Hi Sherry,

Those were some good changes. LF toe needs to com back a touch more, RF more. RF has the hoof capsule twisting toward the inside from push of the lateral heel being run further forward than the medial one. I'll do mark-ups to explain.

Gald she's feeling better.
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team

Hi Stephanie,

There is a lot of excess foot here - both toe and hoof length in general. The vertical measurement line shows roughly where the hoof wall should be and everything to the left of that line is excess.  The long horizontal line is where the bottom of the foot should be, with everything below that excess length. As another example, the beginning of the toe bevel at ground level should be under the tip of the coffin bone and I think you can see how far forward of that point it is.

I'll bet you have noticed his feet grow really fast. They do this in an effort to put as much distance as possible between the internal structures and the ground. However, if not controlled this is counterproductive.

Otherwise, of concern is the multiple lucencies (black areas), possible calcifications (white areas) in the laminar space and closer to the bone as well as obvious bone loss at the tip of the coffin bone. This is a normal hoof for comparison:

http://www.equipodiatry.com/images/valueofradio/2.jpg

Some of what looks like calcification could actually be dirt on the surface. Can't tell with only one view. In any event the changes tell a story of infection which certainly fits with his history. The important question is whether that infection has penetrated the bone - osteomyelitis.  If the drainage holes are still open your vet could inject contrast material to see where it goes. Otherwise, it would be good to obtain all three standard views of the foot to get a better idea of how much bone has been destroyed.

I would be aggressive with the trim. There's a good chance that will lead to an impressive round of abscess drainage but that's a good thing.  If an avenue opens on the sole you can try treatment with medical maggots to destroy infected and damaged tissue.  Another option for osteomyelitis is regional limb perfusion with antibiotics.  Unfortunately, bone infections do not respond to oral or even intravenous antibiotics because the blood supply to bone tissue is too poor to deliver a high enough concentration of the drug.

--
Eleanor in PA

www.drkellon.com 

EC Owner 2001

Hi Karen,

I've added a mark-up to King's album:

https://ecir.groups.io/g/CaseHistory/album?id=1402&p=pcreated,,,20,2,0,0

Was he standing squarely on the foot when that view was taken? It doesn't appear so.

Green are the trim lines - way too much toe and excess hoof capsule height. Whether or not the heels can be lowered further is going to depend in part on what the rest of the bony column alignment is when he is actually weighting the leg. Initially, I wouldn't lower them more than in the mark-up. Yellow lines are evidence of sinking - which is not new. It was present on the last xrays as well. Pink area shows fuzziness on the dorsal surface of P2, which is consistent with ringbone formation.

There is a considerable amount of erosion of the tip of the coffin bone (inside purple circle). There are also several dark shadows that could be gas pockets, abscess collections and/or infection so otseomyelitis is a concern. When the toe is taken back, it is likely there will be some kind of exudate inside, as well as possible open gaps. The overall texture may be punky.

I've asked Dr. Kellon to please comment as soon as she has a moment.
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team

Hi Karen,

It can be quite surprising when you view the feet from ground level.

In general, yes to everything your current vet has said. I'll explain fully with the mark-ups. Thanks for adding the new pix. You are correct that you cannot make a club foot "normal" just by trimming it that way. A club foot is a symptom of an issue further up the leg/in the shoulder that is causing the altered bony column configuration. Need to address that in order to actually change the resulting club foot. In the meanwhile, the trim must still conform tightly to the bones within. In Luke's case, this isn't happening as the heels have been allowed to get a tad too high even for the current bony column alignment and the toe is much too far forward (long).

Also a good idea to use boots and pads at ANY time a horse is not comfortable. If you don't, they will attempt to compensate for the pain by landing toe first and by by altering the scope of the stride. Once you are sure the current boots are "keepers" you will need to add a strong bevel between 9 and 3 (rasp, grinder will do it easily) to keep the break over where it needs to be. Have  look here for more info:

https://ecir.groups.io/g/Hoof/album?id=4740
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team

We’ve had several requests for fliers for our ECIR Group Inc 2017 NO Laminitis! Conference in Tucson, AZ, to distribute to vets, farriers, and fellow horse friends.

I’m happy to announce they are available! Many thanks to ECIR Group Inc. Director Fran for her hard work in designing them. 

Professionals are contacting us upon learning of CE credits (see below) through IVIS, our websites, FB, and word of mouth, so it is a good time to get this info to your contacts.

Please contact Fran or our Conference host, Leigh, at the emails below for more information.

