2004 - 17th Annual Bluegrass Laminitis Symposium Notes
How To Make It Happen; Evaluation, Strategy, Planning and Execution
Written and presented January 2004 by R.F. (Ric) Redden, DVM
"Making It Happen" requires a farrier and a veterinarian to prepare themselves for the mission. Preparing for a professional career has an initial "crank up" period. Vets normally attend four years of college followed by four years of professional school. This intense period is very demanding and requires very serious discipline and dedication. Vet medicine is a much more complex field then most people understand. Simply staying current with new concepts and techniques requires constant continuing education.
Vet school prepares its graduates with a reliable means of thinking as a vet with an emphasis on small animal, food animal, equine, exotics, regulatory medicine, research and others. This base is a tremendous asset for anyone wishing to excel in any of these fields. Unfortunately, equine podiatry is not one of the areas of intense focus, so it leaves a major black hole in our profession.
One vet stated that he went to school four years and learned that the foot was a primary cause for most all leg problems. However, the professors never got around to teaching them how or why this was true nor what to do about it. Considering the intensity of the four-year program, it is no wonder there is not time to fit a single new subject into the curriculum. The best we can offer a vet student is an insight into the field of podiatry and the incentive to pursue this field after graduating.
Becoming focused on foot problems requires horsemanship skills, farrier skills, a passion for exploring the unknown and an enthusiasm for new ideas. Preparation comes with a price, and there are no shortcuts to a successful career. Vets must learn their way around a foot much the same way farriers do; on the job training. Training, shoeing and shoe making become quite easy once we have learned all we need to know about the basic formula. Understanding simple body language requires months to learn and years to develop. Without it, though, the thought process is stifled when under a horse for a routine exam.
Simply working with an accomplished farrier for several weeks is a great way for most vets to gain exposure to the basics, and develop the feel and insight required for the simplest routine exam. What we don't know is the kicker. This is where ego lives and efficiency doesn't exist.
Farriers on the other hand have a similar dilemma. The large majority of farriers throughout the United States, Canada, and most of the world (except Europe, Scandinavia and Japan) are self-taught or work as an apprentice for someone who was self taught. This is not entirely bad, but the learning curve is vertical many years and can plateau anywhere along the way depending on one's goals, appetite for challenge, business sense and dedication to the horse. Most farrier schools start at ground zero and are measured in weeks of study, not months or years. At best, there is nothing more than a quick glance at farrier science.
Clients have little knowledge about the foot as well. They are holding the shank waiting for their vet and farrier to get their horse's foot fixed with no clue of the education, experience or skill of either professional. Yes, one or both of them may have a great reputation in their respective profession, but how does this prepare them for the mission at hand? Extrapolating one's expertise from surgery, medicine, reproduction, small animal, etc. and applying it to the foot of the horse is high risk at best.
Shoeing and trimming top athletes for 10-15 years certainly doesn't teach the discipline of podiatry either. Unfortunately, many times neither party has a grasp on the subject. Therefore, controversy grows, there is gross miscommunication, and one profession begins to blame the other. This dilemma will only get worst if we fail to recognize the seat of the problem.
Education and training in the field of equine podiatry is the answer. From this point on, we must concentrate on how we can all become more knowledgeable and effective in the field of podiatry.
Let's examine the foot, and for a moment leave the hoof testers and the Carbocaine in the truck. Simply look at each foot from all angles, noticing the body posture and conformation, as well as what the horse is telling you about how he feels about the exam. The message he gives about what is wrong with his feet is loud and clear. Each foot will give you either subtle or strong messages concerning the unhealthy areas.
Compare foot-to-foot, front to back. Mentally split the foot, front to back and medial to lateral. Check all the normal healthy areas, remember them, and then remember the areas of concern. Don't jump to any conclusions at this point, even if you are convinced the horse has an abscess or whatever. Listen to the complaint and then the history. Try to keep it brief by asking only important questions. Most owners and trainers will not be aware of what is important and will carry you through the whole morning bending your ear.
