Stop Problems Before They Start

Thought you knew the latest in keeping your horse healthy from head to toe? Think again! Richard Mansmann, VMD, PhD, from Central Carolina Equine Practice in Chapel Hill, N.C., is using a preventive foot care program that's designed to detect early and/or prevent foot problems that could limit performance in horses. This program involves at least an annual visit by the veterinarian and farrier, with specific radiographs and measurements taken of the feet. These can not only help determine what is going on in the horse's feet at the time of the exam--potentially catching emerging problems--but also provide a baseline of normal parameters for that horse should he become unsound in the future.

Evaluating radiographs with the veterinarian and farrier

"Foot problems are among the most common causes of lameness in the horse," says Mansmann. "Thus, the main goal of this preventive foot care program is to avoid potentially serious foot problems and limit the progression of existing ones." By alerting owners of their horses' potential to develop a particular problem--then suggesting appropriate management changes--the horse can perform at his maximum ability and his useful life can be prolonged, he adds.

"Our program is only a model," says Mansmann. "Talk to your veterinarian and farrier about a program best suited for your horse."

The Program Is...

A systematic way to make the owner aware of any potential or existing foot problems--"By participating in the preventive foot care program," says Teena Middleton, two-time winner of the North Carolina Quarter Horse Association All-Around Amateur Award, "we were able to identify the shoeing techniques that were appropriate for my horse. In addition, this consistent monitoring program helped us notice gradual trends away from our goals that ordinarily would have been missed."

According to Mansmann, re-evaluating the horse's measurements in a consistent manner within a repeatable timeframe increases awareness of changes, which benefits the owner, veterinarian, farrier, and ultimately, the horse.

A basis from which the farrier, now armed with a radiograph, can make more informed shoeing decisions--Because a radiograph of a horse's foot is an internal picture, it can help the owner, veterinarian, and farrier understand a little bit more about what is happening inside the hoof. This particular part of the program could not only lead to management changes or veterinary treatments to eliminate any problems found, it could reveal the potential for problems. Steps could then be taken to deal with these problems before the horse actually becomes lame.

A means to encourage positive interaction among the owner/veterinarian/farrier team--Julie Grohs, DVM, and her husband own and operate Alaska Equine and Small Animal Hospital, where they developed a similar program. She feels that a preventive foot care program is positive not only for the owner and horse, but also for the veterinarian and farrier.

"When viewing radiographs with the farrier, I learn even more about the horse because the farrier looks at films from an entirely different perspective. We complement each other's views."

Her farrier, John Arkley, Certified Journeyman Farrier, agrees. "The phrase that best describes the relationship between the veterinarian that I work with and me is 'learn more,' " he says. "We have learned more together in six or seven years than I thought possible. The interesting part is that we have just begun to learn."

Middleton compares the relationship between the owner, farrier, and veterinarian to that of a racecar driver and his pit crew. "As the 'driver,' I describe what I'm feeling, and my 'pit crew' troubleshoots to determine the solution," she says. "By correlating trends with performance, we are able to identify the very best setup for health and success."

Mansmann feels that bringing the owner, veterinarian, and farrier closer together to help the horse is a very important concept. "Certainly the owner/veterinarian/farrier relationship has been important in the past, but it will become increasingly important in the future as owners demand more and more careful care for their horses," he says.

The Program is Not...

A critique of the farrier's work--Liz Stewart is a riding instructor and farrier who works part-time with Mansmann on the preventive foot care program. She says, "This is an opportunity for the farrier to use an additional tool (annual radiographs and measurements) when shoeing the feet, which can only enhance his or her ability to shoe the feet to perfection!"

Mansmann says the program defines what the horse's feet are doing. "The purpose of our measurements and ideas is to increase everyone's awareness, not criticize anyone," he stresses.

A comprehensive physical and radiographic evaluation of the feet--"The program is currently designed to take only lateral radiographs (radiographs from the side) and only of the front feet, which is a pretty minimal work-up (but is much more than the vast majority of owners do now)," says Stewart.

Mansmann suggests that more views of the foot can be taken, but usually aren't necessary unless the lateral radiographs indicate a problem that requires more diagnostic views. Still, being able to visualize the coffin joint, the actual thickness of the sole, and other structures is helpful.

The specific program that Mansmann designed is based on his idea that adequate heel support is probably the most important factor when shoeing a performance horse. Since he does not take off the shoe, there is no evaluation of the white line at that point. Also, his program does not use a radiograph to evaluate medial to lateral balance (or, how the left half of the foot compares with the right half).

"A meeting between the owner, regular veterinarian, and regular farrier is needed to develop the best preventive foot plan for that particular horse (based on the radiographs)," emphasizes Mansmann.

A substitute for a lameness examination--Stewart says she works with two horses which have been on Mansmann's program for more than two years, one of which became lame. "Thankfully, I have two years' worth of radiographs to turn to and see if there are any changes going on inside the foot." Even if your horse has never taken a bad step, she says, this program can help down the road by serving as a baseline should a lameness develop.

The program can also be useful when put in place after a lameness develops and has been diagnosed with a complete, separate lameness workup. At that point, the owner/veterinarian/farrier team can determine what value a specific monitoring preventive foot care program could have for that horse's condition, and his future.

Mansmann's Program

His program is made up of five parts:

History--The owner is asked to provide general information about the horse and his work schedule, any previous foot problems or lamenesses, and the shoeing schedule.

