New photos and more questions


Mikaela Tapuska
 

Lavinia, thank you so much! 

We have a pair of hind boots in the mail that should be here by next week to get going on correcting the negative plantar angles, as per Kirsten's suggestion. Regarding the broken back HPA of the fronts, are you thinking additional wedge pads in his front boots would help those to straighten out also? He has Soft Rides that have the frog support in the pad, which itself is somewhat angled to have a slight wedge towards the back. 

And for the LF sole plane, would we be relatively safe to follow the guidelines from the RF sole plane (albeit adapted to the LF sole mark up) in terms of maintaining vertical height while beveling excess heel wall out of ground contact?

Thank you again!

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Lavinia Fiscaletti
 

Hi Mikaela,

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

https://ecir.groups.io/g/CaseHistory/album?id=274255

Nice job of getting the breakover moved back considerably, as that is easing a lot of the stress on the lamina when he moves. Need to creep it back just a bit more this time as it has also crept further forward since these pix were taken. This round, concentrate on reducing the bulbous laminar wedge that is present so that the boots will fit more snugly. Please leave the frogs completely alone as they are being over-trimmed. You don't want to see all of that waxy/rubbery layer exposed all over - you need to allow calloused frog to develop to cover and provide protection to the immature frog beneath it. Although the frogs are stretched forward, leave them as is until the excess detaches. When it does, just snip off that piece while leaving the rest in place. I wouldn't recommend treating the frogs with anything at this point, as there is nothing there to treat. Just apply foot powder to the bottom of the foot before booting to help absorb moisture. 

Nothing off the soles as they also need to add more depth everywhere. Bars need to be left alone for now so they can provide support and stability while the rest of the foot heals. Allow them to remain the tallest area in the heel buttresses. When walls are detached, they need to be taken out of ground contact as they don't have the structural integrity to be carrying any load. The horn tubules in the heels need to relax downward so that the heels will stand more upright, so take the walls in the heels out of ground contact as well. This will also move them back without losing critical vertical height in the back half of the foot as the HPAs continue to be broken back.

LF dorsal: Green line follows the angle of the new growth down toward the ground. Blue area is remaining wall flare that can be removed.

LF lateral composite: On the radiograph side, pink line shows how the bony column should line up. It ends where the sole should be and where the point of breakover would be located if there was enough sole. Purple line follows the actual alignment of the bony column, which dips back and away from the pink line.  that 's a broken back HPA.  it's not massively so but it shows the need to preserve the vertical height in the back half of the foot relative to the front half. Green line follows the angle of the new growth down toward the ground. Blue line is where to reduce the toe material to, with the blue X being the wedge that can be removed,Orange line shows where the heels should be found. Red line denotes the need to leave the bottom of the foot alone as there is already too little material there. Yellow line #1 runs thru the coronary band while #2 points to the extensor process. The distance between them denotes the amount of sinking. The lime circle highlights an area of cloudiness at the tip of the coffin bone - might be some demineralized bone from the leading edge of the coffin bone. It was present in the last rads as well.
On the photo side, pink, green, red and orange are the same as on the rad. Blue area corresponds to the blue X on the rad. Yellow line follows the position of the coronary band. Note how it gets pulled down and forward in the heels as the horn tubules in that area are collapsed and running forward.

LF sole: Solid blue line is where the outermost point of weight bearing should be - it runs along the perimeter of the sole. Anything outside of this should either be removed entirely or should not be in ground contact. The red line signifies not to touch anything inside of it.

RF dorsal: Blue are is remaining flare that can be removed on the medial side.

RF lateral composite: Same idea as the LF. Heels are more underrun on this one, so really need to be careful not to lose any vertical height here.

RF sole plane: Solid blue lines denote where to bring the bevel in to. This includes thru the heels as the walls in the heels need to relax down and back but there is absolutely NO vertical height to spare here.

RF sole: Same as the LF. Leave everything inside the red line alone.

