ARCHIVE - ARTICLES 2008

April 2008 - Postmortem of the feet

April 2008 - Biomechanical screening: Are farriers aware of its benefits?

April 2008 - APPEAL - First Feet

 

Archive - Forge Magazine - April 2008
Postmortem of the feet

 

Wiltshire-based farrier, Peter Baker, examined the feet removed from a euthanased polo pony that suffered from long-term, irreversible discomfort. The reasons for its long-term illness could not be concluded. This animal was prone to blowing out abscesses regularly on all four feet. In its later life the animal had become aggressive and resistant to being handled. This series of pictures and captions describe what he found.

Fig 1. The specimens used are not clean, good examples for a presentation on equine foot dissection as they had been removed from a fallen horse 12 weeks previously. However, they are the type of feet farriers will, from time to time, be asked to examine

 

Mediolateral view hind foot, separated from its horny capsule

Fig 2. Notice the disturbance of the fascia of the laminal surfaces, and the eroded areas centre toe
[Figs 3, 4 and 17 are of the same foot]

 

Laminitic condition

Fig 3. Lateral view of sensitive laminal fascia of P3 (hind foot). Note the pink bruise-like discolouration of the sensitive laminae, which demonstrates a sublaminal fascia bleed. This slide relates to the inner aspect of the following picture, its own capsule. An infusion of blood over the surface of a bone seems to kick in an erosion of its outer surfaces (osteoclastic activity). A similar effect appears to happen to hoof horn in/near an abscess site

 

Inside the Hind hoof capsule

Fig 4. Note the lump of horny tissue centre toe, which relates to the crack, carina marginalis bone erosion P3. The right side of this capsule has a infusion of pink bruise like discolouration in the tertiary/cellular layer indicative of a laminitic condition in life. A ring of perioplic tissue formed on the upper aspect of the coronary corium, can be seen around to top edge of this hoof capsule, which clearly appears to include the frog structure

 

Front foot same animal

Fig 5. Notice the tissue at the centre of this picture. It is the upper aspect of the severed deep digital flexor tendon, which is clearly seen to overlay what appears to be a fibrofatty bursal structure. It is felt we are actually looking at the severed bifurcation of the proximal remnants of the distal insertions of the superficial flexor tendon into P2, and the remains of the joint capsule of the proximal interphalangeal joint

 

Heel scar

Fig 6. Bilateral detachment of the heel frog tissue. Typical of the scarring left following an abscess break out

 

Pink area in sensitive laminae

Fig 7. The pink area may be indicative of a laminitic (abrasion induced inflammation and bleed) condition, an idea that is supported by the abnormal area of the coronary crown immediately above the discolouration. Observe the second erosion of the edge of P3 to the left of centre, which may indicate a peripheral fracture some time earlier, while the darkened background may indicate an historical abscess site. See a more extensive underlying bleed, bone erosion and edge sharpening in Fig 17

 

Sharp edges

Fig 8. The fascia of the base of P3 is reflected to expose the eroded, sharp edge of P3. The edge is so sharp it is difficult to see how when under load from the animal’s weight it could do anything other that cut into any surrounding living tissues, which may well account for the animal’s constant discomfort. A nutrient foramen can be clearly seen behind the centre toe. (Under the surface of P3 as seen in Fig 7)

 

Deep digital flexor tendon

Fig 9. The deep digital flexor tendon is exposed to demonstrate the fan-like insertion onto/into the semi lunar crest of P3. The bifurcated remains of the superficial flexor tendon now can be more clearly identified under the severed deep digital flexor tendon structure, both branches of which seem to share a common insertion, and if not common both the insertions are at the very least intimately related

 

Upper aspect proximal interphangeal joint surface

Fig 10. It is difficult to know if the pinkish discolouration is abnormal or not.
Note the two branches of superficial flexor tendon insertions

 

Lateral cartilage. Lateral view of sensitive structures

Fig 11. The author’s thumb is lifting the rearwards aspect of the collateral cartilage and he is pointing to the most forwards aspect of this cartilage. The cartilage, which, in life, is invested with a full set of laminae extends almost the full length of the hoof capsule. It can be seen to extend rearwards far beyond the termination of P3, the cartilage surface is far more extensive/wider than that of P3, specifically in the heel area

 

Front hoof capsule

Fig 12. The development of the under surfaces of the lateral sulcus. These are not symmetrical, one is far stronger and longer and they are not located centrally within the hoof capsule. See an abscess site (Figure 6) at the rearward aspect of the right side internal bar, which is the shorter (having been eroded away to some degree). Remember the earlier abscess break out on this front foot, highlighted/pointed out on the right side rear of the hoof photograph. This erosion would be consistent an observation that the animal suffered persistent recurring heel abscesses that degraded the horny bar structure. Note the small, sub-solar bleed forwards of apex of the frog, seemingly related to the bruising and bone erosion seen in Figs 7 and 8 (same foot). Figs 13, 14, 15 and 16 are of P3 that inserts into this capsule

