confused by wedging for founder

[mojoman77]

hi i found your site not long ago and have really enjoyed being on it. this is my first post. i have been shoeing for about 6 years. i have a pretty good business and many wonderfull clients and i get more and more referalls everyday from current clients and local vets. enough of that.

my question is this, please do not laugh at me i am simply confused, when i went to school and also in talking to vets i have never before heard to wedge the heels on a founder horse it has always been lower the heels. i deal with a few founder issues aside from those owner's who don't listen and still only trim those animals twice a year they have all done well with how i do them.

basically i am looking for some one or even a few of you to explain to me why i would want to wedge the heels that i just cut down. i am not one who thinks they know it all and am always open to something, anything that works.

i look forward to any replies that come my way.

thankyou
david gardner

[reillyshoe]

OK, here is a quick explanation.
The point of trimming down heels and wedging them back up:
1. In most laminitis cases, the affected laminae tend to be at the toe. The heel region is often less affected.
2. Trimming the heels down increases the surface area of the foot, and specifically the hel region. If the solar surface is trimmed in a manner to make better use of the heels by making the heel region "bigger", then perhaps a larger percentage of the horse's weight will be placed on the unaffected laminae.
See pictures for a better explanation:
metron pictures (http://www.eponashoe.com/chat/chat.asp?folder=Trimming+and+Shoeing&chat=The%2Duse%2Dof%2Dwedge%2Dpads%2Dshoes%2Dto%2D increase%2Dsupport%2Dlength)

3. Lower angles place more strain on the DDFT, and this strain is one of the forces pulling the coffin bone out of position (rotation).

Wedging above and beyond the original angle does a couple of other things:

1. Increases the force on the heel. Again, often a less affected area. It does move the center of pressure forward, andthat might be problematic, but that is another issue.

2. Some theorize that wedging increases the circulation to the dorsal laminae.

Of course there is much more to the story, many potential complications of raising of lowering the angle, and many who will argue with you no matter what you choose. I, for one, find the adjustable wedges to be the best part of the NB system. Let the horse decide.
Ihope this helps

[mojoman77]

thanks for getting back so soon. what you said makes sense to a point. and i agree i could argue all day and i am sure there are alot of sides to this particular coin. the only thing that i would worry about (like you pointed out) would raising the foot past the point of rotation and making it worse. but i guess like anything else everything in moderation. i suppose that if all was done and set back to where it was if not slightly lower then to me that would seem much more helpfull. again every horse and every problem is different and should be adressed that way i believe.

anymore info that anyone can give would be great. i always like to learn new things and this idea really has me thinking. look forward to hearing from you

thanks again

david gardner
southern ohio

[mojoman77]

also if any one can point me in the direction on reading material or info regarding this topic that would be great.\

thanks
david gardner

[calshoer]

I have found that following the guidelines as describd by the EDSS instructions for determining what wedge to use (if any) is a good one.
Some need no wedge, some a little and some a lot at least for a little while. (maybe only a few days,then the muscles relax and the wege can be reduced. )
The horses footfall and clinical comfoort helps me determine how much if any wedge is needed after the heels have been trimmed to realign the hoof capsule with the bone (a procedure called 'derotatrion', but I wish there was a better term for realigning the structures with each other). The problem with simply trimming heels and leaving the bone angle low is that if the flexor MUSCLES above the flexor tendon have contracted in response to the pain, the pull on the DDFT may rotate the bone further.....right through the sole.
By following the horses lead, the wedge can be adjusted to suit the horse best at that particular time.
A slightly heel first landing is desireable because it says the DDFT is not too tight and the horse is willing to load the heels . . A toe first is not. Most slightly sunken horses will land with a big heel slap and need NO wedge. As well, a horse that needs a wedge will usually stand with the feet camped forward while a horse that does not will stand straight or even a bit behind himself.

Most recently rotated horses end up needing a wedge for a while. I use the footfall and stance to help determine how much.

And it may change in days or weeks as the disease and the damage goes throuh the various stages of healing, so I'm always prepared to make changes as and when needed .
Patty

[Derin Foor]

To further clarify (or confuse) what Patty and Reillyshoe have said, and BTW they have both made very good points in regards to a foundered horse:

the derotation that Patty wrote about re-aligns the bone (P3) to the hoof capsule and that's a start.......the pain is often caused by the compression of the circ*mflex artery which will eventually shut down sole production and lead to further problems

wedging will help re-align the rest of the bony column and relieve the stress on the DDFT....... if a full wedge pad is used, it can offer protection to the distal border of P3 and provide a place to apply sole support in the rear half of the foot so that region can bear more of the load and reduce the pressure at the toe region

reasearch the NBS website..... it will answer alot of the questions you pose.... also, you might consider attending the Laminitis Symposium in KY.... lots of good info there

hope that helps

Derin

[SlowShoe]

Hey mojoman, welcome!

