Nail in foot today: How worried should I be?

[someday]

My horse stepped on a nail while I was lunging him today. I had picked his feet out before entering the arena so I know it happened there and saw pretty much the exact step he took when the nail penetrated. I immediately called the vet who told me to take it out since about 3" of the nail was sticking out and the vet couldn’t get there for about an hour. With the help of a friend, we pulled out the nail and immediately wrapped a diaper on the foot to keep it cleanish. The nail went in along the side of the frog about an inch deep. The vet debrided the area and packed it with an iodine-soaked gauze and wrapped the foot. He gave me smz’s and told me to call him if it seems the horse is more lame tomorrow (he seemed just a little sore once wrapped, but nothing terrible). I’m supposed to keep it wrapped for a week.

I hate not knowing if anything serious was impacted.

ETA: yes, he is up to date on tetanus vaccine.

[HPFarmette]

Hoping for the best for you, sounds like you did everything right. Sounds like most of the nail did not even go in and you caught it as quick as you could. You are preventing infection, that’s all you can do right now.

[Sport]

Sending jingles that everything is okay.

[Texarkana]

How worried should you be? Pretty worried. Depending on the exact location next to the frog, 1" could be deep enough to penetrate a lot of important structures, namely the coffin bone.

Since it was treated promptly and you are on top of it, here’s to hoping for the best! Many jingles!

P.S. Since the vet was there, I’m assuming you’ve addressed this- but is your horse up to date on his tetanus booster? Hoof wounds are huge culprits for tetanus in horses.

[someday]

oh yes, I meant to mention that he is up to date on his tetanus vaccine.

[flyracing]

How close to the heel versus the toe? Near the frog has the greatest risk of complication. Unless it was close to the toe, I would be asking for more aggressive treatment. But, I know for other people they’d rather play the odds the other way and that’s a reasonable option too.

[Zu_Zu]

Jingles & AO for your gelding ~

Jingles & AO for your gelding ~

Glad the vet was out to attend to him promptly ~

[someday]

The nail was in about halfway down the side of the frog, slightly angled toward the toe. I’m hoping the angle was enough that it didn’t go very deep inside the foot. The nail was not bent at all.

What more aggressive treatment would be recommended? I am not very familiar with this vet as I am new to the area. I was just relieved to get someone out asap.

Thanks for the jingles

[Texarkana]

My advice is watch your horse like a hawk. If your horse’s soundness begins to decline or you see ANY drainage coming from the wound, do not delay in calling the vet. If the vet does not get aggressive at that time, call another vet.

These things can go either way. If you are able to prevent infection, you’re pretty much in the clear-- it’s just a matter of keeping the hole clean as it heals. But once infection takes hold in the hoof, it’s extraordinarily difficult to get the upper hand. That’s when you need to become incredibly aggressive with regional limb perfusions, surgical debridement, stronger antibiotics, etc.

And I can’t stress enough to keep the hoof meticulously clean. Too many people are blasé about the seriousness of these types of wounds. You could possibly have an open hole straight to the bone or joint capsule. When you do a bandage change, be as sterile as possible. Put a clean drape down every time in case the horse slams his hoof down. Store your bandaging materials in a clean location, and keep them uncontaminated. When in doubt, throw it out. If you are using any scrub or topicals on the wound, it may be worth buying a new container for this purpose (if you haven’t done so already) instead of using the stuff that’s been in your tack trunk since last decade.

Best of luck. I’ve been there soooooo many times with serious hoof wounds. They can be a beast, but I’m hoping for a positive outcome for you! With the location of your horse’s injury and your proactive treatment, I am sure everything will be okay if you keep up the good work.

[someday]

ok, thanks! I will keep everything surgically sterile and there will be no blase from me. I am an obsessive owner

[flyracing]

If your horse is lame, chances are extraordinarily high the nail hit something something important. And since it’s not towards the back of the foot, I’d be less worried about the navicular bursa, and coffin joint. But, a coffin bone infection is not off the table. That can be a losing battle on it’s own, but it can also progress to a coffin joint infection.

Probably the best part about seeing a good surgeon is they can tell you when to worry and when not to.

