Me again...

Looking for advice on my other gelding Keegan. Hes 15 yrs old, 16.2hh. He has been on and off lame for 3 yrs now, sometimes so lame he can hardly walk, other times totally rideable.

Ever since Feb 2020 w have been doing all of the diet/thrush protocols,  and I have been doing my own frequent trims to try and get those toes back, heels not so underrun, and the coveted heel first landing. Improvements were steady and encouraging until late August when my life went to hell in a handbasket. He went from almost heel first landing in the paddock/pasture, floaty trots and at liberty cantering of his own volition,  to stumpier and stumpier movements.

I have uploaded xrays taken Oct 4, along with pics taken this past weekend. Last trim was done on Sept 20. He has not been tested for PPID or IR. Diet is forage based, balanced minerals with hay test results. Two different types of  shoes and pads have not helped in the past, nor have boots and pads. I know his heels and toes are still not good. I'm desperate to learn how to improve. Soles are not testing tender,  but frogs were. Happy to answer any questions or provide any other info needed.

Thank you in advance
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Allison in Ontario 2020

Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray

Keegan XRays and Hooves Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Hi Sherry,

Lavinia suggested I post here, since shes thinking his setback at the end of August is possibly due to seasonal rise. He has not been tested but since I have quite a bit of Prascend on hand, I decided to start him on it and see if it helps. 
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Allison in Ontario 2020

Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray

Keegan XRays and Hooves Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Thanks Sherry. It was definitely within the realm of possibility that I screwed up my posting. Brain=useless these days....
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Allison in Ontario 2020

Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray

Keegan XRays and Hooves Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Hi Allison, if you have time it would be helpful if you could go through and rename all your photos in this format:  YEAR-MO-DY_LF lateral
(see naming instructions here: https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions )

As you load more photos and xrays they will quickly get confusing.  With the naming scheme we prefer, they can all be sorted by name (ie, date).

There are definitely improvements that could be made to the trim, but I'll leave that to our hoof professionals to comment on.  It also looks like he might have one or two event lines just below the coronet band?  Did he have laminitis recently?  Are you planning to have bloodwork done?

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Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History  
Shaku's Photo Album   

Ok I'll try to fix the naming. Sorry!

Yes, those are two event lines, which coincide with his recent set backs. Nothing in his life changed when those lines happened. I don't know if he had laminitis, I was hoping the X-rays would determine that. I wasn't really planning on having bloodwork done at this point since he shows no other definitive signs of PPID, and he's already on a starch controlled diet and has been for a long time. I have just recently started him on Prascend to see if that helps, just in case he's one of those weird ones that has PPID but doesn't have the typical symptoms. This lameness is also not seasonal-specific, so again, it's been hard to pinpoint.
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Allison in Ontario 2020

Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray

Keegan XRays and Hooves Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Hello again, 

I have uploaded and named all the photos requested (I think) as per Lavinia's request. If there's anything missing, please let me know.

I would really like to get trimming him ASAP as he's clearly uncomfortable. Any suggestions are very much appreciated.

Thanks!
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Allison in Ontario 2020

Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray

Keegan XRays and Hooves Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Hi Allison,

Thanks for the update. I'll get some mark-ups up for you as soon as possible.

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

I have a follow up question... could Jiaogulan be used for Keegan to help facilitate rehab, if he's not laminitic? Would Jiaogulan be of any assistance if we are dealing with Navicular or Arthritis?

Thanks in advance for any input!
--
Allison in Ontario 2020

Sonseeahray Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray
Keegan Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Keegan
Keegan XRays and Hooves Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Hi Allison,

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

https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Created,,,20,2,0,0

The biggest issues with Keegan's trim are the long toes and underrun heels. These go hand-in-hand, are extremely common and contribute to thin soles, navicular issues, arthritic changes such as ringbone, DDFT and suspensory ligament damage. The HPAs are broken back in all four feet. There's minimal flaring and it appears as if there are bevels added to the walls that are mitigating this to some degree. Although the heels are underrun, the buttresses have been allowed to gain more vertical height, which is also good. Now, you just need to creep those buttresses back to where they belong so they can support the entire bony column properly. The radiographs also show ground-parallel coffin bones and some sidebone .

You can supplement Jiaogulan to help increase circulation. That will also tend to mobilize any trapped, damaged material inside the hoof so there is a possibility of abscessing. It will also speed up hoof growth so you need to be able to make frequent trim adjustments to keep ahead of the accelerated growth.