 

The bones soaked for four more days in clean water

Fig 13. The foot is high on one side. The next time you try to dress a laminitic foot/heel level, remember the irregular ground surface of the foot in chronic laminitics as seen here. Consider leaving a little bit of extra wall on when creating the shoe bearing surface. The following four images demonstrate an explanation of a conundrum I have puzzled over for the past 40 years. Why do certain horses exaggerate landing heel first, pulling their feet backwards prior to full placement on the ground, load in front of vertical and appear to prematurely unload in their respective strides. I always suspected this type of action was related to toe pain. I feel these four pictures demonstrate one of the physiological modifications, leading edge P3 bone sharpening, that could cause this extended landing, loading, break-over syndrome to be adopted by a performance horse, which may relate to work, associated with unsuitable and firm surfaces

 

Dramatic loss of structure, dorsal surface

Fig 14. Note the thinning of the leading edge of P3 in this picture. Osteoclastic activity has cut away the dorsal surface of P3 when it was underlaying the laminal fascia. The nutrient foramen on the dorsal surface have lost their oval shape and become round

 

Skyline of basal surface of P3

Fig 15. The erosion of the ground surface of this pedal bone is far from level. How could an overlaying hoof capsule be prepared for a metal shoe to be attached which afforded a symmetry for a state of comfort of this foot? Note the extent of the cleaned up lateral cartilages and the fan-like insertion of the common digital extensor tendon in Figs 13 to 16

 

Another view

Fig 16. Different shot of the skyline of the same foot, note the attached co-lateral cartilage

 

Cleft centre toe, fascia reflected upwards, front foot

Fig 17. Erosion of P3 centre toe. Nutrient foramina are seen clearly to be damaged, causing the relative blood vessels to leak blood. There appears to be a process of osteoclastic bone reduction associated with an infiltration of blood beneath the various fascias, both laminal and solar in this case. What the author finds particularly exciting is that this demonstrates the solar and laminal fascias are not connected over the leading edge of P3; the two can be reflected independently of each other and the leading edge of P3 in an healthy state feels ‘soft’ rounded. It appears there is little or no connective tissue over the leading edge of P3. This begs the question, where does this fit inside the hoof capsule as it would lead to bone directly over horn? It appears there is a socket at the base of the sensitive laminae into which the leading edge of P3 slots!

 

The 4 hoof capsules, L to R, Rt-HD, Rt-F, Lft-F, Lft-H

Fig 18. There are several unforeseen features to this case. The skyline demonstrates a differential in the heights of both the central frog stay as well as the relative inner height of the horny bars. Both the hind feet (outer feet) have a fairly level skyline. Yet both front feet (middle two feet) appear to be laterally windswept. The inner bars of the front feet are, however, both high right side (as viewed) even though the frog stays run fairly vertical. Ironically, the severe cracks seen on two of the feet (one front and one hind) don’t appear to have an effect when viewed parallel anterior/posterior

 

The 4 hoof capsules, L to R, Lft-HD, Lft-F, Rt-F, Rt-H

Fig 19. The kind of symmetry seen in the previous slide is not consistent when the feet are viewed from above. The colateral inner bars demonstrate differing forms. This form change is most dramatic in the front hoof capsules (inner two feet). The hind feet also demonstrate a non-similar but less dramatic form. The right hind (white foot on right) is fairly normal, the hoof capsule has no vertical cracks, yet the severely cracked left hind shows a far stronger/wider surface to its lateral bar [relative to its medial bar]. At first glance it is unclear what has happened here, but it calls into doubt the perfect theory of uniform symmetry of form. Is nature constantly readjusting form to accommodate structural related changes? What steps should the farrier take to regulate the outer surfaces of the bars?

 

Right front and hind capsules

Fig 20. A central mass (lump) of horny tissue is clearly seen inside the centre front of the right fore hoof capsule (on left in Fig). What appears to be a locating socket for the leading edge of P3 is also visible. Is this socket normal or induced due to bone thinning and the resultant sharp edge of P3 forming it? Consideration needs to be given to the masses of horny tissue forwards of the frog apex, particularly in view of the US observed solar callous [Gene Ovnicek]. The capsule on the right appears to have suffered a recent penetration injury mid heel quarter, right side

 

 

Archive - Forge Magazine - April 2008
Biomechanical screening. Are farriers aware of its benefits?

by Kathy Carter

All horses should be shod with optimum foot balance in mind, in order to maximise the horse’s physical ability. British Equestrian Federation (BEF) consultant farrier, Haydn Price, DipWCF, believes that ‘performance shoeing’ can also help prevent injuries that can be attributed to imbalances of the feet, such as joint, tendon, and ligament stresses.

