Forgot to come back and post the radiographs!
And for reference where this hoof was in Feb 2020:
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Wow, big difference. Glad that youāre seeing improvement.
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Setting up another check in with the vet. Since we are doing spring vaccines/ Coggins/ teeth soon anyway for the youngin (well both but the younger one is the one that needs them on a deadline) I figured we could get more radiographs to check balance and sole depth. Iām likely a little paranoid about the sole depth but better to catch it early than not at all or too late. Hopefully they will be out in the next week or two.
I feel like her progress with her balance has backslid or stalled a bit. Iām not sure if itās just the āoldā (pre surgery) hoof growing out that is distorting my perception or if it is actually looking worse. I am trying to focus on getting the ends of her heels further under her as she has good heel length/ decent height but it is so far forward the back half of her hoof/ leg isnāt supported as it should be. We did all have COVID just a week or so ago for 2 weeks and I was doing more basic care which didnāt include her EquiVibe or PEMF or anything like that. Weāre back into routine now though, and will start to add in slow/ short hacks once itās warmer.
She looks to me like she needs her toe brought back, I think the heels will naturally follow. Iād focus on trying to get the toe back more. But, Iām not a farrier.
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Agree, toes back and start removing overgrown bars. You need to encourage āmechanismā in hoof as crooked coronet band shows.
Good Job, so far.
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I still see improvement - it takes a long time ā and I mean a long time ā to fix feet as bad as the original pictures you showed. For example one of mine came to me only āhalfā as bad and I didnāt like where he was until a year in.
Are these photos right after a trim?
Is that a deliberate notch or is that a chip?
With these situations as tempting as it is to just lop off the excess toe, often times you run the risk of doing more damage than good, because the internal structures of the hoof have run forward, meaning you have very little hoof you can take off at a time until their angles within improve.
The new growth is a different angle than the old, and looks healthy all things considered. =
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That is a chip! She has some separation in her quarters through the white line. On the medial side of that hoof (RF) I anticipate a large section will eventually chip off due to the surgery site growing out. I did touch her up a bit before taking these - not a full/ official trim, but a little touch up.
I am worried about taking too much off which is a large part of why I want another set of X-rays to touch base on how much hoof she has and where. I do feel she is improving (for the longest time her heel bulbs were on the ground without shoes/ pads 
) but am always worried about bias creeping in.
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New radiographs as of last week. Fracture/ remodeling at the tip of P3 on the āproblem childā hoof and right back to where we started with thin soles, oh and add bone demineralization in the RF āunexplained causedā. Not much had changed since December - I had dropped the SmartFlex Rehab pellets I had her on, dropped the circulation supplements (Arginine, Citruline, Niacinamide all bought in bulk and scooped out), reduced and stopped vibe plate sessions. Those all started up again about a week before the radiographs due to obviously thin soles (flex with light pressure from fingers). She is still barefoot in boots, which the vet says he typically recommends for cases similar to hers, but the farrier is coming on Tuesday to go over some options (glue ons most likely, pour in pads also likely). He did recommend turpintine which I went ahead and ordered and am doing once daily, along with cornusicrine(sp?) in an effort to grow faster (not convinced about topicals but we have tried seemingly everything else so why not). Her toe is better, not as ran forward but otherwise significant back sliding happened between Dec and now. I also had her blood pulled for IR, cushings and thyroid. Vet says sheās ānegativeā for cushings and IR but I havenāt been able to see the actual results. One of the thyroid results (reception said T4, vet said T3) came back low so they want to put her on Thyrol. Vet said thyroid and hooves could be related but didnāt seem super convinced and I wasnāt able to find any research or even anecdotes one way or the other.
No words of wisdom for you. Just wanted you to know that you and your girl are in my thoughts and prayers. Hang in there. 
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Sadly, that looks like bone eroding away due to bacterial activity. It looks very similar to what Iāve seen in human bone infection. Who is the Infectious Disease doctor working on this case? Did they ever biopsy and culture? We know that bacteria in bone is totally protected from the immune system so a more active approach must be done to gain local control.
What is the CRP and Erythrocyte Sedimentation Rates? Have they run complete blood panels?
@RAyers The lameness specialist who has been working on her alongside mizzou said it did not look like infection. I believe citing something along the lines of the edges of the bone being smooth rather than jagged, but am not certain.
There is no Infectious Disease vet in the area that I know of, and none actively working on her case. No one has mentioned that to me of the 3 vet practices working with/ on her. They did culture when she was in surgery at Mizzou but I donāt remember hearing the results or how that impacted treatment.
No blood panels that I know of beyond the ACTH, IR and Thyroid panel ran a few weeks ago. Iām not sure about CRP or Erythrocyte Sedimentation Rate - I have no idea what those are or how they are tested for. Is it worth having them out again to test? Is there an infectious disease vet specialist that you could recommend? Iām sure those are few and far between so location matters not.
I do appreciate your continued insight, thank you.
Sadly, there is no veterinary equivalent to what we have in the human world in terms of infection diagnosis and treatment. I research specifically spine infection working with a team that includes infectious disease, orthopedics, microbiology, genetics, and even physicists.
To me, the X-rays show osteopenia with Brody abscesses which are indicators of bone infection in humans. This is how I select patients for my NIH infection research.
CRP is C Reactive Protein. That and ESR show if the body is dealing with an internal infection. They are the standards in human clinical diagnosis of infection. Imaging using MRI T2 Stir can help by showing if the holes are actually fluid abscesses.
I believe you said in the past, antibiotics helped her lameness? That, right there also suggests bony infection. We get tons of patients with horrible back pain and fairly clean x-rays that after an extended course of antibiotics heal very well and the pain ceases.
