Auburn University: Ampututation and Prosthesis Create a Dolphin's Tale Story at Vet School Hospital for Miniature Donkey Foal

Emma, a miniature donkey foal, was just two days old when she arrived at Auburn University's John Thomas Vaughan Large Animal Teaching Hospital with a severe hind limb deformity, one that required amputation of the limb and the placement of a prosthesis.

Auburn University's College of Veterinary Medicine and the Hanger Clinic, formerly Hanger Prosthetics and Orthotics, have been working together since April on this case that could have implications in the treatment and rehabilitation of horses, donkeys and other equids with congenital deformities or injuries.

Dr. Fred Caldwell, an assistant professor in the Department of Clinical Sciences and equine surgeon, performed the amputation procedure, and is working with clinician Billy Fletcher from Hanger Clinic – the same company which made the prosthetic tail for Winter, the amputee dolphin and star of the film "Dolphin Tale" – to develop a prosthesis for her limb. The two worked out a plan to both allow Emma time to heal from the surgery and transition from her cast to the prosthesis.

Emma's fitting session for the new pink prosthesis that accommodates her growth.

"Billy was excited and enthusiastic to assist," Caldwell said. "Once we proceeded with the surgery and amputated the distal limb, he provided a small footplate to incorporate into the cast to even out the length of her hind limbs so she could bear weight until we could get the surgical site healed and have her fitted with a prosthesis. It has been a group effort on behalf of many caring individuals willing to go to great lengths to save her."

Emma's case is providing a unique and beneficial teaching opportunity for everyone involved. The practice of using prostheses with large equids is relatively uncommon because of their size and weight-bearing limitations.

But because Emma is a miniature donkey, she will be fairly small as an adult, weighing approximately 350 pounds when fully grown. This gave Caldwell and Fletcher hope for a positive prognosis and success in Emma's treatment.

Emma is now 11 weeks old and has been thriving with her prosthesis, making an impression on everyone who has worked with her.

An earlier version of Emma's prosthetic hind limb.

"She absolutely loved it from the get-go," Caldwell said. "It was a very impressive design and she did very well in it. She has progressed to the second iteration of her prosthesis, which doesn't incorporate as much of the limb and allows her more range of motion. She is getting stronger; she's growing and doing wonderfully."

Fletcher said that as Emma grows, she could potentially transition through eight or nine variations of the prosthesis before reaching her full size. At that point, she will be fitted with a piece that is more permanent.

The prosthesis is made of carbon fiber, Kevlar and fiberglass. These are materials that are strong and extremely light, and are the same materials used for prostheses for Paralympic athletes. The materials are also flexible and adjustable to allow for growth and progression in Emma's gait.

The first finished prosthesis weighed less than a pound; the most recent iteration, which is pink, is smaller, but weighs a little more to provide stability as she's grown taller and almost doubled her weight since surgery.

"The next step is trying to make sure we keep the prosthesis set up so she's ambulatory and she can run and play and do things uninhibited, but also, to keep the area of concern, the surgical site, offloaded so Dr. Caldwell can do his job in keeping her completely healed," Fletcher said.

Emma shows off her latest prosthesis. Notice how it cups the hock.

"As time goes by," he continued, "we'll continue to provide a prosthesis that's going to allow for growth. We want to provide her with full range of motion, but also give her the ability to use full strength. I think she's got that in her current set-up, so the big thing now is keeping everything offloaded so she heals completely; we'll continue to increase the size of the prosthesis as she grows."

Caldwell said he has learned a tremendous amount from the case and it has given him hope that in the future amputation and prosthesis could be a more feasible option for larger horse patients.

Story by Carol Nelson, Communications Editor at Auburn Univeristy

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.
 

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Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.

Derby Day: Thoroughbreds Start Running Toward the Roses From the Day They Are Born--If They Can, That Is

The foals in this video from Juan Carlos Blazquez, farrier at the University of Madrid 

in Spain, may not be American Thoroughbreds but that hardly matters. "JC" is
someone who obviously enjoys the challenge of helping foals in need--and the reward 

they give him when they respond to treatment.

It happens every year: thousands of Thoroughbred colts and fillies hit the straw bedding of foaling stalls in breeding farm barns across the United States. An estimated 25,000 to 30,000 future racehorse foals are bred each year, according to Jockey Club statistics.