More aggression to me means consultation with a good surgeon. I’d taken X-rays to try and identity the tract of the nail and for future comparison. I’d be asking about a more aggressive antibiotic such as gentamicin. Smz’s are great for many common skin and respiratory bacterias, but not so great for the anaerobes that may take hold in a foot. If there was any chance what so ever of the coffin joint being invaded, I would be asking about placing antibiotics such as amakacin and gentamicin directly into the joint now, because once the serious lameness is evident, the chance of retuning to sounded gets increasingly slim (and it costs thousands of dollars to even try). A single dose of a correctly chosen antibiotic directly into the joint when the bacterial load is very small can completely prevent progression in some cases. Now, your horse doesn’t scream it’s in the coffin joint based on your description, but sometimes we get surprised by what they do hit with puncture wounds. I’d also be asking the surgeon about soaking in chlorhexadine (surgical scrub) and Epsom salts to help draw out any debris that could not be physically debrided. A clean and bandaged sole means nothing if there is debris further up that is going to develop into a sequesterum and require surgery and a year of stall rest.

So, now that I’ve said all the bad stuff, lots and lots of puncture sounds do fine everyday. It’s just the ones that don’t that make us worried. For me, I’m not so sure smz’s and a hoof bandage would make me all that comfortable.

[Frizzle]

I would do some White Lightning or Oxine soaks to hopefully prevent infection.

[FineAlready]

I would want a surgical consult ASAP. I know three horses that stepped on nails. Only the one that had immediate surgical care ended up riding sound.

[Saronicos]

I had the same thing happen to my horse this time last year. Twisted a shoe off and stood down on the nail. Very lame, so had vet do xrays of where nail went in to see what it touched, sure enough it grazed the coffin bone. Aggressive treatment with poulticing, antibiotics, wrapping etc. etc. Absessed and blew out 3 times. He was off work for 3 months. But happily no permanent damage and was back out training and competing. I was thankful to have vet and farrier who worked together with me to get this thing sorted. Be vigilant and any change no matter how minor keep on it. Good luck!

[someday]

Ok, now I feel sick :concern:

I will call my other vet today and see what she recommends. Ugh, I already have one horse with serious foot issues! I really don’t want another one

[AKB]

If he is not completely sound, I would head to see a surgeon at the vet hospital. If he is sound, I would talk with your regular vet this am to see if she wants to do a regional perfusion of antibiotics into the leg vein or anything else. Punctures from a nail can be no big deal, but are often extremely serious.

[sid]

My stallion, Argosy, stepped on a construction screw while standing at a stallion station his first year breeding.

All the way in, at the frog, so the vet told them not to pull the screw out, rushed over and did xrays to see exactly how far it penetrated. Far enough that we sent him to the hospital and to surgery for removal, see the extent of possible damage and to debride the wound. Missed the ddt by a hair! He was put in a hospital plate, daily cleaning with sterile water and lot of antibiotics for quite a while. He recovered without any problems.

For you the downside was not being able to get radiographs before the nail was pulled out, but with an inch not yet penetrating the foot, I can see there was no choice but to pull it out. On the upside, there was still an inch of nail that didn’t penetrate, depending upon the length of the nail.

As others have said, keep the wound sterile, call a surgeon now – just in case – and watch him like a hawk.

Good luck!

[JB]

Was the exact spot the nail was in marked in any way? Was it actually in 1", or was 3" of a 4" nail sticking out beyond the weight-bearing plane of the foot, meaning less than 1" was actually in the foot?

Yes, being angled towards the toe is a good thing - the more the better.

I too would have thought something a lot stronger than SMZs would have been used for something like this - metronidazole or even Excede, or a combination to include gentomycin or something.

Fingers crossed it really did miss all the important stuff!

[bambam]

Just to balance all these horror stories. My mare stepped on a rusty nail and it went in about an inch as well- angled near the toe. We had to pull it out before the vet got there because she was driving it in deeper and so no xrays to see where it went and whether it compromised any important structures. She was sound as soon as we took it out and had healed enough that was back in full work and fine in a week. We treated with wraps, soaks and antibiotics. Not saying you should not be worried, but just that it is not always a disaster story.

[LittleLegsBigStride]

Sounds like you’ve done everything you could so far. I second (third? Fourth?) consulting a surgeon, just in case. Best of luck to you guys!