Monday 30 September 2013

FAQs, flares and froth

This is an "admin" post, really, so those of you who've been blog readers for a while or who are familiar with what happens here can pop off, have a cup of tea and come back tomorrow when there will be more interesting stuff to read :-)

However, its a post I'm putting up because our slow-mo footage (the link is here for anyone who hasn't yet seen it) has already reached nearly 7,000 people in the 2 weeks since its been up. Inevitably, a large number of those people live outside the UK, have never been here and have no idea what we do.
This has led to lots of comments online, some of which are educated guesses, some of which are genuine questions and some of which are pure fantasy. The purpose of this blog has always been to provide information and to be as down-to-earth and transparent as possible, so here are the facts as opposed to the froth :-)

Which horses come here

Horses have to have their vet's consent before they come here. The vast majority of horses have been diagnosed with a front limb lameness which blocks to a palmar digital nerve block ("PDNB") - heel pain, essentially. I can only think of 2 exceptions - Wally, whose lameness blocked to the check ligament and Remi who had a complex multi-factorial lameness.
Following a PDNB, horses will have had either x-rays or MRI (x-rays only reveal bone damage but MRI, which is a very much more expensive option, can detect soft tissue injuries as well).

The site of damage is typically the navicular bone and surrounding structures, commonly DDFT, impar and collateral ligaments, sometimes with coffin bone or lateral cartilage damage as well.  Most horses have undergone conventional treatments (remedial farriery, drug therapies etc) before coming here.
Once owner and vet have agreed they want the horse to come here then the horse goes onto our waiting list. Its first come, first served - I don't choose which horses to take and in fact usually the first time I see the horse is when he steps off the lorry or trailer, as horses come here from all over the country.

I don't take horses whose primary lameness is metabolic (eg laminitis) although there have been 3 or 4 horses here who have had PPID diagnoses in addition to their palmar hoof lameness.

What happens once horses are here

Horses who arrive in shoes have them removed and new horses are slowly integrated into the equine group. Usually 2 of my own horses, Charlie and Felix, perform the "meet and greet" function because they can be relied on not to over-react to horses coming off box-rest, to give confidence to nervous horses and to provide boundaries for pushy horses.
Observing how they react to new horses gives me a pretty clear idea, within a few seconds, of the new horse's character!
In most cases, newbies will meet one or two other rehab horses within their first couple of days and will be absorbed into the herd within a week, though there are always exceptions.

So what about the horses in the slow-mo film?

The film was taken at our annual reunion and all but one of the horses had previously had a long term lameness (blocking to a PDNB). One had collateral ligament damage, one had navicular bone damage, 2 had multiple tendon and ligament injuries and bone damage on MRI.

All had had lots of different (and unsuccessful) treatments before coming here and in each case the horse's vet had agreed to them coming here as a "last chance saloon".

Most of them had very poor hooves when they arrived and struggled on anything but the softest surface; its a testament to their owners' hard work and dedication that they now have feet capable of the sort of work you saw in the film.
The surfaces we filmed on were tarmac and a track of rammed hard-core and crushed limestone. We chose these because they are unforgiving but they are also the sorts of surfaces that these horses now cope with regularly and happily, with no ill effects, even though they would have been crippled on the same surfaces when first out of shoes.

Some people have commented that the feet look untidy and have wall deviations but if you look at how the hooves land, most are loading pretty evenly and all are landing heel first - which is not something they were doing when they were lame.
If you look at the whole limb rather than just the hoof you can see that some horses have less than perfect conformation and that the hoof wall deviations are required in order for the hoof to load evenly. Removing the deviation would upset the whole apple cart and would render these horses much less sound.
The horse above, for instance, was made significantly lamer (before she came here) by a trimmer who took off what she thought was medial flare. In fact its a wall deviation which is essential for even loading and correct medio-lateral balance as this horse has an offset knee on her LF, easily visible in the film.

And the whole trimming/not trimming thing?

There is one over-riding principle to rehab here. Horses MUST be kept as sound and as comfortable as possible .

The horses who come here are all more or less lame, have poor biomechanics and are moving badly. Successful rehab has to change all of that. We need horses to grow stronger hooves, start to move more freely and relieve strain on tendons and ligaments.
Correct, comfortable movement is the key. The more comfortable a horse is, the better he will move and if he is moving correctly he will be giving his hooves the stimulus they need to become healthier. 
Given that the horses who come here block to a PDNB, most are landing flat or toe first when they arrive (heel pain prevents a heel first landing, inevitably) and many also have poor medio-lateral balance (landing on one edge of the foot rather than loading evenly).