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Not all of this information is directly applicable to horses. There are species differences in acute phase proteins and C reactive protein is considered minor in horses. Serum amyloid A is however used in horses as a marker of inflammation.
Also, there are definitely veterinary infectious disease specialists. No, there is not the same degree of formal fellowship training, but there are some internists who specialize in infectious diseases and infectious disease fellowship training programs. In addition, veterinary microbiologists specialize in infectious disease diagnostics. These people are available as part of multi-specialist teams, often along with pharmacologists, to manage difficult cases. OP - Mizzou has a vet microbiologist and there may be additional faculty especially interested in infectious diseases.
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Whoops, itās been too long since my last update! My personal life has been hectic but we are still trudging along with her hooves. She is goes back and forth between being almost 100% sound to being off. We are attributing it to the fact that her hooves are still not where they could/ should be (and there was no guarantee of 100% soundness after surgery anyway). She is pasture sound though, which is all she has to be. She has continued to be barefoot with boots - I tried another pair of Equine Jogging Shoes and a pair of Soft Rides with mixed feelings. The Jogging shoes are all neoprene (HOT) and are quite the process to put on/ off so they havenāt been used. If she is ever sound for light hacking Iāll probably use them for that. The Soft Rides were bittersweet - they gave her immense comfort, she was 100% sound with them on. BUT her frogs atrophied like crazy and she somehow ended up with a white line infection in both hooves (which she has never had issues with before). The boots tore up to all hell in the 60-ish days she wore them and she is not hard on boots (the current Cavallos are several months old and the last pair lasted almost a year). The WLD is clearing up but did take a good portion of the wall at ground level, so she is almost on her soles (and understandably uncomfortable).
I need to get some updated photos to post and will try to remember to do so soon.
Some new things I am looking at trying/ will be trying: Bemer treatments (it comes in today and Iām so excited!), cold laser treatments (also on itās way and will mostly be used for compensation soreness), cupping (tried a few times already and it seems to help her body soreness), looking at putting these 3D hoof pads on her hind end with some DIM and Perfect Hoofware casting them on (Iāve seen a lot of success with others using them and know her hinds could use some assistance as well) Iām just having trouble ordering them, and I ordered happy hoof pads for her front. Iām also trying to refill her Pentosan Plus/ Platinum but canāt remember where I ordered it from in March and canāt find the Plus/ Platinum version (with Glucosamine and HA) anywhere. I know all of that ^ seems like a lot but my thought process is that if I can truly get her comfortable everywhere, for an extended amount of time, maybe we can break this damned pain cycle sheās been stuck in for quite some time (and that by doing so it will encourage her to move more and more correctly which will help stimulate her feet to grow under her and stimulate the weak digital cushion). Will any of it help? Who knows, but all I have to lose is time and money and Iām okay with that. (Disclaimer that all of the above is not a forever thing, but that I am okay with some maintenance such as the Pentosan and/ or Equiox to keep her happy in the pasture).
3D hoof pads https://www.3dhoofcare.com/product/3d-hoofcast-plate-w-d-e-hooftaps-recessed
If someone is reading this thread as they are going through the same or similar with their horse - I would see if you could use these on your horse instead of a regular hospital plate. Both times, the regular hospital plate was terrible for her hoof (as well as a HUGE PITA for her caretakers). I would also suggest looking into gabapentin as it has been helpful for my horse where daily equiox wasnāt.
https://www.3dhoofcare.com/product/3d-hoofcast-treatment-plate
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What laser did you get?
I bought this one BUT I ordered it via AliExpress (after a ton of digging to find the exact one) for $$$ cheaper. Itās the same one my Equine chiropractor/ physio (he does cupping, laser, myofascial release, chiro adjustments, rehab plans etc) used on her with good results. So far I like it. I used it on the SO this weekend and he enjoyed it but said the effects wore off by the next day (only used it once on him). It is a bit of a hassle compared to the EquiVibe and Bemer where I can set the horses up and do other chores, but it seems to help.
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Am I the only one seeing really long toes and no support and underrun heels? These kind of bad feet will produce all kinds of problems, with the frog, with bars, with sole. Itās really hard for me to see feet like these not addressed when they could be almost entirely changed in two trims. This mess isentirely unnecessary.
Thanks for the reminder to update this thread. Iām on vacation and have been mulling over next steps with her - either go back to the 3D pads + casting tape, continue on with boots and new pads, or go back to cast/ glue on composite shoes. Iāll update when I decide and get home to look her over.
No you are certainly not the āonly oneā to see those issues - pretty sure I talk about it at some point (or likely several points). If you read the OP, you know that this was A. A life SAVING surgery for the horse and B. Not the first time weāve done this surgery on this horse and not the first hoof issue Iāve had with her.
These things can maybe be mostly corrected on other/ average/ normal horses in one to two trims but that simply isnāt the case here. We are over a year out from surgery and she still hasnāt grown out the event ring from the surgery (meaning her hoof capsule does not grow down in 9 months like average horses supposedly do). She doesnāt have much hoof to work with and doesnāt grow nearly as fast/ as much as a normal horse despite being on as much an ideal hoof diet as possible, getting nearly 24/7 turnout in dry lot, and having a normal venogram and testing negative for IR/ Cushings.
She has had several trims/ shoe jobs by the best farriers in and around my state, giving each pro 6-18 months to work on her with no one pro making any real progress. She stumps the podiatry specialist at the largest equine hospital in a several hundred mile radius. So no, itās not a simple/ straight forward case of too long toe and low heel letās fix er up in a trim or two as much as I would very much so like it to be.
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I use a bemer on my horse routinely. It has really helped him.
If youāre open to sharing the listing you purchased I would be super grateful!