LH dorsal: Some wall flaring on both sides, with the lateral a bit worse than the medial

LH lateral: Note that he is standing with his legs more forward than square, which is where he is going to be most comfortably until the underrun heels and broken back HPAs are corrected. Back the toe in the blue area, making sure to bevel the bottom of the toe so that the breakover is taken back behind where the toe actually ends. Green and orange lines are only visual markers. Yellow line again follows the coronary band to emphasize how the heels have run forward and been crushed under.

LH sole plane: Take the detached walls and the walls in the heels out of ground contact to the blue line.

LH sole: Same as both fronts. Frog is much more substantial here and is not run forward. Please don't trim the frog so that the waxy, immature layers are exposed as they are here.

RH dorsal: As on the LH, mild flaring on both sides that can be removed.

RH lateral: Same idea s the LH - take the toe back in the blue area, beveling the breakover back behind the actual end of the toe. Orange and green lines are visuals for where the dorsal wall and heels would be when healthy. Purple line shows how the coronary band would be lined up if the heels stood up and the coronary band relaxed back down.

RH sole plane: Same discussion as the LH.

RH sole: As with the LH, bring the toe back and bevel under so the breakover is further back than the end of the toe. Protect all the vertical height in the back half of the foot.

You want to get him to land heel first at all times - which he may be hesitant to do as the structures in the back of the feet are weak and/or damaged. Find the boot/padding combination that helps hi do this as toe-first landings will only perpetuate all the issues. If he doesn't use them, he'll never develop strong frogs and digital cushions. See Kirsten's description of padding to help ameliorate the broken back HPAs until he can develop his own structures:

https://ecir.groups.io/g/main/message/282986

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


Mikaela Tapuska
 

Thank you Cass and Kirsten, that does help a lot. 

Other than being sore on his LF for a couple of days after his Aug 29 trim, I can't say I've noticed any obvious comfort indicators that anything done wasn't what he needed at the time. Unfortunately, he's not shown much improvement movement-wise since right after his first re-aligning trim. He's been okay, but still moving slower than normal and his facial expression and breathing indicates that something is still not 100% right, so I guess I was wondering if we missed something in there.

But really glad I asked, I wasn't sure if he was a case of the severely flared wall that needs aggressive beveling all the way around mentioned in Care and Rehabilitation of the Equine Foot. Based on what you've said, I don't think he is.

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Kirsten Rasmussen
 

Hi Mikaela,

What I'm seeing when I look at your last markups is that the outer wall on the heels should be gently rounded or rolled, but nothing removed that would lower the overall heel height.  That's because the hoof pastern axis (HPA) is broken back on all 4 hooves and lowering heels will only make that worse. 

Since the heel-bar junction is fairly robust on Zahr's front hooves, that definitely should be left alone to support most of the weight and maintain the heel height, so the outer heel walls can be gently rounded.  Your Sept 16 photos look to me like this has been done, just be careful not to lower the height at the heel-bar junction at this time.  I could be wrong but it appears some heel height has been lost when I compare the Aug 1 markups with the Sept 16 photos (look at RF and LF laterals). 

Of course, the biggest factor is Zahr's comfort.  If anything you do makes him more uncomfortable, then it was not the right thing to do at that time.  And there's a lot of lamellar wedge pulling the heels forward that still needs to grow out on the fronts, so it will take quite some time before his heels can start to stand upright.

I hope that helps, at least until you hear back from Lavinia or Dr Kellon. 

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


 

Hi, Mikaela.
Glad you're thinking proactively. Those holes in the frog in the RF --track them over time -- combined with the fact there is essentially no frog in the latest photos suggests to me the health of that frog is compromised. Thrush is always a possible cause. Heel cracks in the LF can harbor thrush. I have one with chronic thrush, so I'm probably hyper-alert.

