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    • Limb Deformities in the Foal

      Written and presented July 2006 by R.F. (Ric) Redden, DVM Introduction Limb deformities are commonly found in new foals. They can be congenital or developmental and with varying degrees of deformity ranging from mild to severe. The majority of deformations will fall into one of five basic categories. 1. Angular - Angular deformities occur when the distal extremities of the limb deviate from the midline of the limb. Valgus deformity is a deviation lateral of the mid line. Varus deformity is a deviation medial of the mid line. 2. Axial - Axial deformities can be described as a medial or lateral shift at the anterior articulation, e.g. offset knees. 3. Rotational - Rotational deformities are muscular in origin and most commonly involve the front limbs. The limb itself may have acceptable alignment, but rotates outward due to muscle attachment variation. At first glance, these foals appear to have a valgus fetlock. 4. Spiral - Spiral deformity involves the metacarpal in the majority of cases but can also involve the metatarsus. At first glance the spiral deformity resembles toed-in conformation. The author refers to this deformity as heeled-out, as the pure spiral does not have a varus fetlock. 5. Flexor Anomalies - Flexor contraction and weak flexors are often found at birth. How to Assess Foot Flight and Leg Alignment Start by watching the foal walk straight away from you, preferably on a smooth surface. Walking the mare along a wall or fence offers a reasonable means of assessing the foal as he travels beside the mare. Focus on foot flight and the landing phase. Watch the hind feet land several times before focusing on the front feet as the foal moves away from you. Foot placement and full load stance appears to occur faster than the eye can detect, but with practice the landing phase can be observed in a slow motion mode. Closely observing the air space under the foot as it lands and loads acts to slow the action and brings out subtle details that might otherwise be overlooked. Next, observe the foot flight and landing pattern of the front feet as the foal comes back toward you. Watch the lateral wall of each front foot land, then observe the medial wall. Note any differences between the two feet. Turn the foal and watch him go away from you once again. This time observe the hind limbs, one at a time, from the hip to the ground as the limb flexes and extends to full length. Placing an imaginary dot at each major joint creates a reliable means of evaluating the angulation. Once both hind limbs are observed focus on the front limbs, paying particular attention to the carpass and the heel of each front foot. The heeled-out foal (spiral deformity) and bowed knee (varus carpass) becomes readily detectable by the trained eye as the foal moves away from you. As the foal walks back to you observe only the front limbs, one at a time, from the shoulder to the foot. Once again, place imaginary dots at each joint. Connect the imaginary lines between the dots as the limb flexes and extends, and as the foot lands. Foals that aren't broken to lead well are more difficult to observe, but with practice the eye can be trained to follow the dot system even at a trot. Once the foal has been evaluated while moving, observe him standing as squarely as possible and in a relaxed position. Assign imaginary dots in the following 7 places: 1st dot: Most proximal point on the forearm. A small swirl of hair is normally located at the top and center line of the radius. 2nd dot: Center of the distal radius at the level of the physeal plate. 3rd dot: Center of the most distal aspect of the carpass. 4th dot: Center of the proximal cannon. Note this dot will be superimposed over dot 3 unless axial deformity (offset knees) is present. 5th dot: Center of fetlock. 6th dot: Center of coronary band. 7th dot: Center of toe. As the dots are observed, visualize an imaginary line between them and note any deviations of those lines. Next, imagine an imaginary laser or arrow centered on each dot, passing through it on the sagittal plane of the limb at that point. Observing these imaginary lines is a reliable, consistent method for identifying planes of deviation that can and often do occur between major joints. Using the dot system helps train the eye to look for minute details that may otherwise be missed in addition to greatly enhancing communication between those observing the foal. Each type of deformity can be graded on a scale of 5: 1. Noticeable to the trained eye. 2. Noticeable to the experienced horseman. 3. Noticeable to the inexperienced horseman. 4. Noticeable to anyone. 5. Off the scale - catastrophic class deformity. Any given individual may have several types of deformities in any one limb. Developing this system and using it in a disciplined, methodical fashion offers a reliable means of assessing foot flight and leg alignment. Identifying the real problem is a vital step for an efficient treatment protocol. Valgus Deformities Treatment Options 1. Stall Rest - Newborns with less than 15 degrees of deviation often respond in a favorable fashion with a few days of stall rest. Various degrees of valgus conformation appear to be a natural finding with most all species that have a long front limb relative to neck length. 