Hooves, appearances, loading and landing

Here is a Thursday conundrum for you hoof anoraks. Sarah has posted some fascinating photos in this post on the Phoenix forum about the changes happening in Solar's feet.  As always, there are interesting questions about whether the human view of "correct" foot balance coincides with the horse's view.

With that in mind, I wanted to upload some photos and video for you to ponder. They aren't photos of Solar - in fact they aren't photos of a rehab horse at all - but they are interesting nonetheless.

This is a hoof that would strike many people (including some hoofcare professionals) as being shockingly "unbalanced". The off centre breakover is the first thing most people notice, but if you focus on the hairline rather than the hoof capsule the whole thing should appear more balanced.

Here is the sole shot, for those of you who are pining for it :-) Stonking frog, healthy sole and from this angle too, a much more balanced foot. Underneath is always the first place to start when assessing balance!

But here is the most important thing - how the hoof is landing, how the hoof is loading.

This is why how a hoof looks (particularly from above) is - in my opinion - the last question anyone should focus on if they are concerned with performance.

How the hoof performs is pretty essential, and whether it compensates for any injuries or less-than-perfect conformation. Whether it conforms to a human ideal of symmetry or perfection comes in a lot further down the list.

From this horse's point of view, whether a hoof is a good hoof is pretty simple. He needs a hoof capsule which supports his limb, enables him to land correctly and which can effectively shock absorb and give him feedback when he is travelling at speed over uneven terrain.

If - as in this horse - his joints require the breakover to be off centre in order for the foot to load and land evenly, then the hoof capsule needs to accommodate that to reduce strain on the limb.

If the hoof capsule does all this well, he will be sound, moving efficiently, comfortable and capable of high mileage over all terrain. The last thing he will care about is whether you think its symmetrical!

...and breathe...

After all the excitement, highs and lows of the last few days, time to chill and just relax - there is sunshine at Rockley for now, anyway... 

Felix and Dom wait for supper...

Roo wonders if the boys want company...

Eva thinks not!

Here is handsome Legend, sunning himself,  

and Roo wondering what on earth this strange stuff on the floor is...

Bailey G and Felix, basically sleeping...

Eva thinks that's not such a bad idea after all...

Roo again...

Dom being regal...

"What you looking at?"

3 of the best

This past weekend was one of THOSE weekends -  there was nothing mediocre about it - it plunged from highs to lows, the rehab roller-coaster in full swing(!). One minute at the mercy of cyber-bitching and feeling as if I never wanted to take on another rehab horse and the next minute awed and overwhelmed by the incredible support from owners and the amazing performance of the Rockley "old boys". 

This post is dedicated to 3 horses (and their owners!) who have confounded every attempt to write them off and who spent the weekend flying the flag in the best possible way, as I found out from updates which came in on Monday morning.

First up, Ginger, who came here in 2010 and is now aged 19.  He not only had a navicular diagnosis but was also quite stiff and arthritic and his vet had been very gloomy about him ever competing again.  

However, he went from strength to strength and I posted photos of him looking a million dollars and cleaning up when he went showing last summer, winning a double first prize.  Of course, he is now doing it again - and still looking a fraction of his true age!

I had an email over the weekend from Danielle confirming that the old boy hasn't lost his touch - in these photos, he is winning both his show hunter and riding horse classes.

Danielle said he wiped the floor with the opposition and no horse or owner could be more deserving (plus, as you can see, he LOVES an audience!).  Its very special when older horses get a chance to come back.

Next up, and equally gorgeous, are the beautiful Bailey W and Lainey, who were at Pontispool for camp in the most incredible weather.

Bailey W was here almost exactly 2 years ago and arrived following a collateral ligament injury diagnosis and months of box rest and remedial farriery.

Like Ginger, since the conventional treatments had been tried and had failed, the expectation from his vets was that he could no longer work (even though he was only 8 years old at the time). Lainey bravely made the decision to send him to us and Bailey is a credit to all the hard work that Lainey (like Danielle) has put in - as you all know, its far from easy being the owner responsible for keeping a horse sound and working barefoot!

Bailey has spent the last 2 years hunting, competing in dressage and is putting in some XC training - preparation for next season's hunting, perhaps?

Last but certainly not least, Kate and Storm, who also came here 2 years ago.  Storm had been diagnosed with severe DDFT damage and like Bailey was only a young horse and had had so many issues that he had never really been in full work.  His rehab not only involved hoof repair but a whole programme of re-education for him, both mentally and physically, and Kate has worked incredibly hard to make him into the horse he is today.

Kate has also worked incredibly hard to keep her veterinary practice updated on Storm's progress and its entirely to her credit that the same practice actually recommended rehab here for one of the scholarship applicants, purely on the basis of what she had reported back about Storm.