Leigh — equinesrfun “at” yahoo “dot” com
Fran — jazzerfrn “at” aol “dot” com

Attendees of the 2011, 2013, and 2015 conferences welcomed the latest in research and specific protocols used to improve the welfare of equines in their care. The 2017 NO Laminitis! Conference will continue to build on that mission:

When:      The weekend of October 27 - 29, 2017
Where:     Tucson Hilton East, Tucson, AZ

If you are ready to register for the conference and book your room, you may do so online through the gorgeous and info-packed www.nolaminitis.org.

Speakers:    Eleanor M. Kellon, VMD
                          Robert M. Bowker, VMD, PhD
                          Jaini Clougher, BSc, BVSc
                          Kathleen Gustafson, PhD
                          Lisa Lancaster, DVM, PhD
                          Lavinia Fiscaletti, BS - Trimmer, Moderator/Senior ECIR Group Member
                          Paige Poss, APF, Anatomy of the Equine, LLC        
                          Carol Layton, BSc, M.Ed, Balanced Equine Nutrition

Full schedule and lecture information at the conference website www.nolaminitis.org.

Attendees:   Any professional or owner who has one or more horses in their care.

Continuing Education:

AAVSB RACE: This program 817-29300 is approved by the AAVSB RACE to offer a total of 13.00 CE Credits (13.00 max) being available to any one veterinarian, and/or 13.00 Veterinary Technician CE Credits (13.00 max). This RACE approval is for the subject matter categories of Category One: Scientific using the delivery method of Seminar/Lecture. This approval is valid in jurisdictions which recognize AAVSB RACE, however, participants are responsible for ascertaining each board's CE requirements. RACE does not "accredit" or "endorse" or "certify" any program or person, nor does RACE approval validate the content of the program.

This event has been approved for 21 American Association of Professional Farriers (AAPF) Continuing Education Credits. For more information visit their website: www.ProfessionalFarriers.com

Pacific Hoof Care Practitioners (PHCP) has approved 20 Elective or CE credits for members attending the 2017 NO Laminitis Conference. http://www.pacifichoofcare.net/

This event has been approved by the International Association of Animal Behavior Consultants for 16 Lecture hour CEUs. For more info see  http://iaabc.org/bin/#/ceus/search/


Ticket Pricing: $280 Full Lecture Admission
                                $250 Early-bird (Registration prior to 09.23.17)
                                $100 Guest (Social functions only - No lecture)
                                $175 Veterinary students      

        (No children under 16 at lectures)

Pricing includes Thursday Night Meet-and-Greet, dinner Friday night and lunch Friday and Saturday. Breakfast is included for attendees staying at the Hilton.

--
Nancy C in NH
ECIR Moderator 2003

Save the date! The ECIR Group Inc. NO Laminitis! Conference, October 27-29, Tucson, AZ

www.nolaminitis.org

Learn the facts about IR, PPID, equine nutrition, exercise and the foot
ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
ecirhorse.org

Hi Sally

Glad to hear about your family nearby Missoula.

Stand by for info about fliers, hopefully today.

For those concerned about Supporters of the Festival, please know there are two separate equine festivals.  One is Equus International Film Festival in MT, the other is Equus Film Festival in NY. The latter had the problem in 2016.  We have also submitted to them. Will be interesting to monitor going forward.

If we are going to talk about this further we need to move this to Horsekeeping, probably.

Thanks
--
Nancy C in NH
ECIR Moderator 2003

Save the date! The ECIR Group Inc. NO Laminitis! Conference, October 27-29, Tucson, AZ

Learn the facts about IR, PPID, equine nutrition, exercise and the foot
ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
ecirhorse.org

Thank you, LeeAnne - I totally missed the two different dates.  That is yet another thing to love about this group - we all watch each others' backs, and with so many eyes on the messages, errors get caught.

Yes, insulin and glucose need to be from the same blood draw, but with a nice normal insulin the index of suspicion is much, much lower. Another reason to have insulin and glucose taken from the same blood draw is that if the glucose is very low, it points to blood handling errors.

Thanks again, LeeAnne!
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy

Karen and Luke 

May 1 2017

Northern California

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921

Hi Jaini,

I may be wrong  but I just want to be sure Tartine doesn't slip through a crack with regards to proper diagnosis? It seems from Tartine's case history (uploaded May 5, 2017) that the glucose was not taken on the same day as the insulin.  Do we not need to have both Glucose and Insulin tested from the same blood draw to make a true diagnosis?

Katrina, we ask that only one copy of a case history (that contains all updates) be posted in a horse's folder.  This is to conserve dataspace and so the support team doesn't have to spend their limited time opening and comparing all the different files to get the real current situation of an equine.  Please see How to Use Your Case History Folder. 

