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The Veterinarian-Farrier-Horse Owner Triangle


2013/07/03

By Nancy Brannon, Ph.D., with consultation from Jennifer Dunlap, DVM

A good working relationship among the horse owner, your farrier and your veterinarian is essential for your horse’s good health, especially when it comes to hoof-related issues. The specialized expertise of the veterinarian and the farrier should work hand in glove to resolve any health or injury issues your horse may have. Then the horse owner’s role is to follow-up with daily care, implementing the process to bring your horse to full recovery and return to performance.

“It is important for horse owners to know that 90% of front limb lameness occurs in the foot,” Dr. Dunlap explained. “Skilled veterinarians can work closely with farriers in a ‘sports medicine’ approach to keep the horse sound and performing well.”

A benefit of the digital age is that the veterinarian can take digital X-rays of the horse’s limb or foot, and email them to the farrier to show the farrier exactly what’s going on inside the horse’s foot. “This is extremely helpful to both for determining what the best shoeing solution for the horse is,” Dunlap said.

“This is especially important if you’re dealing with laminitis,” she continued. “With the X-rays, the farrier can see how much sole he has to work with and how much rotation there is, or worse, how much sinking is going on.”

In an example case, Dr. Dunlap was working with farrier Daniel Bishop on a horse. Dr. Dunlap did a short-acting nerve block on the horse’s hooves so that he could more comfortably be shod by Bishop.

“One area where the veterinarian-farrier partnership is crucial is dealing with keratomas,” Dunlap continued. A keratoma is a rare benign tumor of the inner layer of keratin-producing epidermal hoof wall cells which forms inside a horse’s foot. As the tumor slowly grows, it expands and separates the hoof wall laminae, causing pain and lameness.2 “These arise from keratinized tissue in the hoof hard tissue, also called the horn in the hoof. Often horses present with chronic abscesses in a single location in the foot. If you dig the abscess out, you may see some discolored tissue. With a radiograph of the area, you may see a ‘thumbprint lesion.’ Here a thumbprint sized area has been notched out of the coffin bone due to pressure necrosis – i.e., the little tumor has put pressure on the bone. In the digital X-ray, that thumbprint lesion is a classic indicator of keratoma.

“Then, working with a skilled farrier, the veterinarian can sedate the horse, do a short-acting nerve block the hoof, and the veterinarian and farrier work together to remove the tumor from the hoof. Usually after removal, the farrier puts a bar shoe on the hoof to support it. The area where the tumor was removed is packed with antibiotic paste, or medicinal grade sterile maggots if the damage is severe.” Yes, maggots! Not any old maggots will do! These are medicinal grade maggots that are produced in laboratories, special ordered, with particular requirements for handling and disposal. Professional use only! Restrictions do apply!

“The maggots eat the diseased tissue,” Dunlap explained, “so as to not destabilize the hoof capsule and you don’t have to take out more horn. The area is wrapped with plastic, e.g., saran wrap, and heavily bandaged. The maggots are left in seven (7) days; then the veterinarian unwraps and checks the wound. After seven days, the original maggots have done all the work they can do. Take out the maggots, dispose of them properly, clean the area, and then start treating it as a wound with antibiotic paste and bandaging. If the area has not been cleaned up enough by the maggots, then the veterinarian puts in a second group of maggots, wraps the hoof in plastic – an air-tight seal for the maggots to do their job, and applies another clean top bandage. When all the tumor has been removed by the maggots, you want to have a nice clean wound, treat it, and then it can start to form nice new horn. At this point, the wound can be left open and treated with something like thrush buster, and the bar shoe is left on until the hoof is completely grown out.

“Another area where the veterinarian-farrier partnership works well is with massive traumatic injury to the hoof wall, a large laceration to the bulbs of the heel, or part of the hoof has been cut off. In such cases, the foot is encased in a fiberglass cast and the farrier puts a bar shoe on the hoof to give an area for the hoof to grow to. These can be difficult to treat because there can be three (3) centers of growth: (1) normal hoof on one side of the injury; (2) the injured area grows at a different rate; (3) the other side of the injury grow at yet a different rate. If you don’t have the hoof contained in a cast with a shoe, the horse will have chronic lameness, a weak hoof that is not normal, and this can lead to coffin joint arthritis. Sometimes in these cases, a bottlecap shoe is used. That is a shoe with clips all the way around. The fiberglass cast is put on over the hoof once the shoe has been beveled on the edges. The veterinarian will also use antibiotics, anti-inflammatory medication, and recommend stall rest.”

In general, Dr. Dunlap advises that it is critical that the veterinarian, farrier, and owner all work together to have a successful outcome, whatever the injury or issue. “Treat early and correctly!” she says.
For further reading:

1“Equine Keratoma,” Journal of Veterinary Diagnostic Investigation http://vdi.sagepub.com/content/4/1/99.full.pdf
2“Keratoma,” Keenan McAlister Equine http://www.keenanmcalister.com/sites/site-3575/documents/KeratomaAlpha.pdf

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