Hoof balance and proper shoeing or trimming are part of what you do daily, assisting each horse not only in comfort but also performance through movement.

Some horses are easier to manage than others when it comes to hoof health. In the more frustrating cases, we can encounter a variety of issues such as repetitive hoof cracks, poor growth, improper growth, reduced density or solidity and/or infectious problems including thrush and white line disease. These problems are not only frustrating for all parties involved but can equate to a marked reduction in overall soundness and performance. There is no tried and true remedy for all of these problems, but if we dig deeper, looking at the problem from a bigger perspective, sometimes the answers seem clearer.

Speaking from an equine veterinarian’s point of view and more than 20 years of experience, it can be stated that likely 80% of all equine lameness conditions are connected to the foot, either primarily or secondarily. In many cases, the problem stems directly from the foot, while in others the problem might be elsewhere, such as a joint or tendon, but often linked back to the foot in some fashion.

More commonly we see in cases of ongoing suspensory injuries, more often a result of improper foot balance, movement and landing. We might have a soft tissue injury, but the problem really stems from the foot, and unless this is managed the problem will likely continue.

Hoof Nutrition

The equine hoof is a living tissue that is in need of many of the same nutrients as the rest of the body, including fatty acids, protein (amino acids), vitamins and various minerals. Without these, the hoof tissue will suffer and growth/integrity will be affected. There is no one specific nutrient that can be fed to a horse to improve hoof growth and health. More so, it is a combination of nutrients, pointing toward the importance of a well-balanced diet.

To some degree we need to look at the hoof as an extension of the skin. When problems are occurring, it is important to look at the whole structure.

Realizing that the hoof is a living tissue, dependent on nutrition, one of the biggest problems encountered is improper diet. In many cases, the horse is fed lower-quality forage and then fed high amounts of carbohydrates, in the form of grains, often top dressed with a vitamin/mineral supplement.

Without getting into a detailed discussion on diet, the main thing we need to realize is that the horse is designed to consume plant material in the form of pasture and forage. When we feed or provide lower-quality forage, nutrient intake will be reduced and with it the health of that animal on some level, including the health of the feet. We cannot think that supplementing a vitamin/mineral product will make up for our shortcomings when it comes to feeding high-quality forage.

We need to realize that the high intake of carbohydrates, in the form of grain, is not a good thing for the horse. There are many negative repercussions including obvious ulcer development, anxiety and eventual gastrointestinal compromise. The diet doesn’t need to be complicated, but should be balanced and high in quality. Less money can be spent, if proper forage is purchased and logically provided to the horse. In the long term, that owner will spend less overall because of improved health.

The diet is the main source of nutrients to that animal, helping to ensure overall tissue growth and health. There is no debating this concept, but in many cases, the problem goes much deeper. Our goal, as veterinarian and farrier, is to provide for that animal to improve health, soundness and performance. Unless you enjoy working with these chronic cases, applying specialized shoes routinely and applying Band-Aids to persistent problems, then we need to dig deeper and see a bigger picture of health.

Influence Of Stress

In previous articles, I have discussed the concept of inflammation and how it relates to and impacts health on many levels. Does this hold true for the foot as well? Absolutely!

On a basic level, we have discussed how the concept of stress affects inflammation. Stress comes in all shapes and sizes, with most people associating stress with a psychological condition. Although this is true, stress is also a physical entity.

What happens when you heat a piece of metal and bend it repeatedly? Common sense tells us it breaks, a result of metal fatigue and stress. This theory also applies equally to the hoof capsule, joints and soft tissue structures.

If a hoof is out of balance — medio-laterally, long toe/short heel or any combination — there will be stress upon the structure that’s incurred during movement. This stress contributes to the localized inflammatory process within that structure, affecting cellular health and even blood circulation. This circulation is vital for oxygen and nutrient delivery for overall cell health and growth.

The improper loading of the foot also creates stress, altering tubule growth patterns. Over time, it is like wiring a Bonsai tree, forcing various growth patterns. A shortened inside wall will lead to excessive loading of the outside wall, creating flares at the very least. This is also true of a horse with underrun heels leading to altered tubule patterns, but also excessive stress imparted to the navicular bone, flexor tendons and associated structures.

The same concept applies to a laminitic horse with an excessively long toe that’s loaded, leading to further laminar separation, pain and rotation of the coffin bone. We can’t expect a hoof that is out of balance to support that horse and grow properly. In most of these examples, inflammation is a secondary player in the game, often created by improper trimming, balance or application of shoes.

Despite being a secondary player, the inflammatory process often becomes a “most valuable player,” especially in chronic cases. Often, once that inflammatory process is set into motion, damage begins to develop, then escalates on its own in a vicious cycle of events. This explains why we often can’t just raise heels or adjust angles in a navicular horse, ringbone or laminitic patient and have the lameness completely resolved. We may improve the situation, but the patient often remains lame.

Approximately 80% of all equine lamenesses — either primary or secondary — are connected to the foot.

