Equine

No Foot, No Horse: Surgical Conditions of the Equine Foot

Published

9 months ago

September 3, 2025

By Garrett Metcalf, DVM

There is a wise old saying, “No foot, no horse,” and that is absolutely true. Horses of all breeds, disciplines, and sizes must have healthy feet, or they will suffer from poor performance, chronic pain, or, worse, succumb to diseases of the foot. Several medical conditions require surgical treatment within the hoof wall of the horse, and this article will highlight the most common conditions that necessitate surgical intervention and specialty farrier care.

Foot Abscesses

Foot abscesses are a very common issue that nearly every horse may experience at some point in their lifetime. While abscesses are often minor issues that can be easily corrected by a farrier or veterinarian, allowing access to the abscess for drainage, they can also be debilitating and sometimes serious. Abscesses are localized pockets of infection that find their way into the sole or white line of the foot. These abscesses often form due to structural abnormalities in the foot, trauma leading to bleeding under the sole, improper hoof care that creates abnormal forces on the foot, or, of course, the old hot nail.

For example, trimming the foot without relieving enough sole pressure can overload the sole, leading to bruising and setting up an abscess. Other common foot abnormalities that lead to abscessation are laminitis and club feet. These conditions can cause tearing and stretching of the white line, allowing bacteria and moisture to enter deeper into the foot. In some cases, this can destabilize an already unhealthy foot, leading to a life-threatening situation. Deep abscesses that go untreated for days or weeks can continue to invade and dissect through tissue planes, forming larger abscesses. These large abscesses may require surgical intervention to prevent spreading and to eliminate the infection completely.

Pedal Bone Osteitis

The pedal bone, or coffin bone, is unique compared to other bones in the horse. It is a porous bone that is intimately attached to the foot capsule and sole. The bone and the hoof tissue have a high blood supply due to the vast amount of metabolic energy required to keep the foot supplied with nutrients. However, when the hoof is diseased or compromised by conditions like laminitis or infection, the blood supply can be jeopardized, leading to disaster. The resulting condition may be an infected portion of the coffin bone, or sequestration of bone.

Bone sequestrums occur when bone lacks blood supply and becomes infected by bacteria that thrive on dead tissue. While sequestrums are generally treatable, the coffin bone is unique in that it lacks an outer soft tissue coating called periosteum. This membrane typically provides blood supply and supports healing with progenitor cells and stem cells. The absence of this layer in the coffin bone leads to poor healing, a more delicate blood supply, and increased vulnerability to infection.

Treating an infected portion of the coffin bone requires aggressive action to prevent further spread and destruction. If infection spreads, it can damage the blood supply to the bone and hoof, weakening the bone to the point of fracture under the horse’s weight. The first step in treatment is aggressive surgical debridement or removal of infected tissue and bone. This is followed by aggressive antibiotic therapy using both local delivery methods (such as antibiotic beads, pastes, or ointments) and systemic routes. Regional limb perfusions, where antibiotics are delivered to the affected limb via blood vessels, may also be used. Additionally, proper support for the remaining hoof is essential, which requires the expertise of a skilled farrier.

Quittor

Quittor is a chronic deep infection within one of the collateral cartilages of the coffin bone. The collateral cartilages, which are attached to the coffin bone’s wings, are often referred to as “side bone” on x-ray films. Lacerations, puncture wounds, trauma, and abscesses can lead to infection in the collateral cartilage. While quittor might seem like a minor issue to most, it is often much more serious than it appears. This infection can smolder beneath the surface, not fully resolved until the infected cartilage is removed.

The diagnosis is typically straightforward, as there is often a draining tract with swelling, heat, and proud flesh over one of the collateral cartilages. However, the challenge lies in locating and removing all of the infected tissue. A hoof wall resection, or a window cut in the side of the foot, is often required to access the infected tissue and allow drainage and local treatment. Quittor can be challenging and may require multiple surgeries to clear the infection. After the hoof wall resection, a specialized shoe may be needed to protect the foot and help stabilize it until the hoof grows out to cover the defect.

Keratoma

Keratoma is a benign, tumor-like growth that arises from the hoof wall or laminar tissue of the foot, known as keratin. Keratin is the same material that makes up our hair and nails. This growth expands between the foot wall and the coffin bone, leading to pressure necrosis and damage to the coffin bone. Keratomas typically form at the toe region of the foot and are thought to be triggered by trauma to the hoof tissue.

