Deep puncture wounds to the sensitive structure of the heel should be considered career threatening, and many times it can actually become life threatening. Sepsis involving the digital cushion, the deep flexor tendon, the navicular bone and/or the coffin joint is often very difficult to treat. Most all cases leave the horse non-weight bearing simply because the source of pain is within the weight bearing structure. Therefore, when any or all of the structures are traumatized or infected, the best thing a horse can do is to put its heel down.

Early in the syndrome, the deep digital is often weakened, and it becomes very soft and discolored. Allowing the horse to bear full weight while blocked can cause unwanted and unexpected damage to the tendon.

It is important to know that weeks of non-weight bearing often take a toll on the opposite limb. A large majority of cases will develop contra limb laminitis within 3-6 weeks if the horse is unable to bear weight on the puncture wound foot. Contra limb laminitis appears to be spontaneous as the horse suddenly begins to stand on the lame foot in an effort to unload the support leg. Unfortunately, the syndrome is well on its way before the switch and most are classic sinkers at this stage. Most of these horses are put down simply due to the lack of knowledge and experience with high scale damage laminitis.

Dr. Redden developed a multi purpose shoe in the late 1970's that is a tremendous aid for treating deep puncture wounds. This shoe mechanically unloads the DDF 100%. The tendon is often totally obliterated by the sepsis requiring surgical debridement. This shoe allows partial to full weight bearing within hours after surgery, which is a major preventive aid to contra limb laminitis.

The raised heel should put the face of the wall 80-85 degrees off the horizontal plane. Dr Redden makes 3 separate bars that he uses as step-down aides once the lesion has healed. Normally, the sole and frog cornify within 6-10 weeks. At this point the first step down is used. Other more difficult cases that have a resistant staff infection take 5-6 months to reach this stage.

The opposite foot is routinely fitted with a Redden Modified Ultimate glued on with Equilox or epoxy. This device allows favorable perfusion when fully loaded. (Note: To have optimum mechanics, the device must create a 20 degree palmar angle with the ground surface.) The capsular palmar angle can vary greatly, from -12 degrees to +20 degrees in some club feet. Just remember that the start model must be evaluated with an astute eye. The best results are obtained with a 0-2 degree palmar angle with the capsule, then raising with breakover to 20 degrees.

Five to six weeks growth will result in excessive sole growth and little or no heel growth due to the enhanced perfusion to the sole and compromised heel growth centers. It is very important to maintain advantageous palmar angles throughout the recovery period.

Dr. Redden performs all street nail procedures on the standing horse using sedation, local anesthesia, and a tourniquet for hemostases. The foot is turned and cleaned of all debris. The shoe is applied without the raised heel. The foot is blocked, tourniquet applied and followed by one surgical scrub before surgery.

The approach is quite simple when there is good working knowledge of the vital structure. A small amount of hemorrhage is present at the onset, but the tourniquet provides a bloodless field, which is essential for proper debridement.

Once the deep tissues are well debrided, the hole is packed with Betadine soaked gauze, and the hospital plate is used as a pressure plate to conceal the hemorrhage. Four to six hours after surgery, the plate is removed and a small amount of packing is removed; just enough to allow the plate to set on the shoe without pressure. Leaving it too tight, for too long, will cause unwarranted pain due to the pressure.

The heel is bolted on, using a double nut system to prevent the bolts from coming out. The heel is left on permanently and becomes quite helpful as a handle when changing the pack.

The toe plate is necessary when the palmar angle is elevated 30-40 degrees. This stabilizes the toe and prevents tipping forward when fully loaded.