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Farriers and others: has anyone ever heard of this? (Inflamed foramen)

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  • Farriers and others: has anyone ever heard of this? (Inflamed foramen)

    As is usual for my horse, nothing that goes wrong with her is ever simple! She took a bad step or something on Thursday and went instantly lame on the RF. She had a very similar lameness back in October -- just suddenly went lame on the right front at the trot for no discernible reason. By early December, she was sound again. Both times, there was NO heat, no sensitivity to hoof testers, no swelling, no nothing.

    The vet came yesterday. The X-rays showed, as they did in October, that the foramen (channel in the pastern that takes blood vessels and nerves to the hoof) in the RF is inflamed. In October it was so big that the vet initially thought it was a fracture! Vet now thinks it's chronic, due to that leg's conformation (she toes in, the cannon bone is offset, and she has a huge splint), so when she suffers some trauma to that leg, it will be worse for her. She also is pretty arthritic in the fetlock.

    Her hooves, as usual, are strong, though it does look like she blew two abscesses in the RF just below the heel bulbs, sometime in past few weeks. And was never lame from it -- though she can be quite stoic.

    (In October, she did blow an abscess eventually, so I also have to deal with BO saying I am wasting my money getting the vet out for "just an abscess" -- but it is more than that. Blocking the hoof improves the mare's soundness a bit, but the vet had to block above the pastern to get her moving soundly. One idea is that the inflamed foramen may be contributing to abscesses.)

    For treatment, the vet wants to try a Tildren perfusion to see if that will reduce the inflammation. Horse does have arthritis in the RF. The vet wants her turned out as usual (individual, smallish paddock; my horse wanders around in T/O but is pretty calm.) The vet also thinks it would be OK for me to ride her at the walk for 20-25 minutes a day, once her shoes are back on. She isn't lame at the walk.

    Now for the farrier part: my horse also needs to have the hooves trimmed differently and I am just hoping that my farrier (who is coming on Thursday) won't be a prima donna about having the vet's input. This guy did a great job the first two times -- the first one, in October, he was here when the vet was, and they worked together well -- but the third time wasn't so good and he left too much inner wall. My horse tends to grow more inner wall in front, or maybe just wear down the outer wall faster.

    I have the X-rays on my computer as well as the vet's notes to show to him. Vet wants the walls more evened and horse in leather pads (she does have a possibly laminitis history, in the right front only so possible a mechanical laminitis). The vet also suggested that my horse should be on a 4-5 week shoeing cycle as opposed to a 6-7 week cycle, so the uneven wear is dealt with more often.

    So, farriers: any tips on approaching the farrier with my vet's recommendations?
    You have to have experiences to gain experience.

    1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

  • #2
    My farrier works with my vet directly. Can you arrange for the two of them to talk to each other?

    Comment

    • Original Poster

      #3
      Originally posted by LauraKY View Post
      My farrier works with my vet directly. Can you arrange for the two of them to talk to each other?
      They do get along but I couldn't get them out at the same time this week, sigh. so I get to play proxy. Pony may need her shoes pulled again in 2 weeks (it's not likely, and she really really needs a trim, which is why I'm staying with our regular appointment on Thursday) but if it is, I could try to get the farrier and the vet to coincide.
      You have to have experiences to gain experience.