[mojoman77]

to all of you thankyou very much. everything that was said makes perfect sense with out confusion. and i really appreciate all of your time and effort to help me understand.

thanks

david

[John Barney]

David,
With all due respect for the reponses you have gotten, I disagree with the jacked up heels. I have only been shoeing for six years, but I am in founder capital of the world. Missouri. I have quite a few foundered horse and mules that I care for, and lowering the heels and squaring the toe , has reduced the thickness of the whiteline(laminae) by half within a year. If the DDFT pull is so significant then hacks would founder horses on a regular basis. If you would like to talk about what I do give me a pm. Hell with it, just call me 660-238-1226. Or anyone else that wants to. As Jaye says I am chasing the little green guy.


JB

[mojoman77]

jon,

don't get me wrong i do not wedge founder horses either. in fact i do it exactly as you do ( plus rocker toed shoes). i simply was interested in why and like to know new things. and i will not do it at all without more knowledge on the subject. in the same breath i never discount anything completely untill i know everything. so for now i like you will stick with what i know works and keep looking into this untill i have an honest oppinion on how i feel about it.

thanks for everyones input

david

[calshoer]

John Barney said: If the DDFT pull is so significant then hacks would founder horses on a regular basis.John, a normal non foundered horse is not going to have the same kind of abnormal DDFT pull as a foundered one.
In some foundered horses, the DDFT pull is significantly MORE and constant than it would be in a non foundered horse, due to an involuntary contracture of the flexor MUSCLES in response to chronic pain. It has to do with a microscopic, neurological structure at the tendon/muscle junction called the Golgi tendon apparatus. It is not at all the same kind of normal DDFT tension that raises the heels as a normal horse propels himself.
Hence the need and the****utic benefits of wedging SOME founders temporarilty to reduce that pull and prevent further rotation,and tro assist the flexor muscles to relax. (ie break the cycle) .The horses stance and footfall can easily assist the farrier in deciding if wedging is or is not needed, and when to remove it. Simply "jacking up the heels" arbitrarily in every founder is not the correct course of action. It is 'sometimes' thing, and meant to be temporary.
Patty

[John Barney]

Patty, that makes more sense than some other explainations I have heard from vets. Please tell me what to look for in the stance or listen for in the footfall that would warrant the raised heel. I have a mule the vet wants high heels and toe cut into the laminae on. She has improved since I have been trimming her my way every four to five weeks. I take the toe back to the white line at the BOP but stop short of invading it. Also by lowering the heels I put them at two to three degrees lower than their natural hoof angle woud be, leaving all the sole for support. David, I use rocker/rolled toes alot. Also equithane on thin soled horse at least for the first couple of cycles.

JB

[calshoer]

John, if shoeing for founder, (not planning on leaving him barefoot), after the heels are trimmed look at the way the horse stands.
If he stands with the feet camped forward, he probably is going to need a wedge. If he stands with feet straight under him, (or behind, rarely) he probably does not.
When he is walking, he should land slightly heel first.
It is not something you can tell by the sound, you need to have someone walk him on flat hard ground and just watch carefuly .
Watching from the front with him walking diectly toward you is helpful to see a subtle heel first landing.
Sometimes a horse will land flat to very slighty toe first with the heels trimmed but before before you have rockered the toe. Then after the toe is rockered he will change to heel first.
The wedging takes some "dialing in" to get exactly what the horse needs at that time, hence the adjutable rails on EDSS and the ability to add removeable wedges to the bottom of the Redden Ultimates and the Steward Clogs.
The horses that usually need a wedge are those that rotated significantly.Especialy those who have progressed to the chronic stage and are growing a lot of heel.
In general the horses who sink straight down usually are already slapping the heels down hard and will not need or do well in a wedge.
There are exceptions to both though. Thats why reading the changing needs of the individual is so important. Hope that helps some.
Patty

[John Barney]

Thanks Patty that is the way I do it. Bearing weight on the feet is what is most noticeable after trimming. If the horse has a thick enough hoof wall, sometimes a set back eventer does the trick for a nice landing. If I see the parked out stance after trimming with no heat or pulse in the foot, I now have another tool in the box. Thanks.