 

‘Horses should of be shod individually, according to their individual conformation and level of training and biomechanical screening can genuinely help us to achieve this’, explains Haydn Price.
Various experts have seen the benefits of locomotive assessment in terms of identifying abnormalities in a horse’s gait. The BEF’s Director of Equine Sports Science, John McEwen, BVMS, MRCVS, believes that ‘the objective measurement of lameness and changes in locomotion are the missing pieces of critical information needed to make key decisions related to equine health.’
A relatively recent addition to the arsenal of assessment and treatment is the Equinalysis system. Screenings are performed by trained clinicians, such as farriers and other paraprofessionals in the equine field, and the technology tracks, quantifies and displays biomechanical data using a laptop, dedicated software and digital camera. Farriers may become technicians themselves, or alternatively, horse owners can employ the services of an accredited Equinalysis business partner, and can pass the report on to their own farrier.

Helping farriers optimise a horse’s capabilities

Some farriers have found the technology invaluable in terms of shoeing the horse to meet its requirements, as the portfolio of facts and figures can be used as a baseline of information for future reference. Mark Aikens, DipWCF, uses the technology on certain equine clients within his practice, Anglia Equine in Norfolk. “If pertinent to a particular case, farriers can take the Equinalysis data into account and then shoe the horse according to its workload and discipline, and the dynamic loading of the limb”, he says. “In my experience, the technology can help farriers optimise a horse’s competitive capabilities, for example, ensuring joint angles are correctly aligned.”
However, not all farriers are ‘au fait’ with the growing use of biomechanical techniques, something of concern to Haydn Price, one of the original developers of the Equinalysis software system.
“We, as farriers, should be well informed of any new techniques in the industry, from the developing trend towards barefoot trimming, through to locomotive screening and anything else in between”, Haydn says. “There is growing concern among horse owners that those contracted to shoe their horses should be sufficiently experienced, and deliver the highest standards and practise techniques. The CPD Steering Group (WCF, NAFBAE and the FRC) has recently introduced a continued professional development points system, and is encouraging farriers that a target of eight points per year should be achieved. While this is not mandatory, it does reflect the feeling of owners that registered farriers should be well informed of any new techniques available to their clients.”
Farrier, Martyn Elliott, AWCF, says that being able to evaluate horses with modern technology has been professionally beneficial.
“I now have a much more complete understanding of just how much effect what I put on a horse’s foot has on the rest of the limb”, Martyn explains. “The transformation that I have been able to achieve in some hindlimbs has been incredible. Without the ability to watch slowed-down movement of the horse, I could not even hope to see if there is a specific problem, or if I have any influence on the problem. I am also able to show my clients ‘before and after’ footage, so when they leave the forge, they are in no doubt as to what I have done, and why. Being more interested in locomotion has led me to be more interested in my clients, their horses and the results they achieve. Thus, my clients appreciate and value me more.”

Holistic techniques

Howard Cooper is a Past Master of the Worshipful Company of Farriers, and is the Chairman of the Farriers’ Training Agency. What are his thoughts on the use of biomechanical screening? “This type of technology is wrapping up what experts already knew – that shoeing involves looking at many different aspects of the horse, and being aware of them all,” he says. “Every good farrier uses ‘holistic’ techniques to some extent.”
“The use of video and computer technology takes farriery into a modern world, and is useful in allowing us to analyse movement in a clearer, more precise way”, he continues. “This is especially helpful when demonstrating problems to owners, as video footage can be slowed down for them to see something that may have been missed at normal speed.”
“The main point is that it raises an awareness of potential problems, so if a horse isn’t standing right, or is creating an undue strain on its legs, a farrier can rectify these elements to prevent issues arising in the future,” he adds. “The Farriers’ Training Agency is starting to incorporate more DVDs and analysis into our farrier training, but although it all seems obvious at the time, none of this technology is of any use until students have a good understanding of the other aspects of farriery.”

Farriers, what’s in it for them?