      1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

      Comment


      • #4
        Originally posted by quietann View Post
        As is usual for my horse, nothing that goes wrong with her is ever simple! She took a bad step or something on Thursday and went instantly lame on the RF. She had a very similar lameness back in October -- just suddenly went lame on the right front at the trot for no discernible reason. By early December, she was sound again. Both times, there was NO heat, no sensitivity to hoof testers, no swelling, no nothing.
        Has anyone considered that it may not be in the hoof and it may be other soft tissue related(ie: sprain/strain to muscle(above the knee), or soft tissue below the knee including ligaments and tendons, articular cartilege, etc, below the fetlock)? Or that it may revolve around the joints proper?
        The vet came yesterday. The X-rays showed, as they did in October, that the foramen (channel in the pastern that takes blood vessels and nerves to the hoof) in the RF is inflamed.
        Are you sure its the pastern and not the coffin bone or navicular bone?
        How, precisely, does an x-ray show inflammation?
        In October it was so big that the vet initially thought it was a fracture!
        Since the referenced foramen(opening) is [allegedly]in the bone(are you sure?) how does it enlarge and then, contract in size?
        Vet now thinks it's chronic, due to that leg's conformation (she toes in, the cannon bone is offset, and she has a huge splint),
        Chronic what?
        She also is pretty arthritic in the fetlock.
        Ah, the plot thickens..... Where in/on the fetlock? Osselets or true DJD? Which, if any, treatment modalities have been undertaken? ie: Systemic anti-inflammatory drugs, Corticosteroid injected intra-articularly, intra-articular sodium hyaluronate, rest, cold therapy.
        [quote]Her hooves, as usual, are strong, though it does look like she blew two abscesses in the RF just below the heel bulbs, sometime in past few weeks. Are you sure they were abscesses and not the result of an overreach injury/injuries?
        Blocking the hoof improves the mare's soundness a bit, but the vet had to block above the pastern to get her moving soundly.
        Considering the medical history presented, this is no surprise.
        One idea is that the inflamed foramen may be contributing to abscesses.)
        How?
        For treatment, the vet wants to try a Tildren perfusion to see if that will reduce the inflammation.
        Its your money but I suggest that before you spend it you get a far better explanation of how it is expected to work, where its expected to work and why its expected to work.
        Horse does have arthritis in the RF.
        Apart from the fetlock, where else is the arthritis presenting?
        Now for the farrier part: my horse also needs to have the hooves trimmed differently and I am just hoping that my farrier (who is coming on Thursday) won't be a prima donna about having the vet's input.
        The vet and farrier have to act in concert as a team. If this is not happening, then you need to either replace one member of the team or the whole team.
        This guy did a great job the first two times -- the first one, in October, he was here when the vet was, and they worked together well -- but the third time wasn't so good and he left too much inner wall.
        How do you know this? Did you talk to the farrier about it? If so, what did he say? If not, why not?
        My horse tends to grow more inner wall in front, or maybe just wear down the outer wall faster.
        Or both. Again, have you discussed this with your farrier?
        I have the X-rays on my computer as well as the vet's notes to show to him.
        Good. Now he needs to talk to the vet personally before anything more is done.
        Vet wants the walls more evened and horse in leather pads.....
        Evened how? Why? Why leather pads. Note: these are all questions the farrier and you should be asking the vet. On the farrier's part, this should all be part of his/her regular intake protocol.
        (she does have a possibly laminitis history, in the right front only so possible a mechanical laminitis).
        Possible? "Possible" just isn't good enough. There should be enough 'evidence' to determine whether or not there is or was laminitis present.
        The vet also suggested that my horse should be on a 4-5 week shoeing cycle as opposed to a 6-7 week cycle, so the uneven wear is dealt with more often.
        IMNTBCHO, It Depends. And, in order for a leather pad to be introduced to the equation, the horse is going to have to be shod. If the trim is correct, then the hoof won't be wearing unevenly. Or, for that matter, at all. Something you might want to discuss with your farrier and vet is the idea of applying aluminum(sans steel wear bar) rather than steel shoes. Assuming the trim is done to the vet's specifications, the aluminum will wear faster and will give a very good indication of how the horse wants its hooves to be 'set' to afford it the most comfort. This then forms the blueprint for tweaking the trim. Also,generally speaking,using aluminum lightens the package which will reduce stress torque/stress. A Natural Balance PLR flat or wedged shoe(wedge dependent on several factors) might well be my first choice. Another option might be to use a urethane based shoe.
        So, farriers: any tips on approaching the farrier with my vet's recommendations?
        Be non-confrontational. If you farrier gets upset/bent out of shape it may be time for a change. make copies of the vet's recommendations and give one to your farrier(present or future....). also, ask the farrier if he would like copies of the rads(he should) and if so, send them to him and/or make copies and give them to him.

        Comment

        • Original Poster

          #5
          Rick, as usual thanks for the detailed response. However, it's pretty clear that *my* use of terminology is wrong/not the same as yours. So there are undoubtedly errors in what I presented as neither my memory or my knowledge of veterinary terminology are perfect.

          In any case whatever is going on with the horse, it's not easy to describe/diagnose.

