Monday, December 29, 2014

Balancing Act or Act of Balance

At our school and throughout my travels I am often asked, "How do I balance the horse with less than ideal conformation?" The answer is quite simple really, balance the hoof capsule to the internal foot.  
I have been teaching students for more than a decade to balance hoof to foot. I have gone so far as to have three or more students on one horse at each course. That's right, four different trimmers on one horse, with the end results being a balanced horse. 
I remember doing a clinic for a group of Amish Farriers in Pa. more than ten years ago. There were 29 farriers present. I had four different farriers trimming a draft mare. Each farrier would do one hoof following my direction for achieving balance of hoof to foot. As each farrier trimmed a hoof I noticed a slim guy with a long beard in the back of the group. He was shaking his head side to side and that long beard was swaying back and forth. When I asked him what was on his mind he simply said, I've been shoeing for nearly 50 years and in my opinion there is no way that those hooves are going to match or be balanced. I presented him with a challenge. I said, when those guys are done, you go and measure and check the work over. If you come to me following your inspection and if you feel that any of the hooves are more than an 1/8th of an inch out of balance to one another, I'll pack and leave before sitting down for lunch. 
Once the farriers were done, I moved to lecturing on functional anatomy with the rest of the group. Over my shoulder I saw this guy down on his hands and knees with a small tape measure. He measured medial and lateral hoof walls, he picked up each foot and eyed down the limb, and he check the HPA. 
In a few minutes I saw him standing at the back of the group and that beard was swaying back and forth again as he shook his head. I figured I was heading to Micky D's for lunch, but when I asked him for his conclusions he offered, "No more than a 1/16th of an inch, lets eat." 
There are many methods of trimming that subscribe to balancing the hoof to the foot's axis or COR. Whether you subscribe to theories presented by Mike Salvoldi, Gene Ovnicek, Dave Duckett, or the ever growing population of hoof experts, balancing around the axis of the foot is central to their work. Though all of these methods have merit, they each present a challenge. How do we balance the hoof to foot without a plane of reference? The Dynamic Balance Hoof Level is the first tool to offer a reliable plane of reference, that when followed results in repeatable balance. 
Below are photographs of a horse with toe-in conformation that was trimmed at the December Advanced Level Two Applied Equine Podiatry course in Ocala, Florida.  
The Advanced Level Course was also host to the first Dynamic Balance Hoof Level Certification Clinic offered by the Institute of Applied Equine Podiatry. The Dynamic Balance Hoof Level presents a reliable plane of reference around the axis of the foot, thus allowing the trimmer to establish balance in all horses, even those with less than ideal conformation. I will be presenting more on the DBHL in future posts, along with an instructional video. The Level will be available for purchase by the end of this month. 

before and after LF
before and after RF


Monday, December 22, 2014

Balance, Bottoms Up!

Balance remains a hot topic, regardless of where the conversation begins with break over, toe placement, or heel placement. It really doesn't matter, the topic is hot. It has been a hot topic for over 100 years.
In the late 1800’s, farrier professor William Russell offered many concepts on locating or visualizing the position of the distal phalanx within the hoof capsule. While Russell referenced many structures on the bottom of the foot, most farriers simply focused on the outer hoof wall. Russell felt that measuring back from the trimmed frog apex about ¾” (19mm) would put you in the center of the horses foot, and you could balance your trim or a shoe around that location. More recently, farriers David Duckett and Gene Ovnicek used similar references to define a “Center” point on the bottom of the foot, then balancing a trim or shoe around that point. David Farmillo from Australia, and many other farriers from around the world use sole references to balance the hoof capsule as opposed to using the outer hoof wall that can become distorted presenting a poor representation of its relationship to the distal phalanx. A common factor with all of these farriers is the use of the center of the foot, the foot's "Axis."  Those farriers that use the Axis of the foot are less likely to be misled by the distorted hoof capsule. The majority of the "Experts" agree that balancing the foot around the distal phalanx and center of rotation of the DIP Joint offers the best solution for achieving consistent and repeatable balance.
Great! Now that the Experts can agree on balancing to the "Axis" of the foot how do we get farriers to do just that? Balancing around the axis as described by most means correct break over and heel placement. But what if we could establish balance around the axis on all required dimensions?
What if there was a way to achieve consistent and repeatable three dimensional balance of the hoof capsule to the axis of the internal foot.
Over the years the farrier has been offered many tools to help them achieve balance, but none address true three dimensional balance. The "T" Square addresses distal/proximal balance on the medial/lateral plane, but does not offer reference of distal/proximal balance on the dorsal/palmar plane. The "Protractor"offers a distal/proximal reference on the dorsal/palmar plane. Dorsal/palmar and medial/lateral balance are still left to the discretion of the trimmer.
Follow any thread discussing balance and you will find that regardless of the method used to achieve balance ultimately no definable plane of balance is referenced. It is no wonder that consistency and repeatably is non existent. Refer to my blog post "Trim, Trim, oops, Trim".
That is all about to change. For over a decade I have taught trimmers how to achieve balance by referencing a plane established about the axis of the internal foot, using land marks on the sole of the hoof. There are many farriers that have developed techniques for defining the axis of the foot, and suggesting that the farrier balance around this point. Where my teaching differs is that I teach the trimmer to envision a plane represented by land marks around the axis. This technique has worked well for over ten years with numerous radio-graphic studies and dissections confirming the techniques ability in achieving consistent balance of the hoof capsule to the internal foot. The difficulty has been in teaching the trimmer to visualize the plane of reference. Over the past year I have developed a tool that solves this problem. I have recently introduced the Dynamic Balance Hoof Level. A hoof level that will change how dynamic balance is achieved.