This year, 21 of them made it to the Kentucky Derby.

Today, when the Kentucky Derby comes on tv, think about the foals eligible to race in 2015. They're on the ground now, although some just barely are.

And some are on the ground, literally, because they can't get up. Maybe they can barely stand to nurse. Their spindly little legs give way beneath them like rubber stilts. They walk on the fronts of their fetlocks, or the backs of their pasterns are on the ground. Their hind legs might cross when they try to walk forward. They stand bow-legged. Or even cross-legged.

At most farms, foals go through periodic evaluations by the farrier. Their legs change as their bodies develop and change--for better or worse--can be rapid. (Richard Clay photo)

Phones ring in equine clinics and farrier shops around the country. "Can you come out and take a look?" There will be x-rays, there will be examinations. Decisions will be made based on dollar signs and question marks that will hang in the air.

Some will be sentenced to an early and perhaps merciful death, in spite of their expensive breeding.

The fate of others will be left to the "wait and see" approach.

Some will respond naturally--and positively--to the forces of weightbearing and increasing maturity. A tendon will almost overnight go from lax to taut, while its opposing tendon will go from taut to lax. The foal is soon not only standing, he's walking and jumping around just like the rest of them.

For others, especially those whose problems are in the bony column and joints rather than in the tendons, there will be weeks of splints on, splints off, braces on, braces off. For some, surgical intervention will be needed; for others, the prescription is for special shoes, glue-on levers, massages.

Some foals respond naturally, by themselves to the forces of weightbearing and simultaneous growth. (Richard Clay photo)

More x-rays. More evaluations. As with the tendons, sometimes the legs will start to straighten as the chest develops and the weight changes the pressure of gravity on the tiny hoof at the bottom of the column. Maybe he doesn't toe in so badly after all.

For others, the newborn foal looks fine and a problem in the limb will only become obvious after a week or two. Or a kick in the pasture creates a pain reaction that in turn leads to a club foot.

Heads will be scratched. Tears might be shed.

Foals may only need to wear splints or bandages briefly. (Richard Clay photo)

Maybe while we're all watching the Derby, the potential winner of the 2015 Derby will be trying out a new set of glue-on baby shoes that re-direct its weight down the leg where the foot should have been. An extension will stabilize the tiny hoof and it won't buckle anymore. Maybe it will never buckle again.

It is possible: each year we hear about colts running in the Derby against the odds. Colts so crooked they never made it to the sales. Colts who grew up in a vet clinic. Colts who defied the odds. And each year that goes by, the body of knowledge of foal deformities expands. New products come on the market. This might work...

People try new things. People try old things. They look in the historical books by breeders and vets and farriers and re-try methods that have been forgotten or ruled out of date. Everyone knows Assault had a club foot. And Big Brown won the Derby with a wall separation. Mine That Bird toed out as a yearling. Swaps had a chronic hoof infection. Sir Barton, the first winner of the Triple Crown, was as famous for sore feet and lost shoes as his racing ability.

Removing the bandages is a suspenseful moment. Did the plan succeed? (Richard Clay photo)

The horses running in the 2012 Derby weren't all born with perfect legs and feet. They don't all land flat, some of them wear bandages because they need to protect their front legs from hooves that don't land exactly where they should. The old timers used colorful terms like cross-fire, scalp, paddle, dish, forge, interfere, over-reach, brush, wing, rope walk,  step on themselves--all descriptive terms to put a word on a horse's not-quite-straight path through life.

Splints and bandages and shoes are worthless without people who know how to use them--people who also know and care about a foal. (Richard Clay photo)

Against all the odds, some of those foals grow up to be racehorses. Some grow up to be extremely fast racehorses. Sure, they're always pulling shoes and whacking themselves. And there's a good chance their careers won't be as long as the straight, strong and truly conformed Thoroughbreds they race against.

Two years from now, their first foals may be on the ground.

Foals soon catch up when the bandages come off. (Richard Clay photo)

Sometimes it gets really crowded in the winner's circle after the Kentucky Derby but there are always a few people in a horse's past who deserve to be there, but never are.

You know who you are. Your work and care put these colts on the road to the Derby, whether they were--or are--crooked or straight. They're running for the roses today because they can, thanks to you.