LF lateral composite: On the radiograph, the pink line shows where the bony column alignment should be. It ends below the current sole level as that is where Keegan's healthy sole depth should be. The purple lind follows the actual alignment of the bony column. Notice how it dips back and down, away from the pink line. That's a broken back HPA (hoof-pastern axis). The green line follows the angle of the newest, healthiest growth coming in under the coronary band - note how it runs parallel to the pink line. This is NOT a trim line, just a visual marker. The blue line is where the toe should end horizontally, with the blue X the excess length that needs to be removed. Notice how the bevel starts at the bottom of the pink line, which takes into account the missing sole depth. The red line is where the bottom of the foot should be, which adds the missing sole depth plus adds the needed heel height to correct the HPA.

On the hoof photo, the green line corresponds to the green line on the rad. The blue area corresponds to the blue line and blue X, which is the toe length that needs to be removed. The orange line shows where the heels should line up. Notice that is is parallel to the green line and also to the pastern angle.The yellow lines on the hoof follow some of the horn tubules from top to bottom. These lines should be parallel to the green and orange lines but instead, have a much shallower angle. That's due to the entire foot having run forward from its more centered, upright position under the leg. Lime line follows the coronary band. Notice the slight drop off as it reaches the heels. That's due to the pull from the run forward heels. This will relax once the heels come back into their proper position.

LF DP65: This is looking down onto the front of the hoof from above. The solid blue line corresponds to the blue line on the lateral rad and the hashed ares to the blue X and also the blue area on the lateral photo. That's the extra toe length that needs to be removed.

LF dorsal: Green line again follows angle of the new growth to the ground. The blue area is the slight amount of wall flaring that can be rasped away.

LF sole: Solid blue line is again where the perimeter of the hoof should end. Blue hashed area at the toe needs to be removed back to the line. You can do this incrementally on a weekly basis but don't wait too long between adjustments or the growth will exceed the corrections. Yellow squares are where the current heel buttresses are. Orange circles are where they need to end up eventually. The hard part is that there is currently NO excess vertical height to work with so the trim needs to tweak the walls at the heels and ramp the backs of the heels back toward the heel bulbs but NOT lower the heel buttresses themselves. Here's more in-depth info:

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

Lightly touch up the bars if they are crumbling. Need to leave the rest of the sole completely alone.

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

RF lateral/LF medial: Green line again shows where the dorsal wall should align, orange line where the heels should be. Blue area is the excess toe length.

RF lateral composite: Same general discussion as the LF. Here's some more reading regarding the breakover:

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

RF dorsal: Green lines follw the angle of the new growth down to the ground. Blue areas are the slight flaring (more on the lateral side) that is present.

RF lateral sole plane: Green line is the same as on all the other photos - a visual of where the dorsal wall should be when it's tightly attached and healthy. Blue area is the excess horizontal toe length. Small blue hashes at the back of the heel buttress denote where to bevel the wall. Also add a ramp to the back of the heel behind its highest point.

RF sole: Same discussion as the LF.

RH lateral: Green line shows where the dorsal wall would be when the hoof is correctly aligned under the leg. Orange line is where the heels should be. Blue area is the excess horizontal toe length. Yellow line follows the coronary band. Note how it arches upward rather than being a smooth line from front to back. This will relax down as the heels move back, the toe gets shortened and the entire hoof capsule stands more upright.

LH lateral/RH medial: Same as the fronts.

Left side body shot: This view is perfect to illustrate how the toes on all four feet are too  far ahead of the leg and how the heels are too far under.

He should wear padded boots at all times that he isn't landing solidly heel first (flat at the walk) when moving, NEVER toe first. This is both for protection of his thinner-than-ideal soles and to help him develop stronger feet. Make sure his boots have significant bevels added to the treads at the toes and on the heels as no boot has enough of a bevel straight out of the box to compensate for the added horizontal length a boot adds to the hoof:

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

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

Thanks so much Lavinia, this is all excellent info. I did actually read that article you posted about heel height, and rockered his heels conservatively on the weekend. Hopefully I interpreted the instructions correctly on that.

A question about shortening the toes...should I be going at it from the dorsal or solar side more? 

If I'm understanding your instructions correctly, I should be taking more off the wall, all the way around, in small regular increments, until the foot gets to be a better shape and size, is that right? 

Also re: jiaogulan...I can order it from Mad Barn, but they have two products...the regular and the 10:1 extract. Is there any difference besides concentration? They are impossible to get a hold of lately which is super frustrating when you need product info.

I'll have another go at the feet to start implementing your suggestions re: the toe and the wall flares this weekend and update the pics.