The Dynamic Balance Hoof Level was developed after nearly a decade of study. It provides a plane of reference that when followed achieves dynamic three dimensional balance of the hoof capsule to the axis of the internal foot. Recent studies indicate that achieving three dimensional balance about the axis of the foot supports symmetrical movement improving locomotion. The DBHL attaches directly to a farriers rasp. Three distinct planes are presented, the axis plane, the heel plane, and the toe plane. When the hoof is trimmed to the referenced axis plane, dynamic balance is achieved. A soon to be published paper references the importance of fore foot balance and the importance of balancing to the axis plane. The DBHL provides a reliable plane of reference for achieving accurate and repeatable balance. 

Sunday, December 14, 2014

Frog Function revisited

When you are asked what the function of the frog is what do you say? It's a pump, its for traction, its a shock absorber? Over the centuries we have come to accept the frog's function based on, for the most part supposition. There have been numerous studies done on the frog from many different perspectives, but I have not seen many that looked at the frog from my perspective.If the frog's primary function was to act as a pump then why the triangle shape? A simple question. Why has the frog not take on the form of a pad whose confirmation was closer to that of a half sphere? After all when I need to prime my Weed Eater I pump the little rubber half bubble on its carb, this conformation makes sense, but a triangle?
 One has to explore the foundations of the foot to formulate an understanding of why the frog is triangular in shape. In my video on foot function and in class I use a simple paper plate to help explain part of its conformation. On the paper plate I draw the solar structures of the hoof, then grab the area of the plate that represents the heels and attempt to distort the plate without causing distortion to occur at the area that represents P3 (the toe area). You will find that it can't be done. Now cut out the area represented by the frog, and attempt to do the same. Now you can induce distortion to the caudal foot, and the "V" known as the Frog Stay aids in isolating the distortion to the caudal foot, protecting the coffin joint and P3 from torque. Why? The foundations of the caudal foot are cartilage. Each of the lateral cartilages (Palmar Foundations) can distort independently of one another, providing elastic potential acting as torque arms to protect the dorsal foundation from torque (P3).
In an effort to define frog function it is important that you identify true conformation of the frog, including its distal surface and proximal surface. Many of the studies conducted do not take into consideration the proximal or axial surface of the insensitive frog. The proximal surface is where we find the Frog Spine. The Frog Spine function has not to the best of my knowledge been defined. In frog function studies at the Institute the frog spine is viewed as a dynamic structure that functions to direct the energies created during the stride.  From my perspective the primary function of the frog is to act as a vehicle for the delivery of stimulus to the appropriate structures within the caudal foot. Subscribing to this definition of frog function helps us to understand the correlation between health of the frog and health of the digital cushion, and ungluar cartilages. I recall closing my talk at the International Hoof Summit in 2006 with this statement "if you have poor health to the frog, you can't expect to achieve health in the caudal foot." Under run heels, poor bar conformation (frog stay conformation), contracted heels are all the result of weak structure due to lack of correct stimulus. Having a means to deliver correct stimulus to the structures of the caudal foot is paramount in developing health, and the frog is the primary vehicle for the delivery of that stimulus.

Tuesday, December 9, 2014

Spectrum of Usability

Day three of the Ocala Florida Level One Applied Equine Podiatry course. Working with cadaver limbs teaching Spectrum of Usability. The S of U is used to evaluate the hoof for health and conformation. We first developed our S of U in 2002.
The spectrum was developed for use by the Institute of Applied Equine Podiatry for a study being conducted to compare health and confirmation of a hoof to the position of P3 (coffin bone) in relationship to the ground plane. 50 cadaver hooves were obtained from a local rendering plant. Six structures of the hoof were rated for health on a scale of 1 to 9 with 1 being very poor and 9 being very healthy. Six structures scored: Frog, Sole, Heel, Bars, Quarters, and Toe. We then averaged the scores together to get an average score for each hoof.
We then proceeded to remove the hoof capsule being careful not to damage the internal foot (Internal Arch Apparatus). The internal foot was then placed on a glass panel, with the tip of P3 and the most distal points of the sensitive frog making contact with the plane. Measurements were then taken at the widest part of P3. We measured the space presented between the glass plane and the dermis at this point, both medial and lateral averaging the measurements together.
We then compared these measurements to the S of U score for each given hoof. Our findings were that the hooves that presented height from the glass plane to the dermis scored higher on the S of U than those that presented little to no height (ground parallel) at this location. This pilot study provides evidence to support the belief that correct conformation of the Ungular Cartilages aid in positioning the distal border of P3 within the capsule. It is our belief that when the ungular cartilage conformation is correct the distal boarder of P3 is at a 5 degree inclination to the ground plane.  It is our belief that those hooves with the lowest S of U scores present a caudally rotated P3.

Sunday, December 7, 2014

Passion for Learning, You gotta love it

Yesterday was the first day of the fall Applied Equine Podiatry course held in Ocala Florida. The coursed open with an introduction to the principles and phylosophies of Applied Equine Podiatry, following this up with teaching the basics of Physiological Sequencing. If you have been following this blog you may have taken notice that I refer to physiological sequencing often.
Today's class will continue with the defining hemodynamics and the Suspension Theory of Hoof Dynamics. Also of great importance in teaching AEP is to be certian that all students Have a clear understanding of Dynamic Equilibrium as it pertains to foot function, this allows for a shift in paradym. First time students are often overcome by feelings of, lets just say concern over the current lack of respect offered normal physology in the practice of hoof care. In the first two days of class students are exposed to: The Internal Arch Theory, the Suspension Theory of Hoof Dynamics, Hemodynamics within the foot, Physological Sequencing, the HPTModel, the Spectrum of Usability, and the HPTMethod. We do not expect first time students to retain all of this information. There are however key elements that first time students are instructed to take special note off, in the hope that this key information will be retained following completion of this, the first of their five practical courses. Each practical course is 40 hours, with one building upon the other. Horse owners that wish to be exposed to the basic principles of AEP will find attending one five day course very beneficial. All in all yesterday was excellent. Enthusiastic students, a positive learning environment, and a topic we are all passionate about, what more could you ask for?