It seems you have transferred information to the latest case history file so have removed the excess files . Just to be sure, though they previous copies have been emailed to you so you can double check this when you get a chance.  

--

- ​LeeAnne

When I was taking pictures, it became obvious to my eye getting down at ground level the toes on all the feet are long.  

 It's a real eye-opener, Karen, isn't it? A lot of us have been surprised by this. 

Happy to hear he's becoming more comfortable.

--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002

Yay!  It wasn't a fasting test, was it? I see the glucose was low also, which can happen with blood sitting too long or blood mis-handling; insulin/glucose after fasting can also give a false negative.  

Yes, just the PSSM is more than enough!
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy

Thank you for the explanation.  My brain is exploding with all the new information... I have posted new pictures that I hope are better for you.  I am not a photographer and have to use my iPhone.  Delete any that are not helpful if you want.

so a couple questions... do we need to manage the club foot any differently?  I had always heard that we couldn't make a club foot into a normal hoof.  He does grow hoof very rapidly, which is why I have a trim every four weeks.  I have had three trimmers... the first one I let go as she wouldn't listen to the vet, and since then two different vets have all stated the toes need to be backed up... I have a relatively new farrier now who was surprised when she saw the X-rays as she thought she had removed a great deal of toe, but realized there was more to go.  From what my vet said, we need to shorten the toes, lower the heel on that left front foot, and the right front hoof needs the toes shortened, but already has a low heel... do you agree?   When I was taking pictures, it became obvious to my eye getting down at ground level the toes on all the feet are long.  

Do we need to shorten the toes and lower the heels gradually?  Wouldn't any dramatic trim possibly make his lame or ? I am really out of my league knowing what to have done, so having markups and pictures of what his hoofs should look like would be so helpful.

i did buy Cavallo boots with gel pads for him so tomorrow I'll get himused to wearing them for added hoof protection, particularly when he's well enough to ride, but even now while he might be tender still, although he seems so very much better the last couple days.

Thank you.

--

Karen and Luke 

May 1 2017

Northern California

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921

For Members Who Need Trim Evaluations

When:
Saturday, 6 May 2017

Description:

Trim is often the “missing link” in regaining and maintaining soundness. Because your equine friend deserves the best hoof care possible, the ECIR Group is glad to assist anyone wanting trim evaluations. To do this, we need some specific help from you: 

1. Good Photos: Hooves are a 3-D object that we are evaluating using a 2-D medium. That places us at an immediate disadvantage. Good hoof pictures - of clean feet, taken from the correct angles, with good light and non-cluttered backgrounds - enable us to do this as accurately as we can. It helps the volunteers compensate for not actually "being there" to pick that hoof up or crouch down on the ground and look at it up close. Good photos help eliminate and/or clarify some of the variables that play a part in our ensuing recommendations. We understand that this may be awkward to accomplish but it is essential for providing the necessary info we need to help you help your friend. Although the front feet are where everyone tends to focus, providing pictures of all four hooves is encouraged.  Anything that affects the front feet will also affect the hinds, although often to a lesser degree.  If there are trim issues in front, there will also be trim issues behind as it is usually the same individual caring for both sets of hooves. 

The sooner we get clear and usable photos, the sooner we can assess and make specific, thorough recommendations. Go here for instructions for taking good hoof pictures.

2. Proper Identification of your photos: Having to guess whether a hoof is front/hind, left/right makes helping your horse doubly difficult and the Photo Section of the group chooses its own order when loading your shots so you can't count on them being uploaded in any particular order. Identification of individual hooves can be as simple marking LF, RF, LH or RH with a magic marker on the appropriate hoof before snapping the shots.  For dark hooves try a metallic silver marker or use marked masking tape as a “label”.  Please note that “left” refers to the horse’s left (near side) while “right” refers to the horse’s right (off side).  

3.  X-rays: Radiographs are always a bonus as they clearly reveal what is going on inside the walls where our human, non-superman vision cannot penetrate. With the advent of digital x-rays, however, the cost of a basic set has risen considerably. We understand if this just isn't an option but x-rays are never a waste of money when hoof problems are present and sometimes are an essential ingredient to a good outcome. If you are going to have x-rays done, here are some tips on making the most of your investment.

Hope this helps with the "why" of your volunteers' repeated requests for good hoof shots.

If your equine does not have PPID or IR, your photos go in ECHoof.   This is where all conversation about Non IR and PPID hooves takes place.  Upon joining you will be sent instructions about how to get your photos uploaded. Before emailing your photos please read and follow Getting Good Hoof Photos and Naming Photos and Xrays. 

