Meet Gee I'm Fancy, a.k.a. "GG." GG is an 11 year old quarter horse gelding (yes, he is a boy, even though he is called "GG!") In November of last year, I acquired him as a rehab project.
In his former career as a riding horse, GG was trained in various disciplines including dressage, hunter/jumper, and Western. He turns on a dime, knows piaffe and tempi changes, and was also used as a lesson horse. He was shod for many years in regular keg shoes, and was reasonably sound.
However, about 2 years ago GG started showing intermittent lameness in his left front foot. He was then shod in special wedge shoes designed to treat "navicular syndrome," a mysterious "disease" characterized by heel pain that most vets and farriers consider to be irreversible. This seemed to work for awhile, but the lameness returned, and eventually GG was given up as a lost cause.
His owner at the time, a not-for-profit youth and lesson program, pulled GG's shoes and decided to wait for the time when enough money came in to pay to "nerve" GG, meaning to severe the nerves that go to the back of the foot. This expensive, last-resort measure often needs to be redone in several years because the nerves grow back and the pain resumes. This is a photo of GG in his paddock before I adopted him:
In November 2011, I decided to adopt GG in an effort to try an alternative method to help him, that is, a barefoot, booted approach. This method attempts to correct soft-tissue changes in "navicular" feet. Many "navicular" horses have underdeveloped, weak structures in the back of the foot. When a horse is shod for many years without a break, the rigid shoe prevents the back part of the foot from flexing, which is how the cartilage in the back of the foot develops (sort of like using a muscle to make it stronger). When this occurs, the concussive forces of exercise can damage the blood vessels in that area, resulting in further degradation of the tissue and the vicious cycle continues.
Trimmers remove the shoes, provide more frequent trims, and use padded hoof boots to protect the weak foot so that it can flex again and begin to repair itself. Depending on the severity of the soft tissue deformation, the process of growing a new and better hoof, inside and out, can take a year or more. Some horses can go right back into work with hoof boots for riding, but GG has a significantly deformed hoof and so he is currently at a farm in Lincoln University, PA to "rest up." He is booted for turnout in his grassy paddock when the ground is hard, and barefoot when it is soft.
Here is a photo of GG in his big new field with his buddies! He was barefoot that day, and walking really well, since the ground was soft:
Below are before-and-after shots of the changes to GG's hooves. There is still a long way to go, but the results are promising so far! GG is generally pasture sound unless the ground is hard. His soles are very thin so he bruises easily, particularly on the left front, problem hoof. Because GG's walls have severely flared away from the sole, the hoof wall is made passive at every trim so that it can grow down straighter. As a result, he is walking on his soles. Boots (specifically Easyboot Rx's) are an essential way to protect his feet during the transition process.
The first photo is GG's left front hoof in November, 2011, right after he was adopted. He had already received several trims by me. His toe (which was about an inch too long) has been brought back, but otherwise not much flare has been removed. The image has been marked to compare with the "after" shot. On first glance, it doesn't look too bad:
When I saw the second image, taken on March 3, 2012, I was not very impressed with the changes. In fact, the hoof looks worse from this angle. It is clear that GG is having a tough time growing in a well-connected wall, as evidenced by the rings in this foot. He is currently on a low-starch diet and we are working on a supplement program to address this. However, there are subtle improvements to the hoof despite this challenge. The arch in the hairline has apparently relaxed a bit; also, and more importantly, there is heel material starting to fill in. This is shown much more clearly in the other photos, but you can still see it here:
So, clearly this hoof still has a long way to go. You probably noticed the significant arch in the quarters at ground level. The reason I have done this is because GG's main problem, besides his underdeveloped heel area, is that he has "quarter flares," or flares on the sides of his hooves. The "lateral" outside quarter flare was by far the worst. Aggressively working back these flares has been a major goal for his rehab.
