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TOPIC: Dr. J.M. Denoix

Dr. J.M. Denoix 06 Sep 2010 06:35 #1

The Lingehoeve a big vet clinic here in Holland spend time and money hosting a clinic for farriers by Dr. J.M. Denoix, a Professor that spend decades working on research relating to lameness in horses. Attending was kept free of charge, a gesture that perhaps is taken a little too much for granted by attending farriers. Anyway, I know of several shoers -including myself- that greatly appreciated it.

It took me some time to decide whether I should post on this or not because during one evening so much information is presented I worried about being able to present this here. But on realizing I couldn't anyway, decided to talk about two things that stuck with me relating to LH/LT. (He talked about DP balance as well and promoted the use of "side weight" shoes or wide webbed medial/lateral shoes. I hope I can find time to get to that later.)

Denoix gave us some insight on what actually happens in a low heel/long toe type of foot. We all know that because of the lack of balance a foot like that loosens its ability to restore itself back to a normal foot, due to permanent damage to internal structures.

Denoix focused on one of those structures, the navicular bone and above all the way that bone is attached to P3 and P2. We know the distal sesmoid is situated caudally of the Distal Interphallangeal Joint (DIPJ) and attaches to the DDFT distally and has two collateral ligaments proximally. From books and the Glass Horse (a must have!) I learned that those collateral ligaments do not run straight up and attach to P2 (like the straight and oblique ligaments do) but they run forward crossing the medial and lateral side of the distal part of P2 almost hugging the entire distal end of P2. It was actually only now I realize why. When a foot loads, even in a normal foot the DIPJ stretches (the more or less straight line in P3, P2 and P1 breaks backward at that joint). Because of that the navicular bone gets pushed back! This is even worse with a LH/LT horse.

As Dr. Redden described years ago this increases tension on the DDFT tendon, and because of that makes P3 want to rotate, with or without taking the hoof capsule with it. What I until now missed here is that the caudal movement of the navicular bone also increases tension on the collateral ligaments. According to Dr. Denoix the #1 reason for soft tissue related navicular syndrome.

Obviously we as shoers now that LH-LT feet need help and we provide it. I for one use wedges a lot. Denoix is no big fan of wedges. He stated that the use of wedges in younger horses is even contra-indicated because of the "shortening" effect wedges have on tendons and ligaments. I have always understood that tendons and ligaments do not loose length, its the muscle attached to it that shortens. (Denoix disagrees and he looked into this a lot harder than I have.)

What Denoix proposes in stead is the use of the floating effect some shoes offer. He particularly likes the open toe shoe or reverse shoe. Apparently the "bank robber" shoe in France is called a "Napoleon shoe". Makes you wonder :rolleyes:

I can see the benefits of a reverse shoe. It's cheap, easy and fast. (Yes, I have been very successful using the banana shoe and I will not change this, but nothing is a "cure all" not even a banana shoe.)

Denoix stresses that in a reverse shoe the caudal part (the bar) needs to be widened as much as possible, to gain maximum effect of the floating. The toe needs to be beveled at the branches to gain maximum ease of break over.

As we all know that dealt with big time LH/LT messes, the frog needs support as well. Denoix disagrees. That kinda woke me up, excuse me? You were saying?

After listening to Denoix it turns out he does offer some kind of support to the caudal part of the foot, but not by applying pressure to it, but by using a solid leather pad ánd a semi rigid silicone (Shore 50 for the experts, I think its like Vettecs black Hoofbuild) but in the medial and lateral sulci only! What he does is to cut out the frog (a simple triangular cut in the pad) freeing the frog only but covering the medial and lateral sulci. These are filled with a pretty rigid hoofpack. The effect is enhanced by the application of a onion shoe or thumbprint shoe.

My worry was that in this application way too much pressure was applied to those sulci jamming the bars as well. But Denoix clearly said that he never experienced ill effects of this application.

Further Denoix promotes the use of aluminum shoes especially when bars and stuff are added as steel is pretty heavy. Also he showed a eventer type of shoe as an ideal shoe for sound sport horses.


Ronald Aalders
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RE:Dr. J.M. Denoix 06 Sep 2010 09:55 #2

Intriguing.

Pat R has challenged me to really open my mind. Denoix is clearly one to listen to. Pat what do you think?

And he resurfaces the reverse shoe and lets not use frog support. Really makes one go Hmmmmm but I'm going to pay close attention to what he says.