General inspection--The horse's conformation is briefly evaluated and his body condition score is estimated. The potential for suspensory ligament problems is also assessed.

Assessment of the feet--Both front feet (with the shoes on if the horse normally wears them) are examined and the conformation is evaluated. The feet are inspected for any obvious external problems such as cracks, other hoof wall defects, and thrush. Two simple measurements are then taken--the hoof wall angle (the angle of the front hoof wall relative to the bearing surface of the foot) and the hoof width (measured across the widest part of the hoof).

Lateral radiographs--A radiograph is taken from the side of each front hoof, mostly to evaluate the position of the shoe relative to the center of the coffin joint (the joint within the hoof between the coffin bone and the short pastern bone just above it). The relationship between the shoe and the coffin joint helps determine if the heels are supported adequately. Other evaluations include sole thickness, the position of the coffin bone relative to the hoof capsule, and the presence of any bony or soft tissue abnormalities that can be seen with just this single, side view.

Report--Once the radiographs have been evaluated, a written report is sent to the owner and to the farrier. If a primary care veterinarian has referred the horse for this evaluation, he or she also receives a written report. Included in this report are a summary of the general inspection and hoof measurements, details of any abnormalities found on the radiographs, a tracing of the radiographs with the assessment of heel support, and any specific recommendations for shoeing, turnout, diet, and exercise. The owner is encouraged to have the evaluation repeated every 12 months.

Using the first 50 cases in the program, Mansmann attempted to evaluate the value of such a program. Each case was given a score of zero to five based on the value of the information gained by the owner, farrier, or primary veterinarian.

Following are the score descriptions:

0--Feet appeared normal and no new information was discovered;

1--One or more feet had some abnormality that was already being addressed;

2--One minor problem was discovered that was either not known before or not being addressed;

3--A combination of minor problems was discovered that were either not known before or not being addressed;

4--A moderate problem was discovered that was unknown before and might not be causing problems now, but should be monitored;

5--A serious problem of immediate concern was discovered that wasn't known before.

From the information gained in those 50 horses, 66% had potential problems that were not known or were not being addressed by the owner, farrier, or primary care veterinarian. (See "Specific Findings of Preventive Foot Care Evaluations on 50 Horses" on page 82.)

Why Use A Preventive Program?

According to Mansmann, the main reason he developed his program was because of the number of lameness problems he saw in his practice that could have been prevented with a program of this type.

"At the very least, an annual examination of this nature could have alerted the owner, farrier, and veterinarian to the presence of a problem early enough for simple management changes to have limited its progression," he says.

One example in his practice is a horse with white line disease in which a lateral radiograph shows that the coffin bone has rotated. Whether the rotation was primary or secondary is anyone's guess. The point is, had the film not been taken, the farrier and veterinarian would not have known the extent of the problem.

Another example that shows the value of this program is the older horse with Cushing's disease, in which chronic laminitis and recurring foot abscesses are common and frustrating problems.

Just ask Margie Muenzer, whose horse Orion developed laminitis in both front feet. She enrolled Orion in the program several years ago, but admits to "trying to save a few dollars" and passed on the follow-up examinations and radiographs. Still, having that first set of radiographs was helpful, as it showed Mansmann and her local veterinarian that the current rotation of the coffin bones in Orion's front feet was new. Since it was also determined that the long coat he was still carrying in the summer was abnormal, tests for Cushing's syndrome were ordered, confirming the diagnosis.

"There are many owners and farriers who don't know about this medical condition and also don't know that it can be managed--and the foot problems greatly improved--with medication," says Mansmann.

With appropriate foot care, medication, and nutrition, Muenzer and Orion had a reasonable 1 1/2 years together.

"A preventive foot care program can promote excellent owner/farrier/veterinarian relationships where everybody wins," says Grohs. "Owners learn more about their horses and their horses' feet, the farrier can trim and shoe more accurately based on an inside view of the feet, and the veterinarian can discover early signs of problems."

This type of program can be designed for each horse by the owner, farrier, and veterinarian determining what needs to be recorded. It is more expensive than doing nothing, but it is well worth the investment.

Note: The total number of horses exceeds 50 because some horses had more than one abnormality.
Mismatched feet
Overweight*/cresty neck
Inadequate heel support**
Propensity for hindlimb suspensory problems
Thin soles (radiographic assessment)
Coffin bone rotation

* Body condition score greater than 7
** Less than 40% of the shoe behind the center of the coffin joint.



Before correction
This radiograph of the right front foot of a 9-year-old Quarter Horse gelding was taken in May 2002. Breakover is far forward and heel support is only 21% of the posterior portion of the shoe in relationship to the center of the coffin joint. Ideal heel support should be in the center of the coffin joint, therefore the need for a shoeing change was noted. It was discovered that the horse had non-clinical ringbone arthritis of the pastern joint.

Five months later

This follow-up radiograph was taken in October 2002 to monitor the non-clinical ringbone (which hadn't changed). Following a shoeing change, the breakover is now under the tip of the coffin bone, and there is better heel support. Now 49% of the shoe is behind the center of the coffin joint--closer to the ideal. It was recommended that this shoeing be continued, and that the ringbone be monitored radiographically on a yearly basis.


About the Author

Lydia Gray, DVM, MA

Lydia Gray, DVM, is Medical Director and Staff Veterinarian for SmartPak Equine. She was previously the executive director of the Hooved Animal Humane Society in Woodstock, IL, and an Owner Education Director for the American Association of Equine Practitioners.

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