Q&A

Responses continue to come in on the Sept./Oct. 2014
issue Email Q&A on selecting therapeutic shoes

We received an overwhelming response when AFJ editors asked readers what their primary considerations were when selecting therapeutic shoes. Making the horse comfortable and keeping it simple were common themes among the responses.

Below are some additional tips we received on therapeutic shoe selection.


Q: What are the primary considerations you give to selecting a therapeutic shoe for any particular case?

A: My primary concern is to make the horse comfortable. This process starts with support, alignment and mechanics

If I can’t achieve comfort by keeping the horse barefoot, I start with a Natural Balance shoe. If the horse is still uncomfortable, I use the Natural Balance shoe as my platform and build from there using pour-ins, pads, frog support, wedge, lifts, etc., Keep it simple.

 — Alan E. Folkman, Green Bay, Wis.

A: I consider veterinary diagnosis and supporting evidence, such as radiographs, ultrasound, etc. Other things to consider include the severity of the injury or disease, what the horse is used for and the client’s willingness to be involved.

— T.J. Carr, Mathiston, Miss.

A: Be sure of the diagnosis before you select the shoe. Don’t be too proud to get a second opinion if you feel the need.

— Shannon Dabbs, Royse City, Texas

A: I try to select a shoe that would best suit the horse for comfort. Having the knowledge and education needed to solve these types of problems along with the skills to make the shoes makes it all the better and rewarding!

— DJ Gouge, Easton, Ill.

A: Is the shoe shapeable? Some therapeutic shoes can’t be shaped and it’s hard to make bold-toed shoes fit narrow feet.

— Billy Bishop, Inverness, Fla.

A: When selecting or building a therapeutic shoe, the first and foremost thought is the horse’s needs. How can I help with healing and pain management? How can I help the horse comfortably do its job? Being willing to think outside the box or try something that is unorthodox has taught me much.

I struggle with the term “therapeutic.” I don’t like to say I do therapeutic shoeing. In many cases when a horse owner tells me that their horse needs therapeutic trimming/shoeing, what they really need is to be balanced. If I used that term as some do, then every shoe I apply is in some way therapeutic — built to help the horse make up for faults in its makeup.

— Lori McBride, Maximo, Ohio

A: My main consideration in shoe selection is expansion of the “form to function” concept we use in evaluating conformation. Look at the feet, consider what’s keeping the horse from being able to do its job and decide what should be done to facilitate an improvement in mechanics. Choose the trim and the shoe that will accomplish this.

By doing this, you start with the end in mind (what the feet need to look like when finished) and work toward that. Too often we just massage around the basic shape that is there vs. starting with a definite goal. Balance in all planes and eliminating obstructions (i.e. excessive toe length) are imperative.

— Ed Murray, Pell City, Ala.

A: I have never believed in a one-size-fits-all approach, so each therapeutic case is evaluated on an individual basis. I start with the horse’s age, condition and job. Then I ask for input from the owner/rider as to lameness or movement concerns. I also seek any information from the veterinarian involved — X-rays, nerve blocks or flex tests.

When put together, I determine the best approach for treating the horse.

— Mike Bagley, Canton, Ohio

A: There are several considerations that have to been weighed out when selecting any shoe for any horse, whether for a therapeutic case or not.

1. Farrier modality (this often dictates type of shoe).

2. Customer cost limits (another factor of consideration and can sometimes have less desired consequences for the horse if customer can’t afford desired farrier treatment shoes).

3. Discipline of the horse (this is an important factor and shoe type has to be considered closely as they may have positive as well as negative consequences).

4. Turnout and stall environment.

5. Rider ability (a poor rider sometimes puts the farrier in a position of using an alternative shoe choice to offset a rider’s inability to ride a certain way).

6. Treatment options (farrier experience and education often dictates shoe selection as well as options the farrier will not attempt).

— Esco Buff, Webster, N.Y.

A: As a veterinarian, the first thing I look at is the conformation of the horse, including the foot. I believe that the trim is the basis for therapeutic shoeing, always make sure that the heels are brought back to the widest part of the frog to increase the base support of the foot. Balance is assessed by both visual and radiographic input on all planes.

After a diagnosis, I look at any soft tissue or bone structures that may be stressed. In order to alleviate the stresses, I choose a shoe patterned after the Denoix reverse shoe for problems such as deep digital tendinitis, caudal heel pain, or simply to help with the long toe, low heel syndrome that we all commonly see. The Denoix shoe allows the toe to wear during the shoeing cycle while the heel continues to grow. The horse obtains the proper bony alignment while working as the toe drops into the footing, alleviating pressure on the structures in the back of the foot.  

