Ouch, Ouch, and more ouch its horrible Maria, 

Thank you so very much for your tips Maria , Very much appreciated  i'll give it a go,

I'm thinking of buying a hoof Jack, my problem has been getting Micky  to hold his foot up long enough so i can get a good clear photo, i can hold my ponies feet up easily but micky would probably pull it off the jack he used to do this with trimmer no. 6. just really hard for him to pick up his feet.

 Good news tonight, Micky must be starting to feel a bit better he came cantering in for his dinner earlier, it certainly put a smile on my face its great seeing him like that but looking at his front feet it  is heartbreaking Maria. it amazes me his strength to keep pushing himself through thats for sure. its late here now and will be in Melbourne tomorrow for medical appointments 4 hour trip before surgery on the 30th so will try and get more pics Friday. just wanting everything organised for Micky. 


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

Hi Kath,

I am glad that Pluton´s pics are of help for you. I hope Lavinia can get to you and Micky soon, I can only say "ouch" when I see his pics.

I have noticed that Pluton´s pics also need some improvement. We will work on that for the next session.

For the comparative pics, Laura (Pluton´s owner) can do it with her phone, but I have to do it with photoshop for example because my phone doesn´t allow that. It is old school haha.

I have seen your pics and are not bad, but if you allow me, I believe I can give you some tips. It is important (I know you know) because at the end all what Lavinia has to work with are the pics we take and all her responsabiliy and time will depend on our work. Because pics are 2 Dimension, it is easy to get confused. When you have a doubt in one picture, you can look at it in another one in a different angle and then you can get a better idea, this way sometimes pics complement each other even if the purpose is a different one.

Looking at your pics I would work on:

- Getting a sharp image as some are blurry and structures are not well differenciated.
- In the sole ones, make sure the camera is perfectly parallel to the sole, now it is tipped forward and this makes very difficult to see the white line and heels, frog, bars, etc get distorted so at the end you make a huge effort but the angle is not correct to allow judgement. Also in the sole ones make sure you are not taking the pic from above but get on you knees a bit so that the camera is at sole height.
- Take the sole plane pics from the heels as if you were holding the leg not at the side, because what needs to be seen is the heel height alignment and alignment of quarter walls and toe bevel, if you take sole plane 1.
- In lateral pics go down to the ground literally (lie down if needed) and point your camera to the center of the hoof wall, now the perspective is taken from above (only in some, others are good) and that changes the angle that is supposed to be seen. Make sure you are placed in the middle of the hoof not a bit to the toe area or a bit to the heel area. (this time Plutón´s lateral pic is wrong. I noticed it too late)

You are doing a great job! 

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

i think Maria has done a fantastic Job with photos, was just Looking through Plutons album to get ideas,  for better pictures, i think i know where i have been going wrong now. i have put some close up views in  Mickys  album,   but thinking they still need improvement, if Lavinia could have a look at mickys album and get back to me  would be very much appreciated.  i love the comparitive photos Maria, Great Idea with the dates and comparisons. i just need to work out how to do it and upload comparisons.
--
Kath Chase & Micky
Yinnar Vic Australia
July 2017
Micky's Case History
Micky's Photos

Thank you so much Lavinia, I would have never thought about it without you and Dr. Kellon pointing this out for me. It is absolutely common sense.
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

The 5% angle is an average number, not a "gold standard". It gives you an idea of what is generally found. Using specific, preset angles, toe lengths, heel heights without taking into account what is actually happening with the individual you are assessing is one  of the ways people get into trouble with trims, esp. on feet that aren't healthy.

As Dr. Kellon said, it is the actual correct alignment of the bony column that tells you what is right for that particular individual

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

Thank you so much Dr. Kellon.
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

The alignment is the important thing.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

THANK YOU SO MUCH Dr. Kellon, 

Would you please explain me this last question? I am concerned about the new palmar angle he is growing. I copy it here again so that it is easier for you. Sorry to ask again but if possible I would like to make sure I understand what we are doing.