In case it's not clear, I'm the one doing the trimming. It's literally impossible to find competent help around here. I may not be an expert but at least I'm willing to learn, and understand the concept of underrun heels/long toe being a big no no. Trust me when I say that his current state is an improvement over past trims by "experts".
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Allison in Ontario 2020

Sonseeahray Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray
Keegan Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Keegan
Keegan XRays and Hooves Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Hi Allison,

Shortening the horizontal length f the toes will require a bit of both: from the top and the bottom. Rasping from the top will remove the laminar wedge material, while working from the bottom actually affects the breakover point . I'd rasp/nipper from the top, rasp it smooth, then add more of a bevel to the bottom to make sure that breakover moved back and so that the foot can roll over the toe as easily as possible.

There's a bit of flaring on the walls but low down. bring that inward from the top, rasping downward so you align those walls with the angle of the hoof wall above it. At this time, due to the flaring, don't allow the walls to be in ground contact at all as they aren't structurally sound for weight bearing. Once that flaring has grown out completely, you don't want to have more than about 1/16th" of wall extending beyond the sole.

Not sure about the Mad Barn Jiaogulan - hoping one of our Canada members can help with that part.

You aren't the only owner that's had to take over trimming their horse to get the feet straightened out. In most cases, that has been a huge benefit to the horses - which is an unfortunate commentary on the state of farriery in their areas. It's also a great testament to what a determined owner can accomplish when they have to.

HTH.

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

Hi Lavinia,

Thank you for your additional input. I intended to upload updated pics of his feet after the last trim but alas, I dropped my phone and completely destroyed it, so the pictures are locked away in there until I can figure out how to retrieve them.

He is pretty lame all the time now which is very discouraging. I went ahead and ordered the 10:1 jiaogulan and started administering it to him Friday night. I haven't seen any improvement yet. I've also ordered easy care glove boots for him, which I'm going to try and use for hand walking and stalling only, as the mud situation here is off the charts and won't be better for a couple of weeks more yet. I have the idea to try foam pads for comfort, and if that doesn't work, pad his frogs and soles with DIM.

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Allison in Ontario 2020

Sonseeahray Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray
Keegan Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Keegan
Keegan XRays and Hooves Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Hi Allison,

I may have misunderstood your meaning about the boots,but if he is lame, and he were here, I wouldn't be hand walking him. I'd let him move around as makes him happy.

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Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Hi Lorna,

It's very confusing to be honest. When he's stalled for any period of time longer than an hour, he's very lame walking to the paddock. His stall bedding is quite deep and soft. Then I turn him out and he literally runs to the feeder, which is a good 200 feet from the gate. I've seen him playing in the paddock at liberty too, and doesn't show signs of discomfort. The thing is, he needs stretches and body work as part of his rehab, which requires some warming up. My intent for hand walking him is just for 15 to 20 mins, get him warmed up, then do some stretches to help facilitate healing. Bad idea?
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Allison in Ontario 2020

Sonseeahray Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray
Keegan Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Keegan
Keegan XRays and Hooves Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

I understand what you're saying Sherry, but I've been told by multiple people (massage therapists, etc) that turnout is not enough of a warm up for stretches. So who am I to believe? And if he's cavorting around in the paddock, how would gently hand walking him for a few minutes a day in boots and pads be worse than that? Not being snarky, genuine question. I'm trying to understand why, if he's in so much discomfort, he's not being more naturally cautious when at liberty.

Also looking for any ideas as to why stalling him in a soft stall would cause him to walk worse than he does in the paddock, or when I first bring him in?

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Allison in Ontario 2020

Sonseeahray Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray
Keegan Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Keegan
Keegan XRays and Hooves Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0

Hi Allison,

This is what you said before, " He is pretty lame all the time now ."
But then what you describes seems as if he's just unsound after having been in his stall for an hour.
Can you untangle that for us?

And do you think the cavorting has anything to do with his soreness later?

Sorry, more questions.


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Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Sorry my messages are rather convoluted aren't they?? My apologies.

So, going back 2 weeks, he would come in pretty good from pasture (not riding sound but decent), but if stalled, would limp out. Either way, once his feet hit the paddock (which is pretty muddy right now) he's off like a bullet to the feeder. Or when I'm working in the barn I'll see him goofing off with his pasture mate, trotting, rearing, bucking, etc. 

Now, he's pretty much limping all the time. Worse still after being stalled. Still running through the paddock to get to the feeder.

Does that clear it up? I'm happy to answer any questions that might help me figure out what the heck is going on. He has no heat.
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Allison in Ontario 2020

Sonseeahray Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray
Keegan Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Keegan
Keegan XRays and Hooves Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=255699&p=Name,,,20,1,0,0