For suspensory branch or collateral ligament problems, I choose an asymmetrical shoe with a wide branch on the affected side and a half-round branch on the unaffected side. This reduces torque on the affected tissues. If the horse has degenerative joint disease, I may use this same type of shoe with the half-round side on the affected side to allow that area of the joint to “open” more when working in arena footing.

If there is proximal suspensory strain, I want to make sure the branches of the shoe are not extended too far back and bevel them to enhance the heel dropping in the dirt. This reduces the pressure on the suspensory.  

All of my choices are dependent on the mutual agreement with the farrier. A cooperative team and the comfort of the farrier with the shoeing techniques being applied work best for the horse. We all benefit and learn from each other’s knowledge!

— Cindi LaCroix, DVM, Scottsdale, Ariz.

A: In a therapeutic situation, it is all about mechanics and protection of the foot.

In damaged or diseased feet, place the shoe where the foot would be if it was healthy and protect the compromised area of the foot. In lameness cases, choose a shoe that will mechanically enhance the opportunity for the foot to function in a normal manner.

— Jeff Ridley, Leighton, Iowa

A: There are a number of things that need to be considered. First, know the attending veterinarian’s philosophies on shoeing different types of cases. Second, the severity of the lameness that you are dealing with and are there multiple applications that can be used. Third, the financial situation of the client. You will need to determine if this will be a long-term rehab situation.

I like to give a couple of options for the veterinarian on therapeutic shoeing and what will work best for the horse in this particular situation. Lastly, I like to look over any diagnostics that have been done on the horse so that a complete evaluation can be made.

— Michael S. DeLeonardo Jr., Salinas, Calif.

A: The temptation when shoeing is to over-engineer the problem and then to keep the treatment going too long. Results must be monitored regularly to avoid the possibility of the remedial process ultimately causing a different problem.

To diagnose a hoof-related lameness issue, we must first establish that the hoof is correctly balanced and normal in shape. The major principle of a hoof in flight is that as the hoof leaves the ground, it will travel in the direction of its longest point, and when it lands it will point in the direction of its longest point. We must also understand that Mother Nature requires the frog to have some contact with the planet, to cause the hoof to expand at the heels under load and enhance blood flow within the hoof.

Another major principle is that anything we do which alters the shape of the ground-bearing edges of the hoof contrary to the normal shape of the hoof, which is also the normal coronary band shape, has a detrimental effect to the horse’s normal stride.

FIGURE 1
FIGURE 2
FIGURE 3
FIGURE 4
FIGURE 5
FIGURE 6
FIGURE 7
FIGURE 8

A rolled-toe/squared-toe shoe always has been used effectively for the rehabilitation of bowed tendons, suspensory problems, corns and heel pain (Figure 1). Today, the rolled toe/squared toe shoe is being used as a Band-Aid to control the breakover whenever the hoof is shown to be long in the toe and low in the heel, instead of simply lowering the front of the hoof and shortening it.

 

The double-clipped shoe (Figure 2) is probably the most offensive weapon we could nail onto the bottom of the horse’s hoof. It was always correctly applied in the event of a major hoof injury, such as fractured pedal bones or quartered heel injuries. Today, it is used to prevent a shoe moving after shoeing, or because the hoof is not landing level, and also to stabilize the rolled-toe shoe because there is no center toe clip. The bottom line is that if we can’t keep a shoe in place without clips of any kind then the hoof is obviously not in symmetrical balance — so this shoe is yet another Band-Aid.

It is clear to see that prolonged use of a double clipped shoe causes pressure bulges in the coronary band directly above these clips and results in sensitivity in this area (Figure 3).

When fitted correctly, the frog bar shoe (Figure 4) is excellent for distributing the weight away from crushed and underrun heels and it often incorporates a rolled toe to enhance toe breakover, which in turn reduces heel pressure. However, when the breakover is sped up, the stride is shortened. So while this system works in the short term, it will cause other problems if it is used for too long.

The heart bar shoe (Figure 5) is often considered to be the panacea of all ills, as when fitted with the correct frog pressure and length it is the ultimate support shoe, so much so that when the need for its use is no longer necessary, some horses have problems working soundly in normal shoes. Sometimes you may need to go in steps, for example go from the heart bar shoe to a straight bar shoe to eventually be able to fit a normal shoe again.

The eggbar shoe (Figure 6), named for its egg shape, is supposed to be useful for spreading the weight over a larger area of shoe. However, by its very design it protrudes back past the natural heels of the hoof and thus causes a leverage pressure at that point. It also causes the hoof to land too early, resulting in a shortening of the stride.

Wedged heel shoes (Figure 7), which often incorporate a rolled toe, have a short-term benefit for low heel problems. We must be careful not to use them for the wrong reason, as nearly all low heel problems are caused from the toes being too long, so make sure the toe is correct first. Whenever a man-made wedge is fitted between the hoof and the shoe at the heels, it causes the heels to become even more crushed (Figure 8).