They have weak feet which are lacking all sorts of important elements - strong frogs, robust heels, dense digital cushions. These are clearly not things you can provide with a trim - they only develop with work and growth.
Normally the only bit of the foot which is "excess" rather than "inadequate" (and which could therefore be trimmed) is the toe, which is often long in these horses.
It may look like a good idea to "back up the toe" (it will certainly make a hoof look prettier) but if you try it you will quickly realise that shortening the toe inevitably increases the load on the heels. Remember the PDNB? These are horses with heel pain, so increasing the load before the heels have strengthened will make them lamer.

One comment I read suggested that the reason I do very little trimming is to avoid making horses sore. Well yes, admittedly I am trying to make them sounder not lamer - that is the objective of rehab - but I rather assumed that this wasn't rocket science and that I was not unique in that respect!

But what about flares...???

Fundamentally, I won't trim unless it is beneficial to the horse. I will take soundness over appearance any day of the week (and so will the horse, more importantly!). If the result of a trim is a pretty hoof but a lamer horse then its a failure and a mistake the trimmer should learn from and not repeat.

In my experience many of the justifications which are given for trimming simply don't stack up.

For instance, flared hoof wall  doesn't "pull away" or damage healthy horn because its simply not strong enough to do that. I've seen horses here time and time again grow in a new, better connected hoof capsule and any old, flared growth simply wears away and has no impact on the new angles.
As for the argument that a horses' hoof capsule should be "corrected" with a trim even if the horse is less sound as a result, that's simply preposterous. 

The hoof's purpose is to support the limb and if you mistakenly remove structure and make it less able to do its job that will hinder, not help the horse. As Steve Leigh would say "How is laming a horse now helping to keep it sounder a few years down the line?"   
This horse, for instance, was meticulously trimmed before she came to us. The hooves look pretty but her conformation hadn't been taken into account, so it was a shame she couldn't load the foot, let alone move comfortably afterwards...
Many people voice concerns about leaving flare or wall deviations because they could adversely affect other areas of the body. In fact, they have a point: flare and deviation are linked to other areas of the body but in my experience what you see in the hoof is more often a symptom than a cause.

Here's a horse, for instance, whose hooves were beautifully symmetrical when she arrived but she had been seriously lame and even though she was a young horse had significant soft tissue and bone damage. 
Here she is 12 weeks later, complete with asymmetric feet - not at all pretty but much, much more supportive for her. 

I had a text yesterday from her owner who says she is now fully sound for the first time in 2 years. Although she is under the care of an excellent hoofcare professional, he knows exactly what she needs and she hasn't been trimmed for 6 months.

In all the cases I've seen where horses have dramatic wall deviations in the hoof you can trace the cause back to another area of the body which is less-than-perfect. It might be an offset knee, it might be a pectoral injury, it might be a hock spavin but there is always a reason and the deviation is there for additional support.
Interestingly (but not surprisingly) the further from the hoof the "problem" is the more dramatic the deviation - presumably because the compensatory forces are greater the further you are from the site of the problem.

And has the horse above suffered because of his deviant feet? No. He was given a 5% chance of returning to soundness in 2007 and has been in full work and sound since he finished his rehab here in 2008. His feet are wacky but serve him very well and he is only one example out of many I could post here.
In fact, as I've blogged before, it really doesn't matter if you can't work out whether something is a flare which can safely be trimmed off or a deviation which is required for support, because the horse will sort it out for you. Flare will quickly wear away whereas a deviation will remain (and will reappear rapidly if trimmed).
So if in doubt, leave well alone, work the horse within his comfort levels and respect what he is telling you about his feet. They may not conform to your idea of a functioning hoof, but if its functioning for him then that's exactly what it is, and its your perceptions which need to change, not his hooves!

Friday 27 September 2013

Friday hoof puzzle...

Here is a Friday puzzle for you...
...5 different chestnut horses...
...all TBs or mostly TBs...
...all with less than perfect feet, apparently... can you tell who is the soundest?...
...and can you tell who would benefit from a good trim?...Go on - dare you - have a guess :-)

Thursday 26 September 2013

Arnold's 3 week update

Arnold has been here just 3 weeks and its time for his update. He arrived just out of shoes following his lameness investigation and was landing toe first in front and flat behind.  
These comparison photos are interesting because from the lateral view it looks as if his palmar hoof isn't really stronger today, but in fact when you look at his foot from the sole its a different story. 

