Sensitive to pressure at heel bulbs

[LamenessRus]

Hi folks,

I have a query out to my vet, but thought I’d ask for personal experience/opinions.

Horse has gone from shod to barefoot in the last few months due to a stifle injury, so will be convalescing for a while. Has recently developed heel pain in the hind feet (see photo), sensitive to my pressing on it (so not a ton of pressure).

My feeling is this needs shoes back on, right? What kind of shoes would be best?

Horse is known to have NPA in the back and it has not resolved even with a year of shoeing from the best farrier in town. Hence a last ditch attempt to go barefoot (a recommendation from a rood and riddle podiatrist), but this does not bode well for my experiment.

Open to all suggestions!

[JB]

That toe looks pretty long, so not helping improve the NPA situation. Removing shoes removes some level of protection, and puts sensitive sore heels closer to the ground.

[LamenessRus]

Thanks JB. This photo was well into her 4 week cycle, and she grows A LOT of hoof in the summer, so that’s a fair observation.

In your experience, is heel pain indicative of anything in particular (other than that the heels hurt)? And are there new fancy shoes I should ask for, beyond a shoe with a pad or bar?

[Simkie]

Man, that looks like a lot of toe. Have you considered asking the farrier to show you how to rasp the toe a little through the cycle? Keeping it more in check consistently may make a huge difference, and isn’t hard.

I was able to get my heel pain horse back to normal with rasping the toe through the cycle, between trims, and daily use of durasole. (Not using durasole on the heel, just the sole.)

[Bonnie2]

I tend to think of heels sensitive to finger pressure as more of a surface problem than a bone column problem. Is he out a lot in wet conditions? He could be working on thrush or scratches.

[LamenessRus]

Not very wet, beyond occasional rain now and then.

That being said, we did think there was an abscess brewing, so we soaked it for about a week. Then the horse appeared better, so we stopped. That was about 3 weeks ago (but not necessarily when this photo was taken - photo was in my library and I just used it to demonstrate where the pain is).

No apparent scratches or thrush, and farrier yesterday didn’t comment on any evidence of either.

[LamenessRus]

I think I will here shortly. I’ve dabbled already but this farrier is a little difficult. I’m moving barns soon and hope to work with someone a little friendlier (I know this farrier won’t come to the other barn so it’s a forced choice, anyway).

Why is keeping the toes short so hard for farriers? Easy enough for me to rasp when she’s barefoot, but it was such an issue when she was shod.

I’ve got durasole, keratex, and Venice turpentine. You prefer durasole among these? I’ve been rotating between them (though not everyday).

[Simkie]

@LamenessRus

I’ve got durasole, keratex, and Venice turpentine. You prefer durasole among these? I’ve been rotating between them (though not everyday).

Yeah, durasole on the sole. I like keratex on the wall, but as long as the wall itself is holding up (and it looks like that’s fine if she’s putting on so much length?) it doesn’t sound like you need that.

I’d go daily or even start with multiple coats for a few days to see if that makes a difference in her comfort. Rasping back the toe isn’t hard, if you want to give it a try.

[Scribbler]

This is a very oval foot, but hind feet do tend to be longer than front feet.

I would say that the heels bulbs have prolapsed and pushed the heels forward so there is no heel support on that foot, the heel bulbs are taking all the weight. The hoof wall heel buttress should surround the frog on the outside. You need a farrier who can take out bar and open the heels and let them move back to where they support the hoof.

Also there’s a lot of retained false sole on that foot. Is this from using formalin products on the sole? Retained sole can get lumpy and be painful. It also effectively makes the sole closer to the ground and the foot flatter. But it offers some protection through thickness. So encouraging retained sole is a double edged thing. It might make the foot tougher or it might cause bruising itself

You also have uneven broken bar on the right side of the photo but none on the left. Broken bar can definitely cause hoof bruising.