When doing anything other than correctly balanced trimming and applying a “normal” shoe, we need to ask ourselves these two questions:

  1. Do I fully understand the process I am about to put in place?
  2. Do I fully understand the resulting effect this will have on the horse’s action?

If your answer is yes, then take the time to explain your reasons to the customer. If you are not completely sure, seek a second opinion, as you will win a lot more respect.

— David Farmilo, Oakbank, South Australia

A: My primary concern is to make the horse comfortable. This process starts with support, alignment and mechanics

If I can’t achieve comfort by keeping the horse barefoot, I start with a Natural Balance shoe. If the horse is still uncomfortable, I use the Natural Balance shoe as my platform and build from there using pour-ins, pads, frog support, wedge, lifts, etc., Keep it simple.

 — Alan E. Folkman, Green Bay, Wis.

A: I consider veterinary diagnosis and supporting evidence, such as radiographs, ultrasound, etc. Other things to consider include the severity of the injury or disease, what the horse is used for and the client’s willingness to be involved.

— T.J. Carr, Mathiston, Miss.

A: Be sure of the diagnosis before you select the shoe. Don’t be too proud to get a second opinion if you feel the need.

— Shannon Dabbs, Royse City, Texas

A: I try to select a shoe that would best suit the horse for comfort. Having the knowledge and education needed to solve these types of problems along with the skills to make the shoes makes it all the better and rewarding!

— DJ Gouge, Easton, Ill.

A: Is the shoe shapeable? Some therapeutic shoes can’t be shaped and it’s hard to make bold-toed shoes fit narrow feet.

— Billy Bishop, Inverness, Fla.

A:  Before deciding on a therapeutic shoe, I ask the following questions:

1. Is the horse lame?

2. Where is the lameness located?

3. What is the condition of the foot to which the shoe will be applied?

4. What will horse be doing — trail riding, horse show, convalescing, etc.?

5. Is the client agreeable with the shoeing protocol and willing to do his or her part, including payment?

— Heather O’Brien, Fraser Valley, B.C., Canada

A: My considerations are

1. Vet recommendations.

2. Shoes that I’ve used and know to produce the results I’m trying to achieve.

3. Shoes that look to be beneficial to the horse that I may not have used before.

4. The cost of the shoe or components.

— Scotty Gruczam, Turner, Ore.

A: The first thing is to put a bar shoe on this horse. Or, can I change the trimming and get the horse comfortable on regular shoes? If I have to put a therapeutic shoe on, I always do it as light as possible and after consulting a vet.

— Peter Kristiansen, Strib Beslagsmed, Denmark

A: When selecting or building a therapeutic shoe, the first and foremost thought is the horse’s needs. How can I help with healing and pain management? How can I help the horse comfortably do its job? Being willing to think outside the box or try something that is unorthodox has taught me much.

I struggle with the term “therapeutic.” I don’t like to say I do therapeutic shoeing. In many cases when a horse owner tells me that their horse needs therapeutic trimming/shoeing, what they really need is to be balanced. If I used that term as some do, then every shoe I apply is in some way therapeutic — built to help the horse make up for faults in its makeup.

— Lori McBride, Maximo, Ohio

A: First, a complete study of the case to allow a precise diagnosis is needed. After this, it’s easier and safer to choose the most appropriate shoe for the condition in question.

—Luiz Gustavo Tenório, DVM, Rio de Janeiro, Brazil

A: The first thing I look at is the lameness of the horse. Depending on the severity of lameness and what conditions the horse will be turned out into after shoeing is a large factor on deciding what type of therapeutic shoe will be used.

— Patrick Doyle, Ravensdale, Wash.

A: My main consideration in shoe selection is expansion of the “form to function” concept we use in evaluating conformation. Look at the feet, consider what’s keeping the horse from being able to do its job and decide what should be done to facilitate an improvement in mechanics. Choose the trim and the shoe that will accomplish this.

By doing this, you start with the end in mind (what the feet need to look like when finished) and work toward that. Too often we just massage around the basic shape that is there vs. starting with a definite goal. Balance in all planes and eliminating obstructions (i.e. excessive toe length) are imperative.

— Ed Murray, Pell City, Ala.

A: I have never believed in a one-size-fits-all approach, so each therapeutic case is evaluated on an individual basis. I start with the horse’s age, condition and job. Then I ask for input from the owner/rider as to lameness or movement concerns. I also seek any information from the veterinarian involved — X-rays, nerve blocks or flex tests.

When put together, I determine the best approach for treating the horse.

— Mike Bagley, Canton, Ohio

A: There are several considerations that have to been weighed out when selecting any shoe for any horse, whether for a therapeutic case or not.