Saturday, December 6, 2014

Fall Applied Equine Podiatry Course

Today is the first day of the fall AEP course being held in Ocala, Florida. It is always encouraging to meet horseowner, farriers, and veterinarians that are seeking knowledge and that are open minded to new ideas. I am excited to be including information and education on achieving dynamic balance. This will be the first course in the U.S.A. in which I will be using the newly released "Dynamic Balance Hoof Level". More on the level to come. It' going to be a great course.

Friday, December 5, 2014

Trim, Trim, oops, Trim

I've been saying it for over a decade; our profession does not offer up a solid model for learning how to apply, with consistency a balanced trim. Recent studies suggest that today's farriers may start out  handicapped, in that they are not provided the tools needed to quickly develop the skills needed to consistently apply a correct trim. This is not my finding, evidenced based research supports these statements. The fact; regardless of how skilled one is at forging and shoeing if the shoe is applied to an imbalanced foot the results are going to be less than desired.
So what is the answer? One of my pet peeves is when someone constantly comes up with a multitude of problems, and then wallows in the woe of the seemingly unsolvable, never offering positive input. I for one believe that there are solutions to most all problems, so long as we approach the problem from as many perspectives as are available. Before we can do that we first need to state the problem in as many ways as we can. Wait a minute, didn't I just say that was a pet peeve of mine? No, I said those that wallow in the seemingly unsolvable was my pet peeve.
The problem: Difficulty in applying balance to the hoof. The lack of consistency in applying a balanced trim. Difficulty in teaching the application of a balanced trim. Lack of a solid model for teaching a balanced trim. Difficulty in defining a balanced trim. Lack of tools available to aid in achieving a balanced trim. I am sure that you could add to this list of problems and for each you may be chomping at the bit to offer a solution, but before you start pounding at those keys to submit your comment let me offer up one more problem.Contemplate this problem; how to implement the solution.
You don't believe there is a problem? Well you may be among the minority in the farrier industry. Dr. Doug Butler, author of “The Principle of Horse Shoeing II,” and renowned educator, once stated in the American Farriers Journal that most farriers have difficulty visualizing the internal bone structures and their relationship to the hoof capsule.  I find this remark to be of paramount importance. If a trim is based on one’s ability to visualize and the experts are finding it difficult to do just that, then my belief that a problem exist that handicaps our prospective farriers from the start is justified. I invite your comments.

Thursday, December 4, 2014

My Horse has a What?

You go out to the barn to feed in the morning and your horse doesn't approach you like he usually does, he just stands there off at some distances with his head hanging a bit lower than usual. Then when he begins to move, ouch he is really lame. You note that he is pointing his right front. Panic sets in, you immediately start looking for signs of injury, you find none. You feel for heat in the affected limb and foot, and you find that the hoof feels warm, warmer than the others. If you have experienced an abscess before you may breath a little easier, even feel a sense of relief. But if you have not experienced it you are likely to call your vet in panic mode, with thoughts of laminitis, broken bone, or stone bruise bouncing from one side of your brain to the other. What I am talking about here is the onset of an acute abscess. An abscess that forms quickly and often works its way out of the hoof following a path of least resistance in a relatively short time. Sometimes your veterinarian or farrier will help things along by probing, creating a path of less resistance that allows the abscess to drain. Once a acute abscess has drained the horse usually feels immediate relief.

Being well versed in the hoof, you would think that if my own horse developed a acute abscess that I would have no difficulty identifying it, and aiding in alleviating my horse's discomfort. The wrench in the works here is the descriptor used in that sentence "my own horse". No one knows my horse better than me, at least that is how I usually see things.

I recall several years ago while teaching at our facility in north Florida my wife interrupted my class to say that one of our horses was really lame. As described above, she went to feed and found our big warmblood was not weight bearing on his right hind, he's a big guy over 17 hands tall.
I had adopted him at age 6 from a dressage barn in New York. While in training he was plagued with stifle and hock issues so they retired him to the warmth of Florida. Did you catch that? They retired him because of stifle issues, right hind to be precise. He would often hike his right hind as though he suffered a locking patella. I have always battled with hoof deformity in the right hind, this because of how he moved. Well, we took a break from class and I went out to the yard to examine the big guy. Sure enough he was hiking his right hind. I checked for heat in the limb and hoof finding nothing significant, even probed a little with my hoof knife. Knowing his history and seeing him hike that limb in the same fashion as he has may times, I simply assumed he had injured the stifle. We called our vet out for an x-ray. You guessed it, it was an abscess. You see, even us experts can fall into the trap of vertical thinking, especially where patterns have been established. The vet followed his set pattern of thinking and in this case was correct. I don't regret calling the vet. Though it was tough chocking on such a big piece of humble pie, I can appreciate the lesson learned; Never Assume. I had once again been taught to respect one of the greatest teacher of humility in my life, My Own Horse.
Perhaps I should mention that recently that same horse presented the same scenario, and even though I had been served up a huge helping of humble pie the last time, I still called in the vet. Why? Because I looked at the situation from a lateral perspective, approaching the situation as if it were a client's horse and not my own. The result; it was not an abscess this time. 


