Texas Equine Veterinary Association

www.teva-online.org • Page 15 PAlMER FOOT PAIN: FROM FINdING TO FaRRIERy The palmar aspect of the foot has been subject to a multitude of changes in nomenclature when describing pathology in that region. Navicular syndrome has often been used to describe the complex etiologies and pathogenic mechanisms involved in clinical signs associated with that region. Prior to this, navicular disease was used to describe the clinical problem, but inferred a known cause and a specific treatment of which there is still debate. The term was also very anatomically specific but was often used to include any pathology associated with the palmar foot. Both terms have fallen out of favor with some, and the more general term "palmar foot pain" has become the standard. Palmar, obviously, is specific to the front limb as the manifestation is seen more frequently there and has been estimated to be responsible for one-third of all chronic forelimb lameness in horses. By generalizing the term, we promote a greater awareness of the vast array of other structures that can be compromised besides just the bone. With this awareness comes the reality that empirical treatment based on incomplete diagnosis can be idiosyncratic and unrewarding. What needs to be understood is there can be bone specific pathology that fits into the historical understanding of navicular disease, but advanced diagnostic capabilities have given us new insight into a number of commonly affected structures in horses with the same historical presentation. By gaining a better diagnosis, we can be more specific with our therapeutic treatment. The author realizes, however, that many practitioners are limited in what diagnostics can be performed and will often be left with a regional diagnosis that may be incomplete. Because of this, the owner must understand that treatment is empirical and may have to be modified based on the response to initial therapy. This discussion will focus on treatment primarily associated with the therapeutic manipulation of the foot and the thought process behind it. It will also touch on common treatments used by the author to attenuate healing of affected structures Parenteral medical, surgical, shockwave and nutraceutical treatments will not be discussed, but their benefits should be considered when developing a treatment plan. BRITT CONkLIN, dVM, CF Boehringer-Ingelheim Most would agree that changing the mechanics of the foot in a horse that suffers from palmar foot pain is one of the first things to be addressed especially if there is imbalance. It is also a conservative first step and can be combined, early in disease, with controlled athletic rest to facilitate healing. When evaluating the effect of shoeing on cases like these, an adaptation period of two-three weeks is often necessary to achieve pain relief. Any therapeutic shoeing protocol should have a strong basis for its recommendation. The basis should revolve around an approach to reestablish normal equilibrium within the foot. Equilibrium can be difficult to define; but by following a sequential guideline, we can develop a mechanical shoeing prescription that is tailored appropriately to the patient's needs. theraPeUtic shoeing gUideLine 1. Obtain an accurate quantitative anatomical diagnosis. 2. Have an understanding of the form and function of the anatomy in question. 3. Consider the appropriate therapy based on the ability to alter leverage, tension, pressure, or protection. 4. Consider what consequences the alteration could induce. 5. Develop a mechanical shoeing prescription, not a shoe choice. An accurate quantitative diagnosis implies identifying both location and severity. External evaluation can tell us the location of hoof abnormalities that may need to be addressed (like crushed heels, under run heels, medial to lateral imbalances, etc.), but determining location and severity of internal abnormalities requires the aid of diagnostics as previously mentioned. Once all the information regarding pathology is obtained, appropriate therapy that addresses internal and external components can then be implemented. It must be understood that therapeutic shoeing, at its root, can only manipulate leverage, tension, pressure or protection, and alterations can only be made in three planes (dorsal to palmar, medial to lateral, and proximal to distal). It is important to realize that some of these alterations can have negative side effects. For example we know that elevation of the heels induces flexion of the DIPJ, decreases tension in the DDFT, reduces stress on the hoof capsule and decreases deformation of the hoof capsule. These all may be intended therapeutic outcomes, but elevating the

• Cover