rashid follow-up to "noticed something unexpected"
equinebiomkanix
I spoke to Jim Crew ( http://healthy-stride.net/ ) tonight about my question as to how raising a hoof can cause a lowered fetlock.  He explained it rather easily.  Raising the heel causes a release of the Deep Digital Flexor Tendon and a more engaged Superficial Digital Flexor Tendon.  The DDFT lies at the back of the leg and attaches to the bottom of the coffin bone or P3 deep within the hoof capsule.  The SDFT lies behind the DDFT and attaches at 4 points near the bottom of P1 and the top of P2 in the fetlock joint.  Elevating the heel releases some pressure on the DDFT as the front of the coffin bone tips downward, and the SDFT engages as the pastern angle lowers causing the fetlock, leg, knee, shoulder to drop slightly. 


The pad combination used on Rashid elevated the entire hoof but was thicker in the medial heel than the medial toe and likewise the lateral heel v.s. the lateral toe.

Denali evaluation
equinebiomkanix


I first worked on Denali this past June. He has leg length disparity syndrome and, while not actually lame, was having problems with nonclinical or nonspecific "lameness type" issues. As a young dressage horse he was unable to bend effectively in both directions and tended to hollow out his back rather than flex and round through his body.

Key responses I look for in this type of an evaluation are the willingness to lower the head and stretch the back, indications that the horse is feeling more comfortable through the body.


In subsequent shoeings he has continued to improve in his posture and his performance.

This was my first effort with this camera indoors and I apologize for the poor lighting.

Rashid Sept 08 initial shoeing
equinebiomkanix



One of the most striking differences between this initial post shoeing evaluation and the second video below, in my opinion, is the greater willingness of the horse to move forward in the 2nd one.  He appears more energized and engaged, much more willing to move out.  I had to edit this video to get the full segment of the circle to the right because Rashid was less willing to work in that direction and his owner seemed resigned to working him more to the left, either knowingly or unknowingly.  In the second, I see a horse much happier working in both directions and an owner who is comfortable asking for either direction.

For a complete bio scroll down to the Dec 22 entry.


Rashid fall 08 reset
equinebiomkanix
I apologize for the disorganized fashion I'm presenting these entries.  I am technologically challenged at best and am just discovering how to place the actual link in my post.  Clearly much more convenient than switching from one page to another.  Bear with me, some day I may actually be tech savvy (or not....).


noticed something unexpected
equinebiomkanix

This morning I was looking over some pictures and realized something I'd looked at but not actually seen.  Notice the difference in heel and coronet band height and then compare the pasterns and fetlocks.  How does that happen? 



Very curious....

Compare again to the pre-shod photo



It seems counter intuitive that I can raise a hoof and actually cause the fetlock to lower.  I guess it's all about how the horse changes it's posture to compensate for biomechanical changes.


shoulder to hoof angle relationship
equinebiomkanix

 

I was sent an article by Dr. Kerry Ridgway DVM that discussed some of his findings in horses with high heel / low heel syndrome which in my mind has many of the same hallmarks as leg length disparity, or club foot syndrome.  In the article he describes some of the influences this condition has on the horse and the rider as well as how to clinically evaluate a horse with high heel / low heel.  He suggests the following:

 

 

<My experience has lead to the conclusion that the best course of corrective shoeing is the use of wedges as orthotic devices, applied on the lower heel in order to achieve the same heel height and pastern angel as the more upright foot.  Sometimes it is necessary to also use a ‘lift’ such as a rim (or full) pad on the same or opposite foot as well, in order to create full symmetry.>

 

 

 