If the crowd only knew, 100,000 or so Derby hats would be rightfully tipped to you.

Note: Richard Clay's beautiful photos were taken in Virginia on May 5, 2009. That's right: three years ago today. Is that little black colt running in the Derby? He could be. If so, it's because the people you see in these photos gave him extra attention and care and concern. Thank you, Richard, for documenting that foal and his people.

About Juan Carlos Blazquez: In his notes to this video, he remarked that he had donated his services to one of the foals. He said that he hoped that someone somewhere might see this video, realize how many lives of horses have been wasted, and be moved to work for the betterment of future horses; if knowledge can be shared, he will be satisfied. I think he speaks for all of us.

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  

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Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.

Foal Defomity: SPANA's Video Postcard from a Developing World Clinic

This video is provided to give you an idea of the type of challenges that a charity like SPANA faces at its clinics. We do not have medical records or radiographs of this foal to document the severity of the injury. We all know that this type of deformity would be a challenge to any veterinary practice, and yet the treatment seems very simple and straightforward and the effect was almost immediate on this foal.

Far away in Morocco, a mule called Amina was born with a painful deformity to her fetlock joints which meant she was unable to straighten her front legs. Her worried owner, Bouishak, brought the foal, aged two weeks, to the Society for the Protection of Animals Abroad (SPANA) veterinary center.

In developing countries like Morocco, most donkeys, mules, horses and camels support the families who own them: they carry goods or produce to market, they plow land for crops or they transport people and their belongings.

Amina arrived at the clinic unable to stand on her hooves.

If an animal is born with a condition that means they can’t work, they’re of little use. Their impoverished owners simply can’t afford to look after a lame animal, so if they're unable to work, they are usually abandoned or put down.

Without veterinary treatment, the wounds to Amina's fetlocks would soon have become infected and the owner may well have had no choice but to put Amina out of her misery.

The wounds were cleaned with antiseptic cream, and then carefully wrapped with soft padding and bandages. Head SPANA vet Dr Hinnach then applied splints to keep Amina's legs in the correct, extended position while they strengthened.

The foal's pressure sores from "standing" on her fetlocks were at risk of infection.

Over the next few days SPANA's dedicated team of vets closely monitored Amina’s care and her incredible recovery surprised everyone. Amazingly, Amina was able to walk a week later, but the splints were kept on for a few more weeks to allow the legs to fully strengthen.

Dr Hinnach filmed Amina’s first steps--Amina’s joy at being able to walk is clear to see.

SPANA vets gave this foal a future.

The low-tech treatment on this young foal used simple splints over bandages.

We all know how expensive a treatment like this would be for a foal in a developed nation. The radiography, antiseptics, medication and orthopedic devices would run into the thousands of dollars. The foal would have to have a high potential value and it would need a good prognosis for an athletic future.

SPANA, however, estimated that it could offer this treatment for less than $50US to pay for splints, padded bandages, antiseptic cream, three rolls of cotton and penicillin.

Visit SPANA's donation page to see how a relatively small donation can be put to work by vets and farriers in developing nations.

Hopefully, you will donate to SPANA. That's the point of this article. But maybe it is a good idea to look beyond just donating some money to support SPANA and organizations like it.

Farrier and vet innovators are climbing a high-tech ladder that towers high above the simple tenets of basic health and care of horses' and donkeys' hooves. We have reached a point where tech-based treatments and products are available to anyone with enough open credit on their cards to purchase them.

But what if the same brain power could be used to de-engineer hoof treatments? The world needs some simple low-cost solutions to the needs of working equids in less-advantaged nations. We also need low-cost ideas for hoof protection when natural disasters hit and hooves are in danger of heat or puncture damage.

The same low-tech, low-cost solutions could be put to good use by horse rescue and wild horse sanctuaries right here in the developed world, as well.

Please, don't stop thinking high-tech, but maybe some little part of your brain power can think about the horses and donkeys in need out there, wherever they are. I'm sure that groups like SPANA would love to hear your ideas, or invite you to be part of their programs.

I would, too...and I'll tell the world what you've developed for them.