As far as being barefoot being good for fixing hoof angles, this is absolutely true if you have a competent trimmer. The huge advantage is that you can trim more often, and the owner can rasp, to encourage the right angle. Plus the hoof loads naturally and can start to grow to support the horse correctly

You do not have competent trimming right now. The migrating forward heel buttress, the prolapsed frogs, and the retained sole and bar did not occur in the past 4 weeks since the last trim. When people say “long toe” they don’t mean “long” in the way a properly set up hoof looks when it’s due for a trim. On your horse, there’s very little to obviously trim at the toe. What’s happened is the whole.hoof capsule has migrated forward on the coffin bone so that there are no hoof buttresses and all the weight is on the soft tissues of the heel bulbs (which are part of the frog). You need a new trimmer.

You could toss shoes on this foot and that might put some support back where the absent heel buttress should be, but you aren’t fixing the problem. I would also say that (same as in humans) that problems in the feet ricochet up the leg to knees and even hips, and if he is having stifle problems it could be that he’s been using his hind end wrong for a while due to foot pain and imbalance. You need to let the stifle recover, fix the NPA and fix the run forward heels too or just end up on the Permanent NQR bus.

[LamenessRus]

Super feedback, thank you. We are well on the road of permanent NQR, unfortunately. There is a long history to this horse that I won’t get into too much detail here (back problems, PSD, now stifle), but I agree that the foot (in my opinion) has created a lot of these issues for this horse. Finding a competent farrier/trimmer has been absolutely impossible - I’ve gone through 4 over the last two years - one that started this mess, one that was good, but putting her in too small a shoe and leaving too much heel hanging over the back, and keeping the heels super contracted, one that was 2 hours trailer ride away (he may have been fine, but was impossible to talk to so it was his way or the highway, and frankly just too far), and now the current one (a short trailer ride, but a whopping $400 for a full set with pads(!)). The current one is pretty darn good for the area - keeps multiple FEI horses sound and in work, but, due to frog/heel pain when she had pads on, did a V-cutout for the frog. I’m pretty sure that cutout made the frog prolapse worse (confirmed on radiographs, which I’ve been getting 2x or more per year for the last two years to track progress), hence taking her barefoot once the stifle injury was diagnosed to try and help the hoof that way. While the current one has done a nice job getting the contracted heels to open up a bit, he just can’t seem to get the heels back where they need to be.

But back to the issue of a competent farrier - I promise I’m trying lol. Getting the heels “back,” versus letting them migrate forward, has been a constant challenge. How does one do this? What can I tell a farrier (who is willing to listen) to do in order to accomplish this? The folks I follow on facebook who seem to have “the solution” put horses in wedge pads to get bony column alignment, but it’s never quite clear how that fixes the hoof/heel position such that you can one day get the horse out of wedges. Keeping the toe shorter is a lot easier to communicate/achieve, but the heel thing is challenging.

She was just trimmed a few days ago, and I will try to get pics tonight as I would love to hear everyone’s thoughts.

Thank you SO MUCH everyone for the feedback/observations. It’s been a real struggle and heartbreak (and ~$15k in vet bills with multiple specialists, trips to NBC, surgeries, etc) with this horse over the last few years.

[cnd8]

@LamenessRus

But back to the issue of a competent farrier - I promise I’m trying lol. Getting the heels “back,” versus letting them migrate forward, has been a constant challenge. How does one do this? What can I tell a farrier (who is willing to listen) to do in order to accomplish this?

If you have to tell them, that’s a red flag. Someone correct me if I’m wrong, but to bring heels back, you need to remove toe. Also, to me, I’ve always had horses shod if trying to correct underslung heels because they need some heel support offered by a properly fitted shoe (not short shod). I’m sure there are ways to do this barefoot, but I have no experience with that method.

[Scribbler]

I myself dont see how wedge pads would help.

Have you looked at the barefoot trimming information on Pete Ramey s websites? He’s kind of the dean of barefoot trimming and someone whose done a lot of thinking and some actual research with academic collaborators. There might be helpful tips in there about how to rebalance. Also he’s a big fan of padded turnout boots for horses with acute hoof pain like laminitis and founder, because the more normally they can move the better the foot will grow out. If the horse isn’t weighting his heel because it hurts, the hoof will compensate in distorting ways, maybe here by building up false sole.