Experts like John McEwen, Howard Cooper and Haydn Price obviously advocate the use of biomechanical screening where appropriate, but farriers will always ask, what’s in it for them? David Beardmore is a second-year farriery degree student at Myerscough College, and reports that all students at the college are taught that taking biomechanics into account when shoeing a horse is important. “However, I question whether the use of video-based technology on a day-to-day basis is really financially viable, although I can see that this technology is a wonderful educational tool for farriers”, he says. “In terms of farriers who perform the screening as technicians, I would be concerned about passing this cost on to the customer. However, if a customer requested a screening, of course I would support their request, as anything that benefits horses has got to be a good thing.”
Mark Aikens uses the technology on certain clients within his farriery practice. He has found that the cost to the client does not necessarily pose a problem, but concedes that most farriers are busy, and admits that the screening does take extra time to perform. “Some farriers would consider themselves too busy to spend a few minutes watching a horse being walked and trotted prior to shoeing, or filmed in the case of screening. However, as professional farriers, we should do our utmost to ensure we shoe each individual horse to the best of our own capabilities,” he says. “We should also ensure the horse is shod to optimise its own conformation and athleticism; in my opinion, in order for us to perform this function, the more information we have the better, even if it does take a little longer. I would agree that the technology is especially useful for remedial farriery.”
Mark concludes that it is vital for professional farriers to be aware of the biomechanical implications of methods used to optimise locomotive ergonomics. “When we use this methodology through farriery, it is important to be able to communicate this information to our clients with the utmost clarity. Equinalysis can help accomplish this,” he says.
Haydn Price is aware that not all farriers may see the benefits, but believes that as horse owners become more knowledgeable, farriers will have to find out more about new technologies. “It is proving extremely beneficial in terms of ensuring maximum equine performance, and provides farriers with biomechanical data that can be used as a baseline and is extremely useful when shoeing a horse on an ongoing basis,” he says. “If, as an example, the technology can ensure the horse’s dynamic locomotion is directly proportional with limb and foot loading, each of which is at the forefront of maintaining optimum performance, it will reduce the potential for lameness.”
“Locomotive screening allows farriers to execute a treatment plan that prevents a horse from ‘breaking’ as we are able to map significant gait changes over time,” he adds. “By performing an annual screening as part of a continued service, farriers are as such ‘benchmarking’ any anomalies within the animal’s gait, and mapping significant changes; this commits us to operate a more proactive approach to the prevention of equine repetitive strain injuries, rather than waiting until the onset of lameness before offering solutions.”

Anyone interested in finding out more should visit www.equinalysis.co.uk or call 01291 671 351 for information.

 

Archive - Forge Magazine - April 2008
Appeal - Feet first by Simon Pope, Director of Communications, SPANA

This article is reproduced with permission of the Society for the Protection of Animals Abroad (SPANA) and was originally published in SPANA news. For further information about the charity, log on towww.spana.org

 

Most of us will have experienced some problems with our feet – from simply stepping on a sharp stone or stubbing our toe, to something more serious like a broken bone.
It’s not just about the pain – the problems can stop us getting about – and there’s often no choice but to give in, lie down and wait until things get better. But few of the donkeys, mules and horses that SPANA treats would ever get the chance to do that. Most will simply have to keep working despite the pain, pulling loaded carts or carrying heavy burdens, which can make their suffering, and their injuries, even worse.
Badly trimmed or neglected hooves are some of the biggest problems SPANA encounters in its clinics. They can be the result of poor standards of farriery, ignorance on the part of the owner, or simply a lack of money to get their working animals seen quickly.
On a recent trip to Mauritania, Jeremy Hulme, SPANA Chief Executive, witnessed some graphic examples of horses suffering from extremely neglected and painful hooves. The veterinary team watched as the animals’ owners led in a succession of hobbling horses, all with contorted and twisted hooves. The heads of the once-proud looking animals were drooping, and their eyes were glazed over with pain from the immense strain being placed on their tendons, which meant they could barely walk.
SPANA doesn’t employ only vets to deal with the issues caused by neglect. ‘We’ve long recognised that hooves are a major source of problems for donkeys, mules and horses, so we have farriers to attend to these conditions.’
SPANA’s farriers are experts at hoof care. Whether it is paring an overgrown hoof, replacing a worn out or broken shoe or treating a poorly trimmed foot that has resulted in infection, its dedicated farriers are the equine equivalent of the Formula One pit-stop crew, and they will not let their four-legged patients back out on the road unless they are fixed!
SPANA’s aim is to raise £40,000 to fund its farriery programme in 2008. This will cover the cost of training more farriers, and supplying them with new sets of tools when they qualify. It will also fund the veterinary care and treatment needed to deal with the more serious cases, including many donkeys and horses whose hooves have been so badly damaged that they need respite and time off their feet to recover fully.
Money raised from this appeal will be used to fund SPANA’s farriery programme until it reaches its target. Any additional funds raised will be used to support the work of its animal hospitals, mobile clinics and education programmes across North Africa and the Middle East.