A Valuable Diagnostic Aid The venogram offers tremendous insight into the status of the vascular pattern. Therefore it becomes a valuable diagnostic aid for the vet/farrier team as they seek optimum mechanical decisions. ​ View Dr. Redden's instructional slideshow below. The PowerPoint and PDF files can also be downloaded.

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.

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.

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Syllabus Dr. Redden’s Equine Podiatry Course Syllabus July 10 - 14, 2023 ​ R.F. Redden, DVM 8235 McCowans Ferry Rd Versailles, KY 40383 859-983-6690 ​ Dr. Redden’s Equine Podiatry Course Syllabus August 21-25, 2023 ​ R.F. Redden, DVM 8235 McCowans Ferry Rd Versailles, KY 40383 859-983-6690 ​ ​