This case involves my client Heidi Thompson’s 18-month-old filly, Maybeline. On June 9, 2017, she was turned out after it had been raining. She was out in the arena because it offered the driest surface at that time. Maybeline managed to find a puddle and slip. Her foot went under a wire fence, which lacerated the medial side of her hoof. Dr. Valerie Biehl, Maybeline’s veterinarian, came out to examine and suture the wound that day.

When Heidi contacted me to come by about a week later, the stitch pulled and Maybeline ended up with quittor in the medial wing of her coffin bone. At that point, I advised Heidi that the animal most likely needed to go to surgery. Heidi did not want to pursue surgery, so my next thought was that Maybeline should probably be euthanized.

“Clayton, that’s not an option,” Heidi told me. “Fix her.”

My main objective in a case like this is simply to save the animal. I invest a lot of time on shoeing applications and they are frequently changed. Each visit, I had to re-evaluate the situation. What I would look for is an improvement. As long as that horse is getting better, I consider my objectives for that day met. If I arrive and it seems that the horse is worse, my overall objective is that it’s in a better place by the time I leave.

When Heidi told me she wanted to pursue a therapeutic shoeing plan, my first goal was to keep pressure off of the lacerated area. I put on a cuff, glued it to a heart bar (middle) and cut the cuff away so I could put on a stabilization hospital plate to assist what sutures were left. I took the heart-bar shoe and just cut out the zone where the injury was and let it rest on the frog and the rest of the foot with a leather pad and then poured it. I put a frog support pad on the right foot to allieviate the added weight bearing. I applied hoof boots after the first two shoeings for additional support and protection.

First Shoeing Visit

When Maybeline slipped under the barbed wire, Heidi’s daughter Malayna wrapped her with medical bandages. After the horse was cleaned and bandaged, Biehl came out and tried to suture the coronary band (Figure 1 top of page) Maybeline had no shoes on at that point and the goal was to stitch the foot, wrap it up to try to hold it together and keep infection out. Biehl’s portable radiograph machine was down and they had no way of safely transporting the filly, so no X-rays were taken. Soft Ride boots were applied to help manage the trauma.

My first visit with Maybeline after the injury was June 13. What I encountered was an injury, stitches pulled, and things starting to fall apart. In fact, there were only a few stitches left. My goal was truly trying to save that foot. I put on a cuff, glued it to a heart bar and cut the cuff away so I could put on a stabilization hospital plate to assist what sutures were left (Figure 2). My shoeing goal was to keep pressure off of the lacerated area. I used Luwex Air Ride to provide pedal support and stabilized the foot as much as I could, keeping it forward to improve circulation. I didn’t choose a Z-bar at that point because I wanted to protect the coronary band. I took the heart bar and just cut out the zone where the injury was and let it rest on the frog and the rest of the foot with a leather pad and then poured it.

I treated that foot like it was laminitic. I wanted to float it because we were missing half the wall. When missing half the wall, the foot stands a huge chance of mechanical rotation, just like a horse with major white line disease. I also provided a frog support pad to the contralateral limb, hoping to decrease the load burden on that foot. All total, the visit lasted at least 4 hours.

During the next few weeks after my first visit, the horse developed an infection (Figures 3 and 4). Dr. Biehl came out to look at the wound on July 20, 2017 and the medial wing of the coffin bone fell out (Figure 5). In February 2018, Dr. Biehl took a radiograph that confirmed the missing bone (Figure 6).

Tough Prognosis

For the next few weeks, Heidi cleaned the wound twice a day, applying PF Wonder Salve, and Wonder Dust around it as much as was practical. She also used PEMF MagnaWave treatments to help alleviate pain. She also kept me up to date on Maybeline’s progress, sending photos daily. Despite Heidi’s best efforts, an infection developed (Figures 3 and 4). The veterinarian prescribed an antibiotic, but when I came back to check on her she was very lame and they didn’t seem to be working.

The veterinarian came out to look at the wound on July 20, 2017, and the medial wing of the coffin bone fell out (Figures 5 and 6). Heidi sent me a video. The next time I saw her, I asked, “How far do you want to carry this?”

Heidi and I had both done some reading and research and the general prognosis was doom and gloom. I talked to two of the leading equine surgeons in the world and they told me no way the horse recovers from this and to euthanize it. I am there for the horse, but I don’t want to bleed clients dry on a hope and a prayer. I have an ethical obligation financially to tell my client she may be throwing good money for bad.

She asked what her chances were.

I told her it was extremely unlikely that the horse is ever going to walk again.

“Well, what can we do?” she asked me.

I decided the best course of action was to keep the foot floated and hope it fills in with scar tissue or calcification.

On July 31, I removed the hospital plate and Heidi’s husband debrided as much of the dead tissue as he could. Heidi applied medicated antibiotic cream, as well as sugar and medical-grade honey. The infection cleared after a week. Heidi continued to provide additional therapy using MagnaWave 15 to 30 minutes once or twice a day.

On the second visit, I removed the cuff and applied a Z-bar with a Luwex pour-in. I chose a Z-bar to alleviate all pressure to the laceration (Figures 7-10). I continued to apply frog support to the contralateral limb (Figures 11 and 12).

Connect the Dots

For the second shoeing visit, on Aug. 14, I removed the cuff and applied a Z-bar with a Luwex pour-in (Figures 7-10). Dr. Biehl was present during this visit. I used hoof testers to find the sore zone. I noted where she flinched, making a dot on her foot with a Sharpie. When it came time to shoe it was a matter of connecting the dots. I knew that was where she was sore, so that is where I stopped the pour. The horse lost maybe 3% of the edge of the frog, too, in this injury.