2. Medial Extensions - Those that fail to respond sufficiently with confinement can be improved by applying a medial extension to the foot of the affected limb. Several products can be found on today's market that offer quick, easy temporary medial extensions. 3. Self Correction - Valgus deformity appears to be self-correcting, as the large majority of valgus foals will steadily improve until they reach full growth. Unfortunately, today's market for young performance stock and a lack of patience has changed the scope of raising young horses, routinely speeding up the corrective mechanics as a result. Low grade valgus deformities can be seen in mature, very successful race horses and may simply be a variation of normal. 4. Surgical Correction - Periosteal elevation and physeal bridging are also means of surgically aiding correction with non-responsive or greater than 15 degree deviations. 5. Therapeutic Trimming - Therapeutic trimming requires caution. Lowering the lateral side of the hoof in young foals in an effort to bring the toe to center can be detrimental, as it can cause permanent deformation of the fetlock joint and hoof capsule. Varus Deformity Varus deformation most often occurs at the fetlock. When it occurs at the carpass it is referred to as bowed knees. Thirty years ago valgus deformities far outnumbered varus deformities, but the opposite is true today. A correlation may exist between incidence and growth rate. Early muscle development and heavy body mass may play a role in the increased incidences found in most breeds today. Treatment Options for Varus Fetlock Surgery - Periosteal elevation over the medial and distal MCIII physis can be an effective treatment when performed within the first three weeks of age. Caution: Surgery at one week of age can result in overcorrection. Overcorrection creates a valgus fetlock, which is an extremely rare deformity. The lateral anterior surface of this fetlock joint is proximal to the medial side. Thoroughbred foals that are born with linear long bone alignment are often referred to as straight-legged foals and may be perceived as normal. Unfortunately, in absence of the natural valgus stance, many will develop varus fetlocks within weeks. To prevent this unsightly and costly deformity, periosteal elevation is performed at 1 week of age. The results can offer cosmetic approval on sale yearlings as they appear acceptable when standing, but have a very strange foot flight pattern as the fetlock flexes in an abnormal plane. Further studies need to be conducted to fully evaluate how the valgus fetlock affects racing soundness. Therapeutic Shoeing - Applying a lateral extension with slight lift can be very effective. The developmental stage of the distal MCIII physis closes very early. Although physiologically closed in 90 days, the most effective window of response is during the first 30 days. Trying to correct varus fetlocks once the foal has reached 3-4 months of age is futile. Unlike a valgus carpass, which remains responsive for many months, the fetlocks mature very quickly. Therefore when observing a foal with a valgus carpass and varus fetlock, the initial focus should be on the fetlock. Once past the stage of responsiveness, focus on the carpass. Note that overzealous trimming (lowering the medial wall) does not appear to have the detrimental side effects found with overcorrective trimming in valgus foals. Therapeutic Trimming - Lowering the medial side of the foot can offer desirable results with low grade varus deformities. Deciding whether to lower the toe, heel or both is the decision of the farrier based on his experience with corrective trimming. Correction should be put on the untrimmed foot. Trimming the foot on a young foal, then applying correction can be detrimental to the development of the foot and often causes post trim lameness. Note that the varus foal will often have a medial sheared heel with a similar appearance to the valgus foal. More studies are needed to better understand the etiology of the sheared heel. Axial Deformity When the cannon bone (MCIII) is displaced lateral to the carpass the deformity is referred to as offset knees. This deformity is not desirable for speed horses and should be distinguished from the canted knee that is often described as offset. The canted knee sits squarely on the proximal cannon. Using the imaginary dot system, the dot at the center of the base of the carpass will be superimposed over the dot at the top of the cannon. The dot at the top of the carpass (center physis), however, will not be in a linear line with the lower dots (see diagram). This line down the radius will be perpendicular to the ground surface but medial to the peripheral lines along the cannon bone. Axial deformity is often referred to as offset, and therefore not considered undesirable. Use of the dot system will clearly distinguish it from the offset knee. Many top race horses have canted knees that apparently cause no threat to soundness. Therefore the deformity may simply be a variation of normal. The dot at the top of the