Dr elanor kellon just put a friends laminitic horse on race horse oats which have an NSC of 48% again puzzling but I'm going to consider what she says. My friend has a clarifiying email in to her.
George Spear
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".....and I said to the horse: Trust no man in whose eyes you do not see yourself reflected as an equal."
Don Vincenzo Giobbe
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"What people do not appreciate is that every time a horse submits to...
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RE:Dr. J.M. Denoix 06 Sep 2010 14:11 #3

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ive had the honor of attending his clinics twice ,a real top bod ,
chris
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RE:Dr. J.M. Denoix 06 Sep 2010 20:41 #4

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I shod this horse a bunch of years ago at a Denoix conference in New Hampshire. I can't say that this is exactly what Denoix would like, but this was my attempt at providing the shoe package Ron described. I remember Denoix stating that he would prefer a softer packing under the leather pad (I used Equipak, I think he preferred something comparable to Equipak soft). I probably should have drawn the heels out more than I did in this photo.

(Bet you didn't know I could nail on shoes)


I respect Denoix's interest in shoes as much as anything. There are many lameness specialists who avoid the subject, yet Denoix not only appreciates the influence he researches the effects of shoeing. The idea of using shoe shape to influence hoof ground positioning in soft footings is very interesting, and it is a central part of my concept of correct shoeing. I regularly use asymetrical shoes to protect certain structures in the hoof.

The general rule with this shoe is to position the wide side of the shoe under a tendon/ligamentous injury, or alternatively put the narrow side under a bone related injury. I think this works well in the right footing/environment.
P
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RE:Dr. J.M. Denoix 06 Sep 2010 20:45 #5

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Ronald Aalders wrote:
Obviously we as shoers now that LH-LT feet need help and we provide it. I for one use wedges a lot. Denoix is no big fan of wedges. He stated that the use of wedges in younger horses is even contra-indicated because of the "shortening" effect wedges have on tendons and ligaments. I have always understood that tendons and ligaments do not loose length, its the muscle attached to it that shortens. (Denoix disagrees and he looked into this a lot harder than I have.)

Hello Ron,

I don't see lt / lh horses as needing our help. If a foot is broken back then I can see it needing our help though I don't agree with Denoix. If the horse is broken back and wedging shorten's the tendon, I see that as a good thing, although through my eyes I've never seen anything that would suggest the tendon was shortening.

The stuff I've read from Denoix seems very interesting and makes a lot of sense but he definitely seems to be stuck on the premise that everything can be fixed through flotation. We can see with out own eyes that the foot obviously breaks down. Flotation doesn't fix the break down.
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RE:Dr. J.M. Denoix 06 Sep 2010 21:13 #6

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I think the idea is that a wedge will potentially lose effectiveness over time, as the muscle of the other end might adjust to the elevated position. By contrast, the flotation only occurs during work, and might therefore be more effective. It only provides releif on the DDFT during excercise, which in many cases is when one might expect an injury to occur. I am not saying I agree or disagree, but I think that is the logic.
P
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RE:Dr. J.M. Denoix 07 Sep 2010 03:30 #7

reillyshoe wrote:
I think the idea is that a wedge will potentially lose effectiveness over time, as the muscle of the other end might adjust to the elevated position. By contrast, the flotation only occurs during work, and might therefore be more effective. It only provides releif on the DDFT during excercise, which in many cases is when one might expect an injury to occur. I am not saying I agree or disagree, but I think that is the logic.
Pat, are you speaking of management, of the pre-existing problem? I have heard Great-Claims , that the structures, that are compromised, i,e, Digital Cusion, can be regenerated. I asked Chris Pollit, about this condition, his thoughts that he gave me were , once it's gone, it's lost. Management , at that point. Pat , I wonder what better management of these feet , with enviornment, nutrition, exercise, would have a better effect, at a young age? Or do you feel that we can affect a change, at a distressed -state?
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RE:Dr. J.M. Denoix 07 Sep 2010 03:37 #8

I did not word that right, to my thinking. I mean, do you think that one can reverse-pathology, in the digital cushion?
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RE:Dr. J.M. Denoix 07 Sep 2010 06:22 #9

reillyshoe wrote:
I think the idea is that a wedge will potentially lose effectiveness over time, as the muscle of the other end might adjust to the elevated position. By contrast, the flotation only occurs during work, and might therefore be more effective. It only provides releif on the DDFT during excercise, which in many cases is when one might expect an injury to occur. I am not saying I agree or disagree, but I think that is the logic.


