The first time Jim LaClaire met Starring Charisma “Twister” was when the veteran farrier stepped out of his shoeing rig at Hopewell Farm and heard the stallion screaming and kicking the sides of his stall.

Hopewell Farm owners Gary and Shirley Shrum and managers Shelly and Joel Strickland had asked LaClaire to take a look at the lame stallion at their Lillian, Ala., operation. They had been told that they should euthanize Twister, but they wanted another option.

LaClaire took a look at the stallion and recommended that they haul him to the Lee Veterinary and Podiatry Clinic, 60 miles away in Atmore, Ala. 

Twister and his owners made their first visit to the Lee Clinic on October 9. Twister is a 12-year-old American Paint Horse stallion, a son of champion stallion Red Charisma. Purchased by Hopewell Farm for breeding in 2007, the horse has had a history of founder since he was a 2-year-old.

In 2004, Dr. James Lee and Dr. Andrew Lovelady had performed a deep digital flexor tendon tenotomy on Twister’s right leg, when he belonged to a different owner. The procedure worked so well that the current owners believed the previous surgery had been performed on the left leg that had always been considered the problem.

But the owners now feared that at the rate Twister was deteriorating, they would have to euthanize him. Even with some remedial actions, the owners and farm staff felt they would be lucky to keep him alive for another 5 years, much less having him function as a stud.

Diagnosis Not Good

X-rays showed the coffin bone in the left front foot had approximately 23 degrees of rotation. The end of the coffin bone had significantly remodeled, having lost one-third of its original shape, with the tip looking like the toe of an elf’s shoe. There was not much sole and the horse had an abscess at the apex of his frog. He obviously was in pain.

The only hope was to perform another deep digital flexor tenotomy. Given that the horse was not a performance horse or used for anything more athletic than breeding, the assumption was that any added stress on the leg could be managed post-surgically. However, the real concern was whether the veterinarian and farrier could get the heel to drop sufficiently to provide the necessary relief.

While it was clear that a therapeutic shoe would be necessary, the question was whether to fit the shoe before or after the procedure. The team decided the only way to know if the surgery would create enough heel drop would be to wait to fit the shoe. But the first step would be to trim down the heel as far as possible.

Once that was done, the goal was to work out a therapeutic shoeing strategy to add enough drop to the heel to achieve the desired effect after the tendon was severed. After another check of the X-rays, farrier Tracy Cooley began paring away the hoof. When Cooley and Lee were finished, they had removed 10% of the caudal hoof.

The horse was then sedated for the tenotomy. Once the tendon was severed, the left fore heel was able to touch the ground. Lee closed the incision, wrapped the leg and waited for LaClaire and Cooley to work out the therapeutic shoe strategy.

At this point, the trim and tenotomy had only reduced the coffin bone rotation by 10 degrees, approximately half of what the vet and farrier team concluded that they would need.

Shoe Design Critical

The trick for the farriers was to design a shoe that would provide enough drop in the heel to align the coffin bone in a normal orientation.  Since Lee had lowered the heel as much as possible using the natural hoof wall, the team knew something very radical would have to be done to provide proper coffin bone alignment. They needed approximately 7 degrees more coffin bone derotation.

LaClaire suggested that it might be possible to reconfigure a commercially available cuff with a thick rubber wedge in the heel. His idea was to deconstruct the cuff, reversing the wedge and reattaching the collar, producing a shoe with approximately 7 degrees of toe wedge. The shoe could be glued to the foot, providing the proper lift in the toe.

Starting with a standard cuff, LaClaire and Cooley unscrewed the thick rubber sole of the cuff. It was reversed so that the highest part of the original wedge was at the mid-toe line. After the reversed sole was screwed in place, the farriers trimmed away the center of the rubber sole, leaving space for the frog and room for treatment of the abscess. They sanded the edges and attached the shoe to Twister’s foot with an acrylic adhesive.

Once the horse’s sedation wore off, the horse walked relatively comfortably. His owners were given instructions to keep the stallion in a dry stall, keep the tenotomy site clean and wrapped and return in 3 weeks for a checkup.

The next time the team would see him was when LaClaire visited the farm 2 weeks later. To his amazement, the horse was docile, easily yielding his feet to the farrier’s attentions. It was not yet possible to fully assess the condition of the foot, because it was too early to remove the cuff.

When Shirley and Gary Shrum brought the horse back to the Lee Clinic for a checkup, it was apparent that the horse was significantly better.

The hoof had grown out to the point that it was clear that the therapeutic shoe should be removed and the foot trimmed. New X-rays showed the coffin bone angle was significantly improved. After trimming, it was determined that the horse could be left barefoot and be within 7 degrees of normal coffin bone alignment — within 4 weeks of initiating therapy.

After some discussion about the next hoof-care strategy, the team agreed that the foot could be trimmed and the horse left barefoot. Trimming revealed a strong sole structure and no abscess.

Twister gingerly tried out his “revised” foot and was soon bearing full weight on it with only a slight limp.

“I’m thrilled,” says Shirley Shrum. “I never thought I’d ever see him walk so comfortably.”

When trimmed properly, Lee’s experience indicates that these tenotomy cases can often gain an additional 3 to 6 degrees of coffin derotation within 6 months of the surgery. If this holds true for Twister, he will be completely realigned.

Successful Rescue

Twister’s story is a success, but when heroic measures are undertaken there are the inevitable failures. There is no doubt this was a salvage operation. The desire of the owners to preserve their animal a bit longer must be weighed against a realistic evaluation of the animal’s condition and whether heroic measures, no matter how creative, will substantively relieve the animal’s distress.

In Twister’s case, both veterinarian and farrier agreed that something could be done to alleviate his pain. The innovative solutions provided by the team gave this stallion the opportunity to live a much longer and productive life.

Once free from pain, he has become a much safer and happier animal. In hindsight, what might have seemed like a rather extreme form of “studdy” behavior stemmed in no small part from a naturally angry reaction to pain.

The surgery and therapeutic shoe provided significant relief for everyone involved — horse, owners, vets and farriers. 

James H. Lee is an equine veterinarian and the owner of the Lee Veterinary Clinic in Atmore, Ala. James LaClaire is a certified journeyman farrier in Pensacola, Fla., and Janice M. LeCocq is a freelance writer and photographer in Century, Fla.