Foot Problems: One Step at a Time
How hard are you really working to understand what makes a foot healthy, and what's happening that could cause problems? Training yourself to observe--not just see--the horse's foot is the first step. Each person involved with a horse, whether it's the groom, owner, farrier, or veterinarian, needs to be able to recognize subtle differences today that might mean a major problem down the road. It is this early window of opportunity that can mean the difference between a horse thriving, or merely surviving.
Ric Redden, DVM, who has focused exclusively on podiatry for 30 years during his careers as a farrier and veterinarian, says, "If you don't see much--you don't notice changes in your horse's feet or even notice that all four feet are different--you aren't a bad owner, you are just uninformed on how to do it."
All owners, trainers, and barn managers should get out their cameras and head to the barn, recommends Redden. Take a picture of each horse's foot separately, label it, and file it away. Do this immediately, then add to the collection, including pictures taken just before a trim, just after a trim, and in the middle of the trim cycle.
But these can't just be snapshots taken any old way; they need to be taken in a consistent manner so that you can use them for comparison. Standardization is the key, says Redden.
"You have to have a standard way to look at the feet, and photograph the feet," emphasizes Redden. "I've done the same with radiographs. There are 32 standardized views I use, so I can track that view on any horse next week, next month, or 20 years from now. I can detect minute changes in anatomy if I have something to compare it to."
Redden suggests that you take an AP (front) view and a lateral (side) view of each foot with your camera. Then take one of each heel from the back, and pick up the foot and take a photo of the sole. Then, he says, take out your pictures every time your horse is trimmed and shod and compare the old foot to the one in front of you now.
"Once you start developing your powers of observation, you can start seeing when the caution light starts flashing for that foot," says Redden.
He likens it to learning to ride a bicycle. At first, you only noticed that you could stay up on two wheels most of the time. Then, you began to realize that when the front tire was getting low, that your bicycle didn't handle as well. And you noticed that when the front tire was fine and the back tire was low, it meant a different problem. And, when the tire was flat, you knew you weren't going anywhere.
"It's the same with riding and your horse's feet," explains Redden. "When you begin to notice that the 'tire' isn't quite right, you'll start to equate that with problems you have riding. Then you'll become a better observer, and a better owner."
Tuning the Professional's Eye
While the first line of defense for every horse's feet is the owner, the second should be the team of the veterinarian and the farrier. Redden says it's hard for a veterinarian or a farrier who doesn't deal with major foot problems on a regular basis to suddenly become an expert in a crisis. It would be like asking a general practitioner in human medicine to do heart surgery.
"Having a radiograph and seeing what's there is a matter of experience," says Redden. "Vets and farriers who don't focus on feet don't have that eye trained to see the detail. They know normal and when something is outside the norm, but not necessarily the gray areas when something isn't normal for that horse.
"I've gone through thousands of feet, so I sympathize with someone who's only seen two, or even two hundred," adds Redden. "There isn't a cure-all for horse foot problems. You can't throw all horses the same life preservers. There are variables to every case, and experience and observation are what tell you how to use those variables."
Redden says that feet will "scream" data to the trained veterinarian or farrier, and what those feet are telling you is important right now. He says if your horse is having a problem, then informative X rays of his feet need to be taken properly and immediately. If your farrier isn't used to looking at X rays, then you need a veterinarian who can interpret what is happening so that the farrier can correct it.
But, adds Redden, the veterinarian needs to know how to take consistent and informative radiographs of the foot, and he needs to be able to translate that information to the farrier.
"You have to remember that the veterinarian is looking to solve a medical problem, and the farrier is trying to solve a mechanical problem," explains Redden. "They both have to work together.
"And you can't look at a radiograph and not look at the foot, that's only 10% of the information," he adds, meaning you have to take into consideration not only the physical characteristics of the foot, but what that horse is used for, his demeanor, his owner's determination and dedication, and his overall general health before deciding the treatment for any foot problem.
Redden gave this poignant example: A mechanical engineering teacher gave his graduate level students a problem to solve. The task was to build the perfect windshield for a high-tech jet fighter. He gave them all the mechanical and mathematical parameters--how much air pressure the windshield had to withstand, the g-forces, the temperature changes, the lifespan, etc.--then left them to their designs.