Remarkebly (at least to me) Denoix specifically mentioned tendons and ligaments that adjust to the "shortening" caused by wegdes.

The floating part interests me more than anything (I'm pretty confident I have the low heel deal covered ;)). However the first thing that came to my mind when listening to Dr. Denoix on this while picturing me under a actual horse with lameness issues is a quotation by A. Kent Allen, Dr. O'Grady uses a lot.

"Absent a correct diagnosis, medicine is poison, surgery is trauma and alternative therapy is witchcraft"

I'm not being disrespectful to Dr. Denoix, far from it, but I do wonder how many horses, even the great ones will be checked under a MRI machine to pinpoint that "correct diagnosis" allowing us to do what's needed.


Ronald Aalders
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RE:Dr. J.M. Denoix 07 Sep 2010 06:29 #10

Ron, do you see the digital - cushion, involved in this? What are your experiences, Or should i be looking further up the limb for my answers?
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RE:Dr. J.M. Denoix 07 Sep 2010 06:34 #11

Jake Whitman wrote:
I did not word that right, to my thinking. I mean, do you think that one can reverse-pathology, in the digital cushion?

I never could. Not ever. And on some -research wise- I tried everything known to man. Lifting heels with wedges, using arcylics to jack them up, not raise heels at all, everything with and without frog support, open toe with added false bar, rails, eggbars, even fishtails and onion shoes.

"I never failed, I just found over a thousand ways that did not work". Edison.

My conclusion is that when the digital cushion is atrophied, the only thing left is get that foot back in a "normal" stance to reduce strain on other structures. An atrophied digital cushion itself is beyond fixing.



Ronald Aalders
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RE:Dr. J.M. Denoix 07 Sep 2010 06:42 #12

Ronald Aalders wrote:
I never could. Not ever. And on some -research wise- I tried everything known to man. Lifting heels with wedges, using arcylics to jack them up, not raise heels at all, just provide support (worse of them all), open toe with added false bar, with and without wedges, rails, eggbars, even fishtails and onion shoes.

My conclusion is that when the digital cushion is atrophied, the only thing left is get that foot back in a "normal" stance to reduce strain on other structures. An atrophied digital cushion itself is beyond fixing.


Ronald Aalders
Thanks , Ron. On these negative P/A , horses, do you find a corrilation, with an atrophied digital -cushion? I think i am just looking at one aspect of it, and am not seeing the bigger picture , of how to deal with them??
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RE:Dr. J.M. Denoix 07 Sep 2010 10:46 #13

Jake, I think that on negative PA feet the biggest issue is to regain a normal situation. We need to normalize matters rather than correct them as Grant Moon once told me. Without it all structure are out of whack and stay out of whack so to speak. Meaning the strain on the DDFT remains high, break over can only be achieved by evasive actions around that difficult break over overexerting other structures (like hocks and stifles on hinds), the collateral ligaments, the impar ligament and the navicular bone itself as Denoix explained are stretched to a breaking point, strain that accounts for ringbone and spurs on the distal sesmoid, just to name some of the trouble caused by a negative PA coffin bone. And obviously all that impact makes the digital cushion take so much beating it will not find a way to heal anymore, that way the horse looses an important part of caudal support.

For me regaining a normal situation clearly that means wedges and easing of break over. Easing the job of the digital cushion and with any luck allowing genetics to restore where needed. We have an abundance of shoes, wedges and other tools in our toolbox to achieve that.

I can not always tell whether the delayed break over caused so much beating to a digital cushion is indeed atrophied (if we would -incorrectly- define atrophied as beyond repair). In fact for me when I see a foot actually improve that means the digital cushion was not atrophied in the first place but just on its way. But the digital cushion will not improve itself and push a foot back up. It will not it can only improve if the reasons it got messed up in the first place are taken away as much as possible.

At the risk of sliding a little off topic here, for me perhaps the most important thing about "normalizing the situation" is not even the foot or overcoming digital cushion or DDFT problems. If I may be so straightforward perhaps that is where Dr. Denoix misses out. The last couple of years I started looking upon shoeing not as much ways to "fix" a foot, but to improve the way a horse moves and uses it's back. I found that if you can take away the poor movement in a horse, foot quality improves with it. Our shoeing protocols in that respect are ways to improve a horses gait. The abundence of possibilities allow an educated shoer to pick what he thinks is right given a particular horse in a particular situation adding training protocols in the mix.

On low heeled feet we can use soles and add hoofpack all we want, but without actually improving the way a horse uses its body, all that in the end just gets us a horse with poor feet and trush.