Every single rehab horse who leaves here depends absolutely on their owners to keep them sound and in work. When horses are as good as these three you can bet your bottom dollar that the owners have devoted blood, sweat and tears - not to mention hundreds of hours of work - getting them to this point.

There is nothing better than seeing these horses back doing the jobs they love but there was nothing smooth or easy in the journey these horse and their owners had to travel; we all had crashing ups and downs on the way, moments of jubilation and moments of despair.

But I hope this post is an encouragement to all the owners who aren't 2 years in and who have most of the roller-coaster ride still ahead of them.  It doesn't always turn out like a Disney movie, but sometimes it does - and its without doubt an incredible journey.

Meet Roo...

Meet Roo, our newest arrival, who arrived on Friday.  She is a very smart girl whose regular job is dressage.

There will be lots more on Roo over the next few weeks, but for now here are her hoof pics.

Roo's lameness is comparatively mild but its most evident in her RF.  She is landing heel first but when we filmed her, her m/l balance wasn't right as she was loading laterally then tipping medially.

In a shoe, as you'd expect, her frogs aren't in contact with the ground although she has been well shod and her hooves are in good condition. 

Roo has definitely confused Dom no end, as prior to her arrival he was the only coloured horse at Rockley.  She is (certainly at the moment) ultra laid back - though that may also be because the sun has been shining since she arrived.  Dom has told her not to get used to this state of affairs...!

Eva's photo updates

I posted on Monday about Eva but I didn't have up-to-date photos of her feet to compare against her original pictures.  I've now rectified that, and these are her comparison shots.  

I'm focussing on her RF because this is the foot she is lamest on (a severe DDFT split was evident on MRI), and its also the foot on which she is still struggling to land properly.  You can't see much from the photo with the bar shoe, but below is the same foot a few days later. 

Now you can see that the foot isn't evenly loaded - there is some distorted bar on the lateral side and her heels are under-run (the heel buttresses are well in front of the widest point of the frog).  You can also see from this angle that she has a split in her central sulcus and this is undoubtedly contributing to her reluctance to land heel first.  

This is the same foot today and although she has a way to go she is making some good changes.  The frog is much more robust, despite that stubborn central sulcus split, the heels are beginning to be less under-run, the sole is much healthier and the sole is starting to load more symmetrically. 

For interest, here is the same foot from the caudal view. Look at the difference in the lateral and medial walls, and imagine how the weight of the horse is transmitted - you can begin to see why there is unlevel loading evident in the solar view above.

This is the caudal shot a few days out of shoes - long hoof wall, weak frog and that annoying split(!).

The same foot today.  Despite her reluctance to land heel first on a hard surface, she is clearly putting in the work on the track because the frog is improving and her heels are better too.  Obviously, I haven't trimmed her, so these are the changes she has made as a result of good surfaces and being out of shoes. Still, though, that annoying central sulcus split...

More on Eva soon, of course!

"...or, alternatively, shoot the horse."

This is a blog post I've been mulling over for a few weeks but didn't want to publish it while I was annoyed and disappointed - there is no denying though that this post is an attempt to find the silver lining(!).

A few months ago I saw that the British Equine Veterinary Association (who have their annual conference in September) were asking for submissions of abstracts of clinical research papers.  These are for a section of their conference where short presentations are made on various research topics, often where research has been done by practitioners in the field.  The call for abstracts said:

"Abstracts should report recent clinical research. This may include observational reports on clinical case series, accounts of new techniques in vitro or in vivo experimental studies; preliminary findings will be considered. "

Encouraged by Nico's owner Emma, who has herself presented abstracts at the conference, I approached Professor Peter Clegg (who has provided regular help throughout Project Dexter) and asked whether he thought it would be worth submitting the results so far.  He was supportive, and said that to increase credibility we should focus only on the horses who had been diagnosed using MRI.  With his help and Emma's we put together an abstract in the required form (300 words or less) giving brief details of the rehab we do and a summary of the results.

