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

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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.

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Equine

From a Kid’s Horse Point of View – Western Housewives

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By Summer McMillen

As the land starts to thaw and cowboys and cowkids everywhere are gearing up for spring there is one specimen in particular that is dreading the coming season. And that is ponies. Or more specifically, kid horses.

Let’s look at life from the kid horses point of view for a second.they have the winter off. They’ve gotten to enjoy some much needed R&R in the back pasture. Their hair has gotten long and so have their hooves. They’ve spent the winter feasting on native grasses, alfalfa, and the occasional bucket of grain when it’s was especially cold.

They’ve gotten to wonder aimlessly while the real work horses were still being caught for essential tasks. The most work these kid horses have had to endure the last few months were being tied to the arena fence to get the cockleburs brushed out of their tail.

Yes, life has been calm for these kid horses. But, there is a season for everything and the season for being used and abused is fast approaching.

My own children all share a little pony they affectionately call “Rubble.” He is a certified welsh pony that is as tall as he is wide and is as passive as he is…not. They spend summers riding him bareback. And when they aren’t riding him bareback they are riding him fully saddled. Tiny little bit in his mouth being yanked in every which direction.

The little fellow takes everything in stride. But I can feel him starting to resent me from the back pasture already. Every time I carry him some feed he gives me a look that just screams “please keep all three of your children away from me forever please.” I laugh at him and tell him he doesn’t mean it and then he runs away as fast as he can. It’s a special bond.

Kid horses are funny like that. We entrust them with the lives of those most special to us. We saddle them up and throw the little cowkids on them and assign them small tasks like moving 200 pairs to a new pasture or, holding the herd while dad doctors wheat cattle. More often than not, the young partners get their job done. Sometimes in unlikely ways.

Last summer my daughter hopped up on Rubble bareback and was going to trot down the road and get our mail. A simple and harmless task I thought. I was proud of her for taking the initiative. I was also proud of her when I looked out the window, saw the little pony start crow hopping with excitement and the unassuming 8-year-old being catapulted in the ditch. Instead of crying she climbed back on. Tenacity, I thought. That’s what kid horses are good at teaching.

A few months later I was watering all our geldings. The three kids whom I raised, better known as the three amigos, were all harassing the little pony. My youngest son decided it was his turn. He climbed up on Rubbles back as proud as a peacock.  But, he couldn’t help himself. He wanted to look that pony in the eye. So he starts leaning. Farther and farther until he leaned all the way to the ground. Lost a boot in the process. Instead of rushing to his side I waited for the tears. He was only two years old at the time after all. Instead his face was filled with glee. Joy, I thought. That’s what kid horses are good at teaching.

My middle boy is afraid of heights. So mounting a horse has been tough for him. When we introduced Rubble, I wasn’t sure he could even manage his height. After a little encouragement he donned his chaps, boots, and hat with a turkey feather in it and mounted the little horse. In a matter of five minutes the little cowboy had rubble trotting around the arena with his hand in the air and his spurs in his neck. (Gently of course.) Confidence builder, I thought. That’s what kid horses are good at teaching.

While, most of the time kid horses are a nuisance. Eating all our alfalfa and requiring special horse shoes to function properly.. they are more often than not a priceless gift. Teaching the ones we love most how to have tenacity, joy, and confidence.

While the ponies in our life may love their time off in the winter you can’t convince me that they don’t love their jobs in the spring. Even if it’s just a little bit. When that little cowboy shoves a bucket of grain in their face after a job well done together, the ponies head sits a little higher and so does that little cowboys hat.

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Foot Abcesses in Horses

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By Garrett Metcalf, DVM

A foot abscess is a common occurrence in horses throughout the year, with wet weather often contributing to an increase in cases. These abscesses can cause significant pain, lameness, swelling, and overall misery, making it important to address them quickly and manage pain to keep the horse comfortable. There are various methods used to treat foot abscesses, and this article will outline techniques to evaluate and treat them as efficiently as possible.

A foot abscess is a localized or sometimes diffuse infection trapped between the sensitive and non-sensitive laminae within the hoof capsule. Abscesses may develop spontaneously due to everyday stress and environmental factors that allow bacteria to penetrate down to the sensitive tissues. Other causes include penetrating injuries to the sole from nails, sharp rocks, or even thorns. Poor hoof care and misdriven shoeing nails can also lead to abscess formation. Common sites include the white line, where the sole and hoof wall meet, and the bars of the heels.

The level of lameness caused by a foot abscess can vary, but it often results in visible discomfort at the walk and can even cause non-weight-bearing lameness. Swelling that begins at the foot and moves up the leg may occur, particularly if the abscess migrates and ruptures at the coronary band. These cases are often referred to as “gravel” abscesses, which are simply abscesses that find the path of least resistance and exit at the coronary band, creating a draining tract. In some cases, especially involving a hind foot, the horse’s movement may appear so abnormal that it mimics neurological issues, confusing owners and veterinarians.

