An Orthopedic View Point

[George50]

An orthopedic view point---

My husband is a Board Certified Orthopedic Surgeon practicing over 20 years with expertise in joint replacement, fracture management and sports medicine. I have owned, showed, and trained horses for over 25 years; and I have had recurrent lameness problems with my horses since moving to North Carolina. Frustrated by equine care (veterinarians and farriers) in my area, I begged my husband to take an interest in equine orthopedics. Upon on-line research and his personal experience with orthopedic human alignment, he has found a recurring fault in aligning the leg with the foot. In order to understand a common terminology between veterinarians, farriers, and human orthopedics terms correspond as follows: P1=long pastern=proximal phalanx, P2= short pastern= middle phalanx, P3=coffin=distal phalanx, with metacarpals and metatarsals being uniform terminology. To achieve correct alignment of the leg and foot the horse most stand with its leg (metacarpals, metatarsals) perpendicular to the ground. An illustration of this is found at www.anvilmag.com/farrier/balancin.htm on page 10. In the illustration a line is drawn on the leg of a horse marked D-- this line continues to the ground where the back of the heel meets the ground surface-- marked C. Without too much discussion I will briefly state that farriers and vets are missing this key point in the alignment of the horse. Too often the heel is trimmed. The heel should not be trimmed-- trimming with nippers should occur from the widest part of the foot forward--and the heel should be filed to an even plane with the whole of the foot. Another problem that is common in trimming is the excessive shortening of the equine toe which leads to P3 injury. In humans this is commonly seen in athletes (football and soccer) and is referred to as Turf Toe. My husband states years ago children were often braced to change feet abnormalities or in toeing or out toeing of the lower extremities. This has been proven to be incorrect and today’s literature shows that natural growth will correct alignment without surgery or bracing. This needs to be noted in horses as well. At what age do you begin shoeing a horse is an equine orthopedic question? The last point to remember is that horses who have had comprised trimming or shoeing have had more stress on tendons, ligaments, and joints. These animals are prone to lameness as well as post traumatic arthritis, OCD, tenosynovitis (tendon injuries), and ligament injuries. Therefore it is especially important to note these animals should refrain from additional strain, i.e. workouts. This should be addressed by veterinarians, farriers, trainers, owners, and all involved with the welfare of the equine. Additional reading on these issues is found at:

www.anvilmag.com/farrier/balancin.htm
www.anvilmag.com/farrier/balancn2.htm
www.equipodiatry.com/physshoe.htm
www.neosoft.com/~iaep/pages/protected/jissues/j1709/j1709p476.html
www.equineoz.com.au/art20.htm

[Jaye Perry]

An orthopedic view point---

My husband is a Board Certified Orthopedic Surgeon practicing over 20 years with expertise in joint replacement, fracture management and sports medicine. I have owned, showed, and trained horses for over 25 years; and I have had recurrent lameness problems with my horses since moving to North Carolina. ...I will briefly state that farriers and vets are missing this key point in the alignment of the horse. Too often the heel is trimmed. The heel should not be trimmed-- trimming with nippers should occur from the widest part of the foot forward--and the heel should be filed to an even plane with the whole of the foot. Another problem that is common in trimming is the excessive shortening of the equine toe which leads to P3 injury. In humans this is commonly seen in athletes (football and soccer) and is referred to as Turf Toe. .... The last point to remember is that horses who have had comprised trimming or shoeing have had more stress on tendons, ligaments, and joints. These animals are prone to lameness as well as post traumatic arthritis, OCD, tenosynovitis (tendon injuries), and ligament injuries.


I'll quote Cappy Kaplan again " As farriers the only thing we can do it line up the bones". One can take the old and the new methodoligies and go to the extreme with each. What is missed or misinterpeted by both farier and vet alike is farriery of the horse not just their feet. :rolleyes:

[calshoer]