JB

[Redd Mcintyre]

(a procedure called 'derotatrion', but I wish there was a better term for realigning the structures with each other). Patty

Can someone explain this for me. I have seen spin offs of the subject but not a procedure. Can this be done to barefoot only horse?
Redd McIntyre

[calshoer]

Can someone explain this for me. I have seen spin offs of the subject but not a procedure. Can this be done to barefoot only horse?Not necessarily. Unless the practitioner is willing to wedge the foot after the derotation trim as needed.
Derotation is basically just trimming the heels of the foot to to realign the outer hoof capsule with the rotated bone, to promote proper growth of the capsule attached to the bone.
The means trimming the heels of the foot down.
In SOME cases, this can be done barefoot and the horse is fine with no wedge. BUT many cases of founder, the flexor muscles have contracted ,creating abnormal tension in the deep flexor tendon.In really long standng cases, the deep flexor tendon itself may have contracted.
If you trim the heels of the foot down on those with no option of adding a wedge to the foot afterward to relieve the tension, you will only create more issues.
The way to tell if a wedge is needed is if the horse can easily place his heels on the ground after the trim without having to point his feet forward, AND can land slightly heel first at a walk.
If he can't ,he will need a wedge, something a lot of barefooters won't use. Some ,like Pete Ramey, will use a wedge inside a boot if needed, but many wont. Patty

[Derin Foor]

Can someone explain this for me. I have seen spin offs of the subject but not a procedure. Redd McIntyre

Redd,

I can show you some x-rays and explain it to you that way the next time I see you........the offer still stands to ride along some day.

Derin

[johnthevet]

[QUOTE=mojoman77]
basically i am looking for some one or even a few of you to explain to me why i would want to wedge the heels that i just cut down.

Hi David,

I have just joined this evening and have read the replies, giving differing opinions (one or two from people I have discussed this topic with).
I have written, what I intended to be, a "discussion" do***ent but very few I gave it to found time to read it - one of the reasons I set up a website on laminitis. It is titled "How should we trim the chronic founder foot?" I have tried to provide both sides of the argument (including links to sites that both agree with and disagree with my opinion.

See www.johnthevet.com under either Laminitis / Farriery and Shoeing / Foot trimming, or it can be found in the Downloads.

I hope this might help.

Cheers

John

[Redd Mcintyre]

Thanks Patty,
when you find that correct degree wedge is it a long term use usually? When will you know when it is time to remove the wedges (for me this will be a decision probably made without much from a vet because of lack of money and desire from the owner) and do they need to be graduated down to a flat level plane?
Redd McIntyre

[calshoer]

Thanks Patty,
when you find that correct degree wedge is it a long term use usually?Not always. The goal is to get them out of the wedges as they recover and theflexor mechanism relaxes. In my experience, horses who were long term chronic, seriously rotated for some time and mismanaged through the early stages have less chance to get back to normal and out of wedges. Bit if the condition was addressed promptly on or shortly after onset, , the wedges (if they are even needed) are more often temporary .As the flexor mucles relax, the horse will begin to land heel first more and more with less and less wedge.The EDSS video shows how to evaluate this by footfall and properly choose the wedges. Eventually going to no wedge or even barefoot if the goal . When will you know when it is time to remove the wedges (for me this will be a decision probably made without much from a vet because of lack of money and desire from the owner) and do they need to be graduated down to a flat level plane?The horses stance and footfall determine this. A resting stance with the feet straight under the horse, and light heel first landing is the goal. For example if they are in a medium wedge rail to begin with ,and later start to slap the heels down hard it is time to lower the wedge. I leave wedge rails with the owners and have the call me for advice when the horses movement or stance changes,so they can change the wedge rails themselves upon my advise.
Hope that helps. Patty
(PS, the step by step derotation trimming ,fitting EDSS correctly and the rail adjustments are all in detail in the EDSS instruction video ;)
Patty

[calshoer]

Hello Dr Stewart nice to see you here. So everyone here knows, we have met several times and have had long disscusions about laminitis treatment and agree on a lot of things as well as disagree on a few others....such as the parallell plane P3 being normal in a domestic horse.I believe 'normal ' palmer angle is whatever the individual horse is comfortable with, that being 1 degree, 5 degrees or whatever.
That said,
I want to point out that the example foot you show on your website with the NB steel shoe is an example of a steel NB probably used for the wrong application. Steeel NB shoes were never intended as a treatment for acute laminitis or or severe founder.
Looking at that foot, I see several things.
The pastern is quite steep, indicating probable tight flexors. (muscles and tendon) Or it may have been a club foot before the laminitis ever occurred , I can't know that from here.
The foot appears to have a lot of growth so it has either regrown a lot of heel since it was shod, or was not derotated properly before shoe was applied.