The most common signs of a keratoma are recurring foot abscesses in the same location, accompanied by localized lameness. X-rays, CT scans, and MRIs can help diagnose the presence of a keratoma. Often, the growth is well-formed enough to be visible on x-ray, but advanced imaging may be necessary for a definitive diagnosis.

The only treatment for a keratoma is surgical removal through the hoof wall. This requires a hoof wall resection, performed with either an oscillating saw or drill bit, to remove the hoof wall without damaging the coffin bone. The keratoma typically appears as off-white, crumbly tissue that is easily removed from the surrounding healthy hoof wall. After surgical removal, a specialized shoe is required to protect the foot and allow access to the surgical site for continued treatment and to prevent infection.

Coffin Bone Fractures

Coffin bone fractures can occur in several patterns, some more serious than others. These fractures are typically categorized as either articular or non-articular, depending on whether or not the coffin joint is involved. Non-articular fractures are generally less serious and can heal without major surgery. These fractures are often stabilized with a special shoe and casting tape applied around the foot to make the hoof itself act as a splint for the coffin bone.

Articular fractures, which involve damage to the coffin joint, are far more serious. Any fracture involving a joint threatens the health of the joint and requires surgical reconstruction as soon as possible to prevent debilitating arthritis. The difficulty in treating these fractures lies in the foot’s structure; the bone is located inside the hoof, making it challenging to access. However, techniques exist that allow surgeons to place screws into the coffin bone through small resections of the hoof wall to stabilize fractures. This option is only viable when the fracture pattern and location are suitable.

Street Nail

A street nail surgery is used to treat deep penetrating injuries to the frog or sole of the foot, which can lead to infections in the coffin bone, navicular bone, and surrounding soft tissue structures. This procedure is necessary when a metal object, such as a nail or screw, penetrates and infects these vital structures. The surgical “window” allows for flushing of the synovial structures and removal of damaged or infected tissue.

Success of this procedure is greatly improved with the use of an arthroscopic camera, which can be placed in the navicular bursa or coffin joint, depending on the area affected by the puncture. The arthroscope allows for better visualization and more thorough flushing of debris and infection from these tight spaces. A special shoe called a hospital treatment plate is then applied to protect the foot while keeping it clean and accessible for further treatment.

Conclusion

As you can see, there is a common thread running through these hoof conditions: infection and the need for specialized farrier care. Successful treatment of these conditions requires close collaboration between the veterinary surgeon and farrier. While surgery on a horse’s foot is challenging and sometimes limited, many conditions can be successfully treated with the right surgical intervention and post-operative care.

Equine

Degenerative Suspensory Ligament Desmitis of the Horse

Published

1 week ago

May 26, 2026

bowienews

By Dr. Garrett Metcalf

The suspensory ligament is a vital component of the limb of a horse to produce normal locomotion and support. The suspensory ligament is a common area of concern in performance horses of various disciplines and can be single handedly the cause of lameness or performance issues. This article is going to look at a specific degenerative disease of the suspensory ligament and what horses are at risk for this disease.

DSLD or degenerative suspensory ligament desmitis was first discovered in the early 1980’s in Peruvian Paso horses. The name has been changed because the suspensory ligament is not the only organ affected from the disease but the suspensory is ultimately the biggest issue. The newer name, ESPA or equine systemic proteoglycan accumulation, is more correct because other ligaments and tissues are affected by this disease. In this article we will only focus on the suspensory ligament. The most commonly affected breeds are Peruvian Paso, Paso Fino, Morgan, Saddlebred, Warmblood, Paints, American Quarter Horse, and Thoroughbred breeds. The age of onset of the disease is variable among breeds but it is more common to be seen in middle age to older horses. However it has been documented in horses as young as one year of age. The disease generally will have a slow insidious onset that can go undiagnosed for months or years depending on the horses work and discipline.

A horse that begins to show early signs of DSLD may have a vague lameness issue that is difficult to isolate and they most likely will resolve with a period of rest. As the horse returns to moderate level of work the lameness will return. This scenario may go on for several months or more before the discovery of the DSLD is made. The first indication of DSLD is often pain isolated in the suspensory branches or fetlock region when a flexion test is performed. Horses with DSLD will also have a “dropped” fetlock appearance because the suspensory is the main supporting structure of the fetlock joint. DSLD can affect the hind limbs, forelimbs or all limbs at the same time. A unique sign of DSLD is that not just one limb is affected but rather bilaterally affecting the limbs, meaning it will either affect either both forelimbs or hind limbs at the same time. It is my experience that the hind limbs are more commonly affected compared to the forelimbs. Horses will often have enlargement of the fetlock region and increased joint fluid or wind puffs. Horses will often have a straight hock or post legged hind limb appearance. Horses will often shift weight frequently in an effort to get relief from the discomfort and this can be confused with other lameness issues or foot related pain.

