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Equine Lameness Seminar
In photo of 2 people: (left) Certified farrier Daniel Bishop and (right) Equine Veterinarian Jennifer Dunlap, DVM
Equine Veterinarian Jennifer Dunlap and Certified Farrier Daniel Bishop teamed up to inform horse owners about the number one cause of poor performance – lameness. The spring seminar, “Lameness Therapy from the Veterinary and Farrier Perspectives,” was held May 13, 2014 in the Ed Jones Amphitheater at Agricenter International. They described a variety of lameness topics – causes and solutions – and demonstrated how the veterinarian and farrier can work together to bring soundness back to the horse.
Dunlap began by debunking the myth that farriers and veterinarians have “turf wars.” In today’s sports medicine world, maintaining good health for our horses requires a team management approach: the owner, the veterinarian, and the farrier must all consult and cooperate to gain the best results. Each has an important role and responsibilities.
Since the horse owner spends the most time with the horse, the owner is the first to notice when something is “not quite right.” Just the simple task of picking out the hooves regularly can prevent some lameness problems. Palpate the limbs daily to notice any changes in swelling or “heat” in the legs. Performance horses need appropriate conditioning for their activity. Pay attention to the footing where you are riding and, by all means, do not ride the horse to the point of fatigue.
The owner should schedule regular visits with the farrier for appropriate trimming and/or shoeing, and regular visits with the veterinarian for check-ups, vaccinations, and other health care needs.
Lameness is “any abnormality in gait,” Dunlap explained, as Bishop added, “Everything starts with the foot; 90% of forelimb lameness is in the hoof.” There are grades of lameness on a scale of 1 to 5, with one being “something not quite right” to 5 being non-weight-bearing.
The lameness exam from the farrier’s perspective begins with hoof testers and follows by watching the horse go straight away, being longed and/or being ridden. The veterinarian will add to this palpating the limbs and flexing the limbs to put slight pressure on the joints to see if this is where the lameness occurs. The goal is to find out what is triggering the lameness.
After generally defining the three-way team approach to soundness management and lameness diagnostics, Dunlap and Bishop then “tag-teamed” descriptions, diagnoses, and treatment approaches for several specific lameness problems. For any health problems, the veterinarian’s role is diagnosis and developing a treatment plan, which the farrier and the owner implement. The veterinarian has several diagnostic instruments available for lameness exams, including X-ray, Ultrasound, MRI, and a bone scan.
Just as with new babies, new foals need “well-baby” check-ups: at birth, at 14 days old, then continuing at regular intervals to make sure there are no growth problems. An important potential problem is angular limb deformity. Foal limb deformities can arise from foals growing too fast, dysmature foals, or from injury. “We almost never see deformities in Arabians,” Dunlap commented.
One of the most disturbing is contractural limb deformity, seen in too-fast growing foals, in which the tendons contract to put the foal’s legs at a painful, disabling angle. Here’s a case where working with the farrier is of vital importance! Treatment may range from trimming to lower the heels, to toe extension shoes, to surgery. Reducing the pain is a key element of treatment.
Laminitis and Founder are the most feared hoof diseases. Dunlap explained the types: acute and chronic. In this disease, “The farrier is the cornerstone of long term treatment,” she said. Causes vary and the first goal is to eliminate the cause. Next is pain relief and giving anti-inflammatories. The farrier can develop a plan to provide proper hoof support, ease the breakover, ease the pressure on the sole, load the back part of the foot, and “get the horse comfortable,” Bishop said. “If you watch them move, they land on the back of the heel first. They look like they’re walking on eggshells, and there are defined digital pulses - throbbing.” Dunlap explained the interlocking dermal and epidermal laminae in the hoof that are “like Velcro.”
Navicular syndrome can be caused by one of several factors: increased pressure inside the bone causing pain; scar tissue between the navicular bursa and the deep digital flexor tendon; or arthritis of the navicular bone and associated structures. It is a common cause of front limb lameness. Diagnostics include the hoof testers to detect pain in the heel area, radiographs to look for changes in the navicular bone or bursa, nuclear scintigraphy to detect bone and/or soft tissue inflammation, and heel nerve blocks.
Traumatic injury to the hoof can be life threatening, especially if there is “substantial blood loss and substantial damage,” Dunlap said. An example she gave was a horse that went through the trailer floor.
Milder injuries are punctures, such as from a nail. “Get immediate medical attention!” It’s important to know how far into the hoof the object penetrated. Did it go into the coffin bone? Into the navicular bursa? If the horse is not in any danger of pushing the object further into the hoof, both Dunlap and Bishop recommended leaving it in until the veterinarian and/or farrier gets to the horse. This allows them to know how far the object has penetrated. But if there’s danger of the horse stepping on it and pushing it further in, remove it, but insert a cotton swab and mark it to show the depth of the injury. Antibiotics and pain medication may be needed. More severe injuries may require life-time special shoeing of the horse.
The team discussed abscesses and white line disease. “Most abscesses are small and heal uneventfully,” they said. But it’s important to follow the tract as deep as it goes and to debride it totally (medically remove the dead, damaged, or infected tissue to promote healing of the remaining healthy tissue). Antibiotics may be needed to fight infection.
Keratoma is a hoof wall tumor that grows from the keratin in the hoof wall. This may happen with a horse that has chronic abscesses. It is diagnosed radiographically and treatment is aggressive, sometimes unusual.
Here’s where Medical Maggots come in to save the day! Yes, maggots. “They are sterile maggots,” Dunlap explained, and they are put into the hoof to remove all the micro-tissue that the veterinarian and the farrier can’t remove. “It’s amazing how much they clean out!” Dunlap said.
Other lameness problems the team discussed included coffin bone fractures, which are rare. Because the coffin bone has no marrow, these injuries don’t show up radiographically until about 10-14 days out.
Severe tendon injury can potentially end a performance horse’s career. Treatment requires stall rest and ice compression therapy. Again, good hoof support and support of the fetlock joint are important in recovery. Bishop explained raising the hoof angle to take the pressure off the tendon, but added the caveat, “Keep the horse barefoot, at a natural angle. Ease the break over, but keep the natural angle. Dunlap added, “If you wedge the heel, you put more pressure on the tendon.” Most important to healing tendon injuries is to stabilize the leg, allow the tendons to relax and stay in position. If the broken tendons are put in touch, they will knit back together.
Got questions? Jennifer Dunlap, DVM can be reached at www.dunlapequineservices.com or (901) 463-0937. Daniel Bishop, AFA Certified Farrier can be reached at Daniel Bishop Horseshoeing Services: (901) 292-4955 or (901) 331-3500.
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