Flat foot? Concavity and Health

Concavity, Conformation or Health?

By KC La Pierre

We often receive emails from horse owners exhibiting frustration over their inability to aid their horse in achieving concavity to their horses' hooves. Usually it is said that their horse is footie (tender over rough or hard ground) after months or even years of being barefoot. They go on to explain that they are frustrated, because they feel that they have been doing all the right things; created a natural environment, provided exercise, have addressed nutrition and done all of the other things that are said to achieve concavity and health to the hoof. Why then is my horse still footie over rough ground and why can't I get concavity!

The first objective when attempting to answer such an email is to determine the true conformation and the state of health of their horses' foot. Lack of concavity is not something that can be corrected by trimming, and a lack of concavity is not always the cause for a horse being footie (stay with me here). Concavity defines conformation and not health. Taking a simplistic view of the sole does not serve the horse. The sole, like the hoof wall cannot be viewed or treated as homogeneous (having the same make-up throughout). The sole is divided into two distinct structures, the Primary Sole and the Terminal Sole. Each is defined by its conformation and the property of its horn (tissue). The Primary Sole is the horn that has a foundation of bone (that part of the sole that covers the coffin bone). The Terminal Sole is that which has a foundation of cartilage and forms around the perimeter of the coffin bone. Being familiar with the "Hoof Wall Matrix" will help you to determine the current state of health of both the primary and terminal sole. As the health of the sole increases a matrix is formed creating a healthy transition from terminal sole to primary sole. This matrix is important to overall performance.

Terminal sole consist of horn that is made up of terminal tubules (tough horn that distorts without failure) and intertubular horn, terminal sole allows for needed distortion. Primary sole consist of primary tubules (hard horn that provides stability, resisting distortion) and intertubular horn. The function of each is determined by its foundation. The chief function of the primary sole is to protect the coffin bone (its foundation), not from concussion, but rather from torque (twist). The primary function of the terminal sole is to allow for distortion (also protecting the coffin bone from torque), and to provide protection from blunt trauma. In both instances the horn needs to be healthy, have depth, and have a strong matrix.

Lack of concavity to the primary sole in truth defines the conformation of its foundation, the coffin bone. It is not possible to increase this concavity. If there is little concavity to the distal dorsal (bottom) surface of the coffin bone, there will be little concavity to the primary sole. The Unified Sole Theory by Mike Salvoldi describes uniform thickness of the sole. However, concavity of the hoof capsule is not defined by the concavity of the primary sole. Concavity of the solar (bottom) aspect of the hoof does increase with an increase in the depth of horn of both the primary and terminal sole. Why? Take a look at the illustrations presented here. 

You will see that as the diameter and height of a concave structure increases the depth of the concavity increases (its center is further from its perimeter). The concavity (conformation) of the primary (center) sole does not change, but the conformation of the overall solar aspect does. The internal foot is in effect further away from the ground surface and better protected by healthier thicker horn.

Many of the hooves presented with lack of concavity are in fact exhibiting a lack of depth in solar horn and poor matrix to both the sole and hoof wall.

Is lack of concavity to the primary sole a cause for concern? Because function is determined by conformation and the property of a structure's tissue, a lack of concavity to the coffin bone can result in a diminished ability to dissipate the energies created during the stance (load) phase of the stride. Some horses can handle higher levels of energy and cope well with a flat conformation (within limits), where others are more sensitive to the energies resulting from a flat conformation. If your expectation is for high performance where the foot is exposed to high levels of energy, then conformation of this sort does become a concern.

How can we help the horse with such conformation? After all concavity cannot be returned to the coffin bone. As I mentioned earlier in this article depth of sole can be increased, that is if the conditions are right. Following two principles of Applied EquinePodiatry can help in developing a treatment protocol that can help in the development of a stronger hoof capsule (including Sole).

1.       Accepting that the horse does have the natural ability to heal itself, this provided the environment is conducive to healing.

2.       That correct force is the stimulus for correct growth

When examining environment you must take into consideration not only terrain, but also nutrition, exercise, and how the hoof is treated (balanced, trimmed/shod). 

Starting with a balanced hoof and exercising within the defined Spectrum of Usability for the horse are paramount to success. 

If you are dealing with less than ideal conformation of the coffin bone do your homework on foot function.

It is not possible to increase the concavity of the foundation, but it may be possible to increase the health of those structures that will supplement foot function.   