"If I am not wrong, a healthy palmar angle is about a 5%. Plutón´s new palmar angle has increased to more than that, do I have to assume that his natural healthy palmar angle is greater than 5% in order to have P1, P2 and P3 aligned?"

Thanks a lot.

-
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

LF 10 to 15%. The films aren't true to scale so I measured the total distance from thumb tack center to toe and from thumb tack to a better position so I could give you an actual measurement to work with. For example, if you measure a distance of 2 inchs from tip of  frog to end of toe on sole surface, to bring it back 10% would be 0.2 inches. This will only work for this trim because as the toe comes back the frog will pull back too.

The bony growths in the middle of  P2 typically form where the extensor branches of the  suspensory ligament attach.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

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

Assuming the thumbtack is in the very tip of the frog, you can come back 15 to 20% of the distance between tip of frog and where the current bevel starts.

Is this for both feet or just for the RF? Dr. Kellon, what exactly the thumbtack measures? Is the tip of the frog a measure for something? I don't know how the tip of the frog relates to the rest of the hoof structures. 

The increased concavity is  very clear on the films and has increased the palmar angle but the sole depth/ground clearance is measured at the tip of P3.

Ahaaaaa!!!! Thank you so much! This explains what I wasn't understanding. So now I have another question, if I am not wrong, a healthy palmar angle is about a 5%. Plutón´s new palmar angle has increased to more than that, do I have to assume that his natural healthy palmar angle is greater than 5% in order to have P1, P2 and P3 aligned?

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.

I understand bone spurs can grow over the joint in an effort of stabilizing it but why the bone growths above the joint around the front side of the P2?

Thanks a lot Dr. Kellon for clarifying a bit more. It helps a lot to understand what is happening for making right decisions. It opens a new world of understanding.
 
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Assuming the thumbtack is in the very tip of the frog, you can come back 15 to 20% of the distance between tip of frog and where the current bevel starts.

The increased concavity is  very clear on the films and has increased the palmar angle but the sole depth/ground clearance is measured at the tip of P3.

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.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

On Mon, Apr 15, 2019 at 09:38 PM, Lavinia Fiscaletti wrote:

Firstly, thank-you for the clear pictures - makes it so much easier to see things. You have done a lot of good things with the trim since the last radiographs were done.

Thanks to you for a such detailed and complete answer. Tons to learn. Pics are from the amazing Laura (Plutón´s owner) She is a wild animal with the camera haha. The least we can do is taking clear pics and having the hooves clean if we are asking for help. It is a must!

Overall, the HPA's have improved in both fronts, as have the underrun heels. These changes go hand-in-hand. 
Ringbone appears to be about the same on the RF but has worsened on the LF

I didn´t notice the ringbones. THANK YOU SO MUCH for pointing that out. I guess there is nothing we can do but trying to have a perfect alignment of the Ps, right?

Sinking is about the same (hard to tell as the earlier rads aren't very clear and weren't marked).

Yes, it is a pity. It will not happen again. From now on, all Xrays will me marked. I didn´t know until I arrived here.

Soles are still thin, although the depth has improved slightly in the RF.

I was hoping thiker soles as the concavity has improved a lot compared to when we started trimming when was almost null. How is it possible better concavity without thiker soles?

LF has a lateral wall flare, while RF has a medial wall flare which need to be addressed more aggressively in the bottom 1/3 of the hoof capsule.

We will do it thank you. Would be of great help if you tell me exactly the flare area to trim because we are concerned about taking so much hoof wall in lateral/medial. The reason is that all the wall from 9:30 to 14:30 is off now, so if we trim quarters too, Plutón will be walking almost only over his soles and he will likely be sore. I heard Pete say several times to chose one battle when there was so much wall flare all around the hoof, then pick up another one in order to keep the horse comfortable and functional. It made sense to me because Plutón will not be on boots along the day.

