Hi Lynn,

I've added mark-ups to Relevante's album:

https://ecir.groups.io/g/CaseHistory/album?id=36909&p=pcreated,,,50,2,50,0

First, thanks for getting new radiographs as it's been a year since we last looked inside. As it turns out, it was extremely lucky that you were able to include ones of the hind feet as well as the fronts. Rads show that the front feet are hugely improved, really only needing some minor tweaks to get them as optimal as they can be. There's still pastern arthritis present in all four legs but it hasn't progressed. Still battling thinner than ideal sole depth and underrun heels all around but Relevante is now moving soundly so that's huge.

The hinds rads show some serious issues that no one had any idea were present. The only hint that something might be amiss is that the fetlocks appear to be thicker than you would expect, but that could also be just be the way they appear in the photos. Unfortunately, the bony column alignment is totally out of whack and is putting a huge amount of strain on the tendons/ligaments. So now, we need to shift the focus to alleviating these issues using the same techniques you were applying to get the fronts back into shape. The current trim on the hinds is already really close as your farrier has been carrying over the same work he's been doing on the fronts. Unfortunately, there were hidden issues that needed even more specific attention. The HPAs are severely broken back so will need to add more height to the back half of the hoof capsule to help support everything inside and assist in pushing it back up into the correct position. While the trim is taking shape, using wedge pads with frog support inside of the hoof boots will help (know you've already gotten this part in place).

LF lateral composite: On the rad, the pink line follows the bony column alignment to the ground. Although there is less sole depth than would be optimal, the toe length just needs a bit stronger bevel at ground level (blue line). Red line indicates where the bottom of the hoof should be if everything was ideal. On the picture side, the blue area corresponds to the blue line on the rad. Orange line shows where the heels should be to provide the most support.

Front dorsals: Both front feet are high laterally. Pink lines are level while the yellow lines show what is currently happening. Need to lower the lateral walls to get the medio-lateral balance corrected. Have a read here for more in-depth info:Z

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

LF sole: Blue hashed area in the toe is where to add the bevel. Blue hashed area along the lateral wall is where to address the excess lateral wall height. Yellow hashes along the bars point to the need to lightly remove the cracking, crumbling material as it is ready to let go. Blue areas at the back of the heels are overgrown frog/periople that is detaching from where it was covering the heels and can be trimmed off.

RF lateral composite: Same general idea as the LF, except that the HPA is still slightly broken back. This means really watch that no heel height is removed while working to get the heels to stand up straighter to provide better overall support. Orange line on the picture side is where to add the ramp/bevel to the back of the current heel buttresses to help those heels stand up more. Also have a read here for specifics:

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

RF sole: Same idea as the LF.

LH lateral composite: On the rad, the pink line shows how the pastern bones should line up, while the purple line follows where they actually do. The HPA is severely broken back, with the weight of the horse squishing down behind the coffin bone. This has displaced the digital cushion out behind instead of under the horse, the heel bulbs have leaned back and been crushed under. All Support for the bony column is behind, rather than under it. The yellow dotted line is an idea of where the back of the heel bulbs would be if everything was neatly tucked in where it belongs. Red line shows where the bottom of the foot needs to be for appropriate sole depth heel height. Blue line is where the toe needs to be beveled under - not a lot of excess toe length but every little bit matters right now. Lime arrow indicates the need for the entire bony column to be lifted up and into its proper orientation. Imagine if you attached a string to the front of the P2-P3 joint (like a Marionette) then lifted. As we can't do that, we need to place support underneath to help realign everything until the soft structures in the back of the foot can be coaxed back in where they belong.
On the picture, the blue area corresponds to the blue line on the rad. Orange line is where to add the ramp on the heels.

LH dorsal: Laterally high, same as the fronts.

LH sole: Blue hashed area at the toe corresponds to the blue on the lateral photo. Bevel this under to help bring the breakover back further. Blue hashed areas on the outer edge of each heel buttress are where to bevel the wall inward.Orange areas are where to add the bevels on the backs and sides of the heels.

RH lateral composite: The angle of the rad is not a true lateral as it was shot somewhat from below the hoof, aiming upward (you can see part of the sole). Otherwise, same discussion here as for the LH.

RH dorsal: This one is medially high so need to lower that medial wall slightly.

RH sole: Same idea as the LH: bevel the toe under, rocker the backs of the heel buttresses while maintaining their current location and height.

If possible, ask your farrier to slightly shave the very outer perimeter of the pads so that the hoof wall is unloaded, esp. in the heels. That way, the heels can relax more while the weight bearing is concentrated on  the sole, bars, frogs. Mark the boots left and right so that they don't get switched once you do this.

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

Lavinia, may I ask a question? My visualization skills aren't good, and I'm trying to improve that. Maybe it's a silly question, but here goes.

