Re: lavinia and dr kellon; follow up from markups and 2nd vet opinion


Lavinia Fiscaletti
 

Hi Daisy,
 
The first two attachments are comparisons of the April 2021 radiographs with the June 2021 rads. There is no RH as the April rad was never found. It appears as if the June rads had the front limbs extended forward when the views were shot, rather than standing squarely under the horse. Not certain about this, as there is no part of the cannon bone in any of the June views to help assess that parameter, but the angle of the pastern itself is flatter, suggesting the feet were further forward. That will affect how the bones appear to align. In this case, it would make the alignment appear much better than it may actually be.
 
My concern is that there was a loss of sole depth, esp. in the fronts, from the earlier rads to the most recent. Definitely need to conserve/protect every millimeter of sole that is currently present, so no removal of any sole at all during the trim - even if it appears to be exfoliating. Allow it to do that on its own. Unfortunately, there's been no real change in the bony column alignment or HPA. The goal is to increase the height in the back half of the feet relative to the height in the front half without losing sole depth in the process. Sinking doesn't appear to have changed.
 
Toes still need to be brought back more to shorten the horizontal length of the foot at ground level. This means that you are looking to make the distance between the current tip of the frog and where the toe ends shorter, so that the breakover point is moved closer to the tip of the frog. This will likely mean invading what appears to be the white line. This isn't an issue as where the white line currently appears to be at ground level is a stretched forward point, not its true location. Because of the shoes, I can't point out these areas on the photos.
 
 
The heels, frogs and bars should also be left alone to allow them to callous up and add depth to the back of the feet. Heels are significantly underrun, frogs are elongated and narrow - not uncommon as they don't get much use and the entire foot is pulled/pushed forward. He is actually standing on his heel bulbs, as they have been pulled down and forward along with the rest of the structures.
 
 
https://www.hoofrehab.com/HorsesSole.html

 
RF dorsal: Green line follows the angle of the well attached, healthy wall growth toward the ground. Blue area is the flared medial wall material that needs to be removed so that you don't shoe to the pathology.
 
RF lateral composite: On the radiograph, the pink line shows how the bony column should align, while the purple line follows the actual alignment. Note how the purple line dips back from the pink line, which denotes a broken back HPA. There is no significant change from what was present in April. The pink line ends where the sole depth should be, which is approximately twice as deep as what the sole actually is. Blue solid line is where the toe should end - everything ahead of that point needs to be removed (blue X). Red line shows where the bottom of the foot should be, so need to preserve every millimeter of vertical height that is possible across the entire bottom of the foot. Lime arrows point to areas of inflammation = early arthritic changes in the making.
On the photo, the blue area corresponds to the blue X on the rad. Orange line shows where the heels eventually need to be to support the horse properly. Green line shows how the dorsal wall should appear if the hoof wasn't squished forward.
 
RF sole: Blue solid line indicates where to pull the toe back to, with the hashed area being the excess length that needs to be removed.
 
LF dorsal: Mild flares on both sides in the lower 1/3 of the hoof capsul that need to be removed.
 
LF composite: Same discussion as for the RGF.
 
LF sole: Blue solid line again shows where to back the toe to.
 
RH dorsal: Bit of lateral wall flaring that needs tightening up.
 
RH composite: Same goals as for the fronts: preserve all the vertical height, back the toe.
 
RH sole: Blue line is where to back the toe to.
 
LH dorsal: Slight lateral wall flare that needs tightening up.
 
LH composite: Again, same discussion as for the RF. Maintain all the vertical height, back the toe while leaving all the sole behind the point of the solid blue line alone.
 
LH sole: Solid blue line is where the toe should end.
 
You need to prioritize heel-first landings in order to strengthen the health of the feet. Also want to encourage the heels to stand up taller, so that they will move back under the legs. The digital cushions have been squished out behind the foot, while the heels have run forward: they're designed to be stacked to provide proper support. This is going to be difficult to achieve with shoes in place, as the heels need to be trimmed to float the walls, with weight bearing concentrated on the bars and the heel-wall juncture. The sinking is also something that rarely improves when shoes are applied as the shoes create peripheral loading, which takes the frogs/bars/soles completely out of the weight-bearing equation while suspending the horse completely from the already damaged laminar connections.

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Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
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