George 50 , I urge your husband to look further into the biomechanics of the hoof . He is missing some other parts of the whole picture, and therefore quoting the same theory that has been taught (and unfortunately still is in so many venues) for the last hundred years, and more recently with the rapid influx of research from around the world is being proven to be seriously flawed.
More thorough research is indicating how the coffin bone/ pastern becomes properly aligned through the mechanism of several vital INTERNAL support structures. This alignment cannot happen correctly unless the heels are trimmed near the level of the sole,thereby allowing the frog and digital cushion to do their jobs in supporting and aligning the coffin joint. There is do***ented research into how the frog support is a vital part of that equation. Trimming the heels (as they woud wear off naturally unless we shoe them) allows the frog to supply support upward into the digital cushion, which moves the distal end of P2 forward in the coffin joint and thereby aligns it.
Grossly missing from your husband's equation is the role of the axial projections of the lateral cartilages,(under the digital cushion) and the attachment of the lateral cartilage to not only the coffin bone wings but also both the the distal end of P2 and the navicular bone. These are all part of the equation in the alignment of the boen column. As the digital cushion is moved UP by ground support through the frog, the whole coffin joint aligns as the distal end of P2 moves FORWARD.(and the angle of the pastern therefore lowers to match the coffin bone angle)
Trimming toe and leaving heel has been clearly shown to be the main reason hooves develop subtle but very detrimental hoof capsule distortion, with longer and longer toes and underrun heels. As the connection between the sole and wall at the toe is continually weakened, the long heels drive and stretch the sole in the toe area forward . It completely loses it parallel relationship with the dorsal aspect of the coffin bone. Therefore trying to deterrmine if a hoof is aligned by by sighting the pastern angle and hoofwall is completely unreliable. The toe looks longer and lower at every shoeing so the farrier leaves more heel, and just exacerbates the distortion as he weakens the toe even more. Long heels and this subtle hoof distortion is a major cause of cause of navicular syndrome for a variety of reasons.
I have seen far too many feet where the bone column aligned BETTER (viewed radiographically before and after ) when the heels were properly trimmed so the frog could load. And the horses moved better and became sounder when they had come in with heel pain previously.
I suggest your husband look a LOT further into hoof biomechanics before he jmakes statement just looking at bones. He is making the same mistake so many farrier texts have done for so many years. There is whole lot more to bone alignment (not to mention hemodynamics, load distribution and so on) involved. Dr Bowkers research on the cartilage of the equine foot at MSU is a good starting place, the studies of joint surface stress by DR Jean Marie Denoix from france is another, and the radiographic study presented by Dr Barbara Page at AAEP a few years ago is very important to help explain some of the missing links.
Of course the heels can not be trimmed down correctly without stressing the felxor tendons unless the breakovor point of the foot is also placed in the correct location relative to the tip of the coffin bone, but that should never be done by weakening structure in either the sole or wall of the foot. There are safe ways to do that without damaging the foot. Balancing the hoof involves both ends, the heels and the breakover together.
One more thing..think about this .....a thousand pound horse can not possibly walk on the fragile edge of a two ounce bone anyway. There are however support structures UNDER that bone that he IS supposed to walk on.
As well, the laminae can not possibly hold the bone up in the hof capsule all by themselves without tearing to some extent. What they do is hold the wall to the bone, not the other way around.
Patty

[Jaye Perry]

QUOTE=calshoer]George 50 , I urge your husband to look further into the biomechanics of the hoof . He is missing some other parts of the whole picture, and therefore quoting the same theory that has been taught (and unfortunately still is in so many venues) for the last hundred years, and more recently with the rapid influx of research from around the world is being proven to be seriously flawed.
More thorough research is indicating how the coffin bone/ pastern becomes properly aligned through the mechanism of several vital INTERNAL support structures. This alignment cannot happen correctly unless the heels are trimmed near the level of the sole,thereby allowing the frog and digital cushion to do their jobs in supporting and aligning the coffin joint. There is do***ented research into how the frog support is a vital part of that equation[/QUOTE].

The second paragragh can be analogous in Fleming's Book about the Charlier' Shoe and it's methodology .The book was published in the late 1800's. A good observer of farriery will study not only the latest but also the past.
Discounting research from others, whether academic or empirical, to proclaim certain styles or methods for each equine is a ad homien disreguard for the farrier and veterinarian professions.


