On Wed, May 1, 2019 at 06:38 PM, Lavinia Fiscaletti wrote:

 
- His walls should not be the primary supporting structures in any part of the hoof. They should be sharing the work with all the other appropriate structures and should only bear 5-10% of the total load.

Yes I understand but what I understand from your marks is that lateral and medial side of the hoof wall should be removed from the white line so there there will not be any part of wall sharing the weight. Am I wrong? That's my concern, that Plutón will be bearing his weight over the soles but for the heels.

The whole idea is to provide more of that height overall in the back half of the foot relative to the front half of the foot so that the coffin bone IS supported in a more "tipped forward" alignment because in this case it is now sitting tilted too flat for his conformation. Does that make sense?

Yes it makes sense thank you. My only concern here is that I am struggling with both standards. One is to keep heel height enough so that the HPA is aligned as you have tought me and the other one is that from what I have learned in Pete's videos, the trim in the heels should respect the angle of the inner structures. Knowing Plutón's palmar angle is much more than 5 degrees, should not be the heels trimmed lower and at that angle? I find that aligning the HPA breaks the rule of trimming the heels parallel to the inners structures and if we trim the heels parallel to the inner structures then the HPA will be broken. Am I missing something?

- Rasp down from the top - it will thin the material, not necessarily remove length from the bottom.

Not sure about this. As above, what I understand from the marks in sole view is that length will be removed. Sorry that I don't get it right. 

Locating the true apex of the frog gives you a marker you can use as a gauge of toe length as this point doesn't shift or distort

Thank you so much. And the true apex is under the tip of the coffin bone?

If you mean the pink lone on the radiographs, that is where the dorsal edge of the coffin bone and the dorsal edge of the remaining pastern bones all line up. It is when the joint spaces are even, the tendons and ligaments are neutral at rest.

Thank you so much!

I believe he is only tender. We made a slow motion video and we don't see him toe frst landing. Thank you for the description. It is very clear.

Last question Lavinia. Do I assume that his heel height for his whole life is going to be close to 4.5 mm or will this change at any time? Do we keep this 4.5 mm heel height until next xrays?

I am sorry to ask again but I want to make sure we don't do anything that is wrong and takes several months to be repaired 
 
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Hi Maria,

Good questions.

- Rasp or knife is a personal choice as both will accomplish the goal - choose what works for you and that horse at the time. It can change from session to session.
- Rockering the heel at about a 45* angle is the idea. See this link for some great photos and descriptions:

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

- His walls should not be the primary supporting structures in any part of the hoof. They should be sharing the work with all the other appropriate structures and should only bear 5-10% of the total load. Heel height isn't measuring the amount of wall above the sole plane, it is the total vertical distance from coronary band to the ground that is important. The whole idea is to provide more of that height overall in the back half of the foot relative to the front half of the foot so that the coffin bone IS supported in a more "tipped forward" alignment because in this case it is now sitting tilted too flat for his conformation. Does that make sense?
- You are not removing the quarter walls, you are narrowing the entire side of that foot, from heel to toe so that it aligns with the angle of the healthy new growth. This can be done over the course of a couple of trims so you can monitor how it affects him. Rasp down from the top - it will thin the material, not necessarily remove length from the bottom. You are already doing this in tiny increments - just get a bit more aggressive with the corrections. Confine the corrections to the bottom 1/3 of the hoof capsule.

Locating the true apex of the frog gives you a marker you can use as a gauge of toe length as this point doesn't shift or distort, even when the toe/frog/sole stretch forward. You don't necessarily need to trim the frog back to this point as excess length on the frog doesn't harm anything and will eventually dry up and become an obvious tag that can then be snipped off.

If you mean the pink lone on the radiographs, that is where the dorsal edge of the coffin bone and the dorsal edge of the remaining pastern bones all line up. It is when the joint spaces are even, the tendons and ligaments are neutral at rest.
On the lateral photos, it is the same line that was on the rads, superimposed on the actual leg. If you stand the horse up square, then take several steps back so you can get a better overall view of the entire leg, you can see what angle the pastern is just under the fetlock and see that as your gaze travels down the leg closer to the hoof, that angle changes quite markdely - tells you the toe is too long and the back half of the foot is too low relative to the front half. Bringing the toe back will alleviate this to some degree but unless you have excess sole depth under the leading edge of the coffin bone that allows for lowering the height at the front half, you need to work to elevate the back half instead.