Wednesday, December 3, 2014

The Ego, Destroyer of Customer Service

As a school whose mission is to produce graduates that place the welfare of the horse above all else, it is only logical that developing communication skills has become a priority. 
I learned a long time ago that customer service did not end when my tools were back in my vehicle. I learned that there is more to it than being on time, or doing a pretty trim or shoe job. If I truly had the welfare of the horse in mind, I needed to learn how to communicate with all involved in the care of that horse, including the owner, and veterinarian. 
Below is a exert from the AFJ blog that illustrates the importance of developing communication skills. I respect the farrier for understanding the importance of listening. "When an owner asks him a question at the barn, He takes his apron off, makes eye contact and listens to what they have to say. He addresses their concerns by answering in a thorough, understandable manner." Communication. Our program promotes the use of a Spectrum of Usability, a form which documents the current state of health of the hooves and horse being worked on. This form keeps the owner engaged and the hoof care provider connected. While it does take time to fill out, it gives the owner time to ask questions. 

For the Applied Equine Podiatrist it is important to develop these communication skills, skills that promote team work. For the Applied Equine Podiatrist a team may include owner, vet, farrier, or a host of other care providers. Customer service is all about communication and team work. When it comes to the welfare of the horses in our care, there is little room for ego. That being said, we all need to be very careful not to mistake confidence and good communication skills for ego. 

El Paso, Texas, farrier Doug Hogue conducts 90% of his work at the clinic of Dr. Paul Jenson in Sunland Park, N.M. Hogue in a conversation with Jeremy McGovern, Executive Editor of the American Farriers journal, explained that he sometimes finds local farriers who are angered because another farrier has temporarily taken over the horse at the clinic. He states; I disagree with the opinion, but I understand why that reaction sometimes occurs. Those farriers react as such when they mistake a farrier carrying out a vet’s script as an unwarranted critique. That’s vanity and pride manifested in unprofessional reactions. Furthermore, it is a missed opportunity to learn and a failure to recognize a deficiency may exist in one’s own work that may have caused or contributed to the problem. Not to mention, what’s more important… the health of the horse or your pride?
A more curious reaction Hogue also told McGovern about is when another farrier is mad because the client didn’t tell him or her that the horse went to the clinic. Obviously this is a case of misdirected anger. And it is a reaction that misses the point entirely. Hogue sums it up best that the other farrier should, “take a step back and realize that there is a problem is in the relationship with that client … they don’t feel there was a need to let that farrier know there was a problem.”
Hogue says the farrier as the cause of this problem is avoidable by staying engaged with the owner. He lets the client know he wants to know as soon as they believe there is an issue with the horse. When an owner asks him a question at the barn, Hogue takes his apron off, makes eye contact and listens to what they have to say. He addresses their concerns by answering in a thorough, understandable manner.

All of this is quality customer service. More importantly, this level of engagement lets the owners know you care about the horse and their business. And it makes finding out about visits to the clinic after the fact a rarity.

Tuesday, December 2, 2014

What is Applied Equine Podiatry?

What is it about change that is so hard? In my post "Solving Hoof Problems, Laterally?"  I talk about labels and why when something comes along that is different our thought patterns immediately attempt to apply familiar patterns to it. The example I gave was: You have two boxes one is labeled white ping pong balls, the other black ping pong balls. As long as you are handed a white or black ping pong ball you have no difficulty placing it into the appropriate box, you are comfortable, you have established thought patterns that solve the problem. Then you are handed a gray ping pong ball, which box to put it in? Your mind will struggle to choose, though experience may sway you to put it in the black box because you see gray as closer to black, or you may decide that because black is the absence of all color that it needs to be in the white box.  But, what if you chose to break your pattern of thinking, what then? When do you decide that there needs to be a third box?  Hmmm a third box.

Along comes someone calling themselves an Applied Equine Podiatrist, you have two boxes one labeled "Farrier" the other "Barefooter", which box should I put this person into? Like the ping pong ball, you will use an established pattern of thought assigning one of these labels to this person. I'll ask again, what if you choose to break your pattern of thinking?

It is only fair that if I am going to ask you to change your pattern of thinking that I provide you with information about this third choice. So, What is Applied Equine Podiatry?

I get asked that question all the time, at horse expos, lectures and conferences, and in class by the first time student. In class it is a simpler task, offering information that allows a student to practice lateral thinking and thus accept the need for a third box. The question "What is Applied Equine Podiatry?" is an exercise in lateral thinking, and after being challenged hundreds of times by this question I was able to pen a simple definition. I think at the very least the following definition will allow the open minded individual to entertain breaking fixed patterns of thought.

"The essence of Applied Equine Podiatry is the conscientious study of the equine foot, always striving to expose it to proper environmental stimuli, making every effort to promote proper structure and function, as we progress in achieving high performance. It is accepting the fact that the horse has the innate ability to heal itself, and that domestication of the horse has caused imbalance and broken the golden rule of "Do No Harm." 

Over the next few weeks I will post a question or statement taken directly from a past final written exam of our Entry On-Line AEP Program.
The exam is a list of questions and statements that I have been presented with over the past several years. Students are instructed to read each carefully and respond to each as if it were directed to them and as to how Applied Equine Podiatry would or would not apply. Tip: “Whole Health Hoof Care.” The goal of the Applied Equine Podiatrist is to aid the horse owner in achieving a healthy foot.

Here's a question or rather statement presented to our Entry Level AEP students.
My horse wears his hind outside heel down much faster than the inside; the shoe prevents the wear and my farrier wedges it to balance him. 

Tip: When a statement is presented, often the answer is a question. 

Perhaps with added insight you to will see the need for a third box. 

Monday, December 1, 2014

Prolapse in the Hoof

One of the very first things taught at our school is the functions of the hoof capsule. We talk in terms of protection, support, suspension, and resistance, the hoof capsule has a multitude functions. One of the most important is to provide resistance to distortions induced by the stride. As an example, the wall of the toe must provide much more resistance to flexing than that of the wall at the heels. The primary reason is the task that it must complete during the stride, function is directly related to a structures foundation. The foundation at the heels is cartilage and at the toe bone.
The wall also helps in protecting the corium (sensitive, vascular tissue) that produces it, protecting against blunt trauma, infiltration of toxins, and prolapse (displacement) of the corium itself.