I chose a Z-bar to alleviate all pressure to the laceration. It was the only way to go around the wound without any pressure whatsoever. The Luwex pour-in helps support the foot and keeps the hoof from rotating. I like Luwex for this type of case because I can control the firmness.

This was a challenging visit trying to put pressure in the right place. I put that shoe on four times and modified it, and I threw two shoes away before I got it exactly right where Maybeline could walk somewhat comfortably. At that point, the horse was still a grade 2 ½-3 lame on the American Association of Equine Practitioners (AAEP) lameness scale. I continued to provide frog support to the contralateral limb (Figures 11 and 12).

The third visit, the right foot was very stable with substantial growth (Figures 13-15). I took that same Z-bar and added ¾-width extension of bent bar stock (Figures 16 and 17). I reduced pressure using dental impression material under the frog and then poured the rest of the foot with Equi-Pak pour-in (Figure 18). I noticed some softness over the coronary band in the opposite foot and some rotation. I added a leather wedge and a caudal Equi-Pak pour-in (Figures 19 and 20).

Contralateral Limb Concerns

When I arrived for the next shoeing visit on Sept. 21, I could see the hoof was very stable with substantial growth. Maybeline had started to regrow the coronary band that had been severed, and it was as close to normal as I ever imagined it would be. I couldn’t believe it. The only thing that really kept me going is the frog was growing. It was closing in from the front of the foot toward the heel. My Z-bar did not cover half of what it covered the last visit. So, I took that same Z-bar, and I took some bar stock, and I bent it to fit and added ¾-width extension to the Z-bar (Figures 16 and 17). I reduced pressure using dental impression material under the frog and then poured the rest of the foot with Equi-Pak pour-in (Figure 18). She wore that for two shoeings.

I chose Equi-Pak at this time because it is a firmer product that provides more support and stimulation, which the foot can tolerate at this point because it is less painful and sore.

It was during this visit, I noticed some softness over the coronary band in the opposite foot. I had been protecting that foot with a frog support pad since day one, but obviously it wasn’t enough. That foot had started to rotate and I could see we were getting into a mechanical laminitis situation.

My lameness protocol is the same for every horse. First, if you have lameness, hoof testers are a farrier’s best friend. In my opinion, they should be used on every horse because your shoeing will change from horse to horse. I watch each and every horse come out, and that tells me, “OK, we’re not right in whatever limb it is.” That’s what it’s all about: mechanics, pressure and alignment of the bony columns and tendons and ligaments. I use my hoof testers to find the source. If I can’t find it with the hoof testers, I say,
“OK, now we need radiographs. We need the vet to look at it. Let’s get through our lameness protocol.”

For the rotation in the opposite foot, I added a leather wedge and a caudal Equi-Pak pour-in (Figures 19 and 20). I chose the leather wedge to take pressure off of the deep digital flexor tendon and allow more room for Equi-Pak material for padding. I chose copper sulfate Equi-Pak as caudal support and left the front open because she was sore to the tip of the P3 and to support the coffin bone. This was my longest visit — addressing both of these feet — at 5 ½ to 6 hours.

After shoeing, Maybeline was a grade 1 lame.

On my fourth shoeing visit, I pulled the Z-bar and applied a straight bar (above) on the injured foot with an Equi-Pak pour-in. Maybeline’s foot pain was mostly gone and she was pretty much sound. The hoof wall had grown down almost all the way to support the rest of the foot.

On the opposite foot, I applied a “W” shoe with a half-plate (left) and leather wedge pad with dental impression material. Contralateral lameness was my biggest fear.

Continued Improvement

On my fourth shoeing visit, Oct. 24, 2017, I pulled the Z-bar and applied a straight bar on the injured foot with an Equi-Pak pour-in. Maybeline’s foot pain was mostly gone and she was pretty much sound. The hoof wall had grown down almost all the way to support the rest of the foot.

On the opposite foot, I applied a “W” shoe with a half-plate and leather wedge pad with dental impression material. At that time that foot was my biggest fear. I was just trying to keep her going and save that foot, too. After the shoeing, Maybeline was sound walking in a straight line and grade 1 lame in turns.

On the fifth visit post-accident, Nov. 30, I removed Maybeline’s shoes and gave her a balanced trim. I left her shoes off at this point and moved to a regular trim schedule moving forward. Maybeline was sound in a straight line and grade 1.5 in tight circles. I trimmed Maybeline again Dec. 22 and by Jan. 11, 2018, there was almost 100% regrowth with very little changes of the foot considering the injury. Maybeline was mostly sound, except on uneven terrain.

The only radiographs were taken on Feb. 1, which confirmed that part of the coffin bone was gone and there was rotation in the opposite foot.

On the fifth visit post-accident, Nov. 30, I removed the shoes and trimmed. I left shoes off at this point and gave Maybeline a balanced trim. I moved to a regular trim schedule from this point forward.

A Team Effort

Maybeline has been sound ever since and is now 4 years old. Her successful recovery is really a testament to the farrier-client relationship. This could not have happened without a team effort.

As a farrier, you are only as good as your client. Heidi is an amazing client and she did exactly what the veterinarian and I asked her to do. She would unwrap that foot twice a day and clean it, soak if needed, and wrap it back up.

After the infection went away, Heidi started to let Maybeline out for an hour or 2 a day and — even though she was wrapped to the hilt — as soon as Maybeline came into the barn Heidi would cut that wrap off, clean it and rewrap it. It’s really because of her commitment that Maybeline is alive and sound today.

By February 2018 there was almost 100% regrowth with very little changes of the foot considering the injury. Maybeline was mostly sound, except on uneven terrain.

July / August 2020