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2014 Podiatry Program Proceedings

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2014 Podiatry Program Proceedings 2014 Podiatry Program Proceedings 1 Mission Statement The mission of the NEAEP is to improve the health and welfare of horses by providing state- of-the-art professional education and supporting the economic security of the equine industry by complementing established local associations and giving equine veterinarians, farriers, technicians, veterinary students and horse owners a unified voice at the state and regional levels. The American Association of Veterinary State Board, RACE Committee, has reviewed and approved the program referenced as meeting the Standards adopted by the AAVSB. Additionally, the Podiatry Program has been approved for 24 American & Canadian Association of Professional Farriers (AAPF/CAPF) Continuing Education Credits. 2 Table of Contents Shoeing for Soundness: Sport Horse Lameness and Biomechanics of the Distal Limb ...... 4 Shoeing for Soundness: Coffin Joint Function, Pathology, and Treatment ........................... 9 Applied Anatomy of the Equine Foot ........................................................................................ 16 Biomechanics of the Stance ...................................................................................................... 21 Trimming Fundamentals and Foot Pathology .......................................................................... 22 Physiologic vs. Pathologic I – Functional Implications for the Farrier .................................. 24 Physiologic vs. Pathlogic II – Adaptive Shoeing Concepts .................................................... 29 Traction – External and Internal Factors that Affect the Biomechanics of the Stance ........ 35 Complicated Feet, Case Studies ................................................................................................ 36 The Upright Hoof Capsule (Are Farriers Producing Club Feet) .............................................. 37 Podiatric Considerations in the Soundness Exam .................................................................. 38 Footing/Movement – Limb Injuries: What the Horse Brings to the Table .............................. 43 Hoof Capsule Distortion, Parts 1 and 2 ..................................................................................... 44 Diagnostic Imaging of the Foot in Sound and Lame Horses .................................................. 50 3 Shoeing for Soundness: Sport Horse Lameness and Biomechanics of the Distal Limb Mark Silverman, DVM, MS Sporthorse Veterinary Services San Marcos, California The foot is a complex system of integrated structures performing many functions for the equine athlete. While comprising only a small percentage of the horses’ overall mass the foot is responsible for many factors essential to proper function and survival. The goal of today’s presentation is to examine the biomechanical evolution of the modern horses’ distal limb. Through improved understanding we can optimize our approach to shoeing for performance and soundness. There has been a roughly 70 million-year evolution to arrive at the structure of the modern horse. The Hyracotherium (Eohippus) was the evolutionary starting point for today’s horse. This creature was about the size of a fox and had multiple digits on the end of each limb. The path of evolution was driven by changes in available food sources and environment. These regional changes favored the ability to cover great distances efficiently. In addition, as a prey animal, the horse needed the ability to mount short to moderate distance bursts of great speed. The ability to deliver this duality while carrying a large herbivorous system required a series of adaptations. The relatively rigid structure of the thorax and abdomen dictated that the limbs must be the primary drivers of the horses’ speed and efficiency. The proximal bones of the limbs grew more compact and the muscles responsible for limb movement stayed within the contour of the body. The bones of the distal limbs grew longer as did the associated tendons and ligaments. These changes promoted the function of the tendons and ligaments as energy stores during locomotion while keeping the lower limbs light and making the system efficient. The bone structure of the limbs became simplified and a singular toe evolved, again to improve speed and efficiency and durability in the harsh terrain. The stay apparatus developed into an effective suspension and energy return system. There were compromises made in the course of these adaptations. The long levers that allow the system to perform lent to an increased risk of structural failure of both bone and sinew. Another factor of the modern system was the relative loss of pronation and supination of the distal digit. The more proximal articulations are restricted to motion involving flexion and extension. This is the case for the elbow, carpus and especially the fetlock joint. The restricted degree of freedom of the fetlock is crucial to the function of the suspensory apparatus and its ability to store and return energy. The function of the this lever and spring system allows the horse both speed and efficiency of movement, but the system had need of a method of coping with the rigors of undulating terrain and changes of direction. These challenges fell upon the most distal portion of the limb. The pastern and the coffin joints incorporate added degrees of freedom to allow for following terrain and the demands of turning. The hoof capsule itself is an additional portion of the adaptive mechanism. The limb’s ability to accommodate turns and irregular terrain is all focused below the level of the fetlock. 4 Image1 Angular demands of turning. Image 2 Compensation focused on coffin and pastern joints. Beginning with the most proximal structure involved in the adaptive system, we have the pastern or proximal interphalangeal joint. Through a combination of both minor rotational and collateral movement the pastern accommodates a small amount of the required range of motion required for successful function of the horse. Next up the bony column we have the coffin or distal interphalangeal joint. The design of this complex joint allows for both collateral and translational or sliding movement of the joint. The coffin joint copes with the lion’s share of the demands of turning and limb angulation. This joint, through all of its complex range of motion, becomes more stable as the demands for movement outside of the sagittal plane increase. Image 3 Compensation for angular demands are focused below the metacarpophalangeal joint. 5 The hoof capsule itself is the next part of the equation. The complex shape of the ground surface allows the hoof to work with the terrain, cutting into a forgiving surface, thus minimizing the demands for compensation on the joints. In addition, the capsule itself is plastic in nature and can deform to accommodate irregularities in terrain or lean angle when turning. Though dedicated to small portion of the body, this system allows for useful accommodation of the challenges facing the horse in many scenarios. However, when the available range of motion is exceeded, these structures bear the brunt. Momentary extremes or repetitive challenges at the limit will lead to injury of the soft tissues working to stabilize the joints. Collateral ligaments and joint capsules will stretch beyond their ability to rebound and can potentially tear. Joints will suffer damage to the protective cartilage that allows for smooth and pain free gliding of the joint surfaces. The joint may even be placed in a situation that demands an excursion beyond the congruence of its sister surface, leading to potential damage. Laminae, joining the bony P3 to the tough hoof capsule can be challenged to the point of tearing and separation. Enter into this equation the demands placed on the performance horse. The added requirement for traction or wear resistance or alteration of gait has lead to the placement of shoes on the hooves. This addition of this seemingly minor rim of metal has consequences of great magnitude. Bear in mind that I am not advocating for or against the use of shoes. There are many good and valid reasons for the use of some sort of appliance on the hoof’s ground surface. It is up to us as hoof care professionals to fully comprehend the effects of what we are tampering with when a shoe is placed. Never mind the changes in the ground/sole interface, there are ways to mitigate or even improve this interaction. What is of great concern is the loss of the hoof’s ability to deform in accommodation of the demands of work. By taking this factor out of the equation we add to the challenge of the remaining components of the formula. Keep in mind that the demands of angular adaptation on one side of the equation don’t change. This leaves us with fewer components to cope with the challenge, each taking on greater responsibility and therefore greater risk of failure. This scenario leaves us with the task of how we might approach a patient when we are aware that we are taking something away from them when a shoe becomes necessary or desired. From experience we have all become aware that as a mentor of mine once put it, “you can’t hardly f—k up a good one”. We can inadvertently add to the “good one’s” repetitive stress, and we can certainly help to put a marginal patient over the edge by limiting his natural ability to adapt. What can we do to balance this equation? Through recognition of the detailed biomechanics of the limb we can shoe to limit the demands of motion. If we allow the shoe to do some of the
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