Case Study – Willow

This case study is about a 16 year old off the track thoroughbred mare. In November of 2014, she was initially diagnosed as previously foundered and acutely laminitic. Her past history is a mystery up until about 2 years ago, but research and intuition has found that she foundered in the past and has been left in that state up until November with shoes on both fronts.

For the past 2 years she was ridden in English, Western and treeless and had done reasonably well while managed with shoes in both the arena and trails. She has a history of struggling to go down hills, resistant to going out on trails, tender on rocks and as time went on she tended to stumble on her front feet more and more in just sand. A different shoe was put on that had a beveled front edge to help with that (which helps with break over), but in time that also became completely ineffective. She progressively got worse to put a saddle on and became quite cinchy with increased sensitivity to the girth area and hind gut.

Further research and examination into Willow found her to likely have ulcers and also deficient in some minerals and vitamins due to her hair quality and touchiness around her body. In other words, Willow was in bad shape and needed a lot of work.

This case study will be documenting our process and progress into rehabilitating Willow and getting her to a healthy spot to continue her life of riding. We expect a minimum of a year and likely two as we need to grow out both front hooves, twice.

To start we have some pictures of her feet, which was the first place to start. The hooves were in very bad shape with nail holes compromising the integrity of it, but more importantly she had very problematic soles and frog. Here are a few pictures from the day before having her shoes removed and a basic trim by the farrier at that time. This particular farrier was the only one to maintain these feet up until November of 2014 for the past 2 years so we didn’t have different styles of trimmers/farriers coming in to do her feet.

[responsive]Willow Front Right - front side 11/2014 [/responsive]

[responsive]Willow Front Right - right side 11/2014 [/responsive]

[responsive]Willow Front Left - front side 11/2014 [/responsive]

[responsive]Willow Front Left - right side 11/2014 [/responsive]

As you can see in the above pictures, her toes and quarters were severely flared out and her heels run under due to the front of her feet pulling them forward. The quality of the hoof at the ground was poor and gone completely in the front. This is due primarily to dragging her toes as she was walking as they were easily 2 inches too long and breakover was too far forward for her.

The frog and lateral cartilages were very weak from being shod for too long and not getting any “exercise” and as such the frog was also small and narrow/contracted due to both shoes and a fungal infection, thrush. The sole was very very thin and extremely sensitive to any rocks or bumps on the ground. Boots with pads were a requirement and at times we applied padded “slippers” for her with foam and duct tape. Boots can tend to rub if they are loose and the ones that were applied were loose on her, and as such, rubbed the back of her foot. New boots were purchased and have a far better fit.

The first 2 months were spent just trying to make her comfortable with pads and boots, aggressively treating the thrush, changing her diet and keeping track of her hoof trimming and growth. The huge laminar wedge that had built up between her coffin bone and hoof wall was pushing the hoof wall out and in turn providing no structural strength to bearing her weight. She is walking on just her sole and frog. It was most definitely painful for her and it was made worse that now she had to walk on her deteriorated and infected frog and thin sole.

After about 2 and a half months with about 5 trims to bring back her toe and reduce her quarter flares gradually, she now had a more normal looking hoof and some very good growth at the top of her foot. The thrush in the frog is almost completely eradicated at the level we can safely get to and the frog itself has become firm to the touch from the apex to about 85% back. The heels of both feet dropped nicely and come back some instead of being severely under run and overall a much better foot is finally growing in. The sole has yet to grow much and has maybe created about 2 millimeters of thickness, but that will progress much faster once the thrush has been completely removed and the hoof walls finally attach and reach the ground to help support it. This is likely a year out.

While Willow has been recovering for almost 3 months now, once she grows out a completely new hoof she will feel better than she likely has felt in years and is expected to be sound enough for average riding. Willow’s recovery road is longer due to the longer amount of time she has suffered with the ailments she had. Had her feet not been shod for the last 2 years and the laminitis been properly dealt with in the beginning, she likely would have had less time to recover and need rehabilitation. In our opinion, putting on and then keeping shoes on her made the situation worse and kept the hoof wall disconnected from the coffin bone, no matter how hard it tried to attach again. Having the hoof peripherally loaded for so long without proper pressure being applied to the sole and frog is the most likely and destructive reason her feet are so bad. Without that, there was no way for the hoof to grow more sole as it was too busy growing the laminar wedge and struggling to protect itself while the horse hung by it’s laminae, which are not meant for that at all.

Once Willow makes it to a point where she feels completely comfortable trotting and cantering in boots, she will be physically rehabilitated to bring back all of her muscles to help her support herself and her rider. In time she likely will not need the boots except for rocky trails that may bruise her sole. She isn’t expected to completely recover her soles but we’ll see how far we can get her. X-rays are likely in her near future but are dependent on budget for rehab.