Followup: Amina's treatment was done in July 2011. Dr Hinnich recently visited the family and was pleased that she was walking normally. If Amina needs any care in the future, it will be provided free by SPANA.

To learn more:  

SPANA web site 

British newspaper (Guardian) article about vets going to Morocco to work for SPANA

 

Click on this graphic to go directly to order page and start upgrading your anatomy reference information with the latest version of this 3-D animated CD-ROM

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  

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Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.

Video: Fix My Crooked Foal! Reality Time for Horse Breeders, Skill Time for Surgeons and Farriers

It's that time of year. The 2011 foal crop is here and breeders are looking at them under magnifying glasses. What have they bred? Will this foal make it as an athlete in the long run?

In the short run, will he or she sell at a yearling sale?

Making a foal look and move like a future athlete is a controversial part of horse production. Many foals are born with problems, so corrections are often made. Some are left to see if time, weightbearing and chest or muscle development will compensate for the appearance of a bow-legged or knock-kneed conformation.

Double-click image to view at larger size; image strictly copyright HC Biovision and Hoofcare Publishing

Many would say that corrections should have been made in the selection process of matching broodmares and/or stallions instead of later, in the foals, but the prevalence of conformational defects in so many breeds would make selection based on ideal conformation a daunting task, particularly since a horse's original lower-limb alignment may have been surgically altered to some degree.

In 2011, a sire or mare's true conformation may be better seen in the foals he or she produces than in the legs he or she stood on when breeding publicity photos were taken.

This is the time of year when veterinarians and farriers find themselves holding squirming foals and truly working together to decide what should or shouldn't be done to straighten the appearance of the lower limbs. These are important decisions.

The same principlws used to improve the limb alignment on a valuable Thoroughbred or show horse foal can be used to intervene when a foal is born with more severe  defects. Surgery and special shoeing probably saved this foal's life. (Photo from the Wildenstein Photo Library, thanks to Michael Wildenstein.)

Knowing the bloodlines, knowing the breeders, and most of all, knowing the anatomy and growth schedule of the lower limbs are the keys to success. What might work at one farm won't work at another. What might work on a Quarter horse might not work on a Friesian.  And what works at one clinic or hospital might not work at yours...but you know what worked on this foal's half-brother, or you remember its dam, or you know the farm staff is going to diligent about caring for this little guy (or not).

The video team at Thoroughbred Times caught a typical moment with a surgical team at Hagyard Equine Medical Center in Lexington, Kentucky this spring. This brief two-part video follows one foal from evaluation through minor surgery and application of a lateral hoof extension aimed at bringing a toed-in foot back into line with the limb.

Part 1: Identifying toe-in conformation with Hagyard Equine Medical Institute's Dr. Michael Spirito

Part 2: Periosteal elevation of the fetlock and application of an adhesive lateral extension on the toed-in foal's foot.

And what if the foals weren't corrected? Toed-in, toed-out, club-footed foals grow up unaltered in the fields of breeders without the budgets of business-oriented breeders. Most people feel strongly that correction early in life gives a foal a chance to bear weight correctly and therefore develop normally so that, as an athlete, the horse has a better chance of running. And winning.

But would they have straightened out on their own, without the pressure of yearling sales for racehorses and in-hand classes for show horse yearlings?

There's no question that the correction has to be done at the right time, before the corresponding growth plates in the area of the deformity close. Wait-and-see is a decision of its own. Conservative trimming techniques can sometimes be enough. A tiny extension like the one shown in the video can be used with or without surgery, and surgery, as shown in the video, can consist of conservative periosteal elevation or more elaborate screw insertion to impede development on one side of the bone.

The idea is to help the foal, and give it a chance to be the best athlete it can be, considering the legs it was given.

To learn more: Read Dr. Ric Redden's overview of foal conformation problems and definition of terms.

Read British veterinary surgeon James Tate describes periosteal bridging and elevation techniques on the website of trainer Mark Johnston.

Still one of the best resources ever: Hoofcare + Lameness "Baby Boom" special issue on foal limb conformation, correction, glue-on shoes, medial and lateral extension shoes, club feet, anglular limb and flexural deformities. $15 per copy. Email Hoofcare office to order or call 978 281 3222.

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  

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Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.