Diagnosing a foot abscess begins with a lameness exam. Most affected horses will be visibly lame at the walk, though in some cases a trot may be necessary to detect the issue. Regional nerve blocks can help confirm that the pain is originating from the foot and not another part of the limb. Horses with abscesses often show an increased digital pulse and, occasionally, noticeable heat in the foot. The bounding pulse is due to inflammation and is most easily felt just above the hoof near the ankle. If the horse is shod, removing the shoe is often necessary for a thorough exam. Hoof testers are useful in identifying the most painful area, and horses with abscesses are typically reactive to pressure. Cleaning out the foot with a hoof knife is important for exposing any defects or tracts in the sole or frog. Often, a dark spot or line will lead to the source of the abscess.

There are multiple ways to treat an abscess, and opinions vary widely, but my preferred approach is to open the abscess as soon as possible. This provides nearly immediate relief for the horse and allows the infection to begin resolving. A sharp hoof knife or loop knife is a reliable tool to open the abscess and create drainage through the bottom of the foot. Allowing the abscess to drain from the sole reduces the risk of a gravel abscess and makes it easier to treat the area with topical poultices. After opening, it’s important to bandage the foot both to draw out remaining infection and to keep the area clean.

A large baby diaper makes a simple, effective bandage. It’s absorbent and fits the hoof well. Secure it with layers of Vetrap, duct tape, and Elastikon, or place the hoof in a medicine boot to keep it protected. Poultice choice is often based on personal experience and availability, but the goal is the same — to draw out infection and prevent contamination. Products like Magna Paste, an Epsom salt-based poultice, are effective, as is a homemade mix of sugar and Betadine. There are many other options, but whatever product is chosen should be safe and offer antimicrobial properties.

In some cases, an abscess may be difficult to locate or open. Soaking the foot in warm Epsom salt water can help soften the hoof and encourage the abscess to rupture or become easier to identify. Pain management is also helpful while waiting for the abscess to surface. If the abscess continues to recur or proves difficult to treat, radiographs can help evaluate the hoof’s internal structures. While most abscesses don’t show up on X-rays — since the fluid is the same density as the hoof — they may be visible if gas is present within the abscess. Radiographs are especially important in cases of puncture wounds, to ensure deeper structures like the coffin joint or navicular bursa aren’t involved. In cases of penetration, it’s best to leave the foreign object in place until X-rays are taken, which helps determine the extent of the injury and what structures may have been affected.

While preventing all foot abscesses isn’t always possible, good hoof care goes a long way. Regular trimming on a consistent schedule helps maintain healthy laminae and prevents stretching of the white line, which can allow bacteria to enter. Careful shoeing practices, including proper nail placement, can further reduce the risk of abscess development.

Foot abscesses are painful, frustrating, and often sudden — but with proper diagnosis, drainage, and aftercare, horses typically recover well and quickly return to soundness.

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The Pull of the Barn

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When I was younger, I saw plenty of old Westerns. They were fun to watch, but one part always stressed me out. Inevitably, a cowboy would get shot or thrown from his horse, and while the cameras stayed on the fallen rider, I worried about the horse. Would it wander around lost on the prairie, never finding its way back? The truth is, most horses know exactly where home is. Turn one loose, and it will drift toward the barn. Ride one out, and the trip away from home feels steady, but the return picks up pace the moment the barn roof comes into sight. We even have a name for it: barn sour.

Horses are prey animals, and survival has always depended on familiar ground. For a domestic horse, the barn means food, water, and the company of the herd. Ethologists (scientists who study animal behavior) point out that horses are quick to learn patterns. When hay and grain appear in the same place every day, that spot becomes magnetic. Over time, repetition lays down mental trails as clearly as cattle wear down physical ones in a pasture. What appears to be stubbornness is actually instinct. The barn equals safety, and safety equals survival. Riders from cavalry days to modern ranches have written about horses quickening their pace on the way home. And though the land changes, that pull never does.

People are not so different. We all have barns in our lives — comfort zones we gravitate toward, routines that steady us. They serve a purpose. Like a horse standing at the gate, we lean on safe ground when life feels uncertain. But the pull can also hold us back. A horse that refuses to leave the yard never discovers what lies beyond the fence, and the same is true for us.

That balance shows up in history too. Old cattle trails once served their purpose, guiding herds north and helping to build economies. But when railroads and fences changed the landscape, those well-worn tracks became ruts. Progress required new paths. Our own habits work the same way. Some keep us grounded. Others only circle us back to where we started.

When I see my horses drifting toward the barn, I think less about impatience and more about instinct. They are drawn to the familiar, and so am I. The barn matters. It is the anchor point, the place of rest. But the pasture matters too, because growth is waiting outside the gate.

Those old Westerns had it right in at least one way. The cowboy’s horse was never going to wander off aimlessly. It would head back to camp, back to the barn. That simple truth still plays out in every pasture and arena today. Horses know where home is. The question is whether we will let the pull of our own barns keep us tied too tightly, or whether we will use them as a base to step farther into the wide-open ground ahead.

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