Such a remarkable change for the better! Good on you for advocating for your horse and finding an HCP that can do right by him and you. I hope the positive trajectory continues for you, you both deserve it.
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Thanks! I’m really crossing my fingers and toes for continued progress. Even if he’s not rideable, it’s been such a battle!
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Updating this to ask a question: TLDR do some horses just get “stuck” with a certain internal hoof structure despite everything?
I had the vet out for balance X-rays today. I don’t have copies of the films yet but got to see them.
The good news is his fronts are in decent shape - he could use more sole depth (he has about .5” or a little under) and his flatter foot could use more angle (it’s at 3ish degrees vs the 4-4.5 degrees of the other). IMO both feet could use slightly less toe, but honestly they are not bad. Bony column and all that got a thumbs up from the vet.
His hinds, however, need work. 0 degrees, bullnosed, sole depth meh. Longer toes relatively than the fronts but I’ll have to wait for the copies of the films to come through to look at them more. The vet is of the opinion that lameness is rarely the result of bad feet, which is not an opinion that I share. This is my KS and backsore horse.
Anyways - I compared the hinds to my extensive collection of radiographs and to ME there has been little improvement over the last 2-3 years. Multiple farrier and environmental changes, wedges/pads/barefoot/etc etc. we don’t seem to be able to get ANY internal change in his hind feet.
Do some horses just get “stuck” with hoof structures a certain way? Granted, I’ve been working on his fronts more than his backs as far as swiping at them between appointments (holding his hinds up is tougher for me), but pretty much the hinds look exactly the same if you factor out the shoeing packages. Could his sore back be making him stand funny and run his feet into that NPA configuration?
I could put him in boots and pads, or force my vet to do shockwave/refer for SI injections but I’m just a little lost here.
Absolutely 
Sometimes it’s because they’ve been that way long enough and the body refuses to change.
Sometimes it’s because there are actually other issues going on that just haven’t been discovered and worked on yet.
Sometimes it’s because those feet just need a little extra creativity that might be a long time in manifesting
UGH, how frustrating How can she think that??? WHY does she think that, do you know?
this is probably your answer to why the hinds aren’t improving, unfortunately.
Some horses end up living in wedges to create a healthier angle that their feet just refuse to grow into, and crushed heels are just the lesser of 2 evils and managed as best they can be. There are certainly setups that can help minimize the crushing
100%
Start taking some pics of him randomly, as much from the side as possible, and start comparing them to see what his body does on its own. Sore backs can make horses stand camped under, which is terrible for trying to improve NPA issues
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I have no clue why the vet holds that opinion - they also said if you run an imaginary through the coronet band forward, it should go through the shoulder. I thought you wanted it between elbow and knee? I haven’t googled it yet to check. They also want me to scope for ulcers before pursuing any work on his back - I’m trying to decide how I want to go forward.
I can get him boots and wedge pads to live in for a while - no hind shoes allowed here but I’d really rather not shoe him anyways. I’m unsure if the boots will be a solution but I’m willing to try, once I get his X-rays and maybe chat with my farrier.
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Nooooooo. Good lord. That hind coronet line needs to land around the knee, give or take. Elbow is even too high, shoulder is… 
He may HAVE Ulcers, but until the cause (sore back) is improved, you’re going to treat forever most likely. You could just start your own ulcer treatment
There are good boots you can put wedge pads in, as at least an experiment to see if it makes him happier and less back-sore. Offhand I don’t remember what those are, but I imagine Soft Rides may be one, but start by talking to the folks at Easy Care
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Yeah see I knew the shoulder thing was wrong but couldn’t remember by how much.
Apparently Scoot makes a wedge that can go in anything - my Cavallos for his fronts just got here, but I ordered two sizes so maybe I’ll get lucky and have a full set already 
.
He’s been on Nexium, which has anecdotally worked for me before, but I know the vet can only suggest the FDA approved treatment so I got the rundown on scoping and Gastrogard. I may scope if I can find someone to farm call, in case he needs Misoprostol (sp?) instead but I don’t know.
I COULD haul to the clinic, throw the sink at him and do his back/SI and scope him, but I’m also not rich… and he’s no longer insured for any of that…
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Easycare Cloud boots have a wedge pad. They are therapeutic boots and are not riding boots, but I would think they are exactly what you are looking for with that NPA.
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The vet can recommend whatever they believe in–there’s nothing that limits them to FDA approved stuff. I had a vet who even did her own scoping studies with the compounded omeprazole/ranitidine paste from precision pharmacy.
If you’d like to try something that’s a little more of a “known” entity, but still not gastrogard $$$$, maybe the Abler poprocks are a good compromise?
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My vet actually suggests Nexium for the “cash strapped” and had no problem suggesting ranitidine when we had that. Many vets just don’t bring up non-approved drugs in this context because of the uncertainty. I say “in this context” because SMZs aren’t approved for horses, yet… 
If you want to try something inexpensive, that might at least help for now, get a Rx for sucralfate, and go the Nexium/sucralfate route
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My vet gave the ok to try Nexium on a horse that seemed to need at least a couple rounds of GG a year, and he was such a money pit in general. As I mentioned way back on the other thread, she recommended following the 0.5mg/kg dose at the time.
