Proactive real-life shoeing and management strategies for three common foot conditions

Just 10 years ago the diagnosis of a hoof condition such as podotrochlosis (aka navicular syndrome) or laminitis was career-ending for most horses. Thanks to research into equine biomechanics, advances in farriery, and innovations in veterinary medicine, however, some once-condemning conditions are now, in large part, manageable. In this article two equine hoof care professionals share examples of how they diagnosed, treated, and maintained horses suffering from hoof-related lamenesses. While these are only two professionals’ experiences, and every case should be treated individually, the stories shed light on the importance of communication between the owner and the care team to keep the horse performing to the best of its ability.

The Horse With Laminitis

Laminitis is an extremely painful condition that occurs when the tissues that suspend the coffin bone within the hoof capsule become damaged and inflamed and, in severe cases, separate and release the coffin bone to rotate downward.

“When it comes to treating laminitis, you have to be extremely proactive,” says Raul Bras, DVM, CJF, a podiatrist at Rood & Riddle Equine Hospital in Lexington, Kentucky. “When you see a horse every day, you are able to notice any small changes and stay on top of them.”

When Bras begins working with a laminitic horse, the first thing he does is identify the cause and initiate treatment with oral non-steroidal anti-inflammatory drugs (NSAIDs). “There are different causes that can trigger the inflammatory cascade,” he explains. “First we get a treatment plan together to manage whatever caused the inflammation, be it metabolic syndrome, a reaction to steroid injections, or something else.”

Next, he places NANRIC Ultimate shoes on the affected feet. “The Ultimate shoe has an 18- to 20-degree wedge, an angle which has been shown to help get the blood supply into the areas that get compromised with laminitis,” he says. “Ultimately, it reduces the forces the deep digital flexor tendon (DDFT, which runs down the back of the leg and inserts on the coffin bone) has on the coffin bone, which are what allow it to displace in the weeks after the initial lameness occurs.”

Bras recommends owners of at-risk horses have a set of NANRIC Ultimate shoes on hand they can tape onto the hooves while waiting for the vet. “Those will immediately put the horse into an angle that will diminish the compromised blood supply that’s created by the laminitis.”

If he catches the case early enough, Bras prescribes cryotherapy (cold therapy, achieved by submerging the affected feet in an ice slurry, a boot, or a commercial icing system) treatment for at least 72 hours. Cryotherapy, which has anti-inflammatory and pain-relieving effects, has been proven to ameliorate or decrease the rotation of the coffin bone when used immediately after onset. After cryotherapy is complete, Bras continues treating the horse with NSAIDs for two to three days.

As far as diagnostic tools, Bras is a proponent of venograms—special radiographs (X rays) to assess blood supply within the foot. “You have to be so aggressive when you’re treating laminitis,” he says. “A lot of people like to sit back and wait to see what happens but, by the time they can react to something, it’s too late. A venogram is like the weather forecast; it lets you know what’s coming.”

Bras performs venograms at regular intervals throughout treatment: one on the first day the horse shows signs of laminitis and a second once cryotherapy is complete. Comparing the two allows him to see changes in the blood supply before changes in the displacement of the coffin bone. If the horse responds well to treatment, Bras does another venogram and conventional digital radiographs one to two weeks later.

With laminitis, Bras explains that your horse’s prognosis depends completely on how proactive you are, which is one of the reasons he is not a fan of using hoof boots to treat these cases. “They act like a Band-Aid,” he explains. “They just help the horse feel better, but you’re not doing anything to help him biomechanically—you’re just eliminating the pressure that was causing the pain.”

He says his team might use regenerative therapies such as stem cells in addition to therapeutic shoeing to manage these cases.

Following the described treatment protocol, Bras says he’s had a lot of success getting horses of many disciplines back to performance. “If you notice the changes and get your care team out immediately, your prognosis is good,” he says. “If you take the wait-and-see approach, then your prognosis is grave, and I can almost guarantee that you’ll end up with an unsound horse or one you’ll have to euthanize.”

The Dressage Horse With Thrush

Thrush is a common and frustrating bacterial issue in certain geographical regions. Often the result of living in wet or dirty environments, thrush can create a painful situation that compromises the hoof’s delicate structures. Getting ahead of the problem requires prompt communication between the members of a horse’s care team, specifically the owner and farrier.

Paeden Underwood, CJF, works predominantly in the Pacific Northwest, an area notorious for its wet weather and muddy turnout areas. When Underwood began shoeing a young Warmblood gelding in 2018, one of the first things he noticed was how sore the gelding’s feet were. Further examination revealed why: “He had a thrush infection in the deep central sulcus—the obvious groove between the bulbs of the frog—of all four feet, three of which were pretty badly infected. The infection was 1 to 1.5 inches deep, verging on reaching live tissue, which was causing bleeding when I cleaned out his hooves.” Underwood immediately brought the issue to the owner’s attention, and they began a treatment plan.