Diagnosis of DSLD is often made by clinical signs, breed and ultrasound findings. Ultrasound imaging of the suspensory ligaments will often show diffuse enlargement of the suspensory body and branches. The suspensory ligament will have a poor heterogeneous fiber pattern with periligamentious soft issue thickening from scar tissue deposition and edema or fluid within the tissue. Radiographs of the lower limb may reveal abnormal bone changes in the sesamoid bones behind the fetlock joints and even osteoarthritis of the pastern and or fetlock joints. A definitive diagnosis can be made from a biopsy of a ligament in the neck called the nuchal ligament, but is not often performed because of the invasiveness of the biopsy.

Treatment is very limited and it is mostly geared towards protection of further damage by prolonged rest. Pain management is also important to attempt to keep the horse as comfortable as possible. Different shoeing techniques can be used with marginal success. In early cases of DSLD, a suspensory shoe that helps engage more work from the deep digital flexor tendon can help elevate the fetlock and offer more protection to the suspensory ligament. The devastating thing about this disease is that there is no cure and there are hardly any good options to slow the progression of the disease. DSLD carries a poor prognosis when the diagnosis is made in any breed of horse or any discipline. Although some cases can be managed better than others, it often progresses to the point of debilitating pain and discomfort to the point of humane euthanasia especially in the Peruvian Paso breed.

Read more in the February 2023 issue of Oklahoma Farm & Ranch.

Equine

Gastric Ulcers

Published

1 week ago

May 25, 2026

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By Dr. Devan England DVM

Does your horse have gastric ulcers? Gastric or stomach ulcers are frequently blamed for a variety of things including poor performance, acting ‘cinchy’, weight loss, not eating, poor coat condition, diarrhea and colic. However, gastric ulcers are not always the culprit and the only way to know for sure if your horse has gastric ulcers is to look at the stomach on camera, using an endoscope. Poor appetite and poor body condition are the mostly widely observed clinical signs with gastric ulcers, however, these are non-specific. If you think your horse might have gastric ulcers, the best place to start is to talk to your veterinarian and consider scheduling a gastroscopy. Gastroscopy requires the horse be held off feed for at least 16-18 hours and held off water for at least 6-8 hours. Fasting off feed and water is necessary to allow the veterinarian to see the whole stomach. If restricting feed or water is difficult in your management situation, many veterinarians will allow you to hospitalize your horse the night before gastroscopy for proper fasting.

Gastric ulcers are split into two types, classified by the location of the ulcer in the stomach. Squamous ulcers are ulcers that occur in the squamous or skin like portion of the stomach. This is the top part of the horse’s stomach, is closest to the esophagus, and has squamous tissue to protect this portion of the stomach from stomach acids. The other ulcer type are glandular ulcers. Glandular ulcers occur in the bottom portion of the stomach, which is closest to the small intestine. This portion of the stomach has glandular mucosa with cells responsible for producing stomach acids for digestion as well as cells that produce mucus and buffers to protect the lining from stomach acid. Gastroscopy is important not only for diagnosing whether ulcers are present but also determining the severity and the type of ulcer, because these two ulcer types require different treatments.

Squamous gastric ulcers are common in racehorses both in and out of training, with higher prevalence in racehorses under training. Prevalence in Thoroughbred racehorses in training has been reported to be up to 100% (Sykes 2015). Squamous ulcers are also prevalent in Western pleasure horses, Thoroughbred stallions on breeding farms, and Italian donkeys (Sykes 2015). Glandular gastric ulcer prevalence has not been as well described as squamous ulcers. Glandular ulcers are reported to be most common in Thoroughbred and Standardbred racehorses, Canadian showjumpers and polo ponies, and American Quarter Horses (Sykes 2015).

Risk factors for ulcers vary by ulcer type. Anti-inflammatories (Bute, Banamine) can increase the risk of glandular ulcers in some horses by affecting normal defense mechanisms but are not a high risk in most horses. Horses that display stereotypic behaviors, such as cribbing, have an increased risk of squamous ulcers. Grain fed before hay in non-exercising horses, feeding larger amounts of grain, and increased time between meals increases the risk of squamous ulcers. Increased time with high intensity exercise and housing in single pens is associated with increased risk of glandular ulcers. A straw only diet, lack of water access and lack of direct contact with other horses increases the general risk of gastric ulcers.

