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.