          I may be completely wrong about how the word "foramen" was used here. In any case, if there is a bone problem it's in the pastern; coffin and navicular bones are normal on yesterday's X-rays. I'll try again: something involving the transport of blood to the hoof through the pastern is not right and to my very inexperienced ear it sounds like that "something" is inflamed. Horse sometimes does have a bit of heat in the RF pastern after being ridden. I think the idea with the Tildren is to reduce inflammation and improve bone density.

          A few notes: horse is shod all around since mid-2011, and has been shod in front for most of the time I've owned her (5 years). Plastic pads and some sort of frog support material (I don't know what it is; it's blue) were introduced in October and that along with a better trim kept horse sound and comfortable until last week. I shouldn't have said "possible" laminitis -- but it's not 100% clear so let's say "mild laminitis" instead. Mea culpa. A farrier several years ago said "possible laminitic changes" (again, keeping in mind we are dealing with what I remember here) and at that point the horse's hay was changed. That was at a different barn and there was no further evidence of laminitis until October when a very slight rotation was seen -- again in the RF only. She is a middle-aged Morgan so we definitely think of her as a horse who could be at risk for laminitis/IR/Cushings etc. She is on a low-NSC diet with very little grazing allowed (when there is grass, which there isn't right now.)

          October ultrasound showed no soft tissue issues at all. Vet could not do U/S yesterday because she'd done blocks but she said she would "probably" do U/S when she rechecks horse next week.

          As for the farrier... neither he nor I were at our best at the last trim. I thought he didn't take enough off the inside of the *left* front but he said it was fine.

          BTW -- I did fire my previous farrier because he refused to take feedback from my vet. I am not kidding -- when I said something to him about the vet not liking how the RF was flared, he started getting very sloppy with my horse's hooves. Another boarder had the same thing happen; she challenged him on something and he told her she was wrong and then pared away at her horse's sole until it bled! There's some sort of feud between him and the vet practice.
          You have to have experiences to gain experience.

          1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

          Comment


          • #6
            Originally posted by quietann View Post
            Rick, as usual thanks for the detailed response. However, it's pretty clear that *my* use of terminology is wrong/not the same as yours. So there are undoubtedly errors in what I presented as neither my memory or my knowledge of veterinary terminology are perfect.
            No problem. Ask your vet for clarification and then, if you want, let me know.
            In any case whatever is going on with the horse, it's not easy to describe/diagnose.
            Which is why you need to be very accurate/precise when describing what is going on.
            I may be completely wrong about how the word "foramen" was used here.
            Talk to the vet and see if s/he will write a detailed description for you.
            In any case, if there is a bone problem it's in the pastern; coffin and navicular bones are normal on yesterday's X-rays.
            Just like in real estate, its location, location, location.....
            I'll try again: something involving the transport of blood to the hoof through the pastern is not right and to my very inexperienced ear it sounds like that "something" is inflamed.
            Again, get the vet to write it down for you.
            Horse sometimes does have a bit of heat in the RF pastern after being ridden.
            Not necessarily unusual. Has that been compared to the LF pastern at the same time?
            I think the idea with the Tildren is to reduce inflammation and improve bone density.
            Which bone(s) are being targeted?
            A few notes: horse is shod all around since mid-2011, and has been shod in front for most of the time I've owned her (5 years). Plastic pads and some sort of frog support material (I don't know what it is; it's blue) were introduced in October and that along with a better trim kept horse sound and comfortable until last week. I shouldn't have said "possible" laminitis -- but it's not 100% clear so let's say "mild laminitis" instead. Mea culpa. A farrier several years ago said "possible laminitic changes" (again, keeping in mind we are dealing with what I remember here) and at that point the horse's hay was changed. That was at a different barn and there was no further evidence of laminitis until October when a very slight rotation was seen -- again in the RF only. She is a middle-aged Morgan so we definitely think of her as a horse who could be at risk for laminitis/IR/Cushings etc. She is on a low-NSC diet with very little grazing allowed (when there is grass, which there isn't right now.)
            Thanks for the more detailed update.
            As for the farrier... neither he nor I were at our best at the last trim. I thought he didn't take enough off the inside of the *left* front but he said it was fine.
            IMO, he should have provided a better, more complete answer. OTOH, he may not have known and is practicing CYOAF.......