The most common form of corium prolapse associated with the hoof of the horse is a solar corium prolapse; where by the corium of the sole protrudes from the solar epidermis (horn). This sometimes happens when the horn of the sole is removed to expose an abscess, or following a puncture wound. Other areas of the hoof capsule that have been seen to host a prolapse, though not as common are the frog, and coronary band groove.  

Why does the prolapse occur? As stated above, one function of the hoof capsule is to provide resistance. When this resistance is removed, either by injury or intentionally the risk of prolapse exist. Inflammation and instability are major contributors to the process of prolapse.

How can prolapse be prevented? First and foremost, anytime that corium or living tissue is involved, so to should the vet be involved. As a hoof care provider our work begins and ends with the hoof. Working with an attending veterinarian to prevent infection and reduce inflammation the hoof care provider can help in preventing the prolapse from occurring, by creating resistance where resistance has been compromised.
Resistance does not mean support; it means mild pressure that does not result in pressure necrosis (death of tissue). 

I have attached photos of a case that involved a coronary band prolapse. This type of prolapse is not very common, but can occur when a large area of the coronary groove of the hoof capsule is lost. 

This particular horse suffered an abscess which resulted in substantial loss of resistance at the coronary band. This foot was also very upright, and as a result a higher level of distortion occurred at the sight of the prolapse.

This was treated by providing resistance in the form of a Sole Mate Therapeutic Pad insert. The area was washed with Silvetrasol Hoof and Wound Wash, and the pad was fashioned to mirror the stratum internum (inner wall). 

I then applied a Perfect Hoof Wear Poly Wrap to the foot, paying close attention to the amount of tension applied over the Sole Mate insert. The PHW Poly Wrap provided the resistance needed to prevent further prolapse, while the pad insert provided the stimulus needed for the development of healthy structure. The final picture was taken at four months from the onset of the condition. This package was applied four times. 

Sunday, November 30, 2014

Horse Toes?

Throughout history and still today some horses are born with vestigial toes.

Take a look at Alexander the Great’s horse, he was one such animal.  His name was Bucephalus which translates as Oxhead. Some accounts say that he was so named because he had the image of a bull's head on his shoulder. The name conjures up mental images of a warhorse with a massive head and chest, that carried brazen young conqueror. Quite the picture, but did you know that Bucephalus had vestigial toes (extra, non-functioning).

Toes on a horse are an evolutionary legacy akin to human tailbones and gills in womb. Embryos of modern horses develop the rudiments for three toes in utero. Ordinarily, the middle toe will eventually outgrow the outer ones which then become splint bones. This central toe is then the one which will support the horse through contact with the ground, ie the hoof. Bucephalus’was a polydactyl, which means having more than one toe; his toes  did not develop in the normal manner during gestation. 

The legend of Bucephalus’ mutation was nurtured, imbuing the horse and his owner with mythical properties. The toes, in some way, embodied the outstanding nature of his master’s life, as if everything he touched was extraordinary. Centuries later Julius Caesar hung on the coattails of this myth by sourcing a three-toed horse and protesting that it would let none other than the man himself ride it.

Saturday, November 29, 2014

Balance Dynamics vs. Dynamic Balance

The post "The Balance Dilemma" has been very popular. In that post I talk about the confusion associated with balancing the hoof of the horse. In other post I mention the label Dynamic Balance and how that label is defined by conventional thinking. One of the hardest things to do is break the patterns associated with a label. Fortunately the thought patterns associated with "Dynamic Balance" in my opinion are not yet fully formed. So, here I offer you, our reader something to ponder.

Dynamic Balance, can it be achieved? There is a good chance of achieving Dynamic Balance when the internal foot (Internal Arch Apparatus) is correctly suspended within the hoof capsule. I believe that the internal foot is suspended by the coronary band and its accompanying structures. The Internal Arch Apparatus (IAA) is placed in the proper position to receive the stresses induced by the stride, when the distal border of the coffin bone (P3) is at approximately a five degree inclination to the sole plane of the hoof capsule. The position of P3 however does not define the relationship the internal foot holds to the hoof capsule. Dynamic Balance is when the hoof capsule is balanced to the internal foot and not simply to the distal border of P3.

The position of P3 is ultimately a function of the whole (IAA), and should never be used in and of itself as a denominator in the equation for achieving dynamic balance. You should always remember that balancing the solar aspect of the hoof capsule to the dorsal (solar) plane of the IAA simply places P3 into the desired position within the capsule. It does not return health to the IAA. Dynamic equilibrium is defined as all structures functioning optimally at any given moment of time throughout the stride.

Deviation from the balance of the solar aspect of the hoof capsule, from that of the dorsal plane (also called the Live Sole Plane) of the IAA will result in incorrect stresses being imparted on the coronary band. This also results in abnormal stresses being placed on the ungular cartilages, ligaments, and the dermal structures, a loss of dynamic balance. Stresses resulting from incorrect balance result in conformation change of cartilage, this when elastic potential is compromised. Horn, because of its relatively low elastic potential readily conforms to the stresses imparted on it, i.e. flaring. 