cannon will be lateral to the dot at the bottom of the carpass. When both offset and canted, the cumulative effect of the deformity is very noticeable and undesirable as it leads to unsoundness. Treatment Options No treatment exists at this time. Spiral Deformity Spiral deformities appear to toe in. In pure spirals the fetlock has normal alignment, therefore it is not a varus or toed-in deformity, and is best referred to as heeled-out. This deformity creates a twist or inward spiral involving the metacarpass (MCIII), which may be located from just below the carpass to the fetlock. Looking closely at the foot, you will find it is quite symmetrical relative to the degree of deformity, which indicates that the foot is loaded in a natural fashion. Varus and valgus defects will shift hoof mass medially or laterally depending on the area of excessive load, and will most often have a medial sheared heel. Defining the Deformity Holding the cannon bone in your hand and flexing the foot via a finger centered on the pastern can help distinguish a spiral from a varus fetlock. A center point between the bulbs of the heel will remain flexed in line with the pastern as the fetlock is flexed. The foot and pastern flex medial to the cannon bone when the fetlock is varus. Watching the spiral horse walking away clearly reveals the lateral heel. Normally the heel of the front foot cannot be easily observed as the foal walks straight away from you. Identifying the spiral at an early age is difficult, as the fetlock is a very smooth, round joint with no center point of reference. The finger test is a reliable means of distinguishing the young foal spiral from the varus fetlock. Observing the arrows through the dots helps distinguish the spiral from the varus fetlock. An arrow through the center of the top of the cannon will be in a plane lateral to the plane of arrows through the center of the fetlock. The pure varus fetlock will produce arrows in the same plane. Treatment Options There is no known effective means of correcting the spiral in the long bone. A surgical osteotomy would be an effective treatment if the outcome outweighed the disadvantages. Failure to identify the spiral and trimming the foot as though it were a varus deformity will quickly create an imbalanced foot that becomes a permanent disfigurement and leads to unwarranted foot problems. Cosmetic shoeing can camouflage this deformity and is a common practice with sale yearlings. However, artificially moving the center of the toe more lateral improves the front conformation view, but does not alter the heeled out aspect of the deformity. Rotational Deformity Rotational deformities are often called toe-out as the toe deviates lateral to the mid line. With pure rotational deformities the limb alignment will fall within acceptable conformation standards but the entire limb, including the scapula, is attached to the thoracic cavity in a plane that deviates lateral to the sagittal plane of the animal. Due to the plane at which the limb is attached to the body, the lateral side of the foot is closer to the ground as the limb approaches the landing phase. The more severe the deformity, the longer the time frame from touch down of the lateral side of the foot to full stance phase as the medial side lands and loads. It is the medial side of the foot that incurs a large majority of load once the foot is fully loaded instead of the lateral that lands first, thus setting the stage for excessive internal trauma that often results in sheared medial heels, crushed digital cushion and quarter cracks involving the medial heel. Quarter cracks are rarely found involving the lateral quarter of breeds with a tendency to have some degree of rotational deformity. When present they are the result of direct trauma to the lateral side of the foot or coronary band and usually connected to an injury when found. Standing off to one side of the foal's center line, look at the face of the knee, fetlock and toe and use the imaginary arrows passed through each dot. Pure rotational deformity exists when the arrows are on the same plane but lateral to the sagittal plane of the foal's spine. This system helps rule out the often misdiagnosed valgus fetlock, a very rare deformity that only occurs as the result of injury or periosteal elevation of the medial distal physis of MCIII at a very young age. To convince others who have trouble seeing the deformity, sedate the foal, stand him up as squarely as possible and slowly pull the elbow away from the chest. Pulling the elbow away from the chest will align the limb along the saggital plane of the animal. This is an easy way to evaluate the degree of self-correction that can occur with the same amount of chest development. Treatment Options Correction is self-adjusting in most breeds other than the quarter horse. As the chest develops the increased thoracic mass pushes the elbows outward, rotating the limb toward the mid line. Colts develop their chest muscles at an earlier date than fillies, and often correct this deformity by 12-18 months of age. Discretion should occur with corrective trimming. Lowering the lateral wall to achieve flat or uniform landing should not be attempted with