -- she just tolerates a rider.

You mentioned in your last going down to Andy Bowes' place to be instructed on trimming. Yes, I did do an event there at the very end of my cycle through Oz this last time, and my impression is that Andy is both very sincere and quite skillful. So I am sure that he instructed you well. What I want to mention though, even more importantly, one of the people I met at Andy's place, a man who came there to be a student, was Wayne Anderson. If you will EMail me privately, I will give you Wayne's contact details, and I want you to take your mare to him to get started. Wayne proved himself at that seminar to be a Friend of the Institute and I have heard, and seen, absolutely nothing but good work from him. He was at the seminar (a) to meet me, because he knows I have been with Ray Hunt and our elderly teacher for years; and (b) because he shoes horses and wanted the anatomy knowledge. Wayne sponsors Buck in Australia. You will come out of there with a horse to be proud of -- and one that you can then (and only then) go on to make straight.

All your trimming process sounds good. As I mentioned before, don't be surprised if the horse spits a good deal of horn....it is all going to want to come down, so you are certainly doing right to trim it off rather than hope that substrate and work will cause it to break or wear off (because as we all know, that isn't likely to happen).

So get Matt on that drum project pretty quick....you'll both enjoy it, as Matt is a pretty good trailer-loader himself and he will be quite amused, I think, by how readily and meekly horses take to the drum. You start them on the drum, and then transfer it to the trailer....it won't take Matt ten seconds to see how this is going to make his life better.

All best wishes to you both -- Dr. Deb

 


 Current time is 04:31 pm




Powered by WowBB 1.7 - Copyright © 2003-2006 Aycan Gulez