Re: Requesting markups for Khan from Lavinia


Lavinia Fiscaletti
 

Hi Jessica,

I've added some mark-ups to Khan's album:

https://ecir.groups.io/g/CaseHistory/album?id=267511&p=Created,,,20,2,0,0

The latest rad showed that there was both bony column and capsular rotation present. This means that the tip of the coffin bone is pointing downward more than it should and that the hoof capsule itself has pulled further away from it's correct attachment. The trim that was done before the shoeing package was applied did remove a lot of the excess horizontal toe length, but not enough. Unfortunately, it also removed sole in the front half of the foot when there was already much too little. By removing the shoeing package, some of the pressure that was keeping the coffin bone rotated was relieved but unfortunately how much is a bit of a question mark. The one picture of her hinds also showed long toes and underrun heels, along with the pronounced bull-nose silhouette. Basically, what you want to get done is to back up both toes at ground level so that the breakover gets moved closer to the tip of the frog. Then, take just a little bit off the heel height on the fronts, while leaving the rest of the bottom of the foot alone. Add rockers to the backs of all the heels to ease landings. Here are some links to help:

https://www.hoofrehab.com/DistalDescent.htm

https://www.hoofrehab.com/HorsesSole.html

https://www.hoofrehab.com/HeelHeight.html

https://www.hoofrehab.com/Breakover.html

LF lateral composite: Please keep in mind that the rad was taken with a significant wedge in place, so once that was removed the alignment of the bony column would have relaxed to some degree. On the radiograph, the pink line shows how the bony column should align while thew purple line follows the actual alignment. Note how the coffin bone tips down, away from the pink line. The pink line ends where the sole depth should be. Green line follows the angle of the new growth toward the ground - this is NOT a trim line, only a visual marker. Blue line at the toe is where the toe needs to be backed up, with the blue X being the remaining excess horizontal toe length. Red line is where the bottom of the foot needs to be left completely alone As this are is already critically too thin. The blue line from at mid-foot to the heel indicates that the heels can be lowered just a bit but no more. when you are done, the bottom of the foot will not be flat from front to back like it would be if a shoe were going to be applied. This is necessary to make the needed changes to set up the correct mechanics. Lime arrow indicates the need to lower the height of the back half of the foot to help correct the bony rotation. Yellow line #1 runs thru the coronary band, #2 points to the extensor process. The distance between them denotes the amount of sinking.
On the hoof photo, the green line corresponds to the one on the rad. The blue area corresponds to the blue X on the rad; the red line again indicates that nothing should be removed behind the backed up toe, just as on the rad.

LF sole: Solid blue line at the toe is where to back the toe to. Blue hashed area corresponds to the blue X on the rad. The blue hashes around the rest of the perimeter mean to bevel the wall out of ground contact as it is unstable and cannot handle any load at this time. The orange hashes at the backs of the heel buttresses (sorry - just realized one of them on theĀ  medial heel is red) indicate where to rocker the backs of the heels after lowering them a slight bit. Red line all the way around the perimeter indicates that NOTHING is to be touched inside the red line - leave the frogs, bars, sole completely alone.

RF lateral composite: Same discussion as the LF. There is more toe to be backed up but the principles are the same. Protect the sole depth everywhere else.

RF sole: Follow the discussion for the LF.

Hinds: The bull-nosed silhouette is a red flag that the coffin bones are ground parallel, if not negative plane. This means that the front half of the foot is taller relative to the back half, lifting the front half of the coffin bone above the back half. Need to measure both collateral grooves at their deepest point - looking for that to be 1". The depth of the collateral groove at the true apex of the frog should be 3/4". If you have extra depth, the front half of the foot can be lowered after backing up the toe. If that depth is not there, DO NOT lower the vertical height. Ditto for the heels - if you have more than 1" depth, you can move the heels back somewhat but be careful not to go too far. Add rockers to the backs of the heels to finish.

Make sure to add aggressive bevels to the treads at both the toes and heels of her boots to help maintain the correct breakover placement and to help ease landings and breakovers. Cutting out pressure relief in the pads under the area of the tip of the coffin bones to help with her comfort levels.

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

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