Friday, March 29, 2019

Equine Soundness Professionals Kickoff Seminar in Wellington, Florida Launches New Vet/Farrier Organization

Special report by Ellen Staples, CJF

Equine Soundness Professionals’ first annual podiatry seminar held in Wellington, Florida left attendees eagerly anticipating the next event held by the budding organization. Lecturers Dr. Raul Bras of Rood & Riddle Equine Hospital in Kentucky and Florida, farrier Pat Reilly of Penn Vet New Bolton Center at the University of Pennsylvania, and farrier Shane Westman of the University of California at Davis School of Veterinary Medicine presented the topics of laminitis, navicular disease, and white line disease to both farriers and veterinarians gathered in the elegant ballroom of The Wanderer’s Country Club.

Equine Soundness Professionals (ESP) founder Dave Gilliam, a sport horse farrier from Texas, opened the organization’s inaugural event by detailing his vision to create and facilitate a platform that supports more collaboration between veterinarians and farriers in order to raise the industry standard of equine podiatry.

Gilliam aims to contribute to a progressive reputation for American farriery though continuing education events, access to and encouragement of scientific research, and fostering community between professions. Gilliam envisions the organization serving the estimated 5-10% of farriers and veterinarians who work with moderate to severe lameness each day.

Dr. Raul Bras began his lecture with a stout literature review of the contributing factors to navicular disease including navicular bone shape, foot conformation and size, discipline, and breed. The resulting biomechanics of these contributing factors create abnormal forces of tension and compression on the bone and associated soft tissue structures, leading to an inflammatory cascade and irreversible bony formation and degenerative changes in associated structures.

Dr. Raul Bras of Rood & Riddle Equine Hospital spoke on navicular disease and laminitis. (Dave Gilliam photo)
Steering clear of exact shoeing prescriptions, his treatment goals center on achieving biomechanical balance throughout all phases of the stride. Dr. Bras’ shoeing goals are to protect the navicular bone from repeated concussion, decrease pressure exerted on the navicular bone by tendons and ligaments, and support the functions of foot including shock absorption, proprioception, skeletal support, and propulsion.

Pat Reilly followed up with an in-depth discussion on laminitis, detailing the multitude of etiologies that lead to the condition and resulting mechanics. According to Reilly, the lack of research of mechanical treatments, as well as the individual presentation of cases, forces farriers and veterinarians to be proficient in a variety of treatment methods tailored to each presenting case, rather than using a one-size-fits-all approach.

Pat Reilly, farrier at Penn Vet's New Bolton Center, used CT scans to illustrate his lectures. (David Gilliam photo)

Reilly’s mechanical goals of treatment are to restore P3 and hoof capsule orientation, alleviate lever forces, provide axial support, and to maintain hoof capsule integrity.

Presenting original research performed at the University of Pennsylvania, Reilly detailed the relationship of the length of breakover and pressure measured at the distal margin of P3 utilizing his in-shoe force measuring membrane attached to the horse’s foot. While discussing manipulation of the length of breakover, Reilly concluded “more is not always better and there are consequences to moving the breakover point too far in a palmar direction”.

A CT scan of a fractured coffin bone (P3) was included in Pat Reilly's presentation.

Based on the resulting data, the lowest point of force was correlated with the breakover approximately 1 cm dorsal to the distal margin of P3 and increased linearly with greater and shorter distances.

Shane Westman then presented a ​comprehensive step-wise ​team approach in the management of white line disease with the first step identifying the cause of the infection as genetics, nutrition, hoof imbalance or pathology, or even horseshoe nails. Demonstrating the frustration of this condition, he references the genetic variant called SERPINB11 seen in Connemara ponies with hoof wall separation disease, which often renders these cases refractory to traditional treatment methods.

Shane Westman's lecture showed white line disease treatment cases from the University of California at Davis, where he is farrier at the Large Animal Hospital. 

His next steps to address the cause of the white line disease are: 1) a thorough lameness exam performed by a veterinarian; 2) trimming or shoeing ​changes; 3) nutrition evaluation; and, in some cases, 4) ​bacteriology and histology of the affected tissue​. ​Changes to the horse's home living environment are also addressed.

Westman used video to demonstrate how UC Davis veterinary surgeons utilize a Nd:YAG laser to photoablate the bacteria and/or fungus left within the stratum internum after a thorough hoof wall debridement. This treatment is often repeated once in 2-4 weeks and again at 6 weeks, if necessary.