Trimming toe and leaving heel has been clearly shown to be the main reason hooves develop subtle but very detrimental hoof capsule distortion, with longer and longer toes and underrun heels. As the connection between the sole and wall at the toe is continually weakened, the long heels drive and stretch the sole in the toe area forward . It completely loses it parallel relationship with the dorsal aspect of the coffin bone. Therefore trying to deterrmine if a hoof is aligned by by sighting the pastern angle and hoofwall is completely unreliable. The toe looks longer and lower at every shoeing so the farrier leaves more heel, and just exacerbates the distortion as he weakens the toe even more. Long heels and this subtle hoof distortion is a major cause of cause of navicular syndrome for a variety of reasons.


Whether one trims toe or heel, subtle changes in the hoof capsule cannot be associated with just one technique of trimming. Looking just at feet, leaves out major points of causation of subtle hoof capsule changes. Fetlock, hocks, and other major joint problem are subtle in their onsets, thus subtle changes occcur in the hoof capsule front and hind..
As your husband can justify, George50, injection of a joint to relieve stress will increase motility of the joint. In a horse a conciensous farrier can see the change in the horn of the foot in a couple of shoeing after treatment whether hocks, fetlocks and or coffin joints. Most joint problems are slow in onset, thus a slow change in the horn of the foot and way of going.



I have seen far too many feet where the bone column aligned BETTER (viewed radiographically before and after ) when the heels were properly trimmed so the frog could load. And the horses moved better and became sounder when they had come in with heel pain previously.
I suggest your husband look a LOT further into hoof biomechanics before he jmakes statement just looking at bones. He is making the same mistake so many farrier texts have done for so many years. There is whole lot more to bone alignment (not to mention hemodynamics, load distribution and so on) involved. Dr Bowkers research on the cartilage of the equine foot at MSU is a good starting place, the studies of joint surface stress by DR Jean Marie Denoix from france is another, and the radiographic study presented by Dr Barbara Page at AAEP a few years ago is very important to help explain some of the missing links.

Radiographs show a only a small portion of the total picture of the horse. Most of the sited academic research that is stated is assimulted and analogous for a certain methodolies of farriery. Portions are taken to show points of view and characteristics of a methodology and to lend credibility of proceedure and talking points. It happens in human orthopedics methodolies also.
So, George50, you and your husband keep an objective view of when studying the versitality of the horse , it's legs and feet. This objectivity will increase understanding of the horse's locomotion function(s), disreguard for or adhereing to one or two systems, methodologies or proceedures will narrow undeerstanding of the whole horse. :D

[Mike Ferrara]

Sorry if this seems sarcastic but you're offering a couple of articles to folks who have worked with thousands of horses with all manor of confirmations, diseases and injuries as some kind of revelation "don't take too much heel"? Maybe I can do a little reading this evening and be of some help to your husband in his orthopedic surgery. You know?..streighten him out on a few things that he missed in school and his internship?

I'll see what I can do and get back to you on that.

[Ronald Aalders]

I think first of all we owe the husband here a "Thank you Sir" for taking interest in what we are trying to do. I wished more people from other disciplines would take an interest like this one. It would maybe take some off our tendency to bite our own tails.

I'll have a hard time covering all the ifs and buts here, but I'll try to give some remarks why, IMHO, I think some of your husbands theories can not just simply be incorporated in farriery.

First of all equine anatomy can not be compared to human anatomy. Of course your husband knows that better than I do, but his remark on turf toe worried me here a little. Btw I´m not just refering to horse being on 4 feet most of the time. Just raising heels will put móre strain on the apex of P3. Only raising heels (when needed) on a properly aligned P1, P2 and P3 can take away strain on the apex of P3.

Also important here is that raising and lowering of heels will change leg position and the way forces of impact in the landing and loading phase of the stride are dissipated. I would even take this one step further, I do not think that we are able to realign legs and bone collumns on every horse just like that. Tecnnically we could by using wedges or whatever can help us creating this alignment, but I do not think that´s a situation every horse will be comfortable with. This because of the relation between the way a horse uses its back and its foot angles.

As to statistics mentioned. Numbers like that never could convince me. A simple statement that shod horses have a higher rate of sustained injuries than bare foot horses is just not valid. On statements like this the fact that shod horses work harder (e.g. competion, the reason they got shod in the first place) is never mentioned. To come to an injury risk ratio you can not just simply compare shod horses to barefoot ones. The work and risks of competition involved are to be taken into account here as well. It's easy to see why a barefoot backyard pony will have less leg and foot problems than a highly competitive performance horse.