Anyhow some kind of easy boot cloud type turnout boots and correct therapeutic trimming might help.

I have a very who also trained as a farrier but now just does therapeutic trims when needed as part of his vet call. He’s able to fix things with much more authority than a regular trimmer. Maybe you can find a vet who trims, maybe at a vet school?

[LamenessRus]

I’ll look more on Pete Ramey’s website - she’s been shod most of the time so the option for a little trim assist here and there hasn’t been front of mind.

And good idea with the easy boot cloud suggestion. The theory makes sense and certainly can’t hurt. I’ll measure tonight and order asap. I like this better than putting more shoes on (which have clearly not "fixed’ anything).

Finding a vet who trims would be ideal. I’ve been in this area few years and haven’t heard of any. The local 24 hr clinic theoretically does have farriers, and theoretically they would know what to do, but they haven’t returned multiple calls and texts from me so I gave up. The barn I’m moving her to has different farriers, god willing someone there will work (or have a suggestion of who to contact).

[LamenessRus]

@cnd8

If you have to tell them, that’s a red flag.

That’s what I always thought. But at this point, I’m running out of ideas. I truly don’t understand why so many farriers leave the toe so long and let the heels run forward. It’s like an epidemic.

[stb]

There is a Facebook group called Hoof Care and Rehabilitation. There is lots of helpful information on the page that my help you here. It is a group of predominantly “barefoot trimmers”.

I agree that this horse has very long toes and a weak frog and heel - both of which could be causing him pain. I have used traditional farriers in the past and barefoot trimmers. I’ve had good and bad in both categories. However, I have had better luck with hoof health with barefoot trimmers, as they are the only ones I have found who consistently keep toes short and are mindful of heel health. Just my experience.

I have an older gelding who spent most of his life in shoes (before I got him) and he struggles with long toes and underrun heels, so I feel your pain.

There is also a podcast called The Humble Hoof that you also may find helpful. I hope you get him sorted out.

[luvmyhackney]

Ask your farrier to mark up your horses foot and explain where everything should be.

It takes time so pay them extra but mine took a good hour and we took a marker and mapped out the hoof and what farrier was trying to achieve. Super educational.

[LamenessRus]

Thanks all for the feedback - wish I had posted earlier!

For what it’s worth, here is a recent view, just a few days after the farrier was here. This is about 2 months after pulling shoes.

The problem foot specifically:

All feet:

And here as an imgur file in case it’s easier (except the solar view of the right hind as I must have gotten distracted): https://imgur.com/a/T22drfr

[fivestrideline]

I will let more knowledgeable folks chime in about the trim, but those are a TON of event lines on all four feet. Any idea what those could be about?

[LamenessRus]

Well, two years ago she was with a farrier that let her get super long toes and underrun heels, so we’ve been battling that ever since.

Other than that, no obvious major pathologies beyond the chronic NPA in the back.

[fivestrideline]

@LamenessRus

Well, two years ago she was with a farrier that let her get super long toes and underrun heels, so we’ve been battling that ever since.

Other than that, no obvious major pathologies beyond the chronic NPA in the back.

It shouldn’t take 2 years to fix such feet, if you’re working with a good farrier and don’t have anything else contributing. You’ve still got long toes. Those event lines are pervasive and recent - you don’t have much foot growing down before you hit a big one. They could be trim related, due to stress from bad angles, or they could be signs of chronic subacute laminitis, or who knows what else. I’m just pointing them out as a sign that something is DEFINITELY up. Normal feet, even ones with less than perfect trims, don’t look like that.

I can see the slight bullnose in the back too - again that shouldn’t take years to fix unless you’ve got something else going on.

IIRC you’re moving and thus switching farriers, so I hope that can help. One huge red flag to look out for is if a farrier takes a grinder or rasp to the outside of those feet to “smooth” out the lines. That’s just hiding the problem, so watch out for that.