Care and Rehabilitation of the Equine Foot


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What does it take to grow the very best hooves an individual horse can possibly grow? Is it some magical trim, a supplement, or some newfangled shoeing package? The answers are much farther-reaching and involve every aspect of the horse’s life. Can laminitis and caudal foot pain be cured? Prevented? Can a carefully cultivated hoof form and internal foot development protect the horse from injury throughout the body?

Hoof Rehabilitation Specialist Pete Ramey has teamed up with contributing authors
Robert M. Bowker, VMD, PhD, Hilary M. Clayton, BVMS, PhD, DACVSMR,MRCVS,
Brian Hampson, PhD, Eleanor Kellon, VMD, Kerry Ridgway, DVM,
Debra Taylor, DVM, MS, DACVIM, Kathryn Watts, BS. Together they have detailed countless aspects of the veterinary care, hoof maintenance, internal development, nutrition, biomechanics, property management, and husbandry needed to optimize the equine foot and to treat many of the problems common to horses everywhere.

Cover photo:  Close-up of laminae wrapping around book spine courtesy of Bidwell and Bowker, Am J Vet Res 2006.2 Smaller photos referenced in text from Taylor, Ramey, Bowker files.   Specs: 4 color on 80# Huron Gloss throughout, with Smyth Sewn binding.

Copyright © 2011 by Hoof Rehabilitation Publishing LLC, ISBN#978-0-615-52453-5,  Library of Congress Control #2011917548

Edited by: Linda Cowles and Ruth H. Ramey, BS, MEd, EdS

Featuring Chapters from the Contributing Authors: 

Robert M. Bowker, VMD, PhD

Department of Pathobiology and Diagnostic Investigation, MSU

Hilary M. Clayton, BVMS, PhD, Dipl ACVSMR, MRCVS Professor of Large Animal Clinical Sciences College of Veterinary Medicine MSU

Brian Hampson, PhD

Eleanor Kellon, VMD

Kerry Ridgway, DVM

Debra R. Taylor, DVM, MS, DACVIM

Department of Clinical Sciences Auburn University College of Veterinary Medicine

Kathryn Watts, BS

Layout, Editing and Design: Ivy Ramey

Illustrations: Karen Sullivan

Chief Editor: Cindy “Hawk” Sullivan

Care and Rehabilitation of the Equine Foot

A New 464 Page softback book, in Full-Color with 630 Pictures and Drawings, by Pete Ramey


Introduction  Bare vs. Shod?

A call for some common-sense balance between the extremes. From cover-to-cover, this book is about growing the healthiest hooves an individual horse can genetically grow. What you do with those healthy hooves is up to you. Genetic factors, pathology, environmental factors, intended work and owner compliance all affect the “right path” to take with an individual horse. We all need to listen.

Chapter 1 The Concept of the Good Foot: Its Evolution and Significance in a Clinical Setting

Robert M. Bowker, VMD, PhD

Basic and advanced external and internal anatomy of the equine foot. The extensive internal variables between healthy and unhealthy feet are highlighted to introduce the reader to the concepts of internal foot development and its clinical implications. Morphology, development (or degradation) of the bones, cartilages, ligaments, vasculature, neurology and other tissues of the equine foot (64 pictures).

Chapter 2 The Feral Horse Foot: The Australian Brumby Studies

Brian Hampson, PhD

Detailed description and results of the Australian Brumby Studies. Six different environments; six different “natural” feet. These findings demonstrate that much can be learned from the study of wild horses, but many of the sometimes-assumed ideals may need to be re-evaluated. GPS tracking studies, radiology studies, cadaver dissections, effects of different substrates on the feet (36 pictures).

Chapter 3 Hoof Care Theory

Pete Ramey

An overview of general horse and hoof care. Introduction to many of the principles detailed in the veterinary chapters by the contributing authors: internal foot development, nutrition, biomechanics, grass sugar fluctuations and their affects on the health, morphology, development and performance of the hoof (22 pictures).

Chapter 4 The Growth of the Hoof Wall from the Foal to Adult Horse

Robert M. Bowker, VMD, PhD

Detailed analysis of the growth mechanisms of the hoof. Wall growth from the laminae, bifurcating laminae, sole growth from the bar laminae. Highlights that some serious re-thinking of old ideas needs to be done—about how the equine foot grows, functions, adapts and is held together. A deeper understanding of growth and composition will enhance your ability to make treatment decisions (33 pictures).

Chapter 5 The Horse’s foot as a Neurosensory Organ: How the Horse Perceives its Environment

Robert M. Bowker, VMD, PhD

Detailed analysis and descriptions of the nervous systems of the equine foot, and how they influence the synchronization of limbs and the body, protect the horse from injury, and directly influence blood flow, and perhaps hydraulic energy dissipating systems of the foot. Also includes detailed analysis of blood flow through the foot while the horse is standing on different surfaces using Doppler Ultrasound (48 pictures).