Pull the shoe if necessary or indicated. If it hides pathology grossly or radiographically, it should be removed. Always ask permission to remove a shoe, and be careful if the foot has marginal quality. You goal is to leave the foot in better shape than you found it. I also like to ask if there are any financial restraints before I begin, even if the owner pulls up in a Mercedes. This makes a tremendous difference - Note: financial restraints seriously handicap your exam, so point this out and put it in writing when you make your conclusions. Don't be suckered into doing a $500 exam for $100 with everyone expecting the same quality answers. It doesn't happen.
Pulling shoes from a hunter is a bit different than pulling the shoes from a world champion walking horse. Therefore, veterinarians may want to have the regular farrier present during an exam to pull the shoes. In addition, information concerning the unique characteristics of the foot can be very valuable. Farriers, it is best for you to have the vet present when you pull the shoes, as many feet will be a wreck if left unshod for hours to days. This all-important meeting is a tough one. This meeting will only be successful if there is a strong desire to solve the problem.
We must leave the "what is convenient for me" out of the equation and start thinking outside the box. How can we make it happen? We can only be successful if we approach exams like the last vet and farrier did; together. Quick, down and dirty talk is what drives the market, but it doesn't make it happen!
Think of all the foot exams as routine and you will miss the majority of them. All are unique, and most all problems are relative to the overall health of the foot. Therefore, the basis of my exam is to look for all the healthy areas. What is left over is what you want to further explore, as that is where the problem lies. Seldom do we find simple primary diagnoses with the foot. Most every problem is multi-faceted, and each area involved must be dealt with mechanically or surgically. My goal for any and all foot problems is to simply enhance the healing environment. Mother Nature does the rest!
The secrets of my thinking process begin with foot reading. A few points of interest:
Mismatching hoof angles means one foot is a club foot. Which one is it?Mismatching heel-tubules angles means one is a club heel and one is a slam dunk heel. How well you understand this determines where you go from here.Always relate to the strong image of the foot with healthy soft tissue parameters. You can only learn this range from studying radiographic information on several hundred feet of horses of different breeds, age and use. This is part of the learning curve.
Most vets can spend 10 years studying feet. You must be focused on every foot you examine and add this information to your data base each day. How much sole does your horse have? 5-10mm or 15-20 mm? Most all farriers know if the sole is thin, thick or okay. None can say with accuracy just how thick it is or how thin it is, nor can they describe with consistent accuracy the palmar angle without the benefit of radiographs. Therefore, to make it happen, the first step is to recognize the characteristics of the start model.
Simply recognizing the fact that if the soft tissue message is a major part of the information, we need to consistently gather data and film from the examination. This means we need to develop a meaningful, consistent protocol for gathering information. When we achieve this, we begin to see all feet in the same fashion, and the data banks of what is healthy and what is pathology becomes more clear.
Opening up a foot or pulling a handful of film from the processor with Forrest Gump philosophy will not make it happen. Fresh out of school, I surely felt that x-rays were like a box of chocolates; I never knew what I was going to find. This thought process severely limits our ability to think outside the box. I soon realized if I continued performing any lameness exams in the same fashion, I would expect to get the same results.
I needed to know more, so I developed a disciplined radiographic protocol that allowed me to see every foot in exactly the same plane. I developed over 40 different positions that now allow me to meet the goals of the client, the financial restraints, the history and what I find clinically. I seldom use diagnostic blocking to determine what part of the foot is painful because I can perform a much more accurate assessment by looking at the areas that are no longer healthy. This is where pathology reigns; excluding puncture wounds and fractures. All other soft tissue problems that make up foot lameness can be easily read, and my radiographs serve as a confirmation of my findings.
I hope I can show you how easy it is to focus on the areas that are glaring at you, and how to use the soft tissue parameters to Make It Happen!