this deformity, as it grossly distorts the hoof capsule, adversely alters the physeal plates of the fetlock joint and has no influence on the developing chest and limb attachment. Flexor Contraction New born foals with deep digital flexor contraction involving only the last digit are the most common and fortunately the easiest to treat. These foals will be on their toes at birth. The palmar surface of the foot may form a 30 degree to 45 degree angle with the ground surface. Treatment Options 1. Tetraglycine given at a dose of 2-3 grams IV, preferably diluted in saline can be very effective with results evident within hours of administration. Two to 3 grams of tetraglycine can be repeated every other day if indicated. Very young foals seem to be more responsive to this treatment than older, more mature ones. Caution is due with tetraglycine. Adverse effects can cause sudden death while administering tetraglycine to foals. Despite very low risk, the client should be informed and consent to treat the foal prior to administering the drug. Time is of the essence to obtain best results. The stronger the foal becomes, the more difficult flexor contraction is to correct. 2. Bandaging the lower limb with a firm combine cotton bandage from the carpus to the ground can produce favorable results for foals with mild flexor contractions. 3. Passive extension stretching in conjunction with bandages is also very helpful with milder cases. 4. Air splints have been advocated as a means to relax the flexor group. 5. PVC Splints can offer favorable results with most flexor contractions. The author prefers to use custom molded, thin wall PVC down the posterior side of the limb as a means to quickly weaken the flexor group. The foal is sedated and bandaged from the elbow to the ground surface with firm-fitted combine cotton. Use an amount adequate to protect the sensitive skin. Cut a 36 inch piece of thin wall PVC pipe down each side. Fit one half of the pipe down the back of the limb, 2-3 inches below the elbow and an inch above the ground surface. Using a heat gun, warm the top until the PVC becomes soft. Wear gloves, as it will be very hot. Quickly trim the corners with a pair of scissors and fit the top of the half pipe to the back of the forearm. Hold in place until it has cooled. Heat the area of the pipe that will fit over the back of the carpass in the same fashion, allowing it to cool in place. This step is very important. The custom fit over the forearm and carpass prevents unwarranted pressure sores and tell-tale white hairs. Heat a small area at the fetlock and cut a small pie-shaped wedge out of each side. This allows the lower pieces to flex, fitting closer to the shape of the pastern. Vet wrap the pipe to the bandaged limb, then secure it with a roll of 4 inch Elasticon. Foals only a few hours old will normally respond quite favorably within 4-6 hours. One or two week old foals will require 12-24 hours in the splinting. Two to three days may be required for foals 2-3 weeks of age. Often, foals born contracted develop a mid to high grade club foot later in life. This bandaging technique can offer favorable results to club-footed foals of 3-4 months of age, as well as grade 3 club feet in weanlings. When treating club feet and older foals that may require a few days in the splint, it is best to apply a glue-on Dalric® raised heel shoe or a full rocker aluminum attached with Equilox® before splinting. The shoe will protect the toe - as foals will drag the toe while the splint is on - and releases tension on the DDF. Note: the author finds best results are achieved by leaving the splint on the leg long enough to create hyperextension of the carpass. Caution is due. Hand walk or restrict the foal to stall rest until the carpass is once again in its normal position. Do not turn foals out with hyper extension of the carpass. Often foals respond quite well with one treatment, but occasionally the robust, fast growing individuals will go upright and show mild signs of contraction as a result of sporadic growth spurts. Repeat the process as often as needed to control the affects of contraction. 6. Toe extensor shoes have been advocated and used to stretch the DDF network. Caution is needed, as the hoof capsule, coffin bone and laminae are very immature and are easily damaged by excessive pressure. It is quite easy to permanently damage the apex of PIII, create a dished hoof, or in extreme cases, slough the entire capsule due to excessive tearing of the laminae. Conclusion Accurately assessing angular deformities requires keen observation. Using the imaginary dot system offers a reliable means of training the eye for the minute, characteristic differences that make each limb on each individual a unique study. This methodical approach also offers a means to become more familiar with the range of norm that is influenced by breed, age, use and environment. Many foals have multi-facet deformities, some being compatible with future soundness, others not. Undesirable characteristics need to be distinguished from potential soundness risk deformities, and when attempting to correct foals we must keep first and foremost in mind what is best for the future of the animal.