            BTW -- I did fire my previous farrier because he refused to take feedback from my vet.
            Thus proving that TSS is not limited only to horse owners.......
            I am not kidding -- when I said something to him about the vet not liking how the RF was flared, he started getting very sloppy with my horse's hooves.
            Thus, proving my point............
            Another boarder had the same thing happen; she challenged him on something and he told her she was wrong and then pared away at her horse's sole until it bled!
            So he's a hack......
            There's some sort of feud between him and the vet practice.
            That's no excuse to take it out on the horse......
            Last edited by Rick Burten; Mar. 5, 2013, 09:35 PM.

            Comment


            • #7
              In cases like this it would be great to have digital radiographs on site so that the farrier can asses bone alignment before and immediately after trimming.

              Also helps if the vet actually knows how to take radiographs for this specific purpose - there is a difference. IMO having sloppy radiographs to asses bone alignment is worse than having no images at all.

              Comment

              • Original Poster

                #8
                Originally posted by Tom Bloomer View Post
                In cases like this it would be great to have digital radiographs on site so that the farrier can asses bone alignment before and immediately after trimming.

                Also helps if the vet actually knows how to take radiographs for this specific purpose - there is a difference. IMO having sloppy radiographs to asses bone alignment is worse than having no images at all.
                Thank you!

                I do have the radiographs from yesterday but won't have the vet there when the farrier is there, sigh. (Though it's possible I could make this happen at a later date.)

                What would make a radiograph "sloppy"?
                You have to have experiences to gain experience.

                1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

                Comment


                • #9
                  Originally posted by quietann View Post
                  . . .
                  What would make a radiograph "sloppy"?
                  When radiographs are taken to diagnose pathology, the geometric alignment requirements are not critical, only the exposure.

                  When used to check bone alignment the position/alignment of the image plane, the generator, and the horse are very critical in order to eliminate geometric distortion from the image.

                  Here is a good description of the technique.
                  http://www.equipodiatry.com/Radio.htm

                  If the x-rays are not taken with this protocol they are pretty much useless for a farrier or a vet to asses bone alignment because, well the pictures are crooked.

                  Comment


                  • #10
                    Originally posted by quietann View Post
                    Thank you!

                    I do have the radiographs from yesterday but won't have the vet there when the farrier is there, sigh. (Though it's possible I could make this happen at a later date.)

                    What would make a radiograph "sloppy"?
                    If you have the x-rays on CD, you can just take a laptop to the barn to show your farrier. I've done that.

                    Comment

                    • Original Poster

                      #11
                      Originally posted by Tom Bloomer View Post
                      Here is a good description of the technique.
                      http://www.equipodiatry.com/Radio.htm

                      If the x-rays are not taken with this protocol they are pretty much useless for a farrier or a vet to asses bone alignment because, well the pictures are crooked.
                      Again, keeping in mind that I am not an expert, I am pretty sure this is the protocol my vet followed. Miss Horse was certainly up on blocks with her hooves carefully positioned. Vet commented that because of how she toes in, getting exactly the correct shots isn't easy.

                      This is a photo of X-rays in process from October, before the new farrier worked on her.
                      You have to have experiences to gain experience.

                      1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

                      Comment

                      • Original Poster

                        #12
                        Originally posted by newhorsemommy View Post
                        If you have the x-rays on CD, you can just take a laptop to the barn to show your farrier. I've done that.
                        I'm planning to do that. I can show him a few things the vet pointed out. Am more worried that he'll react badly. Finding and keeping a good farrier is difficult enough without that!

                        At a previous barn, I had a farrier I loved -- the one who caught the "possible laminitic changes" a few years ago -- but the current barn is too far from her home for her to travel there. I am nearly ready to call her and find out the nearest barn she comes to -- probably 45 minutes or so from where I am now -- and haul the horse to her for farrier work.
                        You have to have experiences to gain experience.

                        1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

                        Comment


                        • #13
                          Quietann, can you get her to Tufts? Being a teaching hospital, they have ALL the tools to do an extensive diagnostic detective job on something like this, but they'll do it for 2/3 less than most of the local vet firms charge. Their workups tend to be pretty authoritative, and I'm sure they also have farriers on site with whom they consult who would be happy to do the prescribed job without personality issues.

                          Comment


                          • #14
                            How far are you from here? New England Equine

                            http://www.newenglandequine.com/
                            Some riders change their horse, they change their saddle, they change their teacher; they never change themselves.