Watch him move - is he landing heel first at all times? I tend to doubt this as his frogs do not appear to be thick, rubbery and substantial. If he lands heel first but the stride is shortened, then he is tender. If he is landing mostly toe first, he is sore. Tender or sore means he should be in padded boots that make him comfortable enough to stride out fully, willingly and confidently. The boots need to have good bevels added to the treads both around the toe and at the heels:

http://www.hoofrehab.com/GloveMod.html

HTH.

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

Dear Lavinia,

These are the times where vocabulary falls short to say thank you and this word is not enough to mirror the gratefulness we feel for such a huge effort to help.

Really thank you for all the time and dedication you have spent on us. It is a very detailed, clean and valuable work.

I have some concerns and doubts before we attempt to match your guidelines if you don't mind:

-  When you say the lime triangle is pointing out the area that can be open up for the heels to come back, do you mean by rasping-trimming or by sculpturing the seat of corn with the knife?

- What's the angle we should rocker the heels into? 45°?

-  Because we are asked to trim the quarter walls to remove flares but at the same time to keep the heels higher to align the HPA which are now at about 4.5 mm over the sole, I have two doubts:

     1-  Will not this cause the hoof to tip too much forward over the toe as if Plutón were wearing high heel shoes?

     2- How do we do the transition between the high heels and the quarter walls being removed? Do we just rasp into a soft transition?

Regarding this point I want to be honest with you bu saying that we don't promise to remove the whole wall at quarters because I have in mind several horses that became very sore by removing totally the hoof walls and kept them laying down. I am sure that when you ask us to do it is because you know it will not be the case, maybe because Plutón has enough sole depth in the back of his hooves or for any other reason, but my gremlins keep whispering, "don't take the risk". I don't want to be disrespectful with your time and work (promised) but fears are free and I need to be totally sure this will not happen to Plutón. I apologize in advance. Don't want him laying down, the vet pressing to put him in NSAIDs, several months sore, not wanting to eat, etc. I have this episode in my mind from one horse and I am truly scared. Maybe I need time to understand better and free the gremlins up.

Anyway I need to know how to do the transition even for leaving some quarter hoof wall because if we leave it at 4.5 mm (heel height) I am worried it will cause more flare.

- What's the importance of finding the true apex of the frog? I read the link you sent me but still don't understand what kind of measure it leaves.

- How do you determine the angle of the pink line? Is it the angle of the tip of the coffin bone?

Thank you so much again Lavinia. We so appreciate your help.

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Hi Maria,

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

https://ecir.groups.io/g/CaseHistory/album?id=89698

Generally, you've been doing a good job rehabbing his trim. The HPA has improved since the original radiographs were taken as has the flaring. Concavity is starting to form although the sole depth still is compromised. His frogs are looking healthier and becoming more robust although they are still stretched forward. Toes still need to be brought back more, esp. at ground level. Heels will also need to move back but that needs to be done gradually once you gain some more vertical height in the back half of the foot to work with.

LF dorsal: The green lines follow the angle of the new growth toward the ground. The medial side has a slight amount of flaring remaining that can easily be removed at the next trim as it has already been beveled out of ground contact. The lateral side needs more attention. If you are concerned about possible soreness, you can bring the toe back on one trim, then on the next one, do more with the wall flare while maintaining the toe where it is. Also looks like the medial side may be a tad taller than the lateral wall. Have a read here:

http://www.hoofrehab.com/Balance.html

LF lateral rads composite: Pink lines follow the angle of the bony column to the ground where the breakover should ideally be if the sole is thick enough. Purple lines follow the current alignment of the bony column. You ca see how the HPA has improved from what it was in 6-2018 because the purple line in the 4-2019 rad is closer to aligning with the pink line. Green lines follow the angle of the new growth of the hoof wall toward the ground, which is parallel to the pink line. You can see how the hoof capsule gets further away from the ideal location as you move from top to bottom - this is capsular rotation. Blue line is where the toe should end, blue X is the excess toe length. The lime line is where sole depth is measured - you can see that the sole stops before the line ends. Orange line is where the heels should be. Yellow line #1 runs thru the coronary band, #2 points to the extensor process. These two line should be overlapping, or at least close together. The distance between them denotes the amount of sinking. The sinking, broken is contributing to the lack of sole depth and broken back HPA. Red line is where the bottom of the foot should be.
 