He reinforced that debridement of affected hoof wall is the most crucial step of treatment and emphasized the “importance of solid, clean margins; otherwise we will never win when fighting this disease”. ​

Westman and the team at the UC Davis Large Animal Hospital have been exploring novel approaches to controlling the hoof environment after debridement, such as impregnating methyl methacrylate hoof repair material with antibiotics and rebuilding the area.

A complimentary continental breakfast and lunch were served on the terrace of The Wanderers Country Club. The event site was not far from Wellington's Palm Beach International Equestrian Center, home of the Winter Equestrian Festival.

After a hardy lunch and time to visit with event sponsors, Dr. Bras presented a number of clinical cases that demonstrated the successes of deep digital flexor tenotomies used for the treatment of both clinically apparent and occult laminitis. With his video and photos for documentation, audience members were able to gain an appreciation of several techniques that were successful as well as those that were not.

He stated that, in his experience, anecdotal evidence often does not correlate well with historically published scientific data and reinforced the need for more sound research sourced not just by veterinarians, but by farriers as well. He closed his presentation with a discussion on the ethical dilemmas faced when dealing with end-stage laminitis, specifically focusing on pain management and interpretation of horse behavior on deciding when treatment efforts have been exhausted.

ESP founder Dave Gilliam, a Texas sport horse farrier, began the day with his plans for the new organization and his views on the need for more scientific research in the field of farriery. (ESP photo)

Reilly then walked the audience through cases that demonstrated his collaborative efforts with veterinary surgeons at New Bolton Center with three separate cases: an articular fracture of P3, multifocal keratoma, and P3 bone sequestrum within the hoof. He mentioned the historical intimacy between farriers and veterinarians with photos of farrier shops aside surgery operating suites and lamented the fact that only eight veterinary schools in North America have a full-time farrier on staff.

With the discussion of each case, he restated the flexibility and efficacy of utilizing hospital plates when working with these complex shoeings. He demonstrated that the mechanics of the shoeing package can be easily tailored to the horse’s need without having to apply and reapply the shoe,; instead, he utilizes 1/8” or 3/16” aluminum plate with either slot or hex head screws and bolts to secure the plate in place.

As many of the cases requiring hospital plates involve compromise to the distal phalanx or the hoof capsule, Reilly often fits the hospital plate to the inner web of the horseshoe, reducing the moment arm during hoof breakover.

Shane Westman's lectures included his collaboration with veterinarians on white line disease using lasers after thorough wall debridement at the vet school.

Westman closed the day’s event by discussing the importance of respectful teamwork between the attending veterinarian and farrier, sharing his philosophy of “you are half of the problem”, by definition, within a two-person ​professional relationship.

He included some tips for veterinarians, encouraging them to be descriptive with their diagnostic findings and treatment goals with each case, while using language that is shared by farriers, as well. Reinforcing treatment goals rather than exact methods, followed by allowing farriers time and space to explain what they see as possible for the mechanical manipulation of job allows for greater success as well.

According to Westman, farriers can improve these working relationships by keeping notes and photo records, being familiar with diagnostic imaging and interpretation, as well as and limiting communication of about the interpretation of results to the owner before consulting with the veterinarian.

In this case of a P3 fracture, Pat Reilly's hospital plate design incorporated a Morrison full rolling motion shoe for each of breakover into a Sigafoos Series I glue-on package, and added impression material under a hospital plate secured with slot-head screws. The hospital plate is inset from the edge of the shoe to help with breakover and set back from the toe, as well.

Maintaining professionalism and mutual respect between both parties should be the baseline of all relationships; and without this, he stressed, it is only a matter of time before the working relationship bottoms out.

The event closed with a raffle give-away of many products provided by Castle plastics, GE tools, Hoof Jack, and several more. A big thank you to many of the event’s sponsors for making the day success: Castle Plastics, Equicast, EquiSport Farrier Supply​, ​Farrier Product Distribution, ​Hoofjack, HoofSearch, Osphos,​ Palm Beach Farrier Supply, Polyflex Horseshoes, RevitaVet​ Therapeutic Systems, Sterihoof, and​ Well Shod​.​​

--Ellen Staples

ESP is planning additional seminars around the United States in 2019, including one on the west coast. Visit the association website to become a member and learn about more events.

Ellen Staples, CJF is a student at the University of Florida College of Veterinary Medicine. This is her second article for The Hoof Blog.

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