Regarding this thread I would encourage your husband reading of a book called "Equine Locomotion" by Hillary Clayton and Willem Back.


Ronald Aalders

[Mike Ferrara]

I think first of all we owe the husband here a "Thank you Sir" for taking interest in what we are trying to do. I wished more people from other disciplines would take an interest like this one. It would maybe take some off the tendency to bite our own tails.



That's an interesting point of view. Someone takes a quick look at a couple of articles and concludes that we (as a profession) have it all wrong because we trim heel and somehow missed that. I think we've all just been called *****s. I don't think I'll be saying thanks.

On a more constructive note I would suggest that George50 and her husband talk over some of their revelations with their vet and farrier and put them into practice. I for one, would be very interested in reading about the results. I'm certainly interested in anything that can be demonstrated to prevent or fix problems. Until then it seems they're in a better position to be asking questions than they are to be giving answers.

[Dave Purves]

I think we are all getting way ahead of ourselves. First of all, he/she didn't say you shouldn't trim any heel, taking too much heel he detrimental. I think we would all agree with that. What wasn't stated at least clearly to me was how much is too much? Also taking too much toe is bad, again, how much is too much? These are the "subjective" issues that are dealt with case by case, and horse by horse. I don't know if many of you remember many of the heated debates that Phil and I used to engage in over NB and AFA. Well Phil went to an AFA clinic and found out that there isn't that much of difference in the way the heels or toe or the whole foot for that matter between the two. From reading this post, everyone (except maybe Jaye) has assumed that this person is telling you to stop trimming heels. I didn't read that into it, I heard don't trim too much heel. I agree that after reading a couple of articles doesn't give anyone a real good sense of what is right or wrong, but it did start a good discussion.
Dave Purves CF :cool:

[Mike Ferrara]

I think we are all getting way ahead of ourselves. First of all, he/she didn't say you shouldn't trim any heel, taking too much heel he detrimental. I think we would all agree with that. What wasn't stated at least clearly to me was how much is too much? Also taking too much toe is bad, again, how much is too much? These are the "subjective" issues that are dealt with case by case, and horse by horse. I don't know if many of you remember many of the heated debates that Phil and I used to engage in over NB and AFA. Well Phil went to an AFA clinic and found out that there isn't that much of difference in the way the heels or toe or the whole foot for that matter between the two. From reading this post, everyone (except maybe Jaye) has assumed that this person is telling you to stop trimming heels. I didn't read that into it, I heard don't trim too much heel. I agree that after reading a couple of articles doesn't give anyone a real good sense of what is right or wrong, but it did start a good discussion.
Dave Purves CF :cool:

Maybe I am reading too much into it but this...
Without too much discussion I will briefly state that farriers and vets are missing this key point in the alignment of the horse. Too often the heel is trimmed. The heel should not be trimmed-- trimming with nippers should occur from the widest part of the foot forward--and the heel should be filed to an even plane with the whole of the foot.

...seems to say don't trim the heels and seems a rather odd statement from some one who isn't stating their experience in doing any of it.

Well, I guess I've said enough on the subject but I do agree that it's bad to trim too much heel...or too much toe...or too much frog...or not enough. :D

[Ronald Aalders]

Hi Dave,

The part Mike mentioned stuck out for me too. But then again you may well be right about us jumping to conclusions here. Would not be the first time would it?


Ronald Aalders

[Red Amor]

Mike
the boss didnt inhale and Mon didnt swallow :)


I think Rons response was polite and tackfull, informative and guiding in a friendly manner

This fellow didnt come out and say that all Farriers are boofheads and insult us by saying we and our Idears were cruel and crippling horses like the other good lady doctor did

I believe you dont not gain alies by malineing them , who wrote the artical , him or her , was it dictated word for word , did she misinterprate something
lord knows
but we wont take him out the back of pub and give him a kicking just now will we Mate ;)

I must admit I can see where your comming from Mike , he may have been better recieved had he written Hilldy ;)

[Dave Purves]

