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!


amandap said...

Well of course I had to read this blog. lol

Great round up of your philosophy and practice.
Letting go of what we have been taught, told, read or even our interpretation/rationalisation can be hard but its so liberating!

The focus on how a hoof looks as opposed to how the whole horse functions is endemic it seems.

We humans like order and method and of course our theories but so much effort goes into arguing who is right! Imagine where we and horses would be if that effort was put into observing and learning what horses need to stay and become healthy.

Nic Barker said...

Oh, I am so with you on this Amanda. We just can't resist fiddling and thinking we know best, often without any basis for our beliefs at all!

Molly's hoof blog said...

could not agree more. My horse is an example of the Paint, the coronary band is not straight when looking from the front, yet, she moves best and sure footed with such a foot. All my farriers made it look straight, causing her to only load her lateral toe first, and not the palmar foot.

Nic Barker said...

Interesting, Molly - thanks for the comment :-)

Anonymous said...

Thank you for the very clear explanations - if it's OK with you I'd like to link on my blog.

cptrayes said...

But how can anyone believe that it's right to lame a sound horse with a trim?

That beggars belief!!


Nic Barker said...

Kate, you are more than welcome and glad it was useful.

C, I'm with you but you hear people justifying it all the time - I know of 2 horses which have been lamed by "qualified" trimmers in the last week alone. BTW, like your description of trimming Ace :-)

NicoleJ said...

The work you guys do absolutely fascinates me, and also makes me feel completely inadequate as a trimmer LOL. I live on Vancouver Island, where 80% of the year the ground is soft and wet. Most horses don't get enough movement, and especially not on surfaces that wear or strengthen the hoof to any degree. More people are starting to put types of gravel down in certain areas the horses live which can make dramatic improvements in the hooves, but in general you have to trim every 5-6 weeks to avoid excess hoof wall that then cracks and gets nasty thrush infections or large chips occur, or in some cases horses just end up with extremely long heels and toes. Dietary issues always throw curve balls in as well... but for the horses that get a good diet, and have a generally strong hoof wall, it can be really hard to determine how much hoof wall actually needs to come off vs what simply "looks" right. How much of the wall is there simply due to lack of wear? How much is there because the horse needs it for balance? Would love to stick them all on a track system like yours and see what the feet want to do...

BruceA said...

Brilliant blog post Nic.

I'm a simple bloke. I've been unhappy for a long time about trimmers reducing the support base of the horse by rasping away at the ground bearing wall - if pressure = force/area then does it really make much sense to reduce the ground bearing area?

A few years back I made my own horse unsound by trimming away a deviation in a hind foot - it was that experience that made me start questioning why that deviation should appear and disappear as he was less or more comfortable with his spavins, and do so very quickly.

Nic Barker said...

LOL Nicole - 95% of the year its soft and wet here too :-) Tough if horses are simply pasture ornaments, I would agree, but on most working horses it pays to experiment, as Bruce has described :-)

Unknown said...

I always say pretty is as pretty does and this is so true for hooves. You can have carppy looking hooves that are perfectly sound and perfectly looking hooves that are very lame...few take the time to closely observe how hooves are loaded. Hoof form always responds to load from above, always! I wholeheartedly agree with everything are my observations on the subject of hoof flares :-)

BruceA said...

Problem is that there is a terrible expectation on vets and trimmers to "do something" and as long as that expectation persists, ineffective and possibly damaging trimming and shoeing will be done with the very best of intentions.

The 1 year insurance vet cover also serves to drive a behaviour of trying the expensive and invasive treatments first. As Nic said before, no one makes much revenue out of "take the shoes off, feed them right, work them on a good surface, let their feet naturally balance out"

P.S. I can say that last paragraph because that's what I did :Shame:. Then I fell in with a bad crowd...

Val said...

You made an excellent point about flare vs. deviation and the fact that one will wear away while the other persistently returns. I think this is extremely important for trimmers to realize and put into practice.

ridethetrail said...

I too found the point about flare vs deviation to be an eye-opener. I have a long-term barefoot horse who has needed boots on all but the best surfaces--until I stopped trimming. She persistently wears the lateral wall at the toe more than the medial. 'Just even that out' is the advice I get, 'otherwise she will be loading the limb unevenly and may go lame.'
But if I interpret your comment correctly, she may actually need that asymmetry?
I have to say that I am terribly excited that my ouchy horse can now trot over gravel--even if her feet look weird!