LF lateral: Pink line follows the pastern angle, which is the bony column alignment on the rad. Green line follows the angle of the new growth, same as on the rad. Orange is where the heels should be. Light purple follows the pastern angle at the back of the pastern and is parallel to the pink line. Yellow lines follow some of the horn tubules - which should run parallel to the pink/purple lines - but have a much flatter angle. Blue is the same as on the rad, which is the excess toe length.

LF concavity: Blue hashed areas are where the bars are already crumbling away and can be removed. Lime is where the heel-bar triangle can be opened up to in order to help move the heels back. Purple areas are where to add the heel rocker/bevel without actually lowering the heel height.

LF sole: The blue perimeter hashed area combines bringing the flared walls inward with bringing the toe length back. Blue hashed bar area is the extra that can be lowered to about sole height but no lower. Lime is where the triangle will open up some more to expose the sole underneath. Purple is where to add the heel rockers. Pink circled ara is where the central sulcus is opening all the way up to the hairline (live tissue). Need to monitor that area to make sure it starts to heal and close up. It may need some soaking and treating periodically to make sure there is no infection up inside. Until it heals, it will likely cause some degree of discomfort so will tend to make him not want to fully load his heels. Red V is about where the true tip (apex) of the frog is.

RF lateral rad composite: Same as LF, except there is less excess toe length. Again, medial wall is a tad taller than lateral one.

RF lateral: Again, same general discussion as LF.

RF concavity: See RF. The pink circled area is the excess tip of the frog. This photos really shows how that excess is shriveling up and beginning to peel away as the toe is brought back and the concavity starts to build. You can cut that area away if it's loose but it's not a priority. Here's a link to a more in-depth description of how to determine where the true tip (apex) of the frog is:

https://ecir.groups.io/g/main/photo/1106/0?p=Created,,,20,2,0,0

RF sole: Same discussion as the LF.

LH/RH laterals: The toes behind are in the same situation as the fronts, with the toes needing to come back more.

HTH.

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

It is really difficult Maria  and very stressful trying to get the really good photos  thats for sure and at last farrier visit, we could tell Micky had had enough after having all 4 feet trimmed and decided to leave it that day. I  didnt get the the photos of  hinds after the trim,

I should have taken pics or video , video with a screen shot could work, and do have a camera with sports mode so can try that instead of  mobile phone,

I do place Iphone on the ground when taking dorsal, heel and lateral. 

Messaged farrier to come this week to check Micky, as i have hospital next week, am organising a stable hand  to come to my place to look after my horses while i am in hospital overnight. I dont like leaving my horses and am feeling quite uneasy  about it.

Understand and totally  respect what Nancy said  regarding  ECIR Protocol with Photos and Xrays .

It's so important that angles have to be right, all of Mickys xrays before 31.08.2018 weren't done correctly as they only had one front foot  on the block instead of two, the xrays done  on  31 August 2018   and  8 November 2018  both these xrays  had mickys both fronts on blocks but in saying that could these ones be improved on . Vet didn't  do a  thumb tack at the apex of frog. feedback here would be good before i get next rads, if we get them right this can help Lavinia and Nancy for MIcky also.

Thanks again for all your help Maria

soon as lease cheque goes in to bank its late i can pay for rads but its all too close now to surgery being next week,  damn, getting the rads is a 1 and 1/2 hours away so 3 hour trip total for Micky,  where we got them done the last 2 times, the local vets rads are really bad. so makes it hard. also travelling wise for Micky, he could travel down ok at the moment so thats positive.



--
Kath Chase & Micky
Yinnar Vic Australia
July 2017
Micky's Case History
Micky's Photos

Oh I forgot it Lavinia sorry,  heels at Xrays time were at 4 mm over the sole. We have not trimmed them since you said they needed to be a bit higher. Now are at 4.5 mm.