Gut Health And The Hoof

From a more complicated point of view, we need to look at inflammation in the gut region. Can the gut affect hoof health? Yes!

We can have a horse on a highly nutritious diet, full of whole foods, but still contend with hoof issues and other health maladies. How could this be? One needs to remember that the diet is the source of the nutrients, but the gut is responsible for digestion, absorption and assimilation of those nutrients.

In human research, the effect of the gut on various health problems ranging from eczema to allergies, mental conditions, arthritis and overt gut problems including inflammatory bowel disease and ulcerative colitis are obvious.1,2 The gut is a complicated place, from stomach to small intestine to the large intestine or hindgut. All components need to work together for optimal digestion, which then equates to health for the patient.

Gut health is very important, becoming one of the most important contributors to health on many levels, not just in the horse. The problem is the organ system is complex, not just relying on the integrity and function of each section of intestine to do its job, but also the unseen community of thousands of microorganisms, fungi and protozoa that assist in digestion. In human research models, upsets in the optimal balance are connected with a host of health conditions.

Some of the biggest areas of research, which are included in equine models, are the development of hyperpermeability conditions (leaky gut syndrome) and altered microbial populations within the gut. Based on some equine research, we know that in many cases of laminitis there is evidence that certain bacterial populations are overgrown, including Lactobacillus species.3,4,5 This overgrowth then affects the overall population, impairs digestion and even contributes to the production of potentially pro-inflammatory mediators in the body.

Another area of interest is the leaky gut phenomenon. We see increased intestinal permeability in clinical practice associated with certain colic conditions, intestinal surgeries and toxemia events, but it also seems to occur in many non-acute patients to varying levels. In this condition, the bowel wall becomes more permeable or leaky due to a variety of reasons ranging from medication to diet to even the impact of stress.

The bowel wall is meant to be permeable for some things, such as nutrients, but is meant to block absorption of others, such as bacteria, other invaders and even food additives or chemicals. As the wall becomes more permeable, these items normally blocked can gain access across and into the bloodstream. This equates to an immune response by the animal, both locally and systemically, eliciting an inflammatory response and often immune dysfunction in the long term.

The hows and whys of a leaky gut and other digestive disorders are beyond the scope of this article. The bottom line is that the problem is present in more horses than we care to admit. Easy keeper or metabolic patients tend to demonstrate the problem on a higher level, based on my experience, but the leaner racehorse or jumper is also predisposed, usually on a different level.

Many factors play into the problem, but two of the biggest are a highly processed diet with synthetic nutrients and the impact of stress. If a horse has a history of gastric ulcers, hindgut ulcers or even transient diarrhea upon shipping or competition, then likely we have a problem. In many, these obvious signs are not present, but can be found in the quality of their feces, being more brown, dry and often with a very sweet odor. In some cases, the feces also have a shimmer or shine, which is a mucous coating due to delayed transit times.

How This Affects the Foot

As we can see, hoof health is not as simple as we’d like it to be. We want to provide a supplement or even a better diet to resolve the problem. In some cases, this helps, but those horses usually were on a poor diet initially.

We need to step back, look at that patient with hoof cracks, thrush, white line or overall poor growth and really assess the situation. In most, it is not as simple as rasping those flares, utilizing quarter clipped shoes or clearing out the collateral sulci. We can do this, but the problems often will persist.

To see the problem and address it correctly, we have to treat each horse as an individual. We do need to address the foot, as mentioned above, but we also need to treat or better manage
the problem.

Things to look at in these horses:

• Are they under stress? Stalled a good portion of the day? Little socialization? Bad vices present?
• Are they fed high-quality forage? Do they have access to pasture and sunlight?
• Are they overfed grains? What volume of grain are they fed and is it designed as a meal?
• Are they anxious?
• What is their body conformation? Easy keeper or more lean, maybe even underweight?
• Do they have a history of ulcers, diarrhea, excessive gas production, nervous loose stools?
• What is the quality of the hoof capsule? Dry? Flaky?
• Do they have other health issues? Immune issues? Metabolic concerns?

Maybe now, we can start to see a bigger picture, even putting together some pieces of the puzzle and making connections. This is a good start, but ultimately, the final question is how do we manage the issues for a better outcome? This is a good question that doesn’t always have a definitive answer for every horse.

Answers And Solutions

Every horse is different and thus, management often will vary from one horse to the next. No shoe size fits every horse. This can create further frustration for all parties involved but is really part of the challenge in what we do. We all know, from a farrier’s perspective, that no two navicular horses respond to the same treatment regimen and often that treatment regimen can vary or change from month to month.

1

The first thing that I do is address the foot for more immediate results. Checking balance, growth patterns, regulating flares, adjusting breakover and pulling heels back to where they should be for optimal performance. Then, if needed and desired, applying a shoe to further benefit that horse. By doing this, we can correct any undue stresses or forces, adding to the equation. In many cases, the problems can be resolved or more easily managed just with this approach, but if they become recurrent or chronic, we need to dig deeper.