If your equine does have PPID or IR your photos go in Your Photo Album located in the case history photo section. Once you have posted and correctly named your photos post a message in the main ECIR asking for evaluation. 

-Owners, Moderators & Primary Response Team of the ECIR Group​​

The dishing in the dorsal wall is likely what the vet was referring to when she mentioned rotation - known as capsular rotation. The distance between the dorsal edge of the coffin bone and the dorsal wall of the hoof capsule should be even from top to bottom. The dishing is an outward indication that the laminar attachments have stretched and that this alignment has been compromised. It can be due to mechanical problems (toes too long), laminitis/founder (lamina become inflamed/stretched/give way) or a combination of the two. A realigning trim needs to be instituted to get the excess toe length removed and the breakover set back correctly so that the hoof can heal. If the trim is not corrected, the excess toe length continues to cause the lamina to tear with every step the horse takes.

Rotation can be bony column or capsular. Bony column rotation is when the alignment of the bones is not correct and the hoof-pastern axis (HPA) has a broken forward configuration. It's a more complicated problem that is NOT present in Luke's case.

Sinking is the common term for distal descent. This is where the bony column is sitting deeper down inside the hoof capsule than it should be. Most domestic horses show some degree of sinking over time, but not all. Getting the trim optimized is so that the hoof capsule tightly hugs the internal structures is the only way to get this to start to reverse. Because the lamina cannot actually repair, it means that after the trim is corrected, the hoof capsule needs to be maintained in the proper configuration so that new, well-attached wall can grow down from the coronary band to replace the damaged parts. It takes 9-12 months for an entirely new hoof capsule to grow down from the coronary band to the ground. Because the vet mentions that there has been no change in this set of xrays from the previous ones, it means that the trim has needed correcting since at least 2013
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team

I will add the links to my signature... good suggestion.

The comment about the rotation being stable is directly from the vet notes when she compared these X-rays done on the 25th of April.  That was in reference to the left front hoof which has a mild club.  There is some dishing on the dorsal side of that LF hoof as well.   I am not familiar with the term sinking, so would appreciate learning about that and what remedy is available. 

I have the 2103 and 2014 X-rays on a CD so I am not sure how to add them.  

His last trim was 4/23/17 and next scheduled for 5/25, but have sent a text to my farrier that I'd like to move my appointment up to take care of trim needed... I'd love your input so will go take pictures now and post.  

Thank you so much. 

Karen and Luke 

May 1 2017

Northern California

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921

Hi Jennifer,

The Wiki files are full of information that should help with this.

I found this signature:

Jennifer Reinke
El Segundo, CA
December, 2006

--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002

I'm just getting ready to have my horse tested and wanted to get a start on his case history.  I see the case history file for a pc to update your info but I'm not really sure where to actually get started.  Can someone help me? 

Also, I know I joined this group many years ago and thought I had written down somewhere my signature info but I can't find it.  Might someone have it in the files that I can't see?

Thank you!

Jennifer and Brasco

Los Angeles, CA - ?

Hi Karen,

Here are the links to Luke's case history and to his photo album:

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921

Please add these to your signature. Although there were problems with making signatures due to some Groups.io glitches earlier this week, those appear to have been fixed.

You are correct that the toes are too long and the soles a bit thin. There appears to be a bit of sinking as well. Unfortunately, the xray views were taken from slightly below the feet, aiming upward, so it makes them somewhat more difficult to interpret. There is no rotation evident on this set of xarys so not sure what you're referring to regarding "mild rotation is stable". If you have the earlier xrays, adding them would be helpful.

The bruising is in the heel bulbs so over-reaching being the cause makes perfect sense. It can get incorporated into the walls as they grow down. Generally, over-reaching is made worse when the toes are too long because they delay the time of break over and leave the front feet on the ground long enough for the hind feet to catch them during the stride. Backing the toes to their optimal position will help stop the over reach.

Here's the link to Taking Good Hoof Photos:

https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions

It would help to have a set for all four feet. When was his last trim? Maintaining the current four week schedule makes sense so that's what to aim for.
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team

Hi Dr. Kellon and Everyone, 

Per your advice Dr. K, I got a radiograph of King's front right foot that has kept abscessing. It actually stopped draining a couple days ago, and is currently not draining, but I don't know how long that will last. Besides trimming/backing of the toe which I have an appointment with my farrier on Monday - what do you all see and what are your suggestions? 

https://ecir.groups.io/g/CaseHistory/photo/1402/3?p=Name,,,20,1,0,0

Thanks!! 

--
Stephanie & King
October 2014
Oregon
Case History