Chapter 6 Metabolic Laminitis

Eleanor Kellon, VMD

A history of our understanding of Equine Metabolic Syndrome, PPID, IR, various Endocrine/Hormonal Disorders . Detailed diagnostic and treatment considerations including husbandry, medications and supplements.

Chapter 7 Nutrition and the Hoof

Eleanor Kellon, VMD

Overview of specific nutrients and their effects on hoof growth and quality. Feeding and supplementation recommendations. Which nutrients are important to the hoof? All of them (4 pictures). 

Chapter 8 Carbohydrates in Pasture Plants: A Moving Target

By Kathryn Watts, BS

Discussion of various presentations of laminitic horses and grass sugar effects. Detailed description of grass sugars and how weather patterns, fertilization, and other plant health factors affect them (and fluctuations throughout the day and year). Table of sugar contents of various weeds. Detailed instruction on pasture management to maximize yield and reduce sugars. Worth its weight in gold (32 pictures).

Chapter 9 Hay Analysis

Eleanor Kellon, VMD

How to read and interpret feed analysis. This can be a daunting task, until you follow these step-by-step guidelines and descriptions. Provides a full description and evaluates the equine needs for each nutrient found on forage and feed test results. Take matters into your own hands: the only way you can really know what your horse is getting is to test (and then learn to interpret the results) (4 pictures).

Chapter 10 Balancing the Diet

Eleanor Kellon, VMD

Detailed instruction on balancing the diet. NRC values of nutrients listed. Conversion to feed rations. Learn to study your feeds and forages to give your horse exactly what it needs (as far as we know). Very powerful knowledge in the treatment and prevention of almost every problem the horse might have (6 pictures).

Chapter 11 Equine Ulcers: Are We Seeing Just the Tip of the Iceberg?

Kerry Ridgway, DVM

Detailed descriptions of ulcer diagnosis, prevention and treatment. A “sleeping giant” of the horse world. GI ulcers are far more common than almost anyone realizes. Among other things, they affect movement, and thus hoof form and conformation, and can create dangerous situations for those who work under the horse. Detailed descriptions, tips for clinical diagnosis and/or “becoming suspicious” of ulcers, and a detailed evaluation of treatment medications, including their costs and effects (22 pictures).

Chapter 12 Veterinary Management of the Laminitis Patient

Debra R. Taylor, DVM, MS, DACVIM

Detailed instruction for the equine veterinarian. Comparison and evaluation of medications and treatment protocols for laminitis patients. Body Scoring, introduction of a new Modified Obel Grading System, protocols for SID-induced and carbohydrate overload/insulin-induced laminitis cases. Real-world advice from one of the true masters of laminitis treatment in the field (12 pictures).

Chapter 13 Radiographic Imaging of the Laminitis Patient

Debra R. Taylor, DVM, MS, DACVIM

Detailed instruction for the equine veterinarian. Set up and horse handling tips, perfecting markers and images, communicating with the farrier, measuring and analysis of films. Covers lateral, 0 degree DP, 65 degree DP, and venograms  at each angle as well. Reading the radiographs and venograms of laminitic patients, with treatment options described and prognosis discussed. Covers a very wide range of laminitic presentations. Also compares venogram patterns to coronary wall growth patterns seen in the field (90 pictures).    

Chapter 14 Hoof Mechanics During Locomotion

Hilary M. Clayton, BVMS, PhD, Dipl ACVSMR, MRCVS

Gait analysis—description and results, stance phase analysis, swing phase, structural and functional asymmetries, coffin joint kinematics, hoof angle effects on locomotion and left or right handedness in horses. Biomechanical links to under-run heels, hi-lo syndrome and other hoof morphologies (9 pictures).

Chapter 15 The Hoof Trimmer’s Attitude

Pete Ramey

What we are trying to accomplish when we trim a foot and why? A brief but critical overview of the trimmer and farrier’s role at the horse (2 pictures).

Chapter 16 Evaluating and Trimming the Sole

Pete Ramey

Estimating sole thickness, using the shape and conditions of the sole to precisely locate and to evaluate each internal structure. How to read or “suspect” various types of P3 remodeling in the field. Trimming considerations for optimum sole growth and function. Identifying and removing retained sole. Identifying lamellar wedge, thin soles and problems with sole growth. Special considerations for laminitic patients. Case studies presented and discussed (28 pictures).

Chapter 17 Evaluating and Trimming the Frog

Pete Ramey

Estimating thickness of frog epidermis, treatment of frog infections, trimming the frog, evaluating the health of internal structures. Special considerations for treatment of caudal foot pain. Case studies presented and discussed (23 pictures).