Expanding on Expansion, Hoof Function

A new twist on things.

It's not about going barefoot or being shod.

            Ever since someone decided horseshoes were a necessary evil, the debate over their effect on foot function has raged. Those advocating barefoot for the better of the horse, claim that horseshoes do not allow for expansion and contraction, resulting in a loss of foot function (read circulation), while those nailing on horseshoes loudly proclaim that expansion and contraction is not impaired, as nails should never be place behind the widest part of the hoof.

Several hundred articles and even a scarce few scientific papers have been produced to support the belief that horseshoes could be applied in a way that did not inhibit hoof expansion and contraction.

            Let me present a new twist on foot function that cast a stone upon the water, a stone that could, and should result in a tsunami.

            Expansion and Contraction are not enough. "Nearly all-new research into the functions of the frog, lateral cartilage, and digital cushion are flawed." This is a bold statement, but one that can be easily proven.

            Over the last decade there have been several papers published on the function of the digital cushion, and its function during footfall, and its relationship to overall foot function. In each of these papers the importance of frog contact with the ground has been stressed, or somehow referred to. Nowhere in theses studies has the importance of frog anatomical function been clearly defined. What am I talking about? The anatomy of the proximal internal frog surface (the surface that makes contact with the digital cushion), and the structure defined as the frog’s spine. As a horse person you may be more familiar with, and identify with its ground surface counterpart, the central sulcus, often seen as a deep crevice in the back, center of the frog.

            Our studies are proving that the health of the frog’s spine is crucial to the overall health of the caudal aspect (back half) of the horse’s foot. 

            The attached picture shows a healthy frog spine, and how distal and proximal (up and down) movement of the heels cause it to move either laterally or medially, directing the downward forces to the appropriate heel bulb and cartilage.

This action results in the correct distribution of pressure and force occurring at impact. This action is also responsible for directing the stimulus needed for correct growth of the heels, bars, digital cushion, and cartilage of the foot. When distortion of the hoof capsule is limited to expansion and contraction only, the frog spine remains centered and the forces created by the downward movement of the pastern and deep digital flexor tendon cannot be distributed to the advantage of the foot. Simply stated; expansion and contraction is not enough, the foot needs to be able to distort on all dimensions.

            Simply removing the ridgid horseshoe may be a step in the right direction (provided stability exist), but how the frog is addressed during the trimming process is of greater importance. A weak or unhealthy frog results in the foot’s inability to deal with force. A deep central sulcus is unhealthy, and is evidence of a weak spine (instability), the direct result of a lack of correct stimulus. Correct pressure is the stimulus for correct growth, and only with its application can the frog, and its spine become healthy. It is now clear that simply applying pressure to the frog is not enough to achieve true foot function, or a healthy frog for that matter. Dental impression materials, frog wedge pads, and any other attempt to apply pressure to the frog in a foot that can only expand and contract will not result in correct frog growth. We need to know how to apply the correct amount of pressure to the frog and heels, while allowing the foot to distort on all planes. The frog then becomes the vehicle for the distribution of energies to the back half of the foot.

            There is a simple protocol for treating an unhealthy frog, and helping your horse develop a strong frog spine. It involves treating any infection that might be evidenced in the central sulcus, the deeper the central sulcus the weaker the frog’s spine.  I suggest infection be treated with a non-necrotizing treatment (those that will not damage healthy tissue), Silvetrasol Hoof and Wound Wash is one such product. The frog should be trimmed by removing all dead or exfoliating horn, working to center it on the centerline of the foot. It is best to trim a slight angle to the sides of the frog, following its contour. This helps in distributing needed pressure to the correct underlying structures, resulting in healthy spine growth. You will then need to exercise the horse, exposing its feet and frogs to the proper environment (provided the hoof is stable enough), turnout is not enough. Hand walking a horse over uneven ground will cause the foot to distort, working the frog spine. Be sure to evaluate the frog and the health of the horse’s foot before you begin, a very weak foot cannot cope with excessive amounts of distortion. In such cases, you will need to work slowly, exposing the foot to less distortion in the beginning, increasing the work with the steady return of health to the frog, its spine, and to the stabilization of the caudal (back) foot. In cases where stability is in question it may be necessary to provide dynamic stability (stability by means of materials with elastic potential) by using Perfect Hoof Wear or a spring steel type of shoe.  Flexible horseshoes do not provide stability and often glue on shoes are too immobilizing, causing restrictions, which result in incorrect distortion.