2

The second is diet. We need to take a look at the forage and assess its value. Is that performance horse being fed a low-quality fescue or even Bermuda hay, with the idea that this will provide enough nutrient value? Do they have access to pasture? If so, what is it, how large and of what value? How much and what type of grain are they fed? Is it a commercial product or a natural, whole grain product? What is the list of ingredients and are there a lot of synthetics added? Is this grain really being used as a meal?

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The third is the effect of the gut and is it a factor? Personally, I look at the body composition. Easy keepers have a higher incidence of gut problems that often are not visible to the naked eye. This doesn’t mean the lean ones are exempt. Does the horse have a history of ulcers, diarrhea, colic or even just loose stools with stress? Are there other signals of poor gastrointestinal health? How about skin? Is there dandruff present, lack of luster to the hair coat? Does it have dry, brittle and cracked hooves? Is there a history of immune problems, such as recurrent infections, allergies or even Lyme disease or equine protozoal myeloencephalitis (EPM) problems? These all can signal that maybe we have an underlying gut problem as the immune system is closely tied in.

4

The fourth is stress in that animal. Are they overtly stressed and anxious? Are they stalled 23 hours a day? Do they have a history of ulcers or cribbing, weaving or pawing? Where do they fit in the herd? We cannot forget that some horses are not quite as obvious in expressing or releasing stress. Some are more stoic and quiet. We also cannot forget that if that horse has a lameness issue, especially ongoing, or other health problem, they are likely under stress to some degree, which may be then effecting our efforts.

Upon inquisition, answers often begin to fall into place, at least regarding potential causes, contributors or even results of the problems at hand. In the end, we are still stuck with trying to find a solution or resolution, which begins with the foot and addressing it properly. We need to do this and should continue to do it, but maybe now we can become more aware of the bigger picture.

In terms of resolving underlying and secondary issues, this can become complex. In many cases, such as ulcers or anxiety, the owners are using medications and even sedatives. This complicates matters as that approach is not solving anything, but more often contributing.

Many ulcer medications, such as proton pump inhibitors (PPIs), are linked back to poor digestion, impaired nutrient absorption and even altered microbial balance in the gut. Many owners are also using probiotics, not just in supplements but in feeds. These probiotics are questionable, as not much research has been done in horses regarding their overall benefits. In some studies, there is even evidence that their use might be complicating matters.

As professionals, we need to assess the entire situation, seek problem areas and advise to the best of our abilities. If we see a problem but don’t have the answers, we should offer to find a resource for the best outcome. If the diet needs to be improved, it’s a good starting point to increase forage quality and reduce grain load. However, not all horse owners are willing to hear this or accept it.

Diet is one of the key areas that I have found beneficial in improving many equine conditions, including those pertaining to the foot. As part of that diet, herbs are included, which help us curb the inflammatory response occurring within that animal and even address gut health. These herbs include curcumin or turmeric, boswellia, dandelion, parsley, marshmallow and even aloe to directly target the gut inflammatory problems. Many other herbs including spirulina, wild yam and alfalfa can supply nutrients in their natural form, which directly impact gut and hoof health.

Almost every hoof ailment or problem we encounter is tied back to health in that animal on some level. Hoof cracks and splits, even improper growth patterns are indeed affected by improper farrier care, but if they fail to respond to appropriate therapy, it is a sign of other problems. Even infectious conditions including canker, thrush and white line disease are a sign of a problem.

Seeing the hoof as an extension of the skin, it should be resistant to infections and invasions outside of normal trauma. These infections, when present, are not only a sign of problems such as laminar separation or poor living conditions but signal an improper or unhealthy immune response in that animal. These are all signs pointing toward potential areas of improvement.

Soundness is a complex topic, often frustrating for all parties. Prevention of these problems is often paramount, but we will soon find understanding if we dig a little deeper in the more chronic situations. Not every horse owner wants our advice. Regardless, it is our job to gain a better understanding of the problems, and if we can’t provide information, then we need to be capable of directing them to the right resources.

References

1. Ferreira, C et al. The central role of gut microbiota in chronic inflammatory disease. J Immun Res. 2014
2. Lobo, L et al. The interplay between gut microbiota and inflammation; lessons from peritonitis and sepsis. Clin Trans Immun. 2016(5).
3. Moreau, MM et al. Illumina sequencing of the V4 hypervariable region 16S rRNA gene reveals extensive changes in bacterial communities in the cecum following carbohydrate oral infusion and development of early-stage acute laminitis in the horse. Vet Microbiol. 2014 Jan 31; 168(2-4):435-441
4. Elliot J, Bailey S. Gastrointestinal derived factors are potential triggers for the development of acute equine laminitis. J Nutr. 2006, 136:2103S-2107S
5. Johnson R, et al. Fructokinase, Fructans, Intestinal Permeability, and Metabolic Syndrome: An Equine Connection. JEVS, 2013, Feb;33(2) 120-126

December 2017 Issue Contents