[responsive]Willow Front Left - right side 01/2014 [/responsive]

[responsive]Willow Front Left - front side 01/2014 [/responsive]

[responsive]Willow Front Right - front side 01/2014 [/responsive]

[responsive]Willow Front Right - right side 01/2014 [/responsive]

As you can see in the above pictures, we are finally growing in a better wall. It’s not without it’s issues with the ripples in the middle and the lower front area on especially the right (which could indicate a damaged coffin bone and permanent damage), these hooves are well on their way to growing in better connected.

Diet Change
For her diet she immediately needed to change from getting any grain, oats, sugars etc to none. Laminitis can be caused by quite a few things, but most likely it’s diet. Almost a completely new diet was introduced of just hay with 2 pounds of our custom diet mixture per day to bring up what we suspect are low levels of minerals and vitamins and fiber. While she wasn’t underweight, she was determined to be a “hard keeper”. This particular diet didn’t do all we needed and she still seemed to be struggling with a possible ulcer. A modified diet was formulated for her to keep her on strict amounts of minerals, alfalfa, flax, magnesium and other ingredients, along with a product called Gastra FX which is very helpful for maintaining a protected stomach for the horse from the acid while it heals. The diet was formulated to encourage natural healing and provide assistance with both fore and hind gut possible complications.

Willow is still in rehab mode and while she definitely is a slower mover most of the time, at other times she’s very playful and can launch her whole body in the air. Here is a video from about 2 months in and her fronts placed in Easy Boot Glove boots. As you can see, she’s doing well in such a short time.

Update Feb 11, 2015: Willow is still slowly growing her new hooves in. The vet was out recently to check her out and found her getting along as expected. Her soles are still thin but growing slowly and she is being actively booted daily. The great news is that her thrush is mostly gone and she only gets maintenance treatment now for her frogs until the rest grows through. They have become quite hard instead of the mush that they started out with. The equivalent of squeezing a gummy bear in comparison to a hard eraser. Huge improvement. The vet also suspected she had a minor abscess last week that she was working through on her front left as she had elevated temp in the leg and hoof and some swelling in the fetlock area. All gone now though, it’s daily exercise and bi-weekly trims left for her until her hooves grow out. Slow and steady.

Update Feb 16th, 2015: Willow has started her second stage of rehab this week with longer walks in unpadded boots. Her tenderness has almost disappeared and yesterday’s trim showed great promise in growing down a new hoof. In this picture you can see where the new hoof wall is growing down and what the old is:

[responsive]Willow front left - right side[/responsive]

It should be clear but just in case, only the top inch or so is mostly connected hoof. The rest is severe flare and that’s what we have to grow out. A few more months and we’ll have a better hoof but she’ll likely need to grow one more whole hoof out. Her heels have come back up and the hoof tubules are no longer being bent completely forward almost parallel to the ground. Much better in just 3 months. This is before trimming her and what it looked like just being patient since the last trim a couple of weeks ago.

With that, to show the biggest difference in how she’s doing, here is some footage that we have from our high speed videos of her walking. The most important thing to notice here is that she is stepping heel first and mostly almost flat, no more toe stepping. When she started she was walking toe first as her frogs hurt too much to step on them and also over time they were just too weak to land first on. The toe first landings are mainly what causes stumbling and tripping and over wear of the front of the hoof, along with of course too long of a toe. By landing toe first, the tendons on the back of the leg get “snapped” into their flexed position, which can be very hard and painful for the horse and affects the navicular bone. Furthermore, landing toe first causes flare, underrun heels and flat soles with extended frogs. All bad.

Update 02/28/2015: In the last 2 weeks we have had x-rays done and continued on Willow’s rehabilitation of her front feet with trimming and boots. The results were as expected for her x-rays and there is deformation of the coffin bone which is a huge cause for her hoof shape. After seeing her x-rays it became very clear and obvious as to where she could and should be trimmed to and that was done within days of knowing. Here are her feet now:

As you can see, her quarter flares are growing out slowly and the hoof wall is steadily growing down with decent connection.

[responsive]Willow Front Left[/responsive]

[responsive]Willow Front Right[/responsive]

From the side though it becomes very easy to see exactly how much toe she should have and is missing. This is completely due to the fact that her coffin bone has been completely altered and she no longer has a “tip” to her coffin bone, it has completely deformed and been removed from the bottom to then grow on top and upwards. Resembling a ski tip, which is why her feet are so short. This is called pedal osteitis. The coffin bone being short and growing up will also inhibit her ability to grow in necessary sole to cover the bottom of her foot. Her coffin bones also have sunk down into the hoof capsule (or as it is better put: the hoof capsule has migrated up the leg), which doesn’t help at all either. In time that should resolve itself, but the coffin bone reformation is for life. It can definitely be worked with though and we have to wait for the hoof wall to grow down to the ground with good connection before any further steps can be taken.

