Texas Equine Veterinary Association

www.teva-online.org • Page 16 heels on a patient with a compromised heel structure like that of an under run patient will further weaken and damage the heel base further exacerbating palmar pain. It may be important in cases like this to redistribute some of the load to the sole of the foot if heel elevation is essential for therapy. Therapy to an upright foot can be much more challenging. Relieving tension in the DDFT or navicular complex is difficult because the heel structure is already elevated and the angle the sole of the distal phalanx makes with the ground (palmar angle) is usually positive. Raising the heels more in cases like these will not generally give a favorable response. Focusing on leverage at the toe (breakover) tends to be the primary mechanical adjustment that can be made in such patients. Concurrently if the heels are contracted and the frog atrophied, we will trim the heels to a good bearing surface of healthy horn and focus on increasing pressure to the palmar structures of the foot with the addition of impression material, pads or pour padding. Some cases may have damage or disease to the bars of the foot in which we will focus our attention on protection with such appliances as onion heels or padding. If our diagnosis affords us an indication of collateral support structure pathology, we will often work to minimize leverage forces from medial to lateral. By widening the web of the shoe on the affected side and rolling the off side, we can provide lever support and lever release to the desired structure. Many of these cases have compensatory pedal osteitis at the toe, and remembering to address that in the therapeutic protocol is very important. This falls under the guideline as an alteration in protection. We want to reduce the concussive forces from the ground to the pedal bone. This can be done in various ways from impression material placement, to wide web shoes (specifically at the toe), to pads and plates depending on the severity. Some common misunderstood areas that should be considered when dealing with therapeutic shoeing in the patient with palmar foot pain are: 1) Wedging the foot can further damage week tubules at the heels. 2) Despite its effective use in some cases, the wedged egg bar shoe places a bulk of the weight on the soft structures at the heel which over time can compromise them. 3) The foot conformation of the domestic horse may not necessarily be compatible or able to be modeled after the foot conformation of the feral horse. 4) The proper trim in therapeutic shoeing will often be the most important aspect of application. There are many shoe designs and appliances available. Determine what alterations will benefit the horse and then find a shoe that will best accommodate that protocol. We use many different styles and shoe designs in our practice and don't advocate nor discredit any available product or technique as many have their benefits depending on each unique situation. Once a mechanical shoeing prescription has been implemented, other treatments can then be explored. The most common forms of therapy used today are those associated with the joint, those associated with soft tissue and those associated with bone. If a quantitative anatomical diagnosis has been made, then each of these therapies can be tailored to effectively treat those specific areas. Joint therapies hinge around improving the health of the synovia and cartilage by limiting the destructive inflammatory cascade, improving viscosity of fluid and reducing effusion. Hyaluronic acids (HA) and corticosteroids are still the mainstay of therapy today. HA varies in molecular weight and those with higher weights

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