Those of us who successfully do a lot of these old chronic type rotated feet know that if you derotate that kind of foot very much and do not wedge it after,the horse likely will land toe first and can't get the heels to the ground easily. If that happens, it stresses the flexor tendons and muscles and in response they very quickly regrow that heel, often more than they had before.

If there is no option of wedging them (client cost, or wanting them barefoot , whatever) then enough heel needs to be left on the foot for the horse to stand comfortable square under himself and land slightly heel first.
Lowering the heels very much on an old chronic case like that (especially to a level plane as you would want to) would stress the flexor tendon more and cause more rotation, unless it gets wedged back up. .

Either way, a steel NB with no wedge for this case was likely not the approriate use of that shoe .
If you intended to for it to be an example of a normal and properly applied NB shoeing, you chose either an incorrectly applied example or one on a very old chronic club foot that was that way all its life anyway and therefore isnt going to derotate permanently ,ever.

A properly applied and more appropriate NB on that foot would have been EDSS (not plain steel NB) one with the heels of the foot derotated and appropriate wedge rails. I just want to point that out.
Patty

[johnthevet]

Hello Patty,

Nice to hear from you. Have I got out of my depth here?

Hello Dr Stewart nice to see you here. So everyone here knows, we have met several times and have had long disscusions about laminitis treatment and agree on a lot of things as well as disagree on a few others....such as the parallell plane P3 being normal in a domestic horse.

I don't think I have ever said that - have I? I have said that when the solar surface is ground-parallel that the forces between P3 and the laminae are most evenly spread and in this respect consideration should be given to what the horse is being asked to do and whether it is shod or not and is trimmed so that it does not go beyond this (and tilt back) at its top speed/greatest stress.


I want to point out that the example foot you show on your website with the NB steel shoe is an example of a steel NB probably used for the wrong application.

Sorry, this was from a dead horse whose history I do not know. It was an example that I radiographed and photographed.

The foot appears to have a lot of growth so it has either regrown a lot of heel since it was shod, or was not derotated properly before shoe was applied.

In my opinion the first suggestion follows on from the second and is one of my arguments against wedging.

Those of us who successfully do a lot of these old chronic type rotated feet know that if you derotate that kind of foot very much and do not wedge it after,the horse likely will land toe first and can't get the heels to the ground easily. If that happens, it stresses the flexor tendons and muscles and in response they very quickly regrow that heel, often more than they had before.

I agree with the first bit - however (as you know) I think that it is the pain caused by a tilted P3 by trim or by wedge that causes the deep flexor muscle to contract, so that this problem might be avoided if the heel was trimmed low in the first place.

If there is no option of wedging them (client cost, or wanting them barefoot , whatever) then enough heel needs to be left on the foot for the horse to stand comfortable square under himself and land slightly heel first.
Lowering the heels very much on an old chronic case like that (especially to a level plane as you would want to) would stress the flexor tendon more and cause more rotation, unless it gets wedged back up. .

The same answer as above.

Either way, a steel NB with no wedge for this case was likely not the approriate use of that shoe .
If you intended to for it to be an example of a normal and properly applied NB shoeing, you chose either an incorrectly applied example or one on a very old chronic club foot that was that way all its life anyway and therefore isnt going to derotate permanently ,ever.

I see many natural balance shoes fitted to feet with what I consider an inappropriate trim (well my understanding of it).

A properly applied and more appropriate NB on that foot would have been EDSS (not plain steel NB) one with the heels of the foot derotated and appropriate wedge rails. I just want to point that out.
Patty

Cheers

John
(P.S. I missed our "bar chat" in Cincinatti this year)

[calshoer]

Patty in green, John in red) don't think I have ever said that - have I? I have said that when the solar surface is ground-parallel that the forces between P3 and the laminae are most evenly spread and in this respect consideration should be given to what the horse is being asked to do and whether it is shod or not and is trimmed so that it does not go beyond this (and tilt back) at its top speed/greatest stress.Perhaps I have misunderstood. .Although in conversation I do remember you saying that a ground parallell bone is not necessarily the ultimate goal in normal trimming, (or somehing like that ....there was a whole lot of beer that evening ), here you are saying that in laminitis you do strive for that, which I dont agree with. Maybe thats more clear.

Those of us who successfully do a lot of these old chronic type rotated feet know that if you derotate that kind of foot very much and do not wedge it after,the horse likely will land toe first and can't get the heels to the ground easily. If that happens, it stresses the flexor tendons and muscles and in response they very quickly regrow that heel, often more than they had before.
I agree with the first bit - however (as you know) I think that it is the pain caused by a tilted P3 by trim or by wedge that causes the deep flexor muscle to contract, so that this problem might be avoided if the heel was trimmed low in the first place.Your idea about the pain from a tilted P3 causing muscle contraction contradicts my own my practical field experiences treating these.
I have found that wedging actually has allowed contracted flexor muscles to RELAX. If this is so (and I've had it happen many times) then if the wedge can cause pain leading to the muscle contraction in the first place as you contend, how could it possibly also cure it? I believe pain from the inflammation itself in the laminae can cause the contraction. And relieving the pull on the tendon which is contributing to rotating the bone, relieves the pain.