I guess I see it in a different way, what the author failed to realize is that when you trim the heels either with your nippers, your rasp, or both, you are still trimming the heels. If you trim from the widest part of the foot forward, and then use your rasp to bring the heels into "alignment" with the rest of the foot, guess what, you just trimmed the heels. It's not rocket science. I just feel sorry for the good Doctor and his wife. They had a couple of bad expeiriences and then became "experts" themselves by reading a few articles. Those articles, I will admit I did not read, are a guide line, a place to start. We could all look at one foot, the same foot, and argue about the best way to trim it, however the decision and responsibility lie on the one person that actually does trim it. Then we could all look at how it was trimmed and second guess the way it was done, the fact is no one, can actually and factually say "I wouldn't have done it that way" without knowing exactly what is going on with the foot, the leg and the horse. So for the good Doctor and his wife to come up with a summation of how a foot should be trimmed is the result of bad expierience, maybe they should pay all of us to fly to N.C. or where ever, and we could all take a look at the horses in question. I've run into clients that had a bad farrier, and blamed all farriers for being this way. We've all seen the farriers that stack up the heels real bad, and the farriers that cut way too much heel off. You would think though that an educated man and woman would know better than to attack a group of people for the result of one or two. I don't think they really meant to attack, just get a point across. The one thing I did take away from the post was that we need to take into account the whole horse, the entire limb and the foot, before we pick up our tools.
jmo
Dave Purves CF :cool:

[Jaye Perry]

So for the good Doctor and his wife to come up with a summation of how a foot should be trimmed is the result of bad expierience, ... The one thing I did take away from the post was that we need to take into account the whole horse, the entire limb and the foot, before we pick up our tools.
jmo
Dave Purves CF :cool:


That was my take also, a bad experience or experiences creates an avenue for individuals to seek answers. Asking the questions Why and What for? Out of frustration in many cases.
Anatomy in humans and equine are simular and different, asimulations to both limb and body can be made. So the direction in which the "Couple are seeking" is one of helping their horses, their horses in the disipline(s) they ride. Basic mechanics and methodology are needed . When all else fails to correct problems or problems have been created it ,the problem , can be traced back to the lack of basics.

[George50]

Thank you all for your reply. We were looking for a discussion and other views. I will print off all your responses and discuss them with my husband. Dave-- thank you for pointing out that I did say file the heel. My intention was not to disregard removing the heel entirely, but rather judge how the heel should be adjusted based on the confirmation of the horse. As I stated I will briefly discuss this matter-- I am quite aware that trimming the horse takes more than just confirmation. What I was trying to point out is that confirmation should be taken into account before the horse is trimmed (i.e. the leg as it attaches to the foot). As I have stated I have had a horrible time with lameness in my horses since moving to North Carolina-- sadly there is only one Certified Journeyman Farrier in my area and he is not taking new clients (he is very good by the way). I have recently found a Certified Farrier who lives several hours away and am trailering to him. I know a lot of people say that AFA or BWFA certification doesn't mean anything-- tell that to my horses. I'm sure there are good ones out there but I haven't found them. In regards to the vets-- most don't understand that the foot needs to be properly aligned with the leg. They love to inject joints and peddle shots of Legend and Adequan though.

We moved to this area from Utah and I was previously from California. I have to say I never had so many farrier problems and seen so many lame horses in my life. Interestingly I have pulled old photos of my horses and viewed their feet-- they had much longer feet and there heels were aligned under them -- rather than being underrun. It is almost as if the farriers in this area see other horses with short feet and feel they must do the same or maybe the owners believe that is the way the horse should look and everyone in this area has gotten caught up in during it that way.

I would love for all of you to come to North Carolina and help educate horse owners and veterinarians and other farriers in this area. But until some of you move here I will have to try and educate myself and our horse community. By the way the farriers are charging between $85-$110 for a regular shoe job -- if any of you are interrested in moving this way.

Thank you again-- I will try and post another reply soon!

[Mike Ferrara]

George 50, I sure don't see anything wrong with educating yourself. For that matter, if I'm not mistaken the farrier assiciations even accept non-farrier members. Such membership, would give you access to even more information and a wider netwerk.

There are also some good articles around concerning how to pick a farrier. Personally I would caution against putting too much faith in certifications. They may be a plus but they don't tell the whole story.

Look for horsemenship...something that I don't think can be taught in school and isn't tested for in certification tests. Some fariers will want to watch a horse go before and after shoeing and there's a reason for that. If your farrier isn't watching them I'd ask why. When they do watch, ask them what they see. Ask questions to see what they think...or if they're thinking.