1. Farrier modality (this often dictates type of shoe).

2. Customer cost limits (another factor of consideration and can sometimes have less desired consequences for the horse if customer can’t afford desired farrier treatment shoes).

3. Discipline of the horse (this is an important factor and shoe type has to be considered closely as they may have positive as well as negative consequences).

4. Turnout and stall environment.

5. Rider ability (a poor rider sometimes puts the farrier in a position of using an alternative shoe choice to offset a rider’s inability to ride a certain way).

6. Treatment options (farrier experience and education often dictates shoe selection as well as options the farrier will not attempt).

— Esco Buff, Webster, N.Y.

A: As a veterinarian, the first thing I look at is the conformation of the horse, including the foot. I believe that the trim is the basis for therapeutic shoeing, always make sure that the heels are brought back to the widest part of the frog to increase the base support of the foot. Balance is assessed by both visual and radiographic input on all planes.

After a diagnosis, I look at any soft tissue or bone structures that may be stressed. In order to alleviate the stresses, I choose a shoe patterned after the Denoix reverse shoe for problems such as deep digital tendinitis, caudal heel pain, or simply to help with the long toe, low heel syndrome that we all commonly see. The Denoix shoe allows the toe to wear during the shoeing cycle while the heel continues to grow. The horse obtains the proper bony alignment while working as the toe drops into the footing, alleviating pressure on the structures in the back of the foot.  

For suspensory branch or collateral ligament problems, I choose an asymmetrical shoe with a wide branch on the affected side and a half-round branch on the unaffected side. This reduces torque on the affected tissues. If the horse has degenerative joint disease, I may use this same type of shoe with the half-round side on the affected side to allow that area of the joint to “open” more when working in arena footing.

If there is proximal suspensory strain, I want to make sure the branches of the shoe are not extended too far back and bevel them to enhance the heel dropping in the dirt. This reduces the pressure on the suspensory.  

All of my choices are dependent on the mutual agreement with the farrier. A cooperative team and the comfort of the farrier with the shoeing techniques being applied work best for the horse. We all benefit and learn from each other’s knowledge!

— Cindi LaCroix, DVM, Scottsdale, Ariz.

A: In a therapeutic situation, it is all about mechanics and protection of the foot.

In damaged or diseased feet, place the shoe where the foot would be if it was healthy and protect the compromised area of the foot. In lameness cases, choose a shoe that will mechanically enhance the opportunity for the foot to function in a normal manner.

— Jeff Ridley, Leighton, Iowa

A: There are a number of things that need to be considered. First, know the attending veterinarian’s philosophies on shoeing different types of cases. Second, the severity of the lameness that you are dealing with and are there multiple applications that can be used. Three, the financial situation of the client. You will need to determine if this will be a long-term rehab situation.

I like to give a couple of options for the veterinarian on therapeutic shoeing and what will work best for the horse in this particular situation. Lastly, I like to look over any diagnostics that have been done on the horse so that a complete evaluation can be made.

— Michael S. DeLeonardo Jr., Salinas, Calif.

A: I will discuss the case with the attending veterinarian so we are on the same page as far as a treatment plan. We discuss the pros and cons of various shoes before choosing one. The owner is also included in the conversation since they are the ones paying for it. Ultimately, the decision is made by the vet.

— Mel Jones, Galloway, Ohio

A: First I look if the horse must wear a therapeutic shoe or if there is another way for it to get better. Second, I ask the owner for all information about the health of horse — age, work, breed, feed, future plans, etc. I also ask the veterinarian’s advice and check X-Rays.

I look at the motion of the horse to get a feel for its natural conformation, paying special attention to its dorso-palmar and medio-lateral balance. I check the surface where it’s kept and where it works and check the quality of its horn.

I compare everything and choose a suitable therapeutic shoe, often aluminum or light steel. One of the best things for horses wearing therapeutic shoes is to let them barefoot.

—  Tomas Kovacik, Czech republic, Europe.

A: The type of therapeutic shoe and the material it is made of that I decide to use depends largely upon the type of work and conditions the horse is used for along with the specific type of lameness or problem of the horse that I am working on is having.

Right now I am using rubber ground control shoes on the carraige horses I shoe with great success of eliminating their contracted and sore heels. Others with laminitis or thin flakey walls I use glue ons. I am using wedge natural balance shoes on  a on a navicular horse with very good results. 

Sometimes its just your good ol best guess coupled with past experiences along with conferences with other farriers and vets. First and formost I would say that you must start with trimming to balance the foot, correct angles for the individual horse you are working with, along with shoeing for proper support of the hoof and correct adherance of the shoe. 

I wish more people would work on preventing the need for therapeutic shoeing by proper preventative maintenance of our beloved horses!

— Janelle Geyer, Vinita, Okla.


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