International Equine Podiatry Center
Written June 2010 by Whitney Rohrer for R.F. (Ric) Redden, DVM
A twenty year old mare grazes on lush bluegrass in the horse country of Versailles, Kentucky. Despite her age, she's still spry as a fox and races around her paddock like a three year old when the mood strikes her, even kicking up her heels for good measure. She'll only allow herself to be caught if she feels like it and nickers to go out if she stays inside too long. She's not a royally bred thoroughbred, high value broodmare or a flashy retired show horse. In fact, there's not much about her that's remarkable except for one small detail. She only has three feet. (See the WKYT video of Josie in action.)
The horse known as Josie has been a longtime fixture at Dr. Ric Redden's International Equine Podiatry Center, where she has lived with a prosthetic for over 18 years. She came to Dr. Redden as a two year old filly after tangling her left rear foot in the guide wire of a telephone pole while trying to evade some aggressive dogs. The accident all but severed her foot at the pastern. Josie's owner, facing recommendations of euthanasia, took the advice of Dr. Dwight Hooten and decided to donate her to Dr. Redden's charitable organization in hopes that there might be an alternative. The alternative was an amputation procedure to remove the remaining attachment of her damaged foot at the pastern. It wasn't going to be easy, though. While her injury location made her an ideal candidate, there was another problem they would have to overcome.
"Josie was barely broken to lead when she came to me," Dr. Redden recalled, "which posed a few problems. You need a horse that is cooperative and easy to work with to get the best results, as they have to be willing to tolerate the sling for changes and trust the people who are caring for them. Fortunately it didn't take her long to learn that we were trying to help her, and when she gave us a chance she learned that life wasn't so bad. She's been great to work with ever since."
Redden had performed 6 prior amputations, but with Josie he decided a new technique he had developed had the potential to offer her a healthier, tougher stump and better quality life. "I had run into problems before where even though the stump healed with the center flap, it simply wasn't tough enough to withstand the rigors of loading," Redden explains. "I used a small piece of germinal frog tissue as an autogenous graft that I hoped would provide her with a natural, tough stump pad, and she's still here 18 years later to tell me it worked." It worked so well in fact, that Redden now uses the procedure on all of his amputee cases, with a great deal of success.
The healing period for the surgery and frog graft procedure took five months, during which Josie was fitted with a temporary prosthesis that was changed every 2-3 weeks until the stump had healed, the swelling had gone down and the transplanted frog was strong enough to support her weight. At that time she was fitted with an elaborate permanent prosthesis with a flex foot and leather top. It was constructed lightly in order to be more comfortable for her, which turned out to be a mistake. "I was hoping she would be comfortable enough to walk around, maybe trot a little," he laughs. "When I put her in the paddock and unsnapped the shank, she took off at a full gallop. She was so happy to be running again. It was one of the most rewarding moments of my life." Josie in fact ran hard enough to pulverize her prosthesis, so it was back to the drawing board. Since then Josie has worn several different designs, including more expensive models that were vacuum modeled and custom fit. Today, she wears a fairly simple clamshell prosthetic that Redden made in his own shop out of cast material, aluminum struts, a foot plate and high tech, shock absorbing silicon. It's easy to change and fairly low maintenance.
Josie's amputation has given her 18 years of life she otherwise would not have had, and she makes the most of it. In fact, she seems to enjoy herself more than the average horse. About once a week she is brought in to have the prosthetic removed, stump cleaned and bandage changed. The biggest challenge of this process is not changing the prosthetic, but bringing her in. "She'll drag you into the barn as if to say, 'Let's hurry up and get this over with, I've got things to do.' If you aren't careful she'll run right over you." And don't make the mistake of leaving the gate open behind you when you go in to get her. "If she spots it open you're in trouble. She'll rip right past you and beat you there."
It's not all fun and games, though. During Redden's teaching symposiums and Equine Podiatry 101 classes Josie provides a teaching opportunity for veterinarians and farriers around the world, who learn how to design and create a prosthesis that best meets a horse's needs and how to care for amputees. They can also see the benefits of the frog graft, which has served Josie well over the years. Her stump is tough and durable, and actually needs to be trimmed every 2-3 weeks or her prosthesis won't fit. "It's an eye opener for a lot of people who come here," Redden says, "because the mindset out there makes them expect to see an old cripple out in that paddock. When they see Josie and see how happy and low maintenance she is, their whole outlook changes. It's very rewarding."
While amputation is not widely practiced - there are only a handful of veterinarians with experience - it offers an alternative to euthanasia and can certainly result in a happy ending. The financial and mental commitment involved is significant, and requires dedicated owners and caretakers. Multiple surgeries can be involved, complications can be expected, and fitting the horse with a final prosthesis is often a trial and error process. And amputation certainly isn't always an option. "Many of my cases have been poor candidates, as the opposite foot already suffered from contra limb laminitis when they were admitted," Redden recalls. Contra limb laminitis is a big concern with any catastrophic injury. Therefore he routinely monitors the health of the blood supply on the good foot and uses high level mechanics to protect it.
According to him, the best candidates are athletic horses, such as race or performance horses, that have suffered a catastrophic injury to a hind leg. "Front legs are a bigger challenge," he explains, "especially on large horses." In addition to the logistical challenges, there are financial ones. "Some of my cases had very limited financial ceilings that did not offer the care the horse needed," Redden says. Despite these challenges, Redden has had several cases besides Josie go on to live long, happy lives. One, a Missouri Fox Trotter stallion, has worn a hind leg prosthesis for nearly 16 years after having his leg amputated just below the hock. Blackie, a walking horse, was amputated at mid-cannon on his left front leg and is still content with his prosthetic today. He even survived chronic laminitis on his other foot, which was dealt with at the time of surgery by using high level mechanics. It's not for the faint of heart, but the rewards can be terrific. Just ask Josie.