I leave comments on beveling the quarters on the two fores to others with more knowledge because they look fine to me right now. Three weeks will come quickly.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


 

Lesely, 
Thanks for the ideas. As an asthma sufferer, I'm not comfortable with the vinegar/White Lightning combination that produces gas. White Lightning makes a gel I'll use if I can get it. The Vetricyn also sound good and is widely available. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Mikaela Tapuska
 

Thanks for the suggestions, everyone. I want to briefly clarify that I don't know that Zahr has thrush, there is no characteristic thrushy odour to his feet or any discharge, I'd just like to keep it that way with some kind of prophylactic treatment as we continue to work on his trim and new areas of his feet are exposed to bacteria.

My feeling currently is that the frog tenderness over his central sulci is due to his front frogs being underdeveloped, granted that along with his age and PPID could easily set things up for an infection. So I will stop with the application of coppertox around his frogs and try either the goo or one of the hoof clays suggested, depending on cost and availability up here in Canada.

And if any of the mods have time to comment (I know everyone is super busy right now, so there is of course no rush) may I get feedback as to whether or not Zahr's heel quarters should be more aggressively beveled on his fronts? That is pretty much the only area of his hoof wall still in contact with the ground. My farrier is more than willing to follow the group's advice, she just wants to know that by doing so she won't be removing an important support structure. Based on his original markups and from reading, my feeling is that we probably should bevel that out of the way as well but wanted to run that past the group first. He's on a 3-week cycle, so it is easy to make smaller changes often.

Thank you!

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Eleanor Kellon, VMD
 

After the seasonal rise is over I would consider doing a TRH stimulation to make sure you aren't dealing with a low ACTH form of  PPID.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Lesley Bludworth
 

Cass,
There are 2 things I have found effective for thrush.
you may already know this about white lighting but it is the gas that gets created that is effective, not the liquid its self.
I soak cotton balls in white lighting or oxine (chicken coop cleaner) and pack them in the hoof then spray with vinegar.
And stuff the hoof into a boot.
Do not inhale!
The chemical reaction between the 2 is toxic. Gas rises as the chemicals interact goes up into the frog cracks.
You can seal boot with plastic wrap to trap the gas if you want but I've never needed to.
The newer product I have used that seems to work immediately is Hoof Care by Vetericyn.
It is a solvent. It is drying but really works!  Smell gone, flake gone.
Wear gloves if you use it, it is blue so you can see where it has been applied but you cannot get it off your hands and I don't think its good to absorb thru the skin
--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749


Eleanor Kellon, VMD
 

P.S.  Try using high kitchen trash cans to keep her in the soak.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Eleanor Kellon, VMD
 

 After the seasonal rise is over I would consider doing a TRH stimulation to make sure you aren't dealing with a low ACTH form of  PPID.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


 

Hi, Mikaela. Frankly, my efforts did NOT cure Cayuse's frogs of thrush. In Cayuse's case, I suspect it persists because of uncontrolled PPID, inactivity from hoof pain, untrimmed frog flaps and possibly contaminated pads and/or hoof boots. I haven't given up. Once thrush has been around this long, we need to do any and everything to stamp it out. 

I'm doing a combination of treatments of the frogs and heels. I don't want to soak 45 minutes in White Lightning until I have a current sole depth measurement. The last soak didn't clear up the frog rot. It's not easy to get a horse to stand in a hoof soak for 45 minutes per hoof.  I'm cleaning the hoof as completely as I can with a quick ACV soak (1 cup ACV  to 1 gallon water) and brushing the sole repeatedly. Then I dry on a towel in the clean barn aisle and blow dry with a hair dryer.

I use a syringe to inject one version of Pete's goo into the heel crack and any holes in the frog. The goo contain a tad of ground copper sulfate, zinc oxide, and an anti-fungal athlete's foot treatment - Lotrimin AF. I mix it all in a small jar. It lasts several months.

After I syringe Pete's goo into the hoof crack, I plug the heel crack with medicinal hoof mud. The few I know about are Artimud, Field Paste, Pure Sole and Hoof Stuff. I also push the mud firmly into the central sulcus. The muds pop out about a couple of days and the process repeats. 

I can't say for sure this will work, but I agree that stronger, more corrosive treatments aren't better because we're dealing with living tissue whose growth we want to support with gentle anti-microbials.