Once more we need to remember the process involved here (Physiological Sequence); first we identify soft tissue changes, then dynamic tissue (horn and cartilage) change, and finally static tissue (bone) changes. It is sometimes necessary to make attempts to aid the horse in reversing this process. Working from x-rays is fine provided you apply your knowledge of physiology and don’t fall into the trap presented by static mechanics. Scrutinizing the palmar processes of the distal phalanx (P3) can help in our assessment of the ungular cartilages. Observing the health of its (P3) solar margin, and the solar canal will help us in physiological sequencing for the condition presented. Has there been long standing inflammation, evidenced by abnormal development of vascular channels? Has modeling of the tip of P3 occurred? All of this information can be used in developing a treatment protocol and ultimately formulating a prognosis.

I  spend more than 140 hours teaching physiological sequencing to our advanced level students enrolled in our level two program. X-rays can be extremely helpful in developing a hoof treatment protocol, way beyond simply balancing of the hoof.
This is not diagnosing, it is learning.

Visit our site for a listing of On-Line courses that will better help you understand Physiological Sequencing, Radiography, and Dynamic Balance.

Friday, November 28, 2014

Solving Hoof Problems, Laterally?

Every day, as hoof care providers we, like everyone else face day to day problems. Most are easily solved using vertical (conventional) thinking. What cloths do I wear today? Do I have toast or muffins? What route do I take to my first client? But on occasion we are presented with problems that are not so easily solved. What thought process do you employ when presented with a hoof related problem. 

Below is a recent post from Facebook. It caught my eye, in that it presents a series of problems that the hoof care provider often faces. 

I view this as an exercise in lateral thinking. My entry point into this problem is likely not the same as many of yours. I make a list of problems, listing the most obvious first and keep adding to the list until my thought process is exhausted. I'll start you off. Most obvious problem: My horse is lame or stated as a question; why is my horse lame? How we approach or enter into a problem is dependent upon what problem we choose to approach. In this exercise feel free to list any problem that comes to mind, even those that sound ridiculous.

When we are presented with something, we immediately begin to establish defined patterns of thinking based on past experience. In the book Lateral Thinking, Creativity Step by Step, written by Dr. Edward de Boneo,  offers an example of how this works: You have two boxes one is labeled white ping pong balls, the other black ping pong balls. As long as you are handed a white or black ping pong ball you have no difficulty placing it into the appropriate box, you are comfortable, you have established thought patterns that solve the problem. Then you are handed a gray ping pong ball, which box to put it in? Your mind will struggle to choose, though experience may sway you to put it in the white box because you see gray as closer to black, or you may decide that because black is the absence of all color that it needs to be in the white box.  But, what if you chose to break your pattern of thinking, what then? When do you decide that there needs to be a third box?  Hmmm a third box.

Facebook Post:

left hind
right hind
I'm trying to understand the nature of my horse’s current lameness... now his left hind foot is smaller and more contracted than his right hind, which had had a series of abscesses. My experience has taught me that the "prettier" foot is usually the one causing all the problems. Because his left hasn't had all those ugly abscesses, it's "prettier". When I watch his left lead canter in the round pen, he will canter a few strides, then switch leads behind. He's much more comfortable and doesn't switch when cantering to the right. His hip is higher on the right, which means he's putting more weight on his right leg. I felt like all along, he was weighting his right hind more because the left front was the original issue. 

Now I think the issue is the left hind. But I'm not sure which issue is the cause: is it the left hip? or the left foot? I can trim the foot for more decontraction, but of course that will make him less likely to want to weight it if it abscesses. Or maybe he's not weighting it because it's so contracted? Maybe it's time to try a chiropractor. Oh me. The left hind is the white one. Now I know color of hooves doesn't make a difference but man, this foot seems much harder and tighter than the right one. The abscesses on the right really helped that lateral wall become more angled out.

Vertical thinking follows patterns, Lateral thinking breaks those patterns, though lateral thinking cannot exist without vertical thinking. Can you outline the pattern of thinking this owner has? 

Wednesday, November 26, 2014

Alternative approach to healing navicular problems (Part 2 of 2)

In Part (1) I defined true navicular disease (lameness due to bone change) is only apparent following a long series of recurrent events. Applying “Physiological Sequencing” in defining this chain of events, soft tissue is the first to undergo change in response to an environmental alteration (balance change, increased vibration, friction and/or pressure), followed by changes to the horn (dynamic tissue), before any modifications to the bone become apparent on x-ray. The hoof capsule will show deformity (flare, excessive wear or growth). As the horse reacts to pain, he changes the way he loads the foot, and deformity appears. The deformity can be minimal, but it will occur.

On rare occasions, a horse may show an acute-onset unilateral (affecting one limb) lameness, which leads to a diagnosis of navicular disease. It is my belief that short of a catastrophic insult (injury), pronounced unilateral lameness is more often the result of chronic loss of structure and chronic inadequate foot function.

How does conventional veterinary medicine approach treating this condition?

Conventionally, whether the diagnosis is disease or syndrome, most veterinarians will recommend corrective shoeing. Most commonly, this means an egg-bar shoe (said to give added support to the heel), accompanied by a rolled or rocker toe, wedge pads when needed to correct hoof pastern angle (HPA), and impression material for cushioning. But other shoeing protocols are used as well. Conventionally speaking, corrective shoeing, regardless of the shoe used, is dependent on the horse’s hoof-pastern angle. This approach to the problem is from the perspective of static mechanics, where pressure from the DDFT is the primary suspect for the cause of the disorder.

In addition, vets may recommend nonsteroidal anti-inflammatory medications to control foot pain, as well as phenylbutazone (bute), but not all horses with navicular pain respond to phenylbutazone. Medications to increase blood supply have also been prescribed. As a last resort, your vet may perform a surgical procedure known as a neurectomy. This procedure severs the nerve supplying the back of the foot but the results are often temporary.

How Does Applied Equine Podiatry Differ?

