Feet change in five days

Itsy's feet are changing literally by the day.

Day one...

...day two...

...day five...

Day one...

...day two...

...day five.

The Paddy Puzzle (or When is a back problem really a foot problem?)

Paddy is an ex-racehorse who has been here just over 6 weeks and like most horses who come here, he is making big changes to his feet. That's just as well since he arrived with a diagnosis of being 4-6/10 lame and the lameness blocked to his feet.

However, Paddy was not content to give us one problem and had thrown another one into the mix. 

Now, its not unusual for horses to arrive here with shoulder or back pain - in fact, its more common than not, and its usually related to the pain in the forelimbs. Its something I blogged about in more detail here: http://rockleyfarm.blogspot.co.uk/2011/12/whole-horse.html

If horses have a regular physio or bodyworker who sees them, its typical (and always satisfying!) for me to get a report like this one (from Red's owner recently) once horses go home: "She reckons Red is "a million times better" than when she saw her last time in the front end". 

Its also common for horses to be lacking topline; the top photo is Paddy the day he arrived, and the lower photo is 6 weeks later, so things were improving (although yes, Paddy's asymmetry is very clear!).

However despite being otherwise a good weight, he was still not building as much muscle as he should have been (as you can see in the lower photo); I was concerned that there was something more going on and agreed with his owner to get the vet to take a look. 

At this point I wasn't sure if it was a metabolic issue (like ulcers or a liver problem) but our vet immediately focussed on Paddy's back and this is what we found... 

This is an x-ray of Paddy's spine showing some of the thoracic vertebrae (click on it to enlarge). You can see that the tips of the first few spinous process are eroded and that further along they are fused and deformed. 

The good news is that this is old damage which is no longer painful for Paddy but of course his back does have restricted flexibility which is why he loses muscle so severely when he is not in work and finds it hard to rebuild. 

Its a good example of when a back problem is genuinely a back problem, rather than being related to foot pain and its an even more dramatic illustration of the damage you can do by putting weight on a horse's back at too young an age, as is so common in the racing industry.  

I'm glad to say though that Paddy has the all-clear to carry on with his rehab and I will post a more detailed update on his hooves shortly!

Frogs in a hurry - aka New girl Itsy

New girl Itsy arrived from Yorkshire earlier in the week but after Tuesday's mammoth blog (which surprisingly appears to have been one of the most popular posts I've ever done) its taken me till today to sort out her photos.

She is a smart 6 yr old mare who has had recurrent RF lameness problems since November 2011, according to her vet's helpful report. On MRI she had impar ligament damage and rest, remedial farriery and anti-inflammatory medication has so far not resulted in her returning to consistent work.

The photo above is of her worse foot; certainly the contracted frog and heels on both fronts are something we would want to see improve fairly quickly.

The comparison shots give an interesting clue as to how much the shoe was restricting the palmar hoof.

There is only 24 hours between the shod and unshod photos but look at what has already happened to the frog.

 More on Itsy soon!

What happens when hoof wall "wears away"...

Surely the commonest - and most misunderstood - reason given for horses "needing" shoes is the perceived "protection" that shoes provide. One of the flaws in last week's H&H article was a vet's assertion that "working on roads can wear away the hoof wall" which, according to the author, leads to pain and means that only horses who work on soft surfaces can cope unshod.

The Worshipful Company of Farriers also cites this in support of shoes. When working an unshod horse, according to its website, "you can have problems with grip, excessive wear and damage to the hoof capsule." There is apparently a risk that unshod hooves "may wear a lot quicker than the hoof wall growth can replace itself, thus making potentially sore feet with lack of performance".

Despite the slightly bizarre grammar, the point is clear: both the vet and the WCF have assumed that horses depend on their hoof wall to support the limb and that therefore once a horse has worn away its hoof wall the hooves become sore.  

If you shoe horses, this is a perfectly logical assumption because - after all - a shoe sits round the rim of the hoof. It not only effectively prevents any wear to the hoof wall but ensures that the horse is loading most of its weight onto the hoof wall; in a shoe the sole and frog have very limited load-bearing.

If you are used to a foot loading like this (what Bowker calls "peripheral loading") then you will assume that even out of a shoe it should load the same way - round the edge of the hoof onto the hoof wall.

And, if you simply take a shoe off, then many horses will indeed load this way for a short time and if they are kept on soft surfaces. The horse above was peripherally loading out of shoes and walking on its long hoof wall (there was at least an inch of hoof wall proud of the sole - the sole shot of the same hoof is below). 

Once the level of wear exceeds the level of growth or the horse works on hard surfaces, the hoof wall length will reduce till the horse is no longer walking on a rim but (we hope!) landing heel first and engaging frog, heels and sole.

This is the same foot a short time later, after turn-out on our tracks but no trimming. 

In a really hard-working barefoot horse (like the self-trimming example below) the hoof wall will be almost completely worn away at ground level and there certainly won't be a rim of hoof wall for the horse to load. The frog, heels and sole will be the main areas of loading, not the periphery. 

These - two of my favourite photos - provide a really clear illustration of how differently shod and bare feet load on the same surface. 

The shod hooves load only the periphery and there is no contact with frog or sole...

The bare hoof loads frog and sole and though the hoof wall makes contact with the ground its not bearing the majority of the load.  For me, its clear that the bare hoof is functioning better - but why do I think this?

Not just because - in a healthy hoof - a "lack" of hoof wall won't impair soundness but more importantly because hoof wall isn't designed to support the whole weight of the horse. 

