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Foundered Case Study with PPID and IR Complications

2/16/2022

This the front right hoof from the medial side

I had spoken on the phone to the owner of this horse prior to arriving and I was prepared to deal with a foundered horse, but I wasn't aware of the severity.

This horse has been under veterinary care and was seen by the farrier every 4 weeks for the last few months. There are also underlying PPID and IR issues.
This horse has been very lame for the last year.

front left hoof

front right hoof

The only radiographs I had to work with were from 6 months previous. They show significant sinking and rotation, but I suspect the damage is even worse judging by the current state of the hooves. Current radiographs would be extremely helpful, but in this case they are not available.

While this trim seems fairly drastic, I am sure I could have done more if I had current x-rays. This was a step in the right direction to restore function and set up the new growth for coming in. The owner purchased Easyboot Clouds to keep this horse comfortable moving forward and we plan to trim every 3 weeks to start.

In the pictures above you can see the huge lamellar wedge. There is so much separation in this hoof wall. I also tried not to touch the sole at all, what I did trim on the bottom was the overlaid bars and overgrown frog. I also tried to lower the heels to realign the bottom of the coffin bone. This horse has very thick bone, and will naturally have a slightly longer heel then the average 1.25 inches because of that.

From a metabolic standpoint this horse is on low sugar hay in slow feed nets placed around her paddock to increase movement, I also suggested adding biotin to her diet to help with hoof growth, and rechecking her ACTH levels to make sure her Pergolide dosage for her PPID is effective.

I will update this case study with more picutres next time I see her.

March 1 2022 Trim and update

Since the last trim the owner reports that she is moving better, though still sore. She wears the Easyboot Clouds 24/7 right now. This trim I really worked on bringing the heels down a bit more and removing some more of the large wedge from the top. Because the heels were so overgrown the frog was also overgrown, but at the first trim it was very hard and I didn’t want to remove too much. This trim the frogs were very crumbly and I trimmed them down until all the rotten material was gone. I didn’t trim any sole, but I did trim down some overlaid bar off the sole. The bar was also quite crumbly. This is still a huge work in progress and I will see her again in another three weeks and reassess.

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Contracted Tendons, Club foot, Crenas Oh my!

2/6/2022

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I got a lot of interesting comments when I posted this picture on social media the other day. I thought I would take a minute to explain this horse's situation and how I handle it.

This horse has bi-lateral contracted tendons, which means both DDFT's on his front legs are short, and also has a club foot on his front right, and a suspensory injury on that front right. This poor horse just has the deck stacked against him.

Dealing with the contracted tendons is tricky. It's important to perform the "stretch test" to determine his ability to extend the DDFT's before deciding how much to lower his heels. The stretch test is when I extend his leg forward and straighten the the knee, and then fully extend the fetlock and pastern. Through this we can measure the horse's range of motion and comfort level. It's important to do this a couple of times and form an assessment based on multiple attempts. Assuming he has a good range of motion and can extend the leg I can then decide to lower the heels based on his extension capabilities. I also use this stretch to help determine heel height on club hooves.

Performaing the stretch test, in this case we could straighten the knee and extend the fetlock. The last step is to fully extend the pastern but tipping the toe up toward the sky. I do this very gently, allowing the horse to pull away at any moment if the stretch become too much.

This is just one thought process I use when determining heel height, I also need to assess the hoof itself, including the pastern angle and the frog health, sole depth etc.

From the bottom of the hoof I want the heels to ideally be in line with the collateral groove exits, the frog height and sitting just a little bit above sole level.

This horse grows hardly any toe, and due to the contracted tendons and club foot the dorsal angle of the coffin bone is quite steep. This leads me to suspect possible coffin bone rim edge damage, due to the fact the coffin bone is perpetually on it's tip. He also has a small crena in the sole at the toe further leading me to this conclusion. A crena is a little dip in the sole, caused by a missing piece of coffin bone, which in turn means there is a missing piece of the solar corium that grows the sole. This results in a tiny divot in the sole, usually right where the tip of the coffin bone would be.

You can see here the slight divot in the center at the toe immediately behind the golden line. The golden line dips down and in this picture there is a bit of dirt stuck into the recessed golden line.

So what's my plan? Generally speaking he has good flexibility in the leg so I can lower the heels about a 1/4 inch at each trim. This leaves them sitting about a 1/4 inch above the height of the sole. In a perfect world I'd like to trim him every two weeks and lower them and 1/8 of an inch at a time instead. I rarely trim the toe other then applying a bevel from the golden line outward, and I usually have a bit of frog to trim and clean up. Thankfully he grows very nice upright and manageable bar so trimming it is easy. I just ramp it down from the heel following the natural concavity of the hoof.

I usually apply a bevel to the heels anytime I have to leave them higher then I would like to. This can also be called a "rocker".

A "rocker" allows the heel to float just a tiny bit off the ground while the rest of the hoof is weighted.

With a rocker applied, during motion the horse must extend his stride and flex the tendon just a little bit more in order to land heel first. You must be very careful with this that you don't ask them to extend any farther then they can comfortably handle. If you trim your heels too low or apply too much rocker you could cause them to land toe first to alleviate the discomfort, and/or risk injury. My aim to to ask for an 1/8 of an inch, and over time keep bringing that heel down until it is at a normal level. This of course is the plan, but it is sometimes a work in progress throughout the entire lifespan of the horse.

Adding to this complicated case is the suspensory injury this horse has. He has an old fractured split bone and as the lower branch of the medial suspensory ligament moves across it becomes torn and jagged. This has lead to an abundance of scar tissue forming, creating less flexibly and range of motion and frequent bouts of lameness as the inflammation flares up. This pertains to my job aligning the hoof as I don't want to further aggravate the injury, so I am forced to trim very conservatively until the owner and vet decide on a course of action for this reoccurring issue.