    • How to Better Understand What We We See

      2017 Equine Podiatry Notes Written and presented August 2017 by R.F. (Ric) Redden, DVM Our eyes simply transfer images to the threshold of our brain as only a glimpse of what was actually before us. How we transfer that imprint to deeper thoughts and meaningful perception is unique to each of us at any given time. No one can actually view the world through another's eye therefore our perspective and perception will never be identical to that of others.  However, to enhance communication we must strive to bridge this gap and search for realistic ways to train the eye and process what we see in a communicative fashion so that once we can clearly see the forest we can then start to see the trees the limbs leaves and smallest acorn. Understanding what we see is obtained through years of searching the finest details we can possibly imagine using a disciplined, methodical training protocol. Repetitious exercises that are well tuned and designed to consistently eliminate eye error are required for most everything we excel in. How to view feet in order to learn the secret message 1. Start with only 2 planes and focus your primary vision on an imaginary laser passing through the sagittal plane of the foot and the transverse plane at a level that is centered midway between the ground and coronary band. This perspective requires photos taken along these planes as it is not practical or possible to view this plane with the eye. Objects viewed through a lens are identical to what the camera sees not what the person taking the photos think they see. We have all been there and viewed our distorted photos. It is very important that we practice taking these precise repeatable views in order to process this image over and over, so we start to all see the same level of detail even when viewing the foot from others perspective views. Also, be sure to put all direct light behind you to prevent blackout photos. 2. Once we have captured the most represented perspective of the foot we can further our image /brain transfer by putting what we see on paper. My students often say, "I can't draw" my answer that's because you are only looking instead of seeing. Our pen or pencil will follow the command of our brain as it traces the image that we have perceived. This may be a bit awkward for a spell but improves quickly once the real image gets further across the processing threshold that is considerably different than just seeing. 3. Develop a systemic approach to sketching what you see perfecting it as your eye hand coordination improves. To do this we must let our eye see specific areas of the foot in a systematic fashion, e.g. dorsal face, coronary band, ground surface, heel and bulbs and pastern plane and alignment relative to the planes of the foot. Repeat the sequence with every foot you observe from the smallest details from this day forth and soon your eye starts to transfer very small details to your brain that before never crossed that line. 4. Break the foot profile down into smaller zones, starting with half then quarter, 1/8 etc.  Just like a zoom view and study what you see, consider the options, healthy areas, pathological or just different from the last feet studied as well as the text book model. Practice drawing with various sized grid patterns overlays. Feet are just as unique as faces on people or finger prints. Stop and think, do we consider faces pathological or unhealthy simply because they are uniquely different? Of course, not and we must become aware of the healthy unique characteristics of feet and learn to identify the borderline between unhealthy areas and remarkable pathology. Equine podiatry is as much about farrier knowledge and experience as it is veterinary medicine and the responsibility to the overall health and maintenance falls equally to the respective professions. Sounds simple and straight forward however the efficiency of the collaborative efforts is dependent on the mutual level of knowledge and skills of each professional as they collaborate on podiatry issues. Developing an eye for detailed characteristics is the first step in our pursuit to better understand podiatry principals and is essential for collaborating professional to communicate goals, options and monitor response. 5.  External characteristics of greatest interest Hoof profile, the angles and planes that can involve the wall surface from coronary band to the ground contact can change every few centimeters and each alteration is there for a reason and considerably different than text book models. Growth ring patterns toe to heel, medial to lateral describes the history that is a direct influence of the nutrient supply to the tubular and solar papillae. This in turn is directly influenced by the forces within the foot giving meaning to the word mechanics. Genetics plays a major role in the basic stereotype of feet however other variables also come into play.  Age, breed, use, nutrition, management, injury and disease all deserve great respect. Therefore, the tremendous need for us to continuously tune our eye for subtle little clues that can be of greatest value to our discovery exercise should never end. Recognizing the collaborating professional’s knowledge and skill level for the issue goes a long way to avoid misgivings, poor communication and even poorer results. This can often be confirmed with basic but relatively accurate sketches drawn by each professional that clearly describe what each sees and understands. This common thread is vital to assure success. Our keen observation is one of our greatest assets. It is one thing to see an object and quite another to understand the many very small details that hold the key to the information we seek.  