Palmar hoof rehabilitation: a means of increasing soundness in horses with DDFT/collateral ligament injuries within the hoof. 
Aims: To assess whether a specific rehabilitation protocol which improves palmar hoof development and medio-lateral balance provides a comparable/better prognosis for long-term soundness than current treatments. Methods: Twenty-three horses with forelimb lameness that had been diagnosed on MRI as having damage to the DDFT and/or collateral ligaments of the DIP joint were rehabilitated over approximately 12 weeks. Shoes were removed and horses kept on surfaces which maximised comfort and encouraged movement (including shingle and sand). Free movement on these surfaces was encouraged. Diets were low in sugar/starch with balanced minerals and adlib forage. In-hand and ridden exercise on varied surfaces formed an important element of rehabilitation. Palmar hoof development and medio-lateral balance were regularly monitored with photography, using video footage to assess foot placement (toe-first/heel-first). After ~12 weeks horses returned home to continue a normal exercise programme. Results: Twenty-three horses (aged 5-13yrs) were enrolled with 17 programmes completed and 6 still ongoing.  Of the 17 horses who completed, 14 have since been maintained at the same level of work or higher than before their diagnosis, 2 improved but did not return to full work, 1 had rehab interrupted by colic surgery and is in light work. Improvements in palmar hoof development occurred relatively rapidly, with most horses’ landing changing from toe-first to heel-first within 2-6 weeks.  Soundness on hard surfaces and on circles typically improved once this landing was established and palmar hoof development also improved with exercise on varied surfaces once horses were landing correctly. Conclusions: Horses with this type of diagnosis may benefit from therapeutic rehabilitation which  improves palmar hoof strength and medio-lateral hoof balance.  Practical Significance: This type of rehabilitation may improve the prognosis for long-term soundness with specific lameness conditions of the foot Acknowledgments: Constructive advice from Prof. Peter Clegg; Jeremy Hyde BVetMed MRCVS. 

As this is an area where conventional treatments don't have a particularly good success rate, I had hoped that our results - even as preliminary research - would be good enough for BEVA to want to learn more.  It was therefore very disappointing to be told that the abstract had been peer-reviewed but not accepted.  Although I asked for feedback, no reasons were given as to why they were not interested or how I could improve the data to make it more useful to them.

I would have fully expected a healthy level of scepticism, even incredulity and was certainly up for tough questions but, as always, I was hoping to generate enough interest for someone to undertake further research and maybe even - the holy grail - obtain funding for follow-up MRIs on horses who have undergone rehab.

Its all the more frustrating given that a significant proportion of the vets I talk to ARE interested.  They want to offer better alternatives to horses and owners than a "guarded prognosis", prolonged box rest, "inevitable" degeneration or euthanasia and - like me - they would love more information as to exactly what is happening when these horse's feet change so fast during rehab.

I'll keep on plugging away gathering data for the research, of course, and meanwhile if any of you have bright ideas for galvanising interest, then please email me!

There are a couple of other avenues I am still exploring so I am trying not to be disheartened. My favourite quote, from David Wootton's "Bad Medicine", always cheers me up at times like this and is so good that I make no apologies for including it here on the blog for the umpteenth time:

"Think for a moment what surgery was like before the invention of anaesthesia in 1842...  Imagine taking pride above all in the speed with which you wield the knife - speed was essential, for the shock of an operation could itself be a major factor in bringing about the patient's death. 


Now think about this: in 1795 a doctor discovered that inhaling nitrous oxide killed pain..yet no surgeon experimented with this.  The use of anaesthetics was pioneered not by surgeons but by humble dentists. One of the first practitioners of painless dentistry, Horace Wells, was driven to suicide by the hostility of the medical profession.


When anaesthesia was first employed in London in 1846 it was called a "Yankee dodge".  In other words, practising anaesthesia felt like cheating.   Most of the characteristics that the surgeon had developed - the indifference, the strength, the pride, the sheer speed - were suddenly irrelevant. 


Why did it take 50 years to invent anaesthesia?  Any answer has to recognise the emotional investment that surgeons had made in becoming a certain sort of person with a certain sort of skills, and the difficulty of abandoning that self-image.


If we turn to other discoveries we find that they too have the puzzling feature of unnecessary delay...if we start looking at progress we find we actually need to tell a story of delay as well as a story of discovery, and in order to make sense of these delays we need to turn away from the inflexible logic of discovery and look at other factors: the role of emotions, the limits of imagination, the conservatism of institutions.


If you want to think about what progress really means, then you need to imagine what it was like to have become so accustomed to the screams of patients that they seemed perfectly natural and normal...you must first understand what stands in the way of progress."

What a difference even a week can make

I keep banging on about how rehab is a continuing process once a horse goes home and here is a perfect demonstration by Bryan and Charlotte.  These are screenshots from Bryan's latest update video, but they tell a very interesting story.

Here he is a week after he went home  - no longer lame, in consistent work, level and moving nicely but still weak behind and still building his strength up.

This is him a week later - much more engaged and powerful movement, better reach and balance and altogether a more impressive picture.  Its a great demonstration of how essential ongoing work is to these horses and how they continue to improve.  Bryan has also had a visit from his physio and this sort of work can also be a huge help for horses during rehab.

The "best" movement is dependent on sound feet, of course, but its only once they are in place that the horse can start to build strength, flexibility, balance and confidence.  And the other essential is exercise - mileage - and of course beautifully sympathetic riding from Charlotte.  

Really the feet, though important, are only the start of it!

For those who'd like to see all Bryan's updated footage, its below, with some gorgeous shots of him landing heel first on the treadmill at the beginning.