Living With Lameness - Part 2

© Ray Miller

Living With Lameness - Part 1, discussed diagnosis and evaluation of lameness in the horse, as well as how best to proceed with the animal's care and management. The most promising means of achieving a degree of soundness and usability is therapeutic shoeing. Therapeutic shoeing can be defined as a procedure undertaken to assist and protect a damaged hoof or limb to achieve more normal movement. This may be for a short-term healing period, or it may be necessary to continue the specialty work indefinitely or for the remainder of the horse's life. Therapeutic should not be confused with corrective. Corrective shoeing usually implies "fixing" a problem that may often stem from an inherent defect in the horse. In this case, the correction may not be in the horse's best interests, as incorrect corrective trimming and shoeing seeks to make a visual aesthetic improvement, rather than a functional one.

The major requirement when beginning a course of therapeutic shoeing is using a qualified farrier. First, he must be well versed in the anatomy and kinesiology of the horse's body. Every swipe of the rasp and pound of the hammer will change the individual's way of going, and he needs to associate those actions to the result.

The farrier also needs to be able to converse with the attending veterinarian. It is essential that all those involved in the horse's care can discuss options, potential problems, and prognoses. Some veterinarians will make a diagnosis and then write a shoeing prescription for the farrier to follow. Most farriers will proceed as directed and add their own comments and suggestions as time passes. Other vets will leave it up to the farrier to determine appropriate therapy once a diagnosis is made.

The farrier must also be available to provide long-term hoof care for the horse. This will usually mean additional cost to the owners since the farrier's time and knowledge are very valuable. But if the owner is willing to undertake the cost and responsibility, most farriers are willing to make a therapeutic horse a priority in their practice. If a special farrier is brought on the case to consult, it is vital that he confer with the regular farrier about proper procedures and be available for follow-up questions.

Most farriers today use keg (factory made) shoes for therapeutic horses, since the manufacturers have advanced to produce shoes that are well-designed and well-researched. A qualified, professional farrier will carry a large selection of therapeutic shoes. At other times it may be necessary to forge a set of specialty shoes; again, this will require additional time and knowledge, and the farrier's rates will increase accordingly. Hot-fitting may be necessary to get an exact fit for an individual horse or if special modifications need to be done. In many situations, though, cold shaping a keg shoe is sufficient.

Bar shoes are regularly used for many lameness conditions. A straight bar is connected at the heels. It has a larger surface area for bearing weight and thus relieves mild cases of lameness, such as ringbone, sidebone, laminitis, sheared and crushed heels, and tendon injuries. The bar aids in relieving tendon pressure, adding heel support and moving pressure off the toe and coffin bone.

An egg bar is similar to a straight, but the bar connecting the heels is curved, forming a continuous oval; it extends farther back behind the foot than the straight bar. This shoe is used for the same conditions as a straight bar, but is effective in more serious cases.

The heart bar shoe has a straight bar or egg bar connecting the heels, along with a solid plate that completely covers the frog. For cases of laminitis, this is the most effective shoeing therapy. It provides support at the heels, allowing a release of pressure at the damaged, painful toe. The frog plate also serves to support the coffin bone within the hoof capsule.

One other specialized bar shoe is the GE-N. With a rolled toe and tapered egg-shaped wedge heels, this shoe seems very effective for horses suffering from navicular syndrome. The design allows the horse to shift the balance and position of the foot to a stance that is most comfortable for him. The GE-N shoe may also be used for cases of laminitis, ringbone and other arthritic conditions.

Many other therapeutic shoes are variations of the basic keg shoe but with modifications that make it useful for specific conditions. Some of these shoes are manufacturer designed, but some farriers prefer to build these less-often-used shoes on order.

The rocker toe and rolled toe shoes are built on the same principle, but the rocker toe is more severe. These shoes have a curved piece that sits at the toe of the shoe on the ground surface. Because of this rolled piece, the foot's breakover speed and position are changed. Horses that suffer from laminitis and arthritis are often helped by this shoe, since the way the foot takes off and lands is altered. Gait abnormalities are also aided, especially forging and overreaching, where the hind legs reach forward and clip the forefeet.

A slippered heel shoe is one in which the heel is beveled, or slanted, to the outside. This configuration makes the heels of the foot expand. Contracted heels, a condition in which the heels fold inward, are set with this shoe. A farrier shoeing a wry hoof, where the entire hoof wall sweeps off to one side, may choose to use a slippered heel shoe.

Several lameness conditions are handled with a wedge shoe. The heels are built up and tapered from the heel forward. The degree of wedge varies, depending on the severity of the condition. A wedge shoe can be either an egg bar or straight bar. Long-toe, low-heel syndrome, ringbone and navicular syndrome may all be relieved by using some type of wedge shoe.

Pads may also be useful for the treatment of a lame horse. A specialty pad is usually paired with a basic shoe, but the farrier may use some creative license when shoeing a particularly difficult case, or one in which many problems need to be addressed. Pads provide protection for the sole and hoof wall and may be used for white line disease. Regardless of the condition, all full-coverage pads contribute to the growth of fungus in the frog, since it is impossible to clean the area regularly.

A wedge pad serves the same function as a wedge shoe. The elevated heels ease the strain of navicular syndrome, ringbone and some tendon stresses. This pad may be used with a regular shoe or a bar shoe.

Rim pads are cut to follow the shape of the shoe along the hoof wall, leaving the sole open. It elevates the foot even farther off the ground and may be used alone or together with a full pad. A rim pad is commonly used for sole abscesses, pedal osteitis and frog injuries. This pad may also be used with a hospital shoe. A removable plate is screwed to the bottom of the shoe that allows the sole to be doctored.

The lily pad is a plastic pad with an extension that covers the frog like a heart bar shoe. The extension adds frog support to the horse suffering from navicular syndrome and laminitis. It is used with a regular shoe or with an egg or straight bar.

Any time a lameness develops that demands therapeutic treatment, many different methods may be employed. A specific problem may have many solutions; when more than one problem is present, the choices of treatment multiply. It will usually take a period of trial and error on both the farrier's and veterinarian's part to find the method of treatment that will be most effective for each individual. The owner must be willing to allow the time necessary to devise the therapy that will help the horse most. Without that cooperation, the horse's chances of recovering to even partial usability are jeopardized.