As Revelante's angles improve, is the angle of the hairline going to become more horizontal? I believe you mentioned this in the past, that some hooves are not going to have a slanted hairline on the outside of the hoof. 

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

Not a silly question at all.

Yes, his hairline will become more horizontal, at least initially, as he will be adding height to the back half of the foot. Whether it then changes again once the bony column realigns and the digital cushion strengthens remains to be seen. Because the coronary band is so pliable, it is easily influenced by firm pressure from any source - both correct and incorrect. So while it's one of the indicators to look at, you can't base all decisions about the trim just on the angle it is currently at.

Pete Ramey has some good discussion here:

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

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

Hi Lynn,

The latest mark-ups are in Relevante's album:

https://ecir.groups.io/g/CaseHistory/album?id=36909&p=Created,,,50,2,0,0

Thanks for getting new rads done of the hinds - major improvement in the bony column alignment!! When looking at the comparisons of the May and Aug 2020 rads, note how the entire foot has become more compact, with the heel bulbs aligned more tightly over the heels, rather than squished out behind the foot. P1, P2 and P3 are now flowing much more evenly into one another, rather than in the jammed up, zig-zag pattern that was present in May. Still need to work on getting the heels themselves to move back, inward and stand up straighter on all four feet.

LH lateral composite: On the radiograph, pink line shows where the bony column should align, purple line is where it actually does. The lines don't quite overlap but are much closer than they were back in May. Green line shows the slight bull nose configuration of the dorsal wall, which will grow out as the heels move back and the breakover gets set a tad further back. Blue X is where to bring the toe back a bit more and add a good bevel to the bottom of the foot so that it breaks over more quickly and easily. Orange line shows where the heels need to get to eventually while the broken lime line is where they are located now.
In the picture, the lines correspond to the ones on the rad. Blue area is where the blue X is.

LH lateral sole plane: Green line is the same as on the lateral view but the slight bull nose is more obvious from this angle. Blue area is the excess wall length across the entire hoof. The missing chunk is part of that excess wall that has brokn off on it's own. You want to leave no more than about 1/16th of an inch of wall length beyond the level of the calloused sole.

LH dorsal sole plane: Red areas are the bar at the point it joins with the wall. This is what needs to remain as the highest point, with all the wall outside of the solid blue line completely beveled out of ground contact. The bar is going to become the heel area support until the wall relaxes back into a more upright configuration. Gold hashed area on the medial bar is excess that is ready to be removed. The blue hashed area around the entire perimeter needs to be out of ground contact as it is not firmly attached due to the lamina having stretched.

LH sole: Red areas are the same as the ones on the dorsal sole plane view. Orange lies are where the ramp on the heels should start so that is doesn't lower the vertical height but helps to allow the heels to stand more upright. Blue hashed areas are where to bring the perimeter of the hoof inward so the solid blue line is what makes ground contact. When you look down at the foot from above while it's on the ground or on the hoof stand, there will be a point in the wall where the heel flare is. Rasping that inward from above so that the entire wall blends smoothly from front to back.

RH lateral composite: Same idea as the LH except that the RH is in a bit better alignment and the toe needs less tweaking.

RH dorsal sole plane: Similar idea to the LH except that again, smaller corrections are needed.

RH sole: Note that the lateral heel has flared out significantly more than the medial heel and has twisted the foot slightly medially. Bevel the wall in the heel strongly so that you create a new heel buttress from the bar, with the wall taken out of weight bearing.

LF lateral: Blue are is where the hard bevel at ground level needs to be added. Orange line is where the heels eventually will end up. Lime line is where they are now.

LF lateral sole plane: Same idea as the hinds. Blue area is the trim/bevel area.

LF dorsal sole plane: This one shows the concavity that has developed in the LF - you can see the nice bowl shape. The ragged, excess wall also shows up very clearly. Red areas are where to create the high points using the bars. Then bevel the wall outside those points out of ground contact so that they are "floated", allowing them to start to relax into a more upright stance.

LF sole: Same idea as the hinds, just on a lesser scale. Orange lines are where to add the ramp on the heels to again encourage them to stand up straighter.

RF lateral: Same as LF.

RF sole: Similar to the LF except that the lateral heel is more flared so needs to be brought inward more than on the LF.

Give him a few days after the trim with his boots on the way you've been doing . Start to walk hm around more and see how he feels.Then graduate to more time without boots, based on his comfort level.

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

Hi Lavinia - this is great news. I'm actually kind of shocked at the difference in the composites from May and August. So just so I'm clear, Relevante has not been ridden or exercised since you and Dr. K diagnosed his problem with his hind feet in May. Throughout this period he has worn the Soft Ride boots with wedged orthotics on the back feet with movement being limited to him being free to move about his stall/paddock at his own volition. So now, with this improvement are we released to begin bringing him back to exercising and riding? And should this be done initially in the Soft Ride boots or should I consider putting him in the Cavallos on the back feet initially - i would see initial "exercising" being me leading him around the arena in both directions for maybe 15 to 20 minutes and going from there. Before all this started he was doing great transitioning out of the Cavallos into barefoot while riding in the arena (we had not yet made it outside when all this happened).  And of course, above all, i will "listen" to what he tells me and adjust accordingly. THANK YOU SO MUCH!!!!!!
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

Compare the before and after angles today once the trim is done. If they maintained, wean him off his Soft Rides by allowing him to remain bootless in his stall/turnout for lengthening periods of time.