            There you have it, expansion and contraction are not enough, and the argument that the conventional horseshoe when applied correctly allows for it, is no longer a valid argument. Foot function is complex, and the current trend of being “complacent with simplicity” can no longer be tolerated, not if our intentions are to serve today’s horse best. True foot function requires multi-dimensional distortion and dynamic stability, not simply expansion and contraction. The argument that the conventional horseshoe, dental impression materials, frog pads, or the host of other devices developed as a result of such beliefs support true foot function, is in my judgment no longer a valid one.

            For more of the latest information on foot function, please visit our website: www.equinepodiatry.com

Why Pad the Hoof?

By:  Robyn La Pierre

Over the two decades, the Institute of Applied Equine Podiatry 

has been successfully aiding horse owners  in the rehabilitation of horses stricken with Deformed Hoof Syndrome (DHS) worldwide.  

We pride ourselves through the constant guidance from KC La Pierre the Institute’s founder and educator, on how quickly and humanely a horse can rebound from lack of structure and lameness.  So what is the secret?  The secret is: there is no secret.  It is commitment and providing the proper environment for that horse, an environment conducive to healing. There are few constants in the realm of rehabilitation.  However, one constant and cushion that horse owners can fall back on (no pun intended), is the use of therapeutic hoof pads, such as those developed at the Institute, the Sole Mate Therapeutic Hoof Pad. Understanding the purpose and theory that these pads represent is the key to any success story.  We receive countless phone calls from clients and horse owners who are struggling with their horse’s rehabilitation, having not utilized the knowledge that has gone into development of these pads.  Sole Mates Therapeutic Hoof pads are meant to be used in conjunction with pinpoint rehabilitation of structure.  For example, if a horse is first out of shoes, we highly recommend identifying each of the hoof’s structures, and where it falls on the Spectrum of Usability (see The Chosen Road, By KC LaPierre).  

This spectrum or wellness chart, will identify pinpoint areas of both weakness and strength.  But more importantly, this form will help in determining how the horse should be used, the level of activity that will produce correct stimulus, while preventing additional trauma.How do these pads work?  The Sole Mate Therapeutic Hoof Padworks in conjunction with the theory that correct pressure is the stimulus for correct growth.  In order to return proper structure that has been lost due to lack of stimulus, “correct” pressure must be applied to the horse’s hoof without causing pin point pressure that may cause pressure necrosis (death of tissue as a result of excessive pressure).  Pain indicates that there is too much pressure, and a good rule of thumb is that pain negates growth.  In many of the cases that we are presented with the horse’s hoof is too short, often having been trimmed below the healthy frog height at the heels.  In order to gain height to the foot, Sole Mates Hoof Pads can be applied creating correct pressure to the heels, bars, walls and sole.

 This pressure is consistent across the entire solar aspect of the hoof capsule with little rebound, this due to the closed-cell formulation that exists within the pad.  A regular foam or rubber pad that has too much rebound (or give), when put into motion with a moving horse, cannot provide consistent and correct support. Even and systematic pressure is what makes the Sole Mate pads unique. Increase in sole depth, hoof height, and frog growth is directly related to the application of correct stimulus.  Correct exercise, working within the boundaries set by an honest assessment with the Spectrum of Usability can greatly improve the rehabilitation of all horse’s hooves.  Without the use of these pads, the progressive next step, a sand arena, may be too harsh for the existing structures, especially if you are dealing with white line stretch, white line disease, or frog infection.  Sand can erode and deteriorate these already sensitive structures, let alone cause irritation to an already deep central sulcus of the frog. Which pads do I choose for my horse?   The Solemates Therapeutic Hoof pads range in three densities: four pound, six pound, and nine pound.  We found it necessary to break down the pad use to less than 1200 pounds for the six, and 1200 pounds and over for the nine. However, if your draft or heavily-boned horse has very weak structure and exhibiting pain, wewould recommend using the six. You may not get as many uses out of the 6 lb pads with a draft horse in that state. However, we don’t want to cause undue stress on the foot either.  So use your best judgment.   The four pound pads are great for that mini horse in your barn, or any acute stages of laminitis.  Why is it so important to specify weight? The pad has a unique characteristic that allows the pads to return to their near natural shape and size after use.  If your horse is heavy or lands excessively in the toe due to caudal heel pain, it will exceed the life of the pad; or rather the pad will not be reusable.  For years, the farrier sciences have been using a styro-foam pad that is supplied from the local lumber yard or Home Depot.  Structural styro-foam is not only not reusable (costly), but crushes down to a hard, stagnant, substance that can cause bruising to the delicate structures (pressure necrosis).  Pressure necrosis is a bruising of the capillaries at the corium level due to excessive force on the foot  Sole Mates Therapeutic Hoof pads have the unique ability to consistently support the foot through the entire stride phase.  Once the Sole Mates pad is removed, the imprint of the foot and hoof are astounding.  The detail in the print much resembles that of a sand imprint on the beach where each intricate structure is delicately etched out.This type of detailed support is what makes the Sole Mate Hoof Pads priceless to anyone practicing hoof care.  Once the structures begin to return to proper conformity, pin pointing additional structures like inner wall or transitioning to sand can be achieved safely.