Until then, Willow will be in boots, sometimes padded as we don’t want her to ever shave off even a millimeter of sole as she walks on harder ground. The option to put her in shoes is not there as that is what has caused her hoof wall to migrate up, which in turn put her coffin bone closer to the sole, which in turn caused the deformation of it. She would be worse off to ever put her in shoes again in our opinion.

[responsive]Willow Front Right - Right side[/responsive]

[responsive]Willow Front Left - Right side[/responsive]

Willow is only 3 and a half months in from removing her shoes and is on her way to getting sound, this takes time. The coffin bone destruction doesn’t help her, but we’re still very confident she can grow out a mostly well connected hoof wall which will get her off her soles to a more balanced level between sole, wall and frog. Her thrush has been eradicated from her frogs and she recently had a shedding of it with some nice firm frog underneath that is much better formed than the last stuff. It represents quite well what is growing inside and it looks pretty good. There is possibly a bit more to grow out from deep inside, but overall it’s good progress.

Update 03/10/2015: A big change this week as we have started Willow back in the arena. We have our resident 90 pound rehab rider on her and she managed a solid 10 to 15 times around in a walk/trot. Willow is currently in easy boots with the gator with foam padding in place to help reduce concussion while her hooves heal. Up until now she has been just on a walk schedule by lead rope around the barn and short trips in the neighborhood. We’re looking forward to a really good month of getting her moving more and really growing in those hooves by doing so. Her mood is better and her muscles a bit more limber for the effort, all good signs.

Update 03/22/2015: Willow has made it up to a canter a few times and walks easily now without boots on. She is booted and padded in her “sneakers” for rides, but goes without when not riding. Her frogs are shedding a bit more and with normal wear on her soles her body is removing false sole and old laminae like crazy. Her hoof walls are growing down nicely and at a faster pace and today was the first time in a while to trim her fronts a bit. Her quarters have yet to attach properly just yet, so they are staying unloaded through trimming. The toes were maintained back a bit and rounded off for better break over. It’s wet here so possible thrush is back and is being treated as usual. It’s imperative to remove it as she’ll go back to landing toe first without getting that pain out of the way to do so.

Update 04/07/2015: Today’s update involves how much her feet have been changing over the past few weeks and a good reminder of what they looked like 5 months ago (just scroll to the top of the page, or down below). We have had dry and then wet and now dry weather here and with a stretch of time with her boots off and going completely barefoot in the paddock area (large 30 x 50 feet), her feet have naturally shed off what she doesn’t need. It becomes much more obvious that there are changes happening and the shape of her sole is matching more what her coffin bone looks like. Here are a couple of pictures to see:

[responsive]Willow, front left with x-ray overlay 04/2015[/responsive]

[responsive]Willow, front right with x-ray overlay 04/2015[/responsive]

If this is the first time you’ve seen an x-ray of a horse’s foot then it should be important to note that Willow’s feet are NOTHING like what a horse’s foot should look like. There are many who may even just put her down due to an assessment of being completely lame with no recovery possible. To also note, the damage that her feet have endured is irreversible. The bones will never recover and her feet will be weak to the day she dies. If you’re curious to know more about x-rays and what we should be seeing, please check out our, Why get X-rays of Hooves, page.

Anyways, once you have, or if you already have, an understanding of the coffin bone and how it affects the whole hoof then it should be reasonably obvious why the sole is growing down and shaping the way it is. The best part of this though is that we can completely verify an assessment of the soles with the x-rays, it comes together. An important item to consider when looking at these pictures is that she is finally forming and shaping a toe callus. It’s odd, and not quite normal, but it’s there. It’s also important to see that the left side is much worse than the right and it is also noticeable from the bottom. The x-rays were taken a while ago, so the hoof outline in them doesn’t match the current state of her hoof walls, but it’s not too far off. Also, these pictures were pre-trim of both frog and hoof and show very well the old frog and laid over bar with heels pulled forward.

If you scroll up the page a ways it will also become obvious how her hoof is growing and why. Both hoof wall and sole reflect the shape and condition of the coffin bone and Willow is going to likely struggle for the remainder of her life. We’ll continue to work on growing down well connected hoof wall, but again it’s important to see that being well connected means that it will be oddly shaped and mirror the deformation of the coffin bone. Her frog is finally shaping and forming properly and the last of the deep thrush is finally working it’s way out.

Just for reference, this is what her sole used to look like last November:

[responsive]Willow, sole view 11/2014 after removal of shoe[/responsive]

It’s a shame that Willow has such bad pedal osteitis as she is a wonderful horse and a lot of fun to ride. Her education is quite high and she has done so well on trails that you can literally let go of the reins and just let her go loose to take you around. We’ll keep working at it though and keep this page updated. Another x-ray will be taken this year to see where we are at once the hoof walls have grown down nicely without flare in the quarters.