Either way, a steel NB with no wedge for this case was likely not the approriate use of that shoe .
If you intended to for it to be an example of a normal and properly applied NB shoeing, you chose either an incorrectly applied example or one on a very old chronic club foot that was that way all its life anyway and therefore isnt going to derotate permanently ,ever.
I see many natural balance shoes fitted to feet with what I consider an inappropriate trim (well my understanding of it).
That is one of the very reasons that Gene Ovnicek has initiated the natural balance certification program.
PS the college where I am teaching now is paying for my next trip to Cincinnati , so if youre going again, I'll see you there...Ill have a cold beer waiting for you . :D Patty

[johnthevet]

Patty

I haven't mastered this colour bit yet.

I was discussing, with another vet, one of his problem cases and the latest treatment had been to apply an EDSS with a large wedge. (presumably correctly since done by Dave N.) The owner had phoned up a couple of days later to say that she had a problem - controlling the horse from running around because it was feeling so much better.

As you gather, I do not think this is the correct thing to do, so I sat down that night and wrote a piece discussing whether wedging the hoof was what we should all be doing, since this had obviously helped this pony. I was debating which part had benefitted the pony so much. Was it the derotation of the trim, or the lifting and protecting of the sensitive sole, or the caudal support or was it the wedged heel or any number of these? (The first three procedures I agree with).

A week later, the pony was reported to be much worse again.

I have asked if I can accompany the other vet on his next visit, since I am more interested to find out why we fail than why we succeed since many get better in spite of us.

I will keep you informed of any developments (and any conclusions - I am not blaming the wedge until I know all the details!)

Every time I have discussed this topic with you and Gene I have always come away doubting my opinions, but I have to say that this has lasted shorter each time.

I look forward to another one in Cincinatti.

Cheers

John

[calshoer]

Laminitis is so complicatd that every factor needs to be considered when they have their "ups and down" , including a lot of things beside the shoes. In my experience,when something like EDSS (or redden shoes, or barefoot or whatever) works great for a little while then seem to fail, there are several things to consider as posibilities . One is that the seeming failure is just a temporary and normal glitch...part of the process of laminitis recovery. for example....

1) Often the pony was ready to begin abscessing, a normal part of the laminitis process where dead tissue begins to slough out as serum. As you know this can often happen a couple of weeks out from the initial onset of the laminitis and periodically after that. Given the pony is probably at about that stage, that is a strong possibility the abscessing has begun.
Many animals are put down just at that time because everything is seeming to fail, but in actuality it is just when the are going to turn the corner to begin real recovery.

2) Perhaps a metabolic issue (most common in underlying cause in laminitis in ponies) that has reared its head again or was not addressed adequately. .or the pony has been out grazing on the same grass/field he imnitially foundered on???

3) Perhaps the pony was placed on medication(s) at about the same time as the shoeing, and is now reacting negatively with toxic / leaky gut issues.

4) Perhaps the owner stabled the pony 24/7 to prevent him from 'partying' in the field, and the stress of stabling had raised the cortisol levels in the pony and is causing an increase in the level of laminitis. Or.... perhaps the pony has been partying too much and has mechanically inflammed the feet.

5)Perhaps the pony no longer needs the tallest rails and just needs an adjustment. That IS why they are adjustable. I sometimes change them in only 1 to 5 days after the initial laminitis shoeing. Wedge Rails are not something you place on there and just leave alone for 8 weeks no matter how the animal is doing.The desired angle changes as the needs of the foot change. And that sometimes can be days not weeks.

I certainly hope that Dave was consulted first when the pony relapsed clinically, because he should be given a chance to evaluate all these potential issues before the EDSS is called 'failure'. Because it may have nothing to do with the shoeing.
Patty

[johnthevet]

[QUOTE=calshoer]Laminitis is so complicatd that every factor needs to be considered when they have their "ups and down" , including a lot of things beside the shoes.

Patty

I agree whole-heartedly, which is why I need to know much more about the details of this case and why I try to analyse all the possibilities when dealing with other problem/recurring cases. Reading my comment about "not blaming the wedges until..." did sound a bit flippant and it should have been more "I cannot judge whether the wedges were a factor without knowing all the details".

John