How long can I leave these pads on?  The Sole Mates Hoof Pads are recommended for hand walking during rehabilitation and should be used daily. Putting the pad in some form of hoof boot can make the rehabilitation process much easier, especially in mud and wet weather. Therapeutic Hoof pads can be left on the foot for up to 72 hours during acute laminitis or until a vet arrives.  Excessive moisture build up will cause the hoof to soften unnecessarily when left on for that long.  We recommend you take the boots off an hour or so to let the hoof and pad dry each day to be safe.  It is also recommended that the hoof be allowed to dry thoroughly in either a stall or isle prior to the application of the pads for an additional 72 hours if needed during your extreme acute stages of founder and laminitis.  Puncture wounds and abscessing are also contenders for the 

use of Sole Mates.   

Do these pads relieve any abscess pain?  It’s not that the pads relieve pain of the abscess, they allow for mobility in a usually painful environment in order to expel the abscess naturally.  Most abscessing is the form of a void in the hoof that is reacting to foreign bodies (necrotic tissue) within that void by providing white blood cells to fight off the infection. Abscesses can re-absorb if not expelled.  By applying the Sole Mates to the bottom of your horse’s foot during an abscess, the horse will be able to be hand walked allowing the abscess to pop.  Without the pads, the horse is in extreme pain due to pressure building within the foot.  This can also cause secondary lameness as the horse is compensating for that painful foot.  You can see now why soaking in Epsom salts is not a good thing during an abscess.  Epsom salts cause excessive drying to the hoof.  So no wonder the abscess gets re-absorbs and returns a few weeks later.  The foot is rock hard and the body cannot expel it naturally. 

What if I have frog trauma and need to either build up or excessively relieve an area that is touching the hoof?  Here is where our Sole Mates pads really step it up in performance.  These pads are uniquely designed so that when heat is applied in the form of a lighter, you can adhere them to each other permanently.  They become one structure with no worry of splitting apart.  This allows you to be able to use different configurations during acute stages of trauma.  You can cut a special wedge out or double up on the pads, by simply applying heat to each side of the pad and sticking them together.  It’s that simple.  Also, the pads are great for beveling out an area with a “roto zip” tool that will relieve an area on the pad so everything but that area is touching the hoof.   It’s so easy to do, and really effective.   As you can see, Sole Mates Therapeutic Hoof Pads serve many purposes.  They are an inexpensive, effective tool for retuning hoof structure during rehabilitation or during extreme trauma to the hoof.  At the Institute, KC La Pierre recommends every barn carry a set of Sole Mates in case of laminitis or trauma. Application of the pads will return an infected frog to a healthy state given the infection has been treated and your environment has been improved.  If you don’t have a healthy frog, it’s almost impossible to return health to any other structure of the hoof. (The Chosen Road, by KC LaPierre 2004).  So be safe and wise, when it comes to rehabilitation.  Proper evaluation of structure and the stimulus needed to return a deformed hoof to health is our ultimate goal.  Sole Mates do that with one thing in mind:  Do No Harm.   

Cracking the Code to Hoof Cracks

Persistent Hoof Wall Cracks

Sand Cracks, Grass Cracks, Toe Cracks, Quarter Cracks plague so many horses that there is an entire segment of the hoof care product industry dedicated to producing products to treat them. A week does not go by that we do not receive a call or email concerning hoof cracks.