Look for experience...interview...discuss your ideas and find out what theirs are. Ask how they got started. I've known farriers who went to school for 12 weeks and hung out a shingle without ever working with any one more experienced. Some even went on to take certification tests. I know others who worked under some one else for several years and were with, on and under horses for 12+ hours a day for years before ever taking customers on their own.

I think an educated eye can talk to and watch a farrier work and see what they're dealing with in fairly short order.

[Rick Burten]

George50 and her husband might want to contact Dr. Mike Miller, CJF,MD,AWCF in Huntsville, Alabama for a rather unique perspective on this subject. Mike is, I believe, an Orthopedic surgeon as well as a farrier(as his appellations indicate).

If they choose to do this, they will then be in a better position to interact cogently with the rest of us. JMNTBCHO.

Rick

[Ronald Aalders]

Hi Rick,

The fact apparently you need a special training to talk to us 'equine specialists' worries me.

What worries me the most is that you may well be right!


Ronald Aalders

[Sentient]

We moved to this area from Utah and I was previously from California. I have to say I never had so many farrier problems and seen so many lame horses in my life. Interestingly I have pulled old photos of my horses and viewed their feet-- they had much longer feet and there heels were aligned under them -- rather than being underrun. It is almost as if the farriers in this area see other horses with short feet and feel they must do the same or maybe the owners believe that is the way the horse should look and everyone in this area has gotten caught up in during it that way.

I would love for all of you to come to North Carolina and help educate horse owners and veterinarians and other farriers in this area. But until some of you move here I will have to try and educate myself and our horse community. By the way the farriers are charging between $85-$110 for a regular shoe job -- if any of you are interrested in moving this way.

Thank you again-- I will try and post another reply soon!

Please don't take this the wrong way everyone, BUT, having at one point owned horses in two southern states very close to NC, I can safely say that ONE of, if not THE, reason horses are trimmed so short there is that people are paid very low wages, and they want their trims/sets to last as long as possible. A farrier that makes it short will get happier clients because it "lasts longer" that way. I am talking from personal experience here, mind you, not pulling all this out my a**. My ex-stepdad would NOT have a farrier out any more often than every 8 weeks, and it often went for 12 weeks between trimmings. Take for example the costs you said you were paying. Anywhere up north or out west that would be cheap to very reasonable, but you stated it like it's gonna make people move out to NC it's such good money. Well, when $85 is 12 hours worth of work at the average pay rate down south, it tends to make the horse owners want it to last longer in between trims. I used to ride around on calls with our farrier sometimes (I don't know why he invited me, maybe he felt sorry for me cause I had no friends, or maybe I distracted the horse owners by talking to them so he could do his job, or something. I did help hold a few horses sometimes), to other clients houses, and I can tell you, short=happy when you're talking about owning a horse on a limited income. Now, and this is just a theory, but I think maybe QH people have made short trims the norm because they breed horses with tiny little peg feet because it looks pretty in halter classes, and they like little short choppy steps in their performance classes also. I think short little feet, and short choppy little gaits are in fashion, and since the majority of pleasure mounts in the southern states are QH's, it's just become habit for most of the farriers to have "tiny little footies" on the brain.

[Phil Armitage]

The key to trimming properly is seeing the sole plain, knowledge of anatomy and the hoof. It is an Art and Science, that requires hand eye coordination, it is more difficult than most people realise. There is a lot of skill required holding up a foot, using nippers and a rasp to trim and level a foot. Good Farriers make it look easy and many horse owners think it is easy because of how skilled there Farrier is, price is not based on time and material it is based on skill and knowledge and the more skilled and knowledegable the Farrier is the better the product is, "You get what you pay for" and if you might end up paying much more in Vet bills if your not carefull about who you use. My best customers are the ones that clean there horses feet regularly and have attempted to remove a shoe. There the ones that realise how difficult this job is, and have a respect for it. I quess it is like the saying goes, "Don't judge a person until you have walked in there shoes". It does not matter if you start at the heel, mid point of the foot or at the toe, use nippers or a rasp as long as it is right. As far as Farriers trimming too short, to make a shoeing job last longer, well this is really bad in my opinion and any horse owener that wants this and any Farrier that does this, should go learn anatomy and structures of the hoof so they can see exactly the harm there causing.