Then you can start adding walking around for light exercise using the padded Cavallos. Gradually work your way up from there if all goes well at each step.

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

Awesome job, Lynn! You and your farrier are an inspiration! 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 

Maxine! I really have to shine the spotlight on Lavinia and my farrier! They are like the Wonder Twins. She does the markups and he implements - "Wonder twin powers activate!" I just clean/wash feet, sweep the aisleway and try to take half-way decent photos! LOL
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

Hi Lavinia - Dumb question alert. I took some post trim photos and posted them. When you say...
Compare the before and after angles today once the trim is done. If they maintained, wean him off his Soft Rides 

I'm not sure what "maintained" means...do you mean if my farrier was able to achieve your markups with today's trim or if the angles maintain over time until the next trim?

Thanks!
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

You're good to go as long as you didn't end up losing any heel height relative to the height at the front half of the foot, so that you were able to keep the HPA the way it was on the latest rads. That would mean the wall angle didn't get lower after the trim.

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

Gotcha, I copied the LH (lateral) composite markeup you did and pasted it in a word doc next to the post trim LH lateral shot i took. This may not be very scientific but to my eye when i compare the two angles it looks to me like we did succeed in moving the heel back and thus making the angle more "straight up and down."  Also, my farrier mentioned that in working on his feet, Relevante hardly "fought" him this time. What he meant by that was that before when he worked on Relevante's front feet he would soon want to put the foot down though he would give it back to him. He attributed this to possible soreness from arthritis in the front feet (because that only happened when he worked on the fronts) but now believes it was because the back feet were bothering him because they had to take on more weight when he was working on the front feet.....So in my amateur opinion I'm going to say we're good to go unless the boy tells me differently.
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

Good observations by your farrier and I tend to agree with his assessment.

Sounds like things are moving in the right direction, so I'd say go ahead with weaning him off the wedges..

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

Yiiippppeee
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

Hi  Lynn,

I've added the latest mark-ups to Relevante's album:

https://ecir.groups.io/g/CaseHistory/album?id=36909&p=Created,,,50,2,0,0

The good news is that he continues to develop more concavity, some of the extra bar material is starting to detach on its own and the heels have started to move back under him more. In general, you want to continue working to move his heels back without dropping them; beveling the toes well to get and maintain the breakover n the correct location; keep the ragged tags on the frogs cleaned up. Watch that the wall height beyond the sole plane doesn't creep up beyond 1/16'', esp. in those areas where the walls still aren't well connected due to flares growing out.

RH lateral: Mustang roll the toe area hard in the blue area.

RH dorsal sole plane: Blue are at the toe is where to roll it well. Blue Xs are all the tags of loose frog material that can be cleaned up but don't get overzealous and trim the entire frog just to make it look "pretty".

RH sole: Solid blue line shows where the perimeter of the hoof should be. Hashed areas are all somewhat detached wall that needs to be rasped away from the top, then beveled/rolled under. Orange circles are the areas that should be the highest point on the heels and shouldn't be lowered. They are where the bar-wall junction should end up.

LH: Roll the toe well ala Mustang Roll in the blue area.

LH dorsal sole plane: Solid blue area corresponds to the blue on the lateral view. Blue Xs on the lateral bar are where it is already lifting away, so just help it along. Blue on the back of the frog is the ragged frog that also be trimmed away.

LH sole: Similar to the RH. Blue solid line denotes where the hoof perimeter should be, hashed area again needs to be brought inward to remove the already weakened wall and take it out of weight bearing until it has grown out well-connected. Blue Xs are where the bars are already detaching, so just clean them up in those areas - but not all the way back to bar-wall junction. Orange areas are again where the bar-wall junction should end up and they should be the highest point. Nothing off those areas.

RF dorsal: Blue line shows where there is still a slight lateral wall flare that can be rasped down and beveled under.

RF lateral: Mustang roll the toe well. 

RF dorsal sole plane: Same idea as the hinds.

RF sole: Same discussion as the RH.

LF lateral: Solid roll on the toe in the blue area.

LF dorsal sole plane: Same as RF.

LF sole: Same ideas as the the other three.

Check the collateral groove depth on both sides in each foot to make sure your are maintaining medio-lateral balance. Be careful not to lose vertical height in the heels/back half of the feet relative to the vertical height in the front half so that you don't inadvertently lose any of the gains that you've made in realigning his HPAs.

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