Ronald Aalders
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RE:Dr. J.M. Denoix 07 Sep 2010 12:59 #14

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Jake Whitman wrote:
Pat, are you speaking of management, of the pre-existing problem? I have heard Great-Claims , that the structures, that are compromised, i,e, Digital Cusion, can be regenerated. I asked Chris Pollit, about this condition, his thoughts that he gave me were , once it's gone, it's lost. Management , at that point. Pat , I wonder what better management of these feet , with enviornment, nutrition, exercise, would have a better effect, at a young age? Or do you feel that we can affect a change, at a distressed -state?

I am an advocate of keeping young horses barefoot for as long as possible. I am not sure how, but I think shoes (any shoe, with or without frog support, nailed, glued) change the structure of the foot, and in particular the heels. I juvenile feet the effect seems to be magnified.

My theory is that the change to the digital cushion is a result rather than a cause of an issue. I think the underlying issue with many heel structures revolve around the inability of the DDFT to assist in supporting the distal limb. A horse with a shortened DDFT apparatus can have no weight on the heels (the heels don't reach the ground, even during full weight bearing), and all of the weight on the front of the hoof. A horse with a deep flexor tenotomy has an increased amount of weight on the heels, and I have found that these horses grow more underrrun heels after the tenotomy. Is it possible that everything else is somewhere in between? Could lesions in the DDFT(which are common) limit the ability of the tendon to support the horse's weight, and result in a less dramatic version of the tenotomy (more weight on the back half of the hoof)? Over time, could the heels/digital cushion change from this increased force? A wedge pad or shoe cannot add to the integrity of the DDFT, and this might help to explain my inability to fix an underrun heel.
P
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RE:Dr. J.M. Denoix 07 Sep 2010 13:44 #15

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Ronald Aalders wrote:
Jake, I think that on negative PA feet the biggest issue is to regain a normal situation. We need to normalize matters rather than correct them as Grant Moon once told me. Without it all structure are out of whack and stay out of whack so to speak. Meaning the strain on the DDFT remains high, break over can only be achieved by evasive actions around that difficult break over overexerting other structures (like hocks and stifles on hinds), the collateral ligaments, the impar ligament and the navicular bone itself as Denoix explained are stretched to a breaking point, strain that accounts for ringbone and spurs on the distal sesmoid, just to name some of the trouble caused by a negative PA coffin bone. And obviously all that impact makes the digital cushion take so much beating it will not find a way to heal anymore, that way the horse looses an important part of caudal support.

For me regaining a normal situation clearly that means wedges and easing of break over. Easing the job of the digital cushion and with any luck allowing genetics to restore where needed. We have an abundance of shoes, wedges and other tools in our toolbox to achieve that.

I can not always tell whether the delayed break over caused so much beating to a digital cushion is indeed atrophied (if we would -incorrectly- define atrophied as beyond repair). In fact for me when I see a foot actually improve that means the digital cushion was not atrophied in the first place but just on its way. But the digital cushion will not improve itself and push a foot back up. It will not it can only improve if the reasons it got messed up in the first place are taken away as much as possible.

At the risk of sliding a little off topic here, for me perhaps the most important thing about "normalizing the situation" is not even the foot or overcoming digital cushion or DDFT problems. If I may be so straightforward perhaps that is where Dr. Denoix misses out. The last couple of years I started looking upon shoeing not as much ways to "fix" a foot, but to improve the way a horse moves and uses it's back. I found that if you can take away the poor movement in a horse, foot quality improves with it. Our shoeing protocols in that respect are ways to improve a horses gait. The abundence of possibilities allow an educated shoer to pick what he thinks is right given a particular horse in a particular situation adding training protocols in the mix.

On low heeled feet we can use soles and add hoofpack all we want, but without actually improving the way a horse uses its body, all that in the end just gets us a horse with poor feet and trush.



Ronald Aalders

Mr. Alders,

With you being an advocate of the rocker/banana shoe concept surely you had the opportunity to discuss this with Denoix? If I understand correctly what your are portraying, I tend to agree that without healtly digital alignment, which should correlate to the horse using his body differently, it is hard to keep the LTLH horse happy. My thoughts on the ability of Digital cushion regeneration is that the abilitiy of the DC to regenerate/recover is directly related to how long it has been crushed/compromised. A common disclaimer that I give to my clients is "Successs will be dependent on Soft tissue response". That response is again related to how long has this problem been in existence.
Sammy L. Pittman, DVM
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