The irony was that most of the students created the perfect windshield for the jet fighter out of stainless steel. They'd forgotten what it was intended to do and only concentrated on what they knew--materials and mathematical specifications.
Redden says it sometimes is the same with farriers and veterinarians. They do what seems best for the foot, but might forget what it has to do with 1,000 pounds of horse on top jumping, turning, landing, etc., and considering the environment in which that horse (and that foot) has to live.
"We've got to put that foot with problems in the optimal healing environment," says Redden. "And we've got to remember that feet go downhill real quick, and that horses are very stoic while that is happening. That means by the time an untrained observer finally notices that something is wrong, it might be too late."
The Magic Six Weeks
Redden says that it generally takes six weeks after a crisis before you know if the horse will live, especially in laminitis cases. "I don't like to use the word 'stable' because the foot is never in one place," he explains. "A horse with a foot problem won't stay in one place. A horse seems to have a six-week 'reserve' that either gives you the time to get him on the road to recovery, or he slips on into the death pit. It's the sequence of events, and it's when you notice and intervene that make the difference."
Once you notice a problem, it then has to be determined how far the condition has progressed. Has he suffered mild, moderate, or severe damage? Then there is the question of how quickly you address mechanical problems associated with the foot. This can be anything from laminitis to white line disease to underrun heels, says Redden.
The most feared--laminitis--might require a venogram to tell you how much damage has been wrought. Redden says that how the horse is acting isn't always an accurate indication of the damage.
"We had a filly come in here who was on her toes and her tail was over her back and she was squealing and bouncing around, but when we took a venogram, she had no blood supply to the foot," says Redden. "Her foot had gotten so bad that she didn't know it was getting ready to fall off."
A venogram is a procedure developed by Redden that uses a special dye injected into the foot just prior to an X ray to determine the amount of blood flow through the foot. The less blood flow, the more damage and the less chance for the foot to heal.
Redden says this is a very helpful diagnostic. "I performed the first clinical venogram in 1992, therefore it is quite new," said Redden. "It's so new that people don't know how to critique their own techniques. Because of that, there are a lot of false positives (venograms that look like the foot has poor or no blood flow when in fact the foot isn't that bad)."
The Shepherd's Sheep
The story goes that a professional shepherd was given a new herd of 100 sheep. For the first week, he really studied and tried to pick out the minute details of each of the sheep. He noticed that one had a spot on its nose; another had wool that was whiter than the others; still another was always the leader when going to water. After a week, the shepherd had named each of the sheep, and could tell them apart.
If someone gave you pictures of eight horse's feet, could you pick out your horse's feet? (And not just by color!) What if they were taken from the heel angle, could you recognize each of his feet then?
"Once you start honing your powers of observation, then you will start associating changes with other things going on," says Redden. "If something does start to go wrong, you often can go back and look at past pictures and see when the caution light started flashing for that foot."
A lot of owners worry if the veterinarian and farrier will like you taking such an intense interest in your horse's feet. Redden says if you have the right veterinarian and farrier, the answer is an emphatic "Yes!"
"If an owner increases his or her powers of observation, it will help everyone," he stresses. "If an owner asks why something is different and the farrier doesn't have time to explain, then get a new farrier. On the other hand, if the farrier goes to the owner to point out a problem and the owner doesn't want to listen, then it's the owner's fault when the wheels come off that horse.
"If your veterinarian or farrier is defensive when you bring up something and ask questions, then it is a mechanism that normally means they are not informed," adds Redden. "To be non-informed is not sinful, it's only when you act like you know and don't that you cause problems."
Even if everyone is on the same page and agrees on the problem and approach to solve it, the techniques used to address various foot problems might be different. You wouldn't, for example, use the same methods for fixing a thin-soled foot in a broodmare as you would for fixing a Grand Prix jumper. Also, how information is gathered and used might mean whether you see what the problem actually is, or if you miss the big picture, says Redden.
Foot Care Professionals
Gathering information is important, Redden adds. If you go into a hospital with something wrong, you'll spend the first days just getting tested. The woman who takes your radiograph is very good at that, but doesn't interpret them. The man who draws your blood and the woman who processes the requested tests aren't the ones who will put all that information together.