Regarding the RF questions:
- Do NOT lower the heels more - that will make the HPA (P2-P3 alignment) worse, not better. There is NO bony column rotation, there is a broken back axis, which is the exact opposite. There is some capsular rotation, which needs to be addressed thru trim modifications.

I was convinced there was a P3 rotation!!!,  I am puzzled at this. (Lacking a suprise emoticon here haha)

- Toe callous is not a ridge, it is an area of extremely dense sole material that blends in with the rest of the sole. That ridged area partly due to the laminar wedge that is still present in that toe and partly due to incomplete concavity of the sole.

Yes, my fault and lack of vocabulary. I was meaning toe callous but perfectly clear now that it is not toe callous. Thank you very much.

- The frog and heels should both engage when the horse lands so unless the frog is actually growing over the heels it isn't interfering. However, if the frog/lateral cartilages are underdeveloped and weak, it may not be able to handle the full impact of landing so may need to be lowered so it is even or slightly shorter than the heel buttresses. Pluton's comfort dictates that.

Thank you! 

Would you please take a lateral shot of each foot (all four), far enough away that it includes the fetlock and lower part of the cannon, with him standing as squarely as possible on the leg being taken. Once those are posted, I can do some mark-ups for you.

Of course! Pics will be taken on thursday and uploaded on friday so that we can apply your marks next trim. Thank you so much Lavinia for taking the time and effort to help Plutón. It means a world for us.


María Durán Navarro.
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Hi Maria,

Firstly, thank-you for the clear pictures - makes it so much easier to see things. You have done a lot of good things with the trim since the last radiographs were done.

Overall, the HPA's have improved in both fronts, as have the underrun heels. These changes go hand-in-hand.
Ringbone appears to be about the same on the RF but has worsened on the LF
Sinking is about the same (hard to tell as the earlier rads aren't very clear and weren't marked).
Frogs are both still stretched forward but appear to be starting to shed away some of that excess length.
Toe length has improved some but still needs to come back more. LF is better than the RF.
Soles are still thin, although the depth has improved slightly in the RF.
LF has a lateral wall flare, while RF has a medial wall flare which need to be addressed more aggressively in the bottom 1/3 of the hoof capsule.

Regarding the RF questions:
- Do NOT lower the heels more - that will make the HPA (P2-P3 alignment) worse, not better. There is NO bony column rotation, there is a broken back axis, which is the exact opposite. There is some capsular rotation, which needs to be addressed thru trim modifications.
- Toe callous is not a ridge, it is an area of extremely dense sole material that blends in with the rest of the sole. That ridged area partly due to the laminar wedge that is still present in that toe and partly due to incomplete concavity of the sole.
- The frog and heels should both engage when the horse lands so unless the frog is actually growing over the heels it isn't interfering. However, if the frog/lateral cartilages are underdeveloped and weak, it may not be able to handle the full impact of landing so may need to be lowered so it is even or slightly shorter than the heel buttresses. Pluton's comfort dictates that.

Would you please take a lateral shot of each foot (all four), far enough away that it includes the fetlock and lower part of the cannon, with him standing as squarely as possible on the leg being taken. Once those are posted, I can do some mark-ups for you.

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

Hi all!

I have uploaded new pics and X-rays under 2019-04-11.

We have backed up a bit more the toe as suggested. Can anyone take a look and tell me if it is better or still not enough please? I have three questions that I wrote under the following pictures:

2019-04-11 Lateral XRay Comparative
2019-04-11 RF Concavity
2019-04-11 RF Lateral Frog.....

If anyone can take a look and give us guidance in what it needs to be done, we would be very grateful. Any comment is very welcome.

For those following the case (if any haha) I have to mention that inmediately after soaking again the hay, he began to lose weight again and inmediately felt comfortable even in hard concrete without boots. 

Thank you very much in advance.

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album