When presented with a horse diagnosed with navicular disease, it is imperative to evaluate the foot structure. As I do not subscribe to the conventional definition of a well-conformed foot, I assess the foot with an eye on the health of the Internal Arch Apparatus. Studies suggest that navicular pain results from a loss of those structures that help in maintaining proper bio-mechanical function of the joint, and in the positioning of the coffin bone in its relation to the joint and the distal limb. These structures include not only the distal sesamoidean ligaments and tendons, but also the ungular cartilages and digital cushion.

Where conventional thinking focuses on the stress exerted by the deep digital flexor tendon on the navicular bursa, and reacts to reduce this stress by reducing break-over or increasing foot angle, one should be more concerned with heel placement and the effect it has on the biomechanics of joint movement, circulation, and neurological function. Where are the heels in relationship to the center axis of the joint? No shoe can alter the position of heels in relationship to this center axis, but a shoe does alter the forces acting on the joint. This may temporarily reduce pain, but it is seldom successful in stopping the progression of the disease.

The conventional approach ignores the importance of the Internal Arch Apparatus and the role it plays in energy utilization and dissipation (Energetics). The key to treating navicular pain is to consider the whole. Simply trimming the heels to get them to the widest part of the frog, or reducing break-over, does not address the underlying cause of the pain – the loss of structure causing undue stress on the supporting structures of the joint.

Instead providing correct stimulus will ultimately result in reducing the stresses associated with the progression of the disease process helping to restore sound structure and proper function. Pain management is essential during this time. Pain can effectively be managed with the help of the veterinarian, and by the use of several appliances (pads, boots, hoof wraps, specialty shoes) that support correct foot function.   .

Over the past two decades, I have worked on many horses diagnosed with navicular syndrome/disease, and most had weak structure to the caudal (back) aspect of the foot. But with correct trimming to achieve balance of the hoof capsule to that of the Internal Arch Apparatus, the appropriate application of stimulus (exercise/pressure) to aid in the return of correct structure, and sound pain management practices many horses returned to work. Review Part One (1)

1. Pool RR, Meagher DM, Stover SM, Pathophysiology of navicular disease, Vet Clin North Am Equine Pract 1989; 5: 109-129
2. Ross MW, Dyson SJ, Lameness in the Horse, Philadelphia, 2003 Saunders
3. Leach DH, Treatment and pathogenesis of navicular disease in horses, Equine Vet J 1993; 57: 415-421
4. Thompson KN, Rooney JR, et al, Considerations on the pathogenesis of navicular disease, J Equine Vet Sci 1991; 11: 4-8
5. La Pierre, KC, The Chosen Road, Achieving High Performance Through Applied Equine Podiatry, Dover, Naked Greyhound Press, 2003

Tuesday, November 25, 2014

Navicular Disease, an Alternative Approach (Part 1 of 2)

In the not so conventional practice of Applied Equine Podiatry, seldom is the term “navicular disease” used. Taking a more holistic approach, several principles, theorems, and philosophies are embraced. At its foundation is the belief that structure plus function equals performance (S+F=P). It is also acknowledged that a horse has an innate ability to heal itself, provided the environment is conducive to healing. 

What does this mean to the treatment of the condition defined as navicular disease? First, it is understand that in coming to a point where a single disease is defined, as is often the case in conventional veterinary medicine, focus is on eliminating symptoms and not treating the cause. As new research provides evidence that there are multiple causes for the clinical manifestations of the lameness associated with navicular disease, it is only logical that a series of events have led to the condition observed (Physiological Sequencing).

As theorized, changes in normal bio-mechanics of joint movement may lead to inflammation of the soft tissues of the navicular apparatus, but the question is: what is normal bio-mechanics of joint movement of the navicular apparatus?

To answer this question, you must subscribe to a specific model of foot function. 
Here is the foot model defined as the Internal Arch Apparatus.

The Internal Arch Apparatus is responsible for 
both energy utilization and energy dissipation within the foot, and is comprised of the coffin bone, navicular bone, distal articulating surface of the short pastern, all connective tissues (ligaments, tendons, fascia), the digital cushion, and all corium (vascular layer of the foot, containing nerves and blood vessels). In short, the Internal Arch Apparatus constitutes all structures of the foot, without the hoof capsule. Applied Equine Podiatry recognizes that true foot function sees all structures working in concert (dynamic equilibrium) to provide performance.
Because this model includes the navicular apparatus as part of the whole, a manifestation of pain within the navicular apparatus would indicate a loss of structure and/or function of the Internal Arch Apparatus.
Taking things a step further, it is understood that the coria (corium) of the Internal Arch Apparatus produce the hoof capsule. It is often said of the foot that the outside is a mirror image of the inside. If one subscribes to this belief, it is only natural that one would become reactive, being held slave to the foot’s internal conformation. I teach and follow the premise that “everything on the inside is a mirror image of that on the outside.” Is this semantics? Hardly– with an understanding that the internal structure’s health is the result of external stimulus, we become empowered. Read Part 2 

Monday, November 24, 2014

Physiological Sequencing - A State of Flux

In a previous blog post, ‘X Rays, Beyond Balance’, KC La Pierre introduced the exercise of Physiological Sequencing. Understanding how Physiological Sequencing applies to the structures of the equine foot can help us to be more pro-active in our efforts to prevent problems from developing.

To re cap; Physiological Sequencing explains the order in which physiological processes occur.
Tissues are grouped into three types, according to the rate they respond to change: Soft Tissue, Dynamic Tissue and Static Tissue.

Soft Tissue is vascular, meaning it contains blood and nerves. Any change of stimulus to Soft Tissue will immediately change the way the horse holds himself and moves in response. Soft Tissue changes cause the horse to move either more symmetrically or more asymmetrically. Such changes affect the foot almost immediately, as change to how the horse moves will result in a change to how stimulus is delivered to the soft tissue of the foot and therefore to the second tissue in the sequence, Dynamic Tissue.