He also discusses the some of the factors that cause the horse to rotate the shoulder on the long heel / short toe side forward as the opposite maintains a more rearward posture.  He asserts that the more upright hoof and the more forward shoulder must exist to accommodate each other, shoulder angle roughly approximating hoof angle, which is most likely an accurate conclusion.  I do know that horses can rotate the scapula forward to compensate for discomfort from a number of sources.  For example, a very narrow fitting saddle or one that is set too far forward will interfere with the rearward motion of the top of the scapula and cause the horse to shorten it's stride and even hollow out it's back.  Likewise, false or forced collection will have a similar effect.  Ultimately these horses will begin to work more off their front ends, grinding down their heels and possibly developing caudal heel pain symptoms as well as muscular and skeletal problems in their backs and hips.  Removing the cause and encouraging the horse to round it's back and use it's hind quarters will enable it to gradually begin shifting the shoulder posture more rearward.   It's a slow process but even older horses will demonstrate the change over time.


Rashid - Limb Length Disparity shoeing
equinebiomkanix
 Rashid Background Info
 


His owner was a self taught farrier and started with the shoes at about age 3. Rashid apparently displayed some Limb Length Disparity at this time.

At age 4 he was sold and moved to Madison, WI where he was extensively trained and shown successfully in halter, hunt seat, and saddle seat.


Between 1998 and 2003 we had a variety of farriers, mostly because of my ignorance and listening to the recommendations of various friends, trainers, etc.  The one who did the most damage was the one who held to the rule that all of the feet had to be the same angle.  He was the one who we used for about two years prior to going to the UW.”


In late 2001 (age 6) he began to short stride on the right front, it was very minimal, but by 2003 (age 8) became marked, at this point he underwent veterinary diagostic nerve blocks, the outcome "almost" sound, and had his coffin joint injected.  Corrective shoeing was recommended.


Mid January of 2003 corrective shoeing was done.  Goal was trim the front heels to equal each other, in hopes of evening out the stride, EDDS shoes were used.


After two years of shoeing in this manner, his stride had not improved, his owner was having problems with saddle fit and trailered him to a saddle fitting clinic, at the clinic his owner was introduced to the barefoot method and decided to try natural trimming.


March of 2006, he was seen for lameness again (grade 2), re-x-rayed, had the coffin joint re-injected, but on follow up in late march had not improved, the vet
recommended that he be rebocked and noted a navicular cyst as a change on the radiograph.  He also had bilateral side bone.


In August of 2006 he was purchased by his current owner in Medina, MN, and was growing out a founder due to an ice storm in March.  His new owner also did her own barefoot trimming and attempted to address his LLD/Club Foot Syndrome issues.


“My initial impression of him was "a circle of lameness" he would short stride on the RF, with a head bob at the walk and his hind feet were very long toed and the heels under run.”

 
”I focused on growing out the founder, but realized after a period of time that his lateral heel was longer than the medial. I had radiographs done (Jan 07) and it was apparent on the films that the lateral joint space was "pinched" believing this was the root cause of the shortened stride, refractory thrush and head bob, I worked on trimming the lateral heel on the right front.  It became apparent that the medial heel was migrating forward, or becoming under run and so I used sulcus depth as a measurement for heel balance, when that was equal, (Mar 07) I had radiographs redone of the RF and had a lameness exam done (grade 3.5) which included blocking the heel.  He showed improvement at the trot, but not at the walk.  The veterinary note: 80% improvement with heel block, 20% probably mechanical in nature vs. pain.  Also toe dragging of the hinds after improvement in the front, and hock injections were also recommended or a 10-day bute trial to see if the hocks improved. The x-rays confirmed improved medial lateral balance and the joint was injected.  The vets looked at him 10 days post-joint injection and thought they had achieved the same result with the coffin joint injection in comparison to the heel block.”


”He was seen again In September of 07 for RF lameness (grade 2) and had his coffin joint injected again.  I didn't see an improvement this time.  I did not see an improvement in the hind with Bute, and thinking the hind limb lameness due to the front, I continued to focus on the front.  Winter founder was a worry along with the resistant thrush in the RF. looking for a treatment for the two, I spoke with a technician from Vettec, who after hearing about Rashid’s long history of lameness and a club foot referred me to Esco Buff's book on Limb length disparity.”