It is not only our eyes that transfer information to our grey matter, but the summation of our other senses certainly compliments what we see and understand.  Experienced hands that have had hundreds even thousands of feet pass over the many prop receptors located in the finger tips and palms develop a memory for details that otherwise simply cannot compare.  This natural body memory can only be obtained with years of full time farrier experience. We all are creatures of habit and repetition is our go-to learning tool. Experience can be our greatest asset, especially if we are constantly fine tuning our senses for the smallest details.  Nothing hurts us more than a bad experience as it can wreck our confidence level and if we can’t quickly recognize the major flaws and source of our failures it can be tough to give it another try. I often hear, “I did it just like you said, and it didn’t work.”  This failure is multifaceted.  I may not have transmitted the info properly relative to the frequency of the receiver and taken for granted we were on the same page from the start.  It has always fascinated me to dissect what several different listeners think they heard or viewed and compare it to how they reveal what they really understand.  The receiver often says I didn’t think you really meant for me to do it exactly like your drawing as it seemed too simple to hold fine details. This is the point of this session:  to understand what we see, process the information by breaking it down into smaller, simpler components, and begin to make logical sense. Skill development follows keen observation, and both require a lifetime to reach full potential. The more we see, the better our skills for interpretation, planning the work and then working the plan. To start training the eye, I like to see an imaginary plumb line reference for most all external features.  We all have developed an eye for plumb since we were toddlers, as structural strength requires load to be plumb, Consequently, we do not throw this natural insight away when hanging pictures, posters etc. It is the norm, so let’s use it when observing the foot.  To simplify our perception of how the external shape relates to plumb, we need to view it in its purest form, which is perpendicular to the vertical and horizontal plane. Photos taken in this ideal plane are much easier to observe and thus eliminates image distortion that is produced by the bird’s eye view.  Once the eye is trained to repeatedly detect the various angles and unique characteristics in a disciplined methodical manner, the bird’s eye observation can quickly adjust the view from what has been previously learned, programed and second nature. Develop a visual system and consistently use it every single time you observe a foot without exception. I personally start by observing the toe angle.   Visualizing plumb and 45 degrees is quite simple as it falls half way between. Divide the upper 45 again included with the lower 45, which will equal 67.5 degrees, and you have an angle that mimics a lot of very upright feet and/or a higher-grade club foot. Now to visualize a relatively healthy toe angle hoof angle of 56 degrees, you are adding 22.5 degrees to the original 45 degrees, which is what you see in a healthy, robust foot. Another way to quickly determine the approximant toe angle is to visualize plumb and add or subtract 5 to 10 degrees relative to which side of the 45-degree imaginary line the angle falls.  As you observe the toe profile as well as the negative space around it you may find several planes to draw your line of reference.  Taking this into consideration, remember each strikingly different plane is there for a reason and influenced by the mechanical forces and their direct influence on the vascular supply to the horn growth centers.  This begins the thought process of better understanding the model.

    • When and Why (or Why Not) to Use Toe Extensions

      Written November 2018 by R.F. (Ric) Redden, DVM Toe extensions with a slightly rolled toe work mechanically in two basic ways.  The most beneficial is to prevent the horse from dragging the foot when unable to extend the coffin joint due to a traumatically severed extensor tendon.  The toe simply cannot be extended in absence of the function of the extensor tendon.  This is a very common injury as this tendon lies along the face of the cannon bone and just under the skin leaving it vulnerable to serious injury. The other function is to use it as a lever to force the heel down via the weight of the horse when there is an air space under the heel when fully loaded. This can be a useful tool but demands great respect and a thorough understanding of the circumstances that can prevent the heel from touching the ground in absence of a painful response. Injury to the muscle belly and or deep flexor tendon that can cause temporary shortening of the flexor apparatus. Easy stretching in small increments can offer beneficial results as healing occurs.The club foot is often thought of as a candidate for a toe extension but it can be contraindicated with grades 2 through 4 Redden categorized club feet. (4 basic grades of 1 to 4) (Image courtesy of Sebastian Duran) This diagram reveals the fragile and vulnerable nature of the blood supply in the toe area.  