"Hopefully, you'll have one person experienced enough to take all the pieces of information and put them together for a correct diagnosis," says Redden. "Veterinarians have to be data collectors, interpreters, transmitters to the owner and farrier, and the ones who decide the proper treatment. And they have to do that with every type of problem. The same can be said of farriers."
One of the items missing from the veterinary community, Redden thinks, is a board specialty in podiatry. He says there is board certified training and testing for many veterinary specialties, including emergency care, internal medicine, surgery, ophthalmology, cardiology, reproduction, etc., but there is no focused training or testing for the equine digit. And, says Redden, most veterinarians are getting very little training in the foot while in vet school.
Redden believes that if a veterinarian gets a foot case that is beyond his experience, he should seek colleagues who have more cases under their belts. And, Redden adds, the farrier needs to look for help in difficult cases, too.
The owner who jumps around getting 40 opinions trying to find the one she is looking for is not helping the situation because the horse is going downhill while that owner is looking for someone to agree with him or her, notes Redden.
All must realize the limitations of the others involved in a particular case, says Redden. The owner might not have the time or financial ability to pursue certain treatments. The veterinarian and/or farrier might not have the experience in handling that particular foot problem or the equipment needed to bring that foot back to good health.
"The veterinarian and farrier have to be willing to listen to the client's complaints within the time frame in which they have to work," says Redden. This, he says, doesn't give the owner leeway to take up valuable treatment time with conversation that isn't concerned with solving the problem at hand. But, the veterinarian and farrier have to be able to take the information from that client and determine when a problem began, and where it might be headed.
"And all of this starts with each of them honing their powers of observation so that they can each help the horse stay sound," concludes Redden.
See the Lameness (Hoof) and Shoeing section at www.TheHorse.com.
West, C. Hoofcare Education at Bluegrass Laminitis Symposium. The Horse, April 2002, 63-70. Article Quick Find #3389 at www.TheHorse.com.
West, C. Radiographic and Venogram Techniques. Article Quick Find #2769 at www.TheHorse.com.
West, C. Value of Digital Venograms. Article Quick Find #3269 at www.TheHorse.com.
REDDEN ASKS: "Where Are You?"
We all should be aware of our level of competence with foot problems--horse owners, veterinarians, and farriers. Since there is no formal education in the field of podiatry, training must be sought on an individual basis. Consequently, there is not a standard of care for foot problems as there is in all other areas of the horse.
Farrier schools are focused on teaching a basic method of trimming and shoeing with a few therapeutic shoes thrown in with a little anatomy, often covered in a matter of weeks. This works quite well to get an apprentice farrier started, but has serious limitations when a career- or life-threatening problem is presented. This is where the farrier and the veterinarian collide--most are simply not educated or trained in the discipline of podiatry. In their respective fields, either is often brilliant, but when asked to join the team and contribute their much-needed professional service, they often feel very inadequate simply due to lack of knowledge and experience.
Radiographs are a major link between the two professions. Veterinarians who fail to realize why a farrier needs timely, informative films are usually not aware of the value of soft tissue detail. Farriers who say, "I don't need film to shoe a lame horse" are simply saying "I do not know how to read film; no one has taught me to see the mysteries of the shadows, therefore I don't need them."
When we attempt to extrapolate competency from other areas of expertise to a field in which we have very little experience, the result can be devastating. The horse gets caught and often falls through the cracks. Simply doing the best we can do is often not enough; therefore we must make it our prime goal to become more knowledgeable about foot disease.
Podiatrists--be they farriers or veterinarians--are in great demand worldwide as there certainly is no shortage of foot problems. This is a very serious business, and dealing with life-threatening foot problems demands tremendous respect and preparation--the same as all other fields that play a major role in the health and life of the animal.
Farriers worldwide are expected to keep the feet sound, and so are vets. Why then can't we have a new mindset and see this as a very serious team effort with both professions on the same page and with adequate training and experience in this field? We must be prepared to make life and death decisions. How does the inspired vet or farrier become better informed and catch up with the standards that have been developed by a few focused professionals? We are working on that...--Ric Redden, DVM
About the Author
Kimberly S. Brown was the Publisher/Editor of The Horse: Your Guide To Equine Health Care from June 2008 to March 2010, and she served in various positions at Blood-Horse Publications since 1980.
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