Update 07/05/2015: Updating Willow’s progress has been delayed as there isn’t a lot to note in the past few months. We’ve moved her to pasture to let her feet grow down faster as the paddock she was in is crushed rock. Most of the time it just shaves off what she grows, a pasture with grass and soft dirt does not wear down hooves and soles and should help her grown down what she needs and also give her the ability to walk a lot more. Walking is the primary action required to grow hooves and the pasture is full of grass so she’ll always be eating. It’s not to see we’re not out there almost everyday with “diet food”, but the constant grass going through her will only help.

On the first day of pasture there was the opportunity to really shave off the bad hoof parts that weren’t connecting at all at the bottom. She will be walking on soft ground for about 4 months and this is the time to get on with getting the peripheral pressure gone on those walls. Her frogs were cleaned up and treated one more time and then off she went, practically running all the way back in the 19 acre field. It was nice to see.

Three weeks in and it was time to look at the feet and make sure excess was removed as her feet grow down unhindered and check out the frogs to see if they have anything going on. The frogs were pretty good but look like they may shed out in a few weeks and the hooves were grow down and outwards. A simple trim of the toes and heels was needed and this is what they look like today. Once more toe grows down, the trim will bring them in a bit more and then hopefully we can let them make it almost to the ground. It’s likely she will never have hoof wall on the ground at the toe as it will just push it up and back due to the ski tip on the coffin bone. From the heels to about 3/4 up to toe on both sides it’s expected to get decent hoof wall to the ground.

[responsive]Willow front left, left side, 07/2015[/responsive]

[responsive]Willow front left, front side, 07/2015[/responsive]

[responsive]Willow front right, left side, 07/2015[/responsive]

[responsive]Willow front right, front side, 07/2015[/responsive]

Here are some comparison pictures with guides. While the focal length and angle aren’t the same between shots, it’s close and gives us an idea of the changes made. Pay most attention to how we can see that the hoof wall is finally able to grow down parallel to the coffin bone. The after pictures (always on the bottom) are showing decent connection for at least an inch, while the before pictures show almost no connection from the top all the way down. Keep in mind, this is 8 months into rehab. As you can see, we have a ways to go yet.

[responsive]Front left before and after from the front 11/2014 to 07/2015[/responsive]

[responsive]Front right before and after from the front 11/2014 to 07/2015[/responsive]

[responsive]Front right before and after from the side 11/2014 to 07/2015[/responsive]

[responsive]Front left before and after from the side 11/2014 to 07/2015[/responsive]

Overall she is doing well on pasture, her coat is nicer, she is relaxed and some riding has been accomplished in the hog fuel arena and in padded boots on the local trails.

[responsive]Willow on Pasture[/responsive]

It’s been 4 months since our last update on Willow as she took a turn for the worse and needed to be put down. After moving from one pasture to another, she encountered a few horses that were more aggressive than the last place and she didn’t make it away from one fast enough. One particular horse had shoes on and kicked her right in the back right hock splitting open the synovial fluid sac that exists between the many bones that are in the hock. This laid her up for about a month with a series of antibiotics, penicillin shots and bute as needed. The day after it happened we had the vet out to flush the joint with basic saline solution and then bandages for a couple of weeks. We did everything we could to make sure she would not get an infection in the joint.

This in turn caused her to use her front feet even more and one of them abscessed. Having to stay off that foot caused the other foot to abscess but despite that clearing up reasonably quickly, the first foot continued to get worse for a couple of weeks until it finally released out the back of the foot between the coronary band and bulb. This was all despite many soakings and care and in turn because it built up for so long and burst in a few places, half of her hoof had come off at the coronary band. Enough so to see inside. Both the abscess and then result of it was causing her a lot of pain.

While perhaps a healthy, young horse could have recovered from this with some time, Willow already had very poor foot structure and the very hard and sad decision was made not to have her struggle through the year of rehab it would require and put her down. It’s not only just sad because she was such an amazing horse, it’s very disappointing because we had come so far with her feet and she was just about to be casted for a couple of cycles before possibly being either barefoot or to continue her life with glue on plastic shoes from Easycare. Had she not been kicked in the hock and then abscessed up front she likely would be really progressing along well right now with a decent future of simple games days and light trail riding for the remainder of her life.

While sad, frustrating and disappointing, it shines a bright light on the fact that not all rehab cases end up as successes. Willow was on borrowed time and destined for a shorter life due to the state of her health when purchased, but this was too short. We all learn from our experiences and hope to do better in the future, but some things can’t be helped and you can only hold yourself accountable for so much. We take heart from the fact that she lived a good last 6 months out on a lush pasture with some good horsey buddies to hang with. The last couple of months were hard, but she did get lots of treats and lovings from some wonderful people.