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I have used this before actually, I might switch over
Threw that at the vet. They didn’t go for it, they want a scope. Which is fair I mean this horse is a big ball of ??? but he’s also not insured. I know Abler makes a sucralfate pop rock, I’ve used it before.
I’d been doing this dose for a couple weeks. He missed yesterday (I had a lot going on) - but to be fair it’s been a learning curve at this barn to get his supps and meds into him so I may just “start over”. He’s been on Nexium for almost 2 months, but not getting it all consistently.
Rads are in. I’m going to send them to the farrier but I’m also going to stare at them and make myself crazy. Specifically his hinds - if I went with boots and pads behind, how much of a wedge would I do? They’re foam, firm but will compress, so I’m not sure. I’m hoping to try wedge boots on him to see if we can get things lined up and maybe relieve some back tension.
Edit: also, looks like he has SOME angle, it’s the bony column that’s broken back. I misremembered
OP, your questions are (except for the vet comment) the exact same ones I’ve run into. JB is absolutely correct here, and gave you the same answers I would have.
6 years in with my mare, 5 with this farrier, nothing we’ve done really works. She can trim up “positive” - and by that I mean about 1-2 degrees, take a rad immediately after and she is STILL broken back in her HPA, mildly, but still. At 4 weeks in, if I’m “lucky” she’s at 0 and not negative.
We’ve done SI injections, mesotherapy, all the “things”. Her stance is much better than it used to be, but it’s not enough.
At this point, I’ve realized that conformation can play a huge role in this regardless of any injury status. My horse is an OTTB, so some of her “issues” are man-made, but how many horses are NPA & KS who are not OTTB’s? A lot.
For the last year +, she’s been barefoot behind. She’s no better and no worse and I keep her on a short cycle. I have debated with myself using some kind of DIY wedge, but there are too many questions… how long do I leave it on, what happens when I take it off (she goes right back to being NPA) and how does doing that every day affect her overall? Do I only use it when I ride? Questions like this.
What I have observed in her, is the line of her heel is the same angle as the line of her pastern, and the line of her hip. That’s what leads me to think there is an overall skeletal conformation that I won’t ever change.
Should she maybe live in 3-4 degree wedges behind forever? In spite of how it made her crushed heels worse? Maybe.
I have sorted out her tendency to ‘camp under’, and she now stands quite properly, but she rocks back on her heels and her frogs are completely flat. I think this is because she is all legs, and even tho her neck is long, it’s a habit as she grazes/eats. I see it as a bit of a catch-22: I put her feed on the ground because I want her to stretch down, but it might actually be better if I fed her at chest level.
I don’t know, and I don’t have many answers. I do feel your pain tho, I have the greatest empathy for you! Hang in there.
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Mine does the “grazing foot” thing, one foot way out in front, the other back under his middle. Same feet in the same configuration alllll day. I feed him his meals in a chest level bucket because he stands square that way.
I know farriers are less excited to wedge behind - the only answer I get is “it can cause other issues”. I’m going to find out what the risks are before I do anything other than try boots and flat pads for comfort.
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I forgot Absucralfate exists! Good deal. The thing about sucralfate is that it almost doesn’t matter what ulcers are there, it will help by coating them. Adding omeprazole (or esomeprazole) can help if there are squamous ulcers. Sucralfate will coat lesions no matter where they are in the whole GI system. You just need to separate feeding the 2.
If P3 is at 0*, then I’d try to get 3* wedges in there. 2* is better than nothing though, as a start.
the HPA - hoof pastern angle, aka the bony column - is broken back because of the almost 0* P3 . The heels have to come up to start correcting that. And in this case, it looks like the lift has to come entirely from behind, as there’s no real reduction on toe height that can be done
the risk with wedges is crushed heels. Sometimes that’s not a good thing but sometimes it’s the lesser of 2 evils. Crushing is almost inevitable with long-term wedges, but that’s a much better issue than permanent NPA or even too low of an angle
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If the horse has been barefoot and received good orthopedic care for 2 years - which the front feet vouch for - the hind feet are a sign and not a cause. He is more comfortable with his feet where they are for some reason. Artificially ‘correcting’ the feet without improving whatever it is that causes him to grow/wear his feet that way will only make him more uncomfortable. If he is sound enough, accept that his feet will never be textbook. But keep nudging them towards more correct as you have been. If his soundness is an issue, his back, SI or other problems need to be addressed first. All in all beautifully maintained feet!
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Thanks - his feet have been a roller coaster. I’d say he’s had okay hoof care for about 7 months. Previous to that? Garbage. Despite my best efforts lol
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Clearly this vet: was not born with club feet, doesn’t suffer plantar fasciitis, has never had a rock in a shoe, has never been stung/stepped on glass, has never had a broken toe, has never had the heel of a shoe break off a mile from home/shoe store, has not purchased shoes that never properly broke in, etc. Because all of those things can affect lameness higher up the leg/spine.
Ugh.
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Yeah I think they were specifically referring to poor angles - but still. I don’t expect a vet to also be a farrier (had one of those, 10/10 would recommend) but it does mean I have to take their advice with a grain of salt. At least when it comes to his feet.
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