All lameness and gait abnormalities are regionalized by means of diagnostic anesthesia (nerve blocks). These minimally evasive procedures may be repeated at subsequent exams or in modification until the region(s) that is the source of pain is clearly defined.

At a minimum, high standard conformational radiographs (lateral-medial & anterior-posterior views) are acquired after the attending farrier has trimmed and prepared the hoof capsule. These images are subjected to computer analysis and real measurements are used to identify incongruence between the boney column and the hoof capsule. Additional radiographic views are taken as needed. Most degenerative changes observed on radiograph are more accurately considered a historical record of past injury. Ultrasound , MRI, and in select cases arthroscopy are diagnostic modalities that offer a real time and more complete view of soft tissue injury but are not immediately necessary when deciding on how best to restore hoof balance and normal physiologic hoof function.

Corrective shoeing, in its most simple terms, can be defined as the rectification of incongruence between the hoof and skeletal structures and the restoration of normal hoof function. The means to these ends, seldom require elaborate shoes or appliances be attached to the hoof. While the appropriate use of pads, impression materials, bars shoes, and composites are sometimes important, their overuse will ultimately lead to a weaker hoof and are to be considered stop gap and unsustainable. More important to the process is the development of a clear, sustainable plan with well stated objectives as to the parameters in need of correction. Shoeing prescriptions that lack vision will fail. The role of the veterinary podiatrist must therefore go beyond a diagnosis and a single shoeing prescriptions. For this reason both farrier and owner must have an understanding of why the corrections are important and just how they will result in the restoration of balance and function.

Almost without exception, a movement toward hoof balance and normalization of hoof function results in clinical improvement Ideally, several weeks are allowed to measure this improvement or lack there of before addressing the various medical needs these patients are likely to have. Farriery plans that do not produce positive clinical results are in need of adjustment, almost without exception.

Prolonged hoof imbalance and/or lameness carries with it likelihood of mild to severe inflammatory processes within the synovial structures of the hoof and digit. These processes if allowed to continue will lead to irreversible damage to the joints and synovial structures of the digit, not to mention continued unsoundness. For this reason, an aggressive campaign aimed at quieting these destructive processes is mounted. Intrasynovial low dose corticosteroids combined with high quality hyaluronate is currently one of the few effective means available for this job. Commonly medicated structures include the distal and proximal interphalangeal joints (coffin/pastern joints), the navicular bursae and the distal flexor tendon sheath. These procedures are performed under sedation in combination with regional anesthesia to insure minimal iatrogenic trauma to these structures. Chronic cases may require multiple injections to achieve a normal synovial environment and cessation of lameness. Other useful medical therapies are outlined in the treatment section.

The importance of breaking the pain and inflammatory cycles, resolving the lameness and returning the individual to some level of exercise can not be understated. Healthy hooves work for a living while diseased hooves are stuck standing still in their own filth. Furthermore, horses with heel pain will land toe first in an attempt to protect the painful part of the hoof. By doing so they are actually subjecting the deep flexor tendon and navicular structures to greater strains as well as predisposing themselves to sole bruising and pedal osteitis. For this reason, cessation of lameness is the first critical benchmark toward success. Appropriate levels of exercise are an important way to monitor this success as well as keep the hooves healthy, growing, and free of the diseases of ill thrift.

Approximately 20%-25% of individuals presented for evaluation and treatment of hoof based lameness in this practice do not return to working soundness with the aforementioned treatment strategy. These individuals are the population where an actual tissue diagnosis becomes more critical for prognosis and further treatment. At this point, follow-up radiology, ultrasonography, magnetic resonance imaging, and nuclear schintigraphy are considered as we try to answer the question “why is this horse still limping?” If resources are not available for these more costly diagnostics a healthy dose of tincture of time should be considered. Many horses come back sound after 12-18 months of turnout. These horses should be transitioned out of shoes and trimmed regularly to maintain balance. The value of a second opinion from another farrier and/or veterinarian should not be overlooked. To make the most of this option and create an environment of true synergy, open discussion between professionals should be facilitated by the owner without concern of offending anyone’s ego. Second opinions represent an opportunity for professional growth and as such are highly valued in this practice.