A big difference in frog and heel strength over 3 weeks - especially important where you have a lameness which blocks to the palmar hoof, so this is an encouraging start. 

This is Arnold's lamer foot but its less under-run. Three weeks on there is some good new growth but lots still to do, of course.

This is the foot with the worse medio-lateral balance and its that which will need to change over the next few weeks. 

And here he is with his pals in his new hippy lifestyle!

Wednesday 25 September 2013

Long toes, collapsed heels and what to do...A Dylan update

I don't normally post updates on horses within the first week because usually there aren't enough changes to make it worthwhile. I'm making an exception for Dylan because his feet were rather ugly when he arrived and have already changed.
Although he arrived a week ago I only posted his initial photos yesterday. They generated quite a few comments on Facebook and on HHO and some explanation is due, but its important to realise that Dylan's feet aren't anyone's fault.

His vet was prescribing a recognised remedy for horses with DDFT damage; his farrier was following the prescription and his owner was following the advice of professionals she trusted. Everyone had Dylan's best interests at heart and was doing the best for him that they could at the time. Although his shoes and hooves looked ugly he was sounder than he had been when he was first diagnosed.
So why did his vet and owner (and farrier) decide to try something else? Because they wanted a long term solution and they all knew that wedges don't provide that. The fact that they stuck their necks out and sent him here shows that they were willing to think outside the box and not just do what they had always done - well done them!

A week later his feet are already changing and the fact that he is able to move comfortably is a vital part of this.
On his initial photos he definitely had long toes and under-run heels. Lots of farriers and trimmers would have tried to address the external appearance by radically shortening the toes and his feet would certainly have looked prettier afterwards - but at what cost? 

Looking at this angle you can see that there isn't lots of dead tissue - his whole foot had stretched forward. 
I am sure that Dylan's farrier realised this. Backing up the toe would only have overloaded his very weak frog and heels and would have required an aggressive trim which would have left Dylan very uncomfortable. His farrier was between a rock and a hard place.
As it is, although his feet are still ugly one week on, he is astonishingly comfortable as he stomps round the tracks and up the fields and I am sure that in a few weeks his feet will look a lot healthier. 
Of course its now up to Dylan and us to prove to his owner, vet and farrier that they made the right decision...Watch this space!

Tuesday 24 September 2013

New kids on the block

There was an influx of new horses last week who have all been patiently waiting to appear on the blog. Having been shunted into second place by the slow motion and RRR footage its finally their turn this week...
First up Indy who made a brief appearance at the RRR where his owner and I had a rendez-vous for him to come home with us last Sunday. 
Indy is an eventer who suffered a DDFT tear in his LF and had a year off. Coming back into work he went lame on his RF, which again blocked to the foot and remedial shoes did not improve him. 
On arrival Indy was landing toe first on all four feet but he is an incredibly cheerful soul who likes nothing better than marching round the tracks looking for like-minded horses to play with so I am hoping to see changes in his landing fairly quickly. 
Next up is Dylan, a TB who has come all the way from Kent. On MRI he was diagnosed with navicular bone damage, pedal osteitis, DDFT and impar ligament damage along with a bone bruise to his LF, the lamest foot. 
 As his lameness has not responded to rest or remedial shoeing Dylan's vet agreed to refer him here. When he arrived he was - as you can see - shod with wedged pads (though he is not to be confused with the first Dillon who came here for rehab, who became known to all and sundry as "Dillon with the wedges"...!).
 The pads effectively completely covered his frog and sole but the central sulcus split he has in both front feet is a sign that all is not well.
 Once the shoes were off these were the rather smelly and contracted feet which met us...
Lots of work to do there, Dylan, but despite all this he has been moving about remarkably comfortably over his first few days and there's no doubt his feet will look very different by the time of his first  update.
Last but not least another eventer - also grey, also Irish but considerably daintier than Indy, her name is Isla.
Isla also has a history of recurrent lameness which blocks to the palmar hoof and which has not responded to rest and treatment. Isla's shoes came off 2 months ago and my first thought when I saw them was that they looked suspiciously symmetrical from the top, though the sole and palmar shots tell a different story.
 They look neat but she is also landing toe first and has a medio-lateral imbalance (worse on the LF) where she lands laterally.
There will be more on all of them soon, of course.