First, they determined the cause. In this case a combination of factors created the deep infection. The gelding had 24/7 access to a paddock, where he had gouged deep, muddy trenches into the ground with his daily foot travel. Because moisture creates the perfect environment for the anaerobic bacteria that cause thrush to thrive, the owners moved him to a stall that offered access to a drier paddock area. Underwood advised them to be sure he had extra bedding in his stall at all times to help keep it as dry as possible.

“When we’re talking about thrush,” he explains, “the deeper the bedding and the more often you’re picking out feet, the better off you’re going to be—especially in moist environments.”

Next, they came up with a game plan to treat the infection. “Every night for five weeks, the owners applied an antibacterial mastitis cream to his frog,” says Underwood (Additional topical medications include products containing iodine or copper sulfate.). “They flossed the grooves out using gauze, and it ended up clearing up completely. The best thing you can do is to just keep it clean and dry.”

Because the gelding’s case of thrush had been relatively extreme, his owners now stall him more during the wet months to help keep his feet as dry as possible. He has remained thrush-free, thanks to his owner’s and farrier’s combined efforts.

“If the infection goes untreated,” Underwood says, “thrush can undermine the whole frog and compromise other structures. If you have thrush eating at the frog, the frog is unable to absorb concussion and function properly, which ultimately puts more pressure on the hoof wall and the sole. Additionally, if the hoof wall is wet and under (abnormal) load, then the structural integrity of the hoof is compromised.”

Being diligent about hoof care is especially important in certain horses. “If a horse has high-low (one foot is at a higher angle than the opposite foot) and the maintenance and living conditions are poor, then generally the high foot is going to be more susceptible to thrush,” explains Underwood. “Being on top of hoof care for these horses is especially important because (the foot is) going to pack bacteria deeper into areas where it will be harder to get rid of it.”

Underwood believes the extent of the gelding’s infection could have been prevented had the previous farrier been in regular communication with the owner. “When you’re looking at managing a ‘problem’ horse, you need to look at the whole horse, and you always need to ask how he’s doing and how he’s moving. If I know about any issues, then I can work with them. The whole team has to be talking and asking the right questions.”

The Navicular Sport Horse

If a horse is performing well, owners often don’t consider assessing or making changes to his farriery. But, says Bras, “as with any athlete, with performance horses we’re … always trying to prevent anything that could lead to an injury.”

With issues such as podotrochlosis—a degenerative condition of the navicular bone and soft tissues in the back of the horse’s foot—or caudal heel pain, Bras says preventive therapeutic shoeing goes a long way toward improving and extending a horse’s comfort level. In these cases Bras advises owners to call their veterinarian and farrier at the first signs of heel pain. “If you’re proactive, then your chances of keeping your horse going are a lot brighter than you think,” he says.

When a horse shows signs of navicular pain, Bras first takes hoof radiographs that allow him to see coffin bone angles and alignment with the fetlock and pastern. “I prefer not to see bony changes—either mineralization or calcification of the structures associated with the navicular apparatus (the navicular bone, bursa, coffin joint, impar ligament, suspensory ligament of the navicular, and DDFT)—on the radiograph because then I’ll know that it’s gone too far,” he says.

If soft tissue structures are involved without evidence of degenerative bony changes on radiographs, he recommends advanced diagnostics such as MRI.

Once he’s reviewed the images, Bras creates a plan for therapeutic shoeing. “Since this is a degenerative issue,” he explains, “we know it will get worse with time. So my approach is always biomechanical, and I shoe them based on the dynamic nature of their movement.”

Shoeing a navicular horse all comes down to a few main points, he says: “The first is that you have to protect the navicular area and the heels so that the ground forces won’t put pressure onto the structures between the ground and the horse and rider. Next, you have to release the tension and the forces on those structures.” Bras likes to use rockered shoes because they can help ease those forces.

He also adapts his shoeing to match the surfaces the horse will be working on and the discipline they are competing in. In disciplines such as eventing, where each phase has different footing and athletic requirements, this can be challenging. When Bras worked with an upper-level eventer with navicular pain, he had to manage him differently for each phase.

“For the dressage, I used a shoe that increased flotation since the footing can be a bit softer and deeper,” he says. “I shod him so his toes could dig in a little more than his heels since that can act as a natural wedge,” which reduces tension on the DDFT that uses the navicular bone as a fulcrum. After dressage Bras would pull the horse’s shoes and get him ready for the next phase. “On cross-country traction is key, so I shod him for that need. And then for stadium, I gave him a shoe that would help him make quick turns and quick landings.”

Other therapies he might use to keep affected horses comfortable include corticosteroid injections in the coffin joint and navicular bursa and shock wave therapy over the heels.

Take-Home Message

Underwood and Bras agree that client compliance and involvement are crucial ingredients for success in every case. “The rehabilitation process will require more work from the owner than they can get from their veterinarian or farrier,” says Bras. “The client is the one rehabbing the horse on a daily basis. I tell my clients, ‘You’ll watch me take time to shoe your horse, but ultimately making a full recovery is going to come down to you sticking to our rehabilitation protocol and understanding your horse’s condition.’ ”