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Thank you so much for the detailed answer Lavinia. It is all perfectly clear. Lets see if I can talk into this to the vet next time.

I uploaded the pics you requested. Just in case you missed the post because we have been talking about other things here. I don't mean to hurry you.

Thank you so much for your time.
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Hi Maria,

Here's the link to a few suggestions:

https://ecir.groups.io/g/main/wiki/Getting-Good-X-rays

A true view of any angle means the machine needs to be aimed level and at the center of that view, not tilted up/down or twisted to either side and it needs to be positioned at the correct distance from the targeted area.

- For laterals that means paying attention to whether you can see the any part of the bottom of the foot or part of the block is seen thru the lower part of the hoof capsule - means machine is too /high/low/close and aiming upward/downward.
- Don't cut the toes or heels off - likely positioned too close or aim is rotated .
- If you can see both heel bulbs the machine is likely positioned too far back and taking more of an oblique or is being held slightly high and aiming downward.

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

On Tue, Apr 16, 2019 at 02:01 PM, Eleanor Kellon, VMD wrote:

Can't say anything about the ringbone because exposures are different and the LF isn't a true lateral. The small bone spurs at the pastern joints have not changed.

Can anyone tell me how do we explain to the vet how to take a true lateral X ray please?  Is it only about being at ground level and exactly in the middle of the hoof? Or is there something more to take into account?

Thank you!
 
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Not my intention to say the opposite. My apologies if my answer leads to confusion.

I perfectly understand the standards and respect them.

Thank you Nancy.

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Hi Maria and Kath

Agree one can only do what one can do however,  I need to respectfully insert the request for clear pictures for hoof advice or consult as outlined in the Wiki and trim advice protocol. It is necessary only to have four shots of each foot in most cases. 
More is not always better. 

Thank you for your help with this. 



--
Nancy C in NH
ECIR Moderator 2003
DDT+E = effective treatment for PPID and EMS/IR equines: https://bit.ly/2J4ZgYT

 

Hi Kath, 

What a difficult situation. If I were you I would just do what is possible for your circumstances and work with that, because otherwise you will end up with a big headache and high frustration level. Pics are very important part of the evaluation but sometimes we can only do what we can do and pursuing perfection only points out failures.

I am sure your big efforts will lead to good acceptable pics. Don't go crazy about having all perfectly done.

You are doing an excellent work for Micky.
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Haha Nancy 😂. Thank you.
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Oh no, Thanks Maria for letting me know, I tried to look at Plutón Photos again yesterday, thought it was odd how his photos weren’t coming up. Will try pressing on the link of your signature today. 

I still need to reply to  your other message about u shaped pad on other  I find its leasier  for him to  lift RF if LF boot is on  but still very difficult to do . I still need to reply to  Nancy’s message, and Kirstin’s message also Kirstin  explained what we are going through pretty well, with her husband red in the face while she quickly snapped picture,  that pretty much the same for me, unfortunately my partner has back and neck injury, so he can’t do it ,  so it’s me that has to hold Mickys foot up which I can hold it up longer with both hands no worries much easier and my partner snaps the picture but I have showed him the ECIR protocol several times but he just can’t get it right. Trimmer no.6 did all Mickys trim  photos from sept 2017 to aug 2018 so they were pretty good, but in saying that Micky wasn’t on dead level ground all the time when alot of the previous photos were taken as well, the recent photos taken I can guarantee the area inside the stable is dead level. Also if Micky has boot on LF when doing dorsal  picture of RF would that put him on a  lower angle with the RF because the LF should then be higher with the boot on than the RF. That’s why we thought we put him on thick mats in stable the photos before then so Lavinia and Nancy can get a good at his cannon bones in frontal body and how he’s feet and legs  are positioned without the boots on I see where Nancy and Lavinia are coming from and what you said Maria pictures can be skewed and taken at the wrong angle  , not on level ground can cause big problems. 

Micky backed up from water bucket to feed bin in stable last night, my feeling he does this when he is not comfortable  again not wanting to turn  to walk back to feed bin. 

