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Sunday, March 31, 2013

On the Case: Thorn-y Hoof Problems at Towcester Equine Clinic

Andrew Hayes BVetMed MRCVS of Towcester Vets Equine Centre in England made this video and writes some details:

The horse featured was a three year old that had been suffering form a fluctuating forelimb lameness for several days. The blood supply to the affected foot was increased (increased heat and bounding digital pulse). 

Squeezing the sole of the foot with hoof pinchers elicited a marked pain response. Careful examination of the solar surface of the foot revealed a small circular mark of a slightly different color to the solar horn. The horse resented digital (finger) pressure applied to this area. 

We realized that this was likely to be a foreign body, almost certainly a thorn! It was assumed that a blackthorn had penetrated the sole and had broken off flush with the sole.

I didn't radiograph the foot as the penetration was in a reasonably safe place although, theoretically, the pedal bone could have been damaged; i.e., it was in the front third of the foot.

The thorn was extracted in one piece.
We tend to worry more when the middle third of the foot is penetrated as there is then the possibility of the navicular bursa and/or the deep digital flexor tendon being damaged and infected. In these cases we would radiograph the foot with the foreign body in situ (although thorns are not particularly radio dense) to assess how close these structures are and whether they have been penetrated.

Obviously if the animal remained significantly lame and did not respond to initial treatment we would radiograph the foot.

The horse was sedated and the foot was numbed by infiltrating local anaesthetic around the nerves supplying the foot (abaxial sesamoid block). This enabled the removal of solar horn from around the thorn with a small loop knife, thus releasing a large amount of pus that had accumulated there. .

All the underrun sole was removed. The debrided area was cleaned with a chlorhexidine (antiseptic) soaked swab, revealing the thorn penetrating the sensitive sole. It was removed using forceps. 

The foot was then bathed in a warm solution of magnesium sulphate ("Epsom salts") before being packed with dry magnesium sulphate crystals. The foot was dressed with duct tape. I love using duct tape in these cases because its cheap and it is waterproof to some degree.

We try not to use a wet poultice in these cases as this can lead to prolapse of sensitive sole causing ongoing pain.

The foot was tubbed and packed daily. The horse was also given pain relief in the form of phenybutazone orally. It is now sound and doing well -- a rather satisfying case.

Andy Hayes, partner at Towcester Equine Clinic--and inspiring videographer.
So ends Andy Hayes' description of his successful treatment case of a case that was at once low tech, effective and affordable.

It is worth mentioning that he makes the terrific videos that document his hoof cases using only his iPhone; the editing is done primarily with the basic iMovie video software that comes in the standard tools for an Apple computer or with Final Cut Pro, a standard off-the-shelf software product.

His clinic name, by the way, is pronounced as if it was "Toaster".  The staff is probably still laughing at how that American on the phone pronounced it!

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