Think about it - hard hoof wall evolved as a protective shell. Anatomically, its a toenail - as this illustration makes clear...

...and horses have hoof wall for the same reason that we have toenails - to protect internal structures from damage. But we don't walk on our toenails and neither do hoofed animals - its the soles of the feet (even though they are apparently softer!) which are designed for that. 

Walking like this - for us or our horses - allows for proprioception, shock absorption and balancing in a way which would be impossible if we were on hard, unyielding nails or hoof wall.

In fact any walker will tell you that if you go hiking with toenails which are too long, so that they come into contact with the end of your boot as you walk downhill, it quickly becomes painful because toenails (like hoof wall) aren't designed to take significant load.

Loading the soles (and in horses' case the frogs too) also means that the surface which is in contact with the ground (the epidermal layer) is capable of growing and thickening in response to stimulus. Another quality that hoof wall doesn't have but which allows the hooves on horses working barefoot to grow faster in response to increased work on abrasive surfaces like roads.

So the next time someone tells you that horses need shoes so their hoof wall doesn't wear away, ask them whether they walk on their toenails or their soles...

Is it me...?

Is it me? I had an email yesterday about a former rehab horse, who had just been seen by his vet for re-assessment.

The horse had been doing well and improving steadily and the vet agreed that his movement was the best he'd seen BUT a few days ago the horse became footy on stony ground. When you know he was enjoying ample turnout, this graph of the recent laminitis risk in the area where he lives gives a clue as to the cause...

Guess what? The huge red spikes in risk profile exactly correspond to when he became footy.

However, the vet, in his infinite wisdom, thought the probable cause of the footiness was working on hard ground - despite the fact that the horse has been working on hard ground for 5 months or more with no increase in footiness. 

So his solution - given that he thinks that the mechanical impact of hard ground has been the problem - is a nice set of metal shoes (well known, naturally, for their fabulous concussion-reducing qualities) and  24/7 turnout on a large, lush field...

Is it any wonder that owners, and me, sometimes wish to give it all up and just keep hamsters instead?

Step in the right direction!

Its definitely a step in the right direction - well I would say that, wouldn't I?! This week's Horse & Hound has a cover story on barefoot and I'm happy to say its a pretty well-balanced article. 

The main section is written by a vet (whose practice has a horse here for rehab, ironically!) and sets out some good background and highlights (for instance) the impact which diet and environment can have on hooves.

I was asked to contribute to the article as our horses have hunted so many seasons without shoes, and its nice to see our piece in there too, along with a photo of Charlie, Bailey and Felix out last season!

Of course I don't agree with everything in the article...(I take a more robust view than the vet about the ability of unshod horses to work on roads, naturally, and unlike him I've not only known many TBs who do brilliantly barefoot but also found that barefoot horses - when fed an appropriate diet - are less prone to abscesses than shod horses)...but on the whole its fantastic to see a sensible article which is evidence-based and has also contains practical advice for owners. 

Well done H&H!

Asymmetry - is the horse doomed?

I was wary of writing this blog post because its a difficult subject, and one where I don't think anyone yet has the answers. However its something I keep coming back to and its a subject where I think discussion, questions and sharing experiences are vital, so here goes...

As most of you know, I think there is a fundamental distinction between symmetry and balance. I see it in feet all the time and if you stick "symmetry" and "balance" into the search box on the right you will come up with an awful lot of previous blog posts!

 A hoof can be asymmetric in appearance BUT still be balanced for the limb. Its common especially in horses who have had previous injuries or lameness and in fact, in these horses a symmetrical foot would actually be less supportive and impair the horse's movement and biomechanics.

So for them, balance can only be achieved at the expense of symmetry - or vice versa, of course.

Again, I've blogged before about the proposition (by an eminent veterinary professor) that "A horse's leg is like a table". I actually don't agree with that, but I found that this photo was a fabulous illustration of how, even if that were true, balance is not necessarily the same as symmetry.

So I was really fascinated to come across this article, which discusses symmetry versus balance in people: 

"People seem to confuse symmetry with balance. Balance is a desirable functional quality, but symmetry is only an appearance. The back of the body can be in perfect balance with the front even though they are completely asymmetrical. Symmetry is not the only path to balance, and perhaps not the optimal one for a given person."

The article is well worth a proper read, but here is an interesting sample:

"Look at this drawing of a vertebrae...not exactly plumb. And yet surely many manual therapists would palpate it, sense it’s a little right of the others, tell the client the vertebrae is “out”; and then start trying to relocate it with various forms of (possibly painful) coercion. 

This is obviously a bad idea. Given that the bones are always a little off here and there, we should completely expect that our bony landmarks, soft tissues, and functions will be at least a little different from side to side. If you could somehow even up just one part of the body but not all the others, you would have local symmetry at the price of global balance. Bad trade."

And this is my big concern about what happens when we require symmetry (as opposed to balance) in horses. Balance is definitely a good objective. Symmetry? I'm not so sure, particularly if we don't know exactly why an asymmetry has arisen.

As is often the case, we are short of research and evidence specific to equines BUT there is a series of  interesting papers from human medicine highlighting the lack of correlation between asymmetry and biomechanical problems:

"My favourite direct evidence — not the best, but my favourite — has always been the simple leg length study published way back in 1984, in the venerable British medical journal Lancet. That paper that showed that leg length differences were unrelated to back pain — no correlation even, let alone a causal relationship."

This is a huge subject, particularly when we are talking about lameness, and its one I am sure I will keep coming back to. In the meantime, I am still on the quest for balance, if not for symmetry :-)