If your horse is diagnosed with ulcers, the mainstay of treatment is a buffered formulation of omeprazole (Gastrogard, Ulcergard). Over the counter Omeprazole and compounded Omeprazole are not effective because without buffering, the acidic stomach quickly breaks down the drug before absorption. Most horses with squamous ulcers will have healing of these ulcers after a 4-week course of Gastrogard or Ulcergard at treatment dose (whole tube for the average horse). Some horses may be healed by 3 weeks of treatment, but all horses should undergo a recheck gastroscopy before stopping treatment. Horses diagnosed with glandular ulcers need combination therapy with Gastrogard/Ulcergard and Sucralfate for 4 weeks. About 2/3 of horses with glandular ulcers will heal in this time, but some horses may require longer treatment times so a recheck is always recommended before discontinuing treatment.

Horses at higher risk of gastric ulcers may benefit from preventative (low) doses of Ulcergard (1/4 tube in average sized horse) given for a few days before and during high stress situations like long distance travel and competitions. Sea buckthorn berry supplement may be protective against formation of glandular ulcers. Dietary management to decrease the risk of ulcers includes providing more frequent small hay meals if pasture access is not available, limiting high sugar grains as much as possible and adding vegetable oil to the feed.

Sykes BW, Hewetson M, Hepburn RJ, Luthersson N, Tamzali Y. European college of equine internal medicine consensus statement – equine gastric ulcer syndrome in adult horses. J Vet Internal Med 2015; 29:1288-1299.

Equine

Trailer Safety Checklist

Published

4 weeks ago

May 8, 2026

bowienews

By Janis Blackwell

As the season arrives to gear up for participation in your equine event of choice, one thing remains a constant for all horse owners. That constant is our responsibility to insure the safety of our horses by being diligent to maintain the integrity of the trailers in which we haul them. There are a number of things that can be dangerous both inside and outside of your trailer. Whether you traveled all winter long or whether your trailer sat unused or was used very little through the cold weather months, at least once a year your trailer is due a thorough going over. So here we go with a checklist that will help you insure a happy and safe trip for you and your equine partner.

A sound floor is absolutely imperative. Whether your floor is aluminum, steel or wood, it should be cleaned regularly after use to preserve it. Urine and manure will erode and weaken all types of floors. Even rubber mats will not prevent erosion of your floor. (Maintenance tip: remove mats and wash aluminum floors often to prevent erosion.)
Especially check wooden floors for rotten boards. Immediately replace questionable flooring before hauling. (Maintenance tip: For wood, remove mats and wash out manure and debris. Coat wooden floor in a cheap motor oil. Allow to sit in hot summer weather until the oil soaks in. Be careful—floor will be slippery until oil cures into the wood. This treatment yearly will preserve a wooden floor for much longer than normal as it repels urine and protects the wood).

Keep the interior and exterior washed to enable you to check for rusted out places, leaks, etc.
Have a professional check your brakes at least once yearly to be sure they are operating properly.
Be sure tires are inflated to the proper air pressure, and check the inside of each tire for hidden unusual wear that could cause a blowout. Replace worn tires before leaving home.
Wheel bearings must be checked and packed at least once a year. This should be done even if the trailer has been rarely used since the last time the wheel bearings were packed. In fact, trailer maintenance professionals say that sitting stationary and unused is even worse for the bearings. Improper care and maintenance of wheel bearings can cause a wheel to seize up and actually twist off while in use. Use a horse trailer professional for this maintenance task.
Axles should be checked for bowing. A bent or bowed axle can cause excessive tire wear and damage wheel bearings.
There should be no more than two inches in height difference from the front of the trailer to the back. More difference than that causes the bulk of weight of the trailer and its contents to ride mostly on the rear axle causing it to bow and wear on both tires and wheel bearings.
Another critical part of the trailer to keep an eye on are the butt chain or bar and the back door. The butt chain or bar should be firmly attached to the wall and its keeper and should always be latched. The door should have a strong secure latch with a pin to insure it stays latched while in motion.
Finally, but certainly not of least importance is a thorough check of the trailer hitch including ball and coupling. Keep the ball well greased. Periodically, check to see that the ball is still securely tightened and the latch on the coupling is working properly.

These few critical safety check points can save you money, stress and the wellbeing of your horse. Until next time, happy trails and safe traveling.

This article was originally published in the April 2016 issue of Oklahoma Farm & Ranch.