Also the bone loss  P3 is on MEDIAL side RF. I read somewhere someone said lateral side, and heels need to be addressed at some point, I agree with heels but am not sure what to do,  will find it and reply   but not sure which message it was it may have been Nancy’s message, I will reply soon.

Nancy I appreciate your response and help ,   I really appreciate the groups  support yous are wonderful, but I’m running out of time I have to go and pick up manure, do stables now, and attend to my three horses. My daughter may be able to help tomorrow to get more photos, hind photos sole shots  I can do if someone holds Micky He easily props toes down on ground so I can get a sole shot, Lavinia told me that one, it works,  but if I don’t have someone holding him he won’t sit the foot there.  This hasn’t changed since 2016 ,But sole shot with front propped and rested  no way he will not place toe on ground  or thick rubber mats it hurts him, whether it’s bending in the joints or likely toe pain, no way it’s impossible to get him to do sole shots that way resting the front foot is too sore for him . 

Thanks  for all the well wishes with my surgery on 30th , be awesome to have sound,  I’m organising farrier no.8 to come  back this week to check Micky. Then I can get 1/2 reasonable photos because he can hold his feet


Kath Chase & Micky
Yinnar Vic Australia
July 2017
Micky's Case History
Micky's Photos

Maria, you are fabulous. 

Your humble servant,
--
Nancy C in NH
ECIR Moderator 2003
DDT+E = effective treatment for PPID and EMS/IR equines: https://bit.ly/2J4ZgYT

 

Hi again, for some reason Plutón´s album had been deleted. I have just uploaded ALL the pics again. Just to let you know that you need to click in the link of my below signature as the former one doesn´t exist. I have redone my link and it is now working.

Thank you.
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Hi Lavinia,

As promised, the pics requested from Plutón for your mark ups has been uploaded under 2019-04-18 Lateral Alignment plus another one where you can see him standing. He has been placed square for that pic but he ALWAYS has his LF and RH forward at rest.

Thank you sooo much for your help.

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

I  Agree Nancy ,Micky when  he had the abscess brewing in RF would lift it easy to show me, and also he did the same with his LF when he had an abscess, He  Would. Point where it was and lick it and bite his foot to show me.  Saying look it’s here. 

Yet when i try to take photos he just doesn’t want to pick up his feet,  when I try to clean around the frog on. RF or. Even put slight pressure with hoof brush to brush debris out usually just saw dust, he hates it. I don’t use a hoof pick because it hurts him, it’s easier to. Tub the foot and wash it. 
--
Kath Chase & Micky
Yinnar Vic Australia
July 2017
Micky's Case History
Micky's Photos

IME, even in pain, with some training, they know you are trying to help and will work with you as best you can.  I say this from 13 years of working with  horse who was often in pain.

--
Nancy C in NH
ECIR Moderator 2003
DDT+E = effective treatment for PPID and EMS/IR equines: https://bit.ly/2J4ZgYT

 

I can imagine it. Micky's pictures speak about pain, more than many of us might handle but also about a very good care and efforts to help so you will win this battle, I am sure.

I am sorry that I didn't realize the blurry pics where due to Micky being in pain. Here are some more tips that might work in this case:

1. Cut a medium thick polyestyrene pad in a "U" shape and tape it in the sole so that the pressure in the sole and P3 can be released. The closed part of the U will be in the heel/frog area and at the toe will be open. Make sure he is comfortable before you hold the other leg and put more pressure on that structure. This usually helps a lot. Change it to the other foot and repeat to facilitate taking the pics.

2. Make sure you have plenty of natural light. This allows the lens in the camera to get a sharp shot and get focus faster.

3. Put your phone or camera in "Sports" shot mode. What it does is to reduce the time the lens of the camera are opened so you get a very sharp shot. This mode is used for shots in movement.

4. If nothing of this is enough, make a video not a pic, then stop the image when you believe is good and do a screenshot.

5. Have someone to get Micky distracted with some safe food at chest level while you take the pics. Pain is more bearable with something tasty to eat haha.

Such great news that Micky came cantering, these are the best moments. I hope he can do it from now on. They are awesome animals. I am sure he enjoyed that moment as much as you did.

Good luck with your surgery and medical issues. 

All the best,

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album