The main Dynamic Tissues of the foot are ungular cartilage and hoof horn: They are avascular structures (have no blood supply or nerves). Ungular Cartilage forms the foundation of the palmar (rear) two thirds of the foot, meaning that the confirmation of the cartilage determines the confirmation of most of the hoof capsule. The ungular cartilage and coronary band work together to suspend the internal foot within the hoof capsule. A soft vascular network of blood vessels, or ‘dermis’, sits between the internal foot and the hoof capsule. Dermis has many important functions in the foot, one of which is nourishing the horn of the hoof capsule. Confirmation and health of both the hoof capsule and the underlying cartilage, along with the application of stimulus determines how effectively the dermis is able to supply the horn with nutrients.

The dynamic hoof capsule is the vehicle for delivery of stimulus to the foot within. The confirmation of the hoof capsule and health of the horn affects both how the dermis is stimulated and how pressure is delivered to the cartilage and coronary band throughout the stride of the horse. Ungular cartilage cannot be nourished by the dermis, it requires appropriate pressure in order to develop healthily. If at any point the horse feels pain in his soft tissues, he will alter the loading of the foot to avoid the pain. This may be very subtle and if left undetected, the result will be improper development of the ungular cartilages and improper horn growth.  Physiological sequencing tells us that these changes will eventually affect the static tissue, the bones of the foot. 

Static tissue, bone, we understand is always in a constant state of flux, modelling and remodelling, however these changes can take longer for physical change to be seen. The changes are less immediately obvious than the other tissues in the foot. The pedal bone, P3, is unable to remodel due to it lacking a medullary cavity so modelling of this foundation bone of the foot is irreversible. Wolff’s Law states that cells will align themselves directly with the line of force. Using a radiograph the line of force can be seen in the density of bone cells where modelling has taken place, for instance in cases where the foot has been chronically imbalanced. Examination of the dynamic structures in the foot, together with the application of Physiological Sequencing, will point to why the Static tissue changes have occurred and how the dynamic tissues can be addressed in order to prevent further changes to bone.

All tissues of the foot are in a constant state of flux. Observing change and understanding what is correct structure and function allows us to ensure tissues are developing healthily. In his article ‘Did I do that?’, KC La Pierre describes how he identified a rider imbalance by noticing lateral flare in one hind foot of each of her dressage horses. A rehabilitation programme was put into place for the horses and the rider. This prevented the cause of the change to the Dynamic tissue of the horses from becoming the cause of bone change.

ETB Pegasus Gait Analysis technology accurately pinpoints where and when any asymmetry or irregularity of gait occurs. Soft tissue needs to be free of pain in order for the horse to move and develop as symmetrically as possible.

Early identification and treatment of pain and close observation of dynamic tissue whilst being mindful of Physiological Sequencing can increase our chances of preventing pathologies.

About the author: Penny Thorpe, DAEP came across Applied Equine Podiatry whilst working for two trainers who were clients of Trevor Jones DAEP. Curiosity to know a 'bit more about feet' led to a fascinating journey of study with the Institute, graduating as a DAEP in 2013 and starting second level study in 2014. She lives in Brighton with her family and is privileged to have a small practice of dedicated owners and lovely horses.

The Balance Dilema

For centuries, the farrier student has been taught how to achieve balance in the equine foot.  Teaching the principles of balance varies greatly among teachers and schools, with this leading to an inherent problem; a multitude of difficult to define reference points being left to the interpretation of the student.  Achieving balance cannot be compared to mechanics or mathematics. It is not simply completing the formula or outlined task, as there are few true absolutes on the equine foot.  Achieving correct balance depends on one’s ability to correctly reference a multitude of factors. Though each dimension listed by tradition has been defined as an absolute, most are a misrepresentation of true balance.  Angle of hoof is one such dimension that has been badly misinterpreted.  In an effort to justify that which has been interpreted as an absolute, various measuring devices have been developed.  The farrier begins to rely on such devices and perceives the reading of the protractor, dividers, T- squares and rulers, as a means to achieve absolute balance.  
It is impossible to state an absolute such as hoof angle, and then expect anyone to use a device that uses undefined reference points to achieve the same.  The protractor and dividers for instance, use reference points that are vague; therefore, any absolute perceived is based solely on the user’s interpretation of those points.  Example: dividers use the hair line, and protractors use dorsal wall and sole surface, all of which can be deviated to the point that the only absolute that can be stated is that neither can be measured accurately with these traditional tools.  Further, traditionally we are taught to use external angles to guide us in achieving balance.  We are all aware of the angles involving shoulder to pastern in relationship to the hoofs’ dorsal wall, as outlined earlier.   Are these absolute, considering conformational defects?  What angle should the hind feet be trimmed to, in light of the fact that there is no shoulder to reference? What about dorsal wall angle to heel angle, and hairline to ground, and so on, and so on, and so on?

 It is true that with years of practice and experimentation, the farrier can capably achieve relative balance.  This is a statement often used in defense of the traditional farrier trade: “leave it to the experts; it takes a long time to learn what is needed to achieve proper hoof balance.”  There are some farriers out there that have the ability to interpret or read a hoof, and can consistently achieve static balance.  Most of these farriers will often admit haven taken many years to get to the point where they can make this claim, and the percentage to those that cannot is overwhelming in my opinion.

Just as we have seen a misinterpretation of the many natural balance theories being practiced, how traditional balance is achieved has been misinterpreted to a far greater extent.  By having so many variables being left to one’s individual interpretation, it is little wonder there has been such difficulty in defining balance.  In my opinion; the true definition of balance should be defined as dynamic equilibrium of function, resulting in the growth of proper structure, and a sound horse capable of symmetrical execution of gait.