Just this week I received a call from a horse owner that wanted a second opinion on how the veterinarian suggested treating a persistent toe crack. Apparently she and her trimmer have been battling sand cracks on several of her horses for the better part of two years. In one case the crack had become so bad that the veterinarian prescribed a hoof wall resection be performed (treat instability with removal of that which is meant stabilize?). The owner was ordering Clean Trax, a deep penetrating hoof wash that works exceptionally well in the treatment of infections of the hoof wall. We received pictures and a small history in which to make our assessment. The type of hoof wall defect seen in this case was of no great mystery. 

The Cause

The truth of the matter is that the majority of hoof cracks seen are the result of poor hoof wall matrix development.

Having a strong understanding of how the hoof wall develops and the function of the hoof wall at any given location in the hoof capsule is paramount to treating hoof cracks. Yes, metabolism and nutrition are important to treating cracks, and for the most part owners of horses with persistent cracks have done their best to address these components. Then why is it that the cracks persist? I have already answered that; poor hoof wall matrix development. Yes, hoof wall matrix is affected by nutrition and metabolism, but the real culprit in persistent hoof cracks is the failure of the mechanism for the creation of a strong wall matrix.

The hoof wall matrix originates at the junction of the coronary band dermis and dermal lamellae. This area is identifiable by the manifestation of the stratum externum (Periople). Roughly speaking it is the top ten percent of the hoof capsule. It is in this area that the tubules produced at the coronary band matrix with the horn developed by the lamellae. The periople aids in slowing the keratinization process allowing for the migration of intertubular horn around and in between the primary tubules. The mechanism that makes this posible is “distortion”. Think of distortion as a kneading process creating the necessary pressures for the development of a healthy matrix. Wall function is determined by the ratio of primary tubules to that of intertubular horn (laminae derived horn and within the matrix the higher the ratio of tubules, the harder the wall (less resistant to flexion), the lower the ratio the more flexible. So what has this got to do with hoof wall cracks?

In many of the cases we see involving sand, grass or persistent toe cracks we have found that the fault has been that the mechanism for the creation of a healthy matrix was simply weak or faulty.

Just this week we met our new neighbor, a new home has just been completed adjacent to our property. The owner is a horse owner who has several horses. She is an avid dressage rider. Naturally the conversation turned to horses and their hooves. According to my new neighbor all of her horses suffer from persistent sand cracks.  The horses are stabled about 10 miles from this new property and would be moving here shortly. The owner asked how we prevented sand cracks. We have seven horses on our property here in SW Florida. The environment is less than ideal for horses, being extremely wet most of the year and the pasture is comprised mostly of sand (sugar sand).  The environment is identical to the environment our new neighbor has been stabled in for the past several years. Why is it that we don’t have problems with persistent cracks, but she does?

The answer in my opinion is quite simple, “Imbalance”. When a hoof is trimmed and it is not balanced, the mechanism for the development of a healthy strong matrix is compromised. Couple that with the dubbing of the toe (backing the toe up), cross hatching, or the application of a rigid horseshoe and you have the recipe for failure. For over eighteen years I have been treating sand, grass, and toe cracks successfully without applying shoes, lacing, staples, or acrylics. There are times when there is instability and dynamic stability must be achieved, but that type of stability is not found in acrylics, staples, or rigid shoes.

Treatment

The first step in the treatment of cracks is to achieve dynamic balance of hoof to foot. Balancing to what is called the Live Sole Plane (Axis Plane). You can use the Dynamic Balance Hoof Level to confirm balance; this tool offers a reliable plane of reference. 

Once balance is achieved treat infection. I recommend Soaking in Clean Trax, with daily follow up application of Silvetrasol Hoof and Wound Wash. If it is determined that the crack or cracks have resulted in unacceptable instability, then I recommend using Perfect Hoof Wear for several trim cycles.

I have said it more times than I can remember, if the mechanism for producing a healthy Matrix is comprised, then no supplement, drug, or dressing is going to help alleviate hoof wall failures. Sure you can attempt to hold it all together with a horseshoe, quarter clips, staples, acrylics, and a host of other products developed as Band-Aids for the dreaded hoof wall crack, but until the mechanism for the development of a healthy matrix (balanced dynamic distortion) is returned you are simply placing a finger in the dyke so to speak.

Evidence Based

Having been a hoof care professional for over three decades, and having graduates in eleven countries all applying the principles of dynamic balance we can say that we have a large sampling of horses that once suffered persistent hoof wall cracks, but no longer do.

If your horse is suffering from persistent hoof wall cracks, you may want to investigate Applied Equine Podiatry further by visiting www.equinepodiatry.com