A "flare" means that the hoof wall is tearing away from the bone inside, essentially a "mechanical founder." GG's wall is almost completely separated from the bone. Flared walls cannot bear the weight of the horse without ripping away further over time, so it is essential to make them non-weight bearing until the flare grows out, another reason why we use a barefoot approach, since a metal horseshoe puts all the horse's weight on the hoof wall.
No need to mark the following photo, the flare is huge. Also note the way the hairline makes a "ridge" at the top of the hoof wall, particularly on the "lateral" (righthand) side. This indicates that the bone inside the hoof has "sunk" down too low in the hoof capsule, a very serious problem (it's no wonder this foot hurts him!)
Now we can see why these photos are exciting to me! Below is the March 2012 photo. The flare is gone, the hairline is no longer showing that ridge, and the walls are considerably more balanced:
Excited with those photos, let's move onto the one that I am most excited about! As mentioned previously, we view "navicular syndrome" as having a lot to do with the fact that the soft tissue structures at the back of the foot are underdeveloped and weak. Our entire goal with a navicular horse, therefore, is to grow heel from the "inside out" that is, to build mass in the heel: not just a longer wall, but a more robust structure in its entirety. Of course, we also want external growth, but the main area I am looking to build with GG is frog material. GG came to me with paper-thin frogs, about 1/4 inch of skin covering blood (I know because once with my knife, doing what I thought was "routine frog cleanup," I saw pink meaning that I nearly drew blood, to my absolute horror. Luckily, I stopped in time and vowed never to take a knife to his frogs again!)
GG's before photo from November shows just what we are talking about: the area in the middle of the heel looks practically like goop propped up by his walls, and his frog is not touching the ground even though it is apparent that his heel walls are themselves too low. Also, note the severe imbalance that we saw from the front. GG really doesn't want to put any weight on the outer wall, where that significant flare is:
Now note the happy after-shot! Again, GG still has a ways to go with this hoof, but note how the whole heel area just looks thicker and more robust. Also note the wonderful new frog growth, reaching for the ground (when before it looked like it was hiding from it). Finally, notice how the hoof capsule is much more centered around the structures inside:
Finally, let's take a look at GG's soles. GG has very thin soles and tends to move "toe-first." Horses are supposed to walk like people do, with their heel hitting the ground first. The heel of the hoof is where all the shock-dissipating structures are.
Now you see GG's problem; since these structures are underdeveloped, landing "heel-first" would cause him to damage them. To protect himself, he lands "toe-first." The problem with this strategy is that the heel structures are developed through use. So, there is sort of a chicken-and-egg issue. Also, landing "toe-first" puts significant stress on structures that weren't designed to dissipate the shock, namely, tendons, ligaments, and bone. We believe that the classic "navicular changes" on the navicular bone, are the result of this vicious cycle, not the cause of it. When the horse lands "toe-first," the tendon along the back of the leg is tight on impact, causing greater friction on the navicular bone. Landing heel-first, the tendon is relaxed and there is less friction.
We break this cycle with the judicious use of padded hoof boots to help cushion the sensitive heel structures so the horse will hopefully feel comfortable enough to use his heels more. We also are very conservative with trimming down the heels.
Ok, so here are GG's soles. The November photo has been marked to show the approximate place where the bone is inside the hoof, since it is a little difficult to see. You can then observe how deformed the lateral (righthand) side of the hoof is, how stretched away from the bone:
In the March photo, you can clearly see the ridge under which the coffin bone sits like a miniature "hoof" and that the rest of the hoof is more centered around it. A note about this ridge: GG has thin soles, and at first glance you might think that the bone is about to break through the sole! However, this ridge is rock-hard and there is no bruising present, indicating that is this not the bone pressing down but a protective callus. Since his toe wall is still flared forward, it doesn't provide the height necessary to protect the bone, so GG's sole is growing this ridge to protect the tip of the coffin bone from the constant abuse of landing on his toes. Because of this, it would be a cardinal sin to take a knife or rasp to this "toe callus on steroids." I let GG break over this callus and am very careful to make sure his hooves are protected on any hard or rocky ground.
