A Fine Balancing Act

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Johnson is a 29-year-old gelding with a history of founder, including coffin-bone rotation, a typical slow-growing toe with rapidly growing heel and classic ’founder rings.’

Fortunately, his owner turned him around using dietary changes and regular farrier care. Johnson was insulin resistant, making him susceptible to founder. But one day, Johnson showed decreased striding in front and less moving around during the day. Over the course of a few weeks, he was back to as lame as he had ever been before, although one foot was worse than before.

X-rays showed no changes in his feet except for enlarged navicular channels. Johnson also prefered to keep his heel elevated when standing and to walk in a toe-heel pattern.

Johnson had a muscle tension and soreness in his shoulder and withers, leading some veterinarians to think the problem was high. Others were sure that his pattern of walking and standing meant he had heel pain. He didn’t react to hoof testers, however, and his hoof quality was good.

A ’navicular’ nerve block only improved him about 25%. The attending veterinarians agreed that the efforts to bring Johnson’s heels down to a normal length, which had been going on gradually for the past few months for the laminitis care, should be stopped. In fact, they wanted to raise them more.

However, another veterinarian who recommended getting his heels lower, suggesting they first try a simple experiment: Get a wedge pad from the farrier and tape it on the foot, first with the heels elevated, then turned around with the toes elevated. Sure enough, Johnson moved off more comfortably with the toe up and heel down.

Efforts got underway to bring the horse’s heels lower, starting with weekly trims. With every trim, Johnson moved better but still had obvious soreness in the foot with the most severe coffin-bone rotation.

Because his feet were like granite, they were soaked several times a day for a few days before trimmings. At the time of the fourth trim, the farrier noted a soft spot on Johnson’s sole, just in front of the frog. They had been leaving his soles alone because of the rotation of the coffin bone but, with just a little paring of that spot, it burst open and drained a large amount of old blood, which is called a ’sterile’ abscess. Johnson’s relief was immediate and he improved steadily.

It’s logical to assume that a horse that doesn’t want to put weight on his heel has heel pain, but that’s not necessarily the case. The horse may stand like this any time he wants to avoid putting full weight on the foot. For Johnson, a major source of pain was his hematoma and sole pressure from the tipped coffin bone, but he also had a pinching-type of heel pain. The combination made full weight bearing too painful for Johnson.

Although the pain was largely due to the fluid collection in his worst foot, his high heels had caused contracted heels, atrophied frogs and taken away much of the hoof’s shock-absorption capacity.