                            Remember the horse does all the work, we just sit there and look pretty.

                            Comment

                            • Original Poster

                              #15
                              About equal distance between Tufts and New England Equine. Current vet greatly prefers New England Equine. I've opened an insurance claim, so some of it would be a matter of who pays for what...
                              You have to have experiences to gain experience.

                              1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

                              Comment


                              • #16
                                Originally posted by quietann View Post
                                . . .
                                This is a photo of X-rays in process from October, before the new farrier worked on her.
                                Yep that's the real deal there.

                                Comment


                                • #17
                                  Originally posted by quietann View Post
                                  I'm planning to do that. I can show him a few things the vet pointed out.
                                  If there is specific pathology to be pointed out, the vet should do that with the farrier in person. Otherwise, you wind up passing messages back and forth and trying to interpret questions and answers. Actually anything less than direct communication between vet and farrier is unethical - according to both the AAEP and The Guild of Professional Farriers code of ethics for vet/farrier communication.

                                  Am more worried that he'll react badly.
                                  I react badly when a vet refuses to communicate directly with me in regards to dealing with lameness. I react badly when a vet passes messages through the owner and uses the owner as a go-between. When we meet face to face with the horse and the x-rays in front of us, then we can have a dialog and reach a consensus. I have information the vet needs. The vet has information I need. And ultimately I am the one trimming the hoof and fitting the shoe and I have to stand behind my work.

                                  If the vet disagrees with me then he or she needs provide evidence to convince me that I should change my protocol. Likewise there may be factors that I have been dealing with that the vet does not know about because he or she has not seen the feet before and after each time I work on the horse. Therefore I am obligated to share whatever history I can with the vet because that information may be valuable in their diagnosis.

                                  When I encounter a vet that wants to dictate and prescribe what I should do based on snapshot assumptions instead of discussing the history I have accumulated from working on the horse over time then I know immediately I am faced with somebody that is not accustomed to following their own medical diagnostic protocols - the first rule of which is GET A HISTORY. That involves the vet asking me questions regarding my observations at each hoof care appointment.

                                  Conversely, if a vet want's to have a dialog directly with a farrier, they should be able to discuss the anatomy and pathology using their standard medical terminology.

                                  If the farrier is not intimately familiar with and very comfortable and fluent in the anatomy of the foot and lower limb well enough to have an intelligent conversation with a vet, then farrier really has no business working on lameness cases with a vet because they are not QUALIFIED. I'm sure that many veterinarians run into this situation on a regular basis and it must be stressful to try to communicate technical details with somebody that is technically illiterate.

                                  Code:
                                  Finding and keeping a good farrier is difficult enough without that!
                                  What is your criteria for "good farrier?"

                                  Comment


                                  • #18
                                    Though it should be of no surprise to anyone, I am in full agreement with what Mr. Bloomer wrote.

                                    Comment


                                    • #19
                                      Originally posted by Rick Burten View Post
                                      Though it should be of no surprise to anyone, I am in full agreement with what Mr. Bloomer wrote.
                                      Perhaps it is time for us to stage another argument for the benefit of the forum.

                                      RABBIT SEASON!!!

                                      Comment

                                      • Original Poster

                                        #20
                                        Minor update: things with the farrier today went great! He looked at the X-rays from Monday and agreed with the vet's feedback. He did a very nice trim, following the vet's written recommendations with only minor changes, and put her shoes back on, again with minor changes he explained to me. And horse is back on a 4-5 week schedule because it's clear that when she goes longer than that, her hooves get too uneven.

                                        I should be clear: this farrier DOES work well with my vet; he turned his schedule upside down in October so he and the vet could be there at the same time. (This was his first time seeing the horse so history was coming from me and from the vet.)

                                        (Unrelatedly, he stuck around today to fix a couple of lost shoes and put them back on other horses, since the regular barn farrier is on vacation for a bit. One lost shoe was on a huge ancient WB mare who jumped the 6 foot fence around her paddock and caught the shoe on a post as she went over.... ah, horses!)

                                        Still not 100% sure about exactly what caused my mare to go lame, but we are working that out. Vet is open to a second opinion. Treating with Tildren makes sense though.
                                        You have to have experiences to gain experience.

                                        1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

                                        Comment

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