Chapter 18 Evaluating and Trimming the Bars

Pete Ramey

Description of the functions of the bars, evaluation, trimming and treatment of the bars. Special considerations for laminitic patients, contracted heels and under-run heels, etc (13 pictures).

Chapter 19 Heel Height: The Deciding Factor

Pete Ramey

Discussion of the long list of variables that influence the “correct” heel height on a given horse—on a given day. Heel trimming, evaluation of gait and stance, special considerations for laminitic patients and those with caudal foot pain. Case studies presented and discussed (19 pictures).

Chapter 20 Care and Rehabilitation of the Hoof Walls and Lamellar Attachment

Pete Ramey

Treatment of the walls for laminitic patients, dealing with wall flare, cracks, WLD, dietary considerations, routine and rehabilitative trimming. Case studies presented and discussed (100 pictures).

Chapter 21 Distal Descent of P3

Pete Ramey

Recognizing and reversing distal descent of P3, recognizing distal descent in the caudal foot. Trimming and treatment. Case studies presented and discussed (11 pictures).

Chapter 22 Under-Run Heels

Pete Ramey

Treatment of under-run heels. Discussion of different causes: capsule rotation, toe flare, quarter flare, coronary distortion, various loading patterns—and the treatment of each. Treatment of hi-lo syndrome. Effects of left and right handedness to gaits and thus hoof form. Trimming and treatment detailed. Case studies shown and discussed (16 pictures).

Chapter 23 Low Heel/High Heel Syndrome

Kerry Ridgway, DVM

Club feet and under-run heels. Details injuries, imbalances, genetic factors and habits that can lead to high/low syndrome. Addresses trouble-shooting and treatment, explains laterality (right or left “handedness”) and its effects on the development of the whole horse. Discusses therapeutic riding to balance the horse, and thus the hooves. Evaluation of joint elevations, spacing and angles. Effects on saddle fit (19 pictures).

Chapter 24 Club Foot

Pete Ramey

Identification and treatment of the club foot. Discussion of early trimming of foals, grazing stance and various injuries that can lead to club feet. Case studies of young vs. mature horses (12 pictures).

Chapter 25 Angular Deformities

Pete Ramey

Treatment options for angular deformities. The farrier or trimmers role, the veterinarian’s role, treatment of adults vs. foals, epoxy extensions (surgical options and splinting are beyond the scope of this book) (10 pictures).

Chapter 26 Contracted Heels

Pete Ramey

Identification and treatment, internal and external caudal foot development. Is contraction a defense mechanism?

(4 pictures)

Chapter 27 Hoof Protection

Pete Ramey

Discussion of the specific needs of horses and humans—what do humans need in a horseshoe, and what do horses need in a horseshoe, item by item. Evaluation and discussion of various hoof boots, epoxy systems, casting systems, synthetic shoe packages, and metal shoe packages. What do metal shoes do best? Synthetic shoes? Boots? Epoxies? Fabrics/casting? Details hoof boot modifications and heat fitting, hoof casting, and insole systems for each (but the application of metal shoes, synthetic shoes and epoxy systems are beyond the scope of this book). Special considerations for laminitis, caudal foot pain, protection and treatment of surgery sites, thin soles and wall cracks (14 pictures). 

Chapter 28 Laminitis (An overview—Also see chapters 1-30)

Pete Ramey

This entire book is directly or indirectly related to laminitis. This chapter attempts to summarize some of the principles and lay out an action plan. Discussion (with dissections) of  the causes and significance of “fan-shaped” growth rings, diet, trimming, protective and supportive devices, and general management of laminitis patients. The bottom line is, “an ounce of prevention is worth a pound of cure” (13 pictures).

Chapter 29 Navicular Disease

Pete Ramey

Most of this book is directly or indirectly related to treating and preventing “navicular disease” and caudal foot pain in general. This chapter focuses on the diagnosis and treatment of navicular disease, navicular syndrome, and caudal foot pain. Outlines some of the causes of specific internal injuries and various types of navicular bone pathology. The bottom line is, “an ounce of prevention is worth a pound of cure” (3 pictures).

Chapter 30 Special Considerations for Donkeys and Mules

Pete Ramey

Detailed examination of the donkey’s internal and external foot. Specific internal differences between donkey feet and those of the horse are demonstrated and discussed. Special considerations for mules (23 pictures).

Chapter 31 Reflections/Closing

Pete Ramey

A call for specific research that needs to be done—specifically, long-term studies comparing various methodologies on healthy and on compromised horses/hooves. Otherwise we will never really know what is the best course of action for a given situation, and the hoof care world will be forever locked in its current state of opinion.