Extending and or lowering the heel on club feet greatly increases the mechanical load on the soft tissue and apex of the coffin bone and that can be counterproductive. Grade 1 being only 5 degrees and a naturally steeper toe angle than the opposite foot. A small toe extension can produce favorable results with a grade 1 provided the sole depth remains adequate, growth rings uniform, and the heel rests on the ground when the foot is placed slightly behind the opposite foot. Grade 2 has more heel growth than toe.  Note the wider heel growth rings.  The palmar angle (PA) will be larger and the bone angle may also be larger than the other foot.  When the excess heel is trimmed off, the heel can no longer touch the ground therefore this age-old concept becomes contraindicated as it is increasing the very force that caused the club. We know with great certainty that the seat of the contraction syndrome lies in the synapsis of the muscle fibers, creating continuous firing of the signal shortening the muscle length and subsequently the muscle tendon unit.  Attempting to counter this force with a toe extension could offer favorable results provided that the hoof capsule, laminae, and solar corium are durable enough to absorb the remarkable increased tension.  Unfortunately, this is not the case as the foot inside and out remodels very quickly due to the increased force applied by the toe extension lever.  The sole gets thinner, the hoof develops a dish simply bending due to the pull of the DDFT, the apex rapidly develops a lip appearance and then starts to resorb as the tension remains constant. Grade 3 has a dish and all the above ill effects and is most often the product of trying to stretch the tendon at the cost of the foot. Removing the dish with a rasp along with the excessive heel adds fuel to the fire and soon the potential for athletic soundness is in jeopardy. Grade 4 the heel is almost as high as the coronary band at the toe, most  proximal dorsal wall is 80 to 90 degrees and the PA can be as high as 30 to 40 degrees.   This is the upper range of the club syndrome.  The mismatched syndrome is apparently a manifestation of the club syndrome ranging from grades 1-4. Points of interest There are common alterations that  occur respective of each grade that can be routinely identified in the high foot, the opposite, and the hind foot that follows the steeper foot in front.  The rocker concept is an option that can accelerate sole grow, increase the dorsal horn grow rate and suppress heel growth especially when employed the first few weeks of life. For those wanting to use toe extensions for foals, think about the forces at play that are responsible for the club foot.  Would it not be better to reduce the tension on the DDFT and  bypass the ill effects of thinning the sole, slowing the growth, creating a dish and increasing heel growth?  One can reduce the tension responsible for the club foot by using the properly applied rocker concept to accelerates sole and toe growth, reduce heel growth and prevent the dish from forming.  The mature horse with a Grade 2 or 3 can respond very nicely with the same concept that is used to manage it in the young horse and remain competitive in the rocker shoe.

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      Equine Podiatry Products & Knowledge Shop Now The Redden International Consultation Service Starting at $250 Learn More The Redden International Consultation Service Starting at $250 Learn More We have partnered with Vets First Choice and now offer an Online Pharmacy to bring you even more quality products. Browse the extensive selection and get free shipping on most orders over $49. NANRIC is Your Source for Dr. Redden's Equine Podiatry Products & Courses. Our product line includes NANRIC Ultimates, Advance Cushion Support, Aluminum Rail & Full Rocker Shoes and Inserts, Steel Full Rocker Shoes, Dalric Glue-On Shoes, Rocker Cuffs, Biotin 100, Specialty Tools and X-ray Items. Subscribe to NANRIC Join our newsletter to receive blog and video updates, special offers, and events notifications. Join Thanks for submitting!

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      Courses Dr. Redden's Equine Podiatry Courses Dr. Redden's 5 Day Equine Podiatry Courses are held at his clinic (8235 McCowans Ferry Rd, Versailles, KY 40383) shown above. The week includes 3 days of lecture with some afternoon hands on sessions (Mon-Wed) followed by 2 full days of hands on work sessions (Thur-Fri). The courses provide an invaluable opportunity for vets and farriers to focus on podiatry and work together as a team. Below are our upcoming course dates. ​ COVID-19 Update After careful consideration and watching events unfold as a result of COVID-19, we cancelled both podiatry courses for 2020. The safety of our students and our own is foremost in making this decision. We will continue to review our options and have 2 courses scheduled for 2021. Courses Dates Jul 26-30, 2021 Sep 6-10, 2021 ​ Subscribe to NANRIC Join our newsletter to receive events notifications, video and blog updates, and special offers. 26 Mon Jul Dr. Redden's Equine Podiatry Course (Jul 26-30, 2021) / R.F. Redden, DVM Learn More 06 Mon Sep Dr. Redden's Equine Podiatry Course (Sept 6-10, 2021) / R.F. Redden, DVM Learn More Syllabus Click here for the course syllabus CE Click here to view CE information. Accommodations Click here to see local accommodations. Payments Click here for payment information. Join Thanks for submitting! Our Previous Courses

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