I wash hoof boots frequently and rinse them with vinegar. I put them out in the sun after they dry (directions from manufacturer).

If you find something that works, be sure to let us know. 

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


Mikaela Tapuska
 

Thanks Nancy!

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Nancy C
 

Hi Mikaela

Try this thread.

https://ecir.groups.io/g/main/topic/90210071#275498


--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Mikaela Tapuska
 

Actually, speaking of vinegar, would diluted apple cider vinegar be okay to use on his frog if the copper napthenate is damaging to live tissue? I remember reading about ACV somewhere in the forum, unfortunately I just didn't save the links.

I could also use Pete's goo, does that work as a preventative for thrush as well as a treatment? It would probably smell better than the vinegar ;)

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Mikaela Tapuska
 

It's not the original brand name coppertox, but it has a similar purpose. Not sure if that would have the same concerns as the original? 
https://avetlabs.com/product/copper-hoof-treatment

Maybe that is why the tack store no longer carries it and sells this one instead.

Prior to this, I used a solution of copper sulfate and vinegar mixed in a squeeze bottle and squeezed it into the crumbly parts of his white line. That worked quite well, too.

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Nancy C
 

Right, Ellen.  There is a concern that CopperTox that can potentially kill live tissue.

For Pete's goo, Kirsten has posted about a Canadian version: https://ecir.groups.io/g/main/message/265269

The best way to stop thrush IMO is to keep working on the trim. For laminitic and foundered horses, this can take some time but IME, it does work.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



 

Someone please correct me... I was thinking coppertox was toxic and no longer used.

Pete surely wouldn't use it :)


--
Ellen
Pal & Savvy
N. Alabama
Aug 2013
Case History 


Mikaela Tapuska
 

Back again with a new round of photos and a couple more questions, please. Zahr had his farrier appointment at a little earlier than 3 weeks, which actually worked out pretty well as his feet had tried to pull forward again. I've included the before pictures from immediately prior to this trim in his album, and was able to get the afters the same day this time, too.

Because of how his feet had grown, the farrier asked if she could see Zahr walk barefoot (which he didn't love, poor guy, being on the barn aisle) but in doing so she noticed that his point of breakover had migrated farther forward than it should have been in both fronts. So she moved his toes back a fair amount again this time so that his feet could lift off the ground at the proper breakover point. She was happy, though, with the appearance of the hairline towards his heels. She mentioned they look like they are relaxing instead of curling down so much.

No frog trimming was done on his fronts this time. He was a little tender over his central sulci, although given it is still dry out would that perhaps be more indicative of his frogs being underdeveloped rather than an infection like thrush? I am applying coppertox in all crevices, including parts of the laminar wedge that have crumbled out, just to be on the safe side. 

Another thing I wanted to double check on was that Zahr's hoof walls can/should be beveled ALL the way around the circumference of his feet? Currently they are beveled to about his heel quarters and his heels are beveled as well, but the heel quarters themselves are still relatively flat as can be seen in the photos. I looked back at Lavinia's mark-ups and based on those I think we could probably have done more beveling in that area, but I wanted to make sure we won't be taking away important support by doing so. 

His hinds are looking better after this trim than last time to my eye but that LH heel is still pretty underrun (I haven't gotten the hind boots for him yet).

Zahr was walking a little slow immediately after his appointment yesterday, but apparently he tried to trot when he went outside this morning according to the barn owner who was turning out! So I am taking that as a positive sign. Other than my questions above, are we still on the right track with his trim and is there anything that I missed that needs to be tweaked?  

Thank you!
--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Mikaela Tapuska
 

Wow, what Shaku's feet went through in that sequence reminds me very much of Zahr's right now. That is a huge change after adding boots! 

Interestingly during some bodywork on Friday the massage therapist mentioned that Zahr's left hip was dropped significantly in comparison to his right one. That's been an issue in the past, but I wonder if the LH heel and his pelvic balance are currently stuck in a cause/effect loop - it'll be interesting to see as his feet are corrected.

Thank you so much for sharing your photos! Good to know the setup for the wedges.

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255