Overgrown Hind Hooves Gone Very Bad: Cruelty Case Video Used in Court to Impose Sentence on Horse Owner

I guess this video doesn't need any explanation. The mare was probably confined in a stall, although I don't know that for a fact, and may even have been born with bilateral hind limb flexural deformity.

This video was provided by World Horse Welfare, formerly the International League for the Protection of Horses. As a result of this prosecution, the owner was banned from keeping horses for ten years, and ordered to pay almost £10,000 in costs and compensation. They ordered that six other horses be removed from the owner's care.

When Mr Barnes of World Horse Welfare and the RSPCA Inspector first saw the mare in the video, named Florence, she was barely able to walk. A veterinarian who examined her decided that so much damage had been done that she could not be saved, and she was put to sleep.

The court magistrates watched video footage of Florence after she had been removed from the owner's premises, possibly the same footage shown here. They heard veterinary evidence that the horse’s feet had been in a bad state for most of its life.

After the hearing Ted Barnes said: “I have found this case extremely upsetting. Years of experience haven’t hardened me to this prolonged neglect to Florence. This horse did not deserve to live most of her life with her feet in this condition. This is something I have never seen before, and neither had the veterinary surgeon who dealt with it.“

The video was apparently shot when the mare had been heavily medicated so that she could walk at all and was probably on her way to be euthanized.

This video is horrifying but I was just as horrified a few weeks ago in Kentucky at the International Equestrian Festival. At an excellent seminar on foal deformities by Dr. Ric Redden, he showed case after case of foals and adult horses with problems as bad as this horse that are brought to him to be "fixed".

One can only wonder what happens to the ones that are never brought forward for treatment or that don't respond to treatment. In spite of the literature and expertise available to them, many breeders never admit that a foal needs expert help until it is too late, if they admit it at all. Some, like this owner, simply hide the evidence in a back stall, hoping no one will see and that the horse will miraculously improve.

There are many ethical questions about keeping animals alive: are they in pain? do they enjoy a quality of life that is suitable? The same questions have come up with horses that have received amputation surgery or that have simply survived severe laminitis rather than recovered from it.

Veterinary ethics is just beginning to explore the issues surrounding chronically lame horses and the ethics of who lives and who dies in the first weeks of life, but the emotions and psychology of horse owners may be a more complex aspect of trying to help young horses with hoof and limb problems than learning medical, surgical or mechanical treatments.

© Fran Jurga and Hoofcare Publishing Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.

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Like a Foal with Extra Long (And Crooked) Legs: Equine-Specialist Vet Helps Louisville Zoo's Giraffe

by Fran Jurga | 18 March 2009 | Fran Jurga's Hoof Blog

A month-old giraffe born in February at the Louisville Zoo is responding after surgery to correct a hind limb deformity. Scott Bennett DVM, a well-known surgeon with Equine Services in Simpsonville, Kentucky performed the surgery at his clinic.

For the first time since his birth, Bakari is currently eating well and is now standing for hours at a time instead of minutes.

Through digital X-rays of Bakari’s legs, Bennett said he determined that Bakari had an angular limb deformity in both hind legs, which the Zoo described as "one side of his bones growing faster than the other", forcing Bakari to wobble and walk sideways.

“Dr. Bennett said the deformity probably started in utero, and that he sees many horse foals with the same problem,” Zoo vet Roy Burns DVM said.

The Zoo said that Bennett performed periosteal stripping, a brief surgical procedure that speeds bone growth on the short side of the leg. As far as Bennett and Burns know, this is the first periosteal stripping ever performed on a giraffe.

Periosteal stripping, also called periosteal elevation, is routinely performed on the front limbs of valuable Thoroughbred foals who show signs of angular limb deformities that might hamper their running ability or detract from their saleability in the auction ring.

Horses helped Bakari both with the technique of his limb surgery and in his immune system. Since he couldn’t stand to nurse, the Zoo’s veterinary team conducted a plasma transfer where horse immunoglobulins (or antibodies) were transfused into the giraffe through an intravenous line. Two plasma transfers were necessary to establish a protective immune system.

Bakari is a Masai giraffe; his name means "Hopeful" in English.

Thanks to the Louisville Zoo for the great photo of Bakari and their help with this article.

© Fran Jurga and Hoofcare Publishing. No use without permission. You only need to ask. Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.