The owner had been referred to Jim Crew and “Healthy-Stride.com” by the previous owner and was then referred to me by Jim. I evaluated Rashid and shod him accordingly, evaluating him and videoing the post evaluation to document the changes. Unfortunately, I did not video the pre-evaluation and only have stills to show his pre shoeing posture and condition. He exhibited a low right shoulder with the corresponding hoof contracted, long in the heel and short in the toe. His LF hoof had low, under-run heels and a longer toe. He also exhibited a slightly low left hip, which was addressed with a thin rim pad (which isn’t evident in the accompanying video).

 
He was adjusted by a chiropractic veterinarian 1- week post shoeing, which included the right sacroiliac, lumbar 1-6, right shoulder and right coffin joint.  He noted decreased motion in the right front medial heel with a "popping" sensation similar to cracking your knuckles.

 
”Still lame with shoes, I hoped to re-inject the coffin joint, but the vets wanted to wait 2 weeks to see if there would be a change with the shoes and chiropractic therapy we had done, at the end of two weeks the vets thought I should take him to the university for a full lameness workup, so treatment was denied at the farm.  I scheduled a consult with Rashied's Chiropractic vet, who agreed to block the coffin joint, but there was no improvement (following the block).  He did improve over time however with the corrective shoes.” 

While I’ve seen horses with greater differences between front hooves in leg length disparity cases such as Rashid’s, he displayed a fairly significant height differential in his shoulders.  His left front, which is the low heel / long toe side, was not only higher but had more muscular development, was held at a lower angle, and more rearward position than the right. The right shoulder was shifted forward at a noticeably steeper angle and the point of the shoulder was held visibly forward of the left. He showed a significant tendency to toe out, more on the right than the left, and showed an excess of wall on the lateral and minimal wall on the medial side of the hoof.  Medial shims were used between the shoe and hoof to bring both hooves back into better medial / lateral balance. The pictures are of the second shoeing (unfortunately I failed to take before and after stills during the first appointment). It shows the combination shim and rim that was used even out his shoulders and improve his medial / lateral hoof imbalance. The appropriate thickness was determined by temporarily applying layers of Superfast acrylic to the bottom of the hoof and evaluating his response by moving him in a straight line and circling him on line. He was shod with EDDS aluminum shoes placed to create matching heel support and toe break over on both hooves to enable landing and break over to occur at the same point on both limbs. Initially he displayed a noticeable elevation of his head on the circle and going straight when loading his right front trimmed but unshod foot, suggesting foot / leg / body discomfort. This has been an ongoing symptom that had increased in its relative severity over time.    

 
pre shoeing - lines indicate the relative shoulder levels     pre-shoes

post shoeing      post shoes

              trimmed, barefoot

     shod w/shims & full rim

The hooves were "poured" using equithane soft pad material to insure good frog and sole contact with the ground surface.  After shoeing he gradually showed a willingness to lower his head and raise his back slightly in the first video and much more so in the second. 

1/26/09 addition
He has since had a 3rd and 4th trim as of this writing and on the 3rd appointment we opted to leave him barefoot.  His hooves were maintaining an acceptable medial / lateral balance and the shoulders palpated and visually appeared level and relatively even distal / caudal (front to back), although the right still showed less muscle development.  By approximately 3 weeks into the trim period he displayed a slightly higher left shoulder and his right medial heel was again beginning to wear excessively, causing the toe out stance and more uneven landing and loading of that hoof. His owner also indicated he appeared less comfortable in his movements.  At just over 4 weeks we re-trimmed and used a 2” hoof cast on the right front to help elevate that shoulder and applied Superfast acrylic to the medial heel and quarter to help create proper medial / lateral balance and a level landing again.  Snow and cold weather have made it impractical to video for the time.



The following links are the video evaluations:
http://www.youtube.com/watch?v=M8lNN3EYvUk&feature=channel
http://www.youtube.com/watch?v=aC1LGCmgKcY
 

 

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