HOW-TO SESSION: FIELD SURGERY


Managing Secondary Infections and Complications in the Chronic Unstable Horse


With more traditional shoeing approaches unstable horses often require the fabrication of specialized treatment or hospital plates to manage areas of sec- ondary subsolar abscesses, seromas, hematomas, osteomyelitis, solar penetration, prolapsed solar co- rium, etc. Hoof boots can be completely removed giving total access to the solar surface. Similarly, boot removal allows easy and frequent access to the coronary band and hoof wall. This allows the prac- titioner access to submural abscesses that drain at the coronary band, partial hoof wall resection sites, or shear lesions. Boot removal allows totally unim- peded follow-up radiographs and venograms to be completed. Easy and frequent access to the entire digit is a significant benefit to this approach. Larval therapy has been described as an adjunc-


Fig. 10. A typical hoof boot capable of accepting the 1-inch-thick EVA foam pad material.


tive therapy to treat secondary infections arising from chronic laminitis.10 The author has utilized larval therapy with light foot bandages under hoof boots successfully. A light foot bandage is neces- sary, given that the larvae tend to escape the boot without it. Care must be taken to ensure that the larvae are not crushed. Felt pads with material removed at the site of larvae placement is helpful if there is not a subsolar or submural cavity to place them in.


treat in the author’s opinion. A retrospective study by Bras9 described a 53% mortality rate for sinkers that resulted from systemic disease. This was despite aggressive foot management. Foot casting with axial support has been described for the treatment of distal and mediolateral dis- placement of the distal phalanx.9 Hoof boots can be used but the author has been limiting their use to mild and moderate cases. Foot casts remain the author’s preferred method for treating severe cases. The author does not believe hoof boots as they currently exist will replace the need for foot casts to treat distal or mediolateral displacement of the distal phalanx. Foot casts are thought to stabilize the hoof capsule and minimize indepen- dent movement of the bony column within the hoof capsule.9 Hoof boots can offer the same axial support but lack the rigidity and stability that foot casts provide. Hoof boots offer the advantage of easy access to the palmar veins at the pastern level for IV regional perfusions of antibiotics or for follow-up venogram studies. This benefit does not outweigh the superior immobilization of the foot cast, but bears mentioning. For cases where casting is not an option (usually for monetary constraints) the author tends to apply hoof boots with 1-inch thick EVA foam pad material. The wall is rounded nicely in an effort to shift weight bearing axially just as it is done typically prior to foot casting (Fig. 4). A boot should be chosen that offers enough depth in the bottom of the boot to accept the thick pad material (Fig. 10).


Mitigating Rubs and Maintaining Skin and Hoof Health While in a Boot


Horses maintained in hoof boots for an extended period of time are prone to dermatitis, skin irrita- tion, rubs, and sores. It cannot be emphasized enough how important a perfect-fitting boot is. Hooves can become soft and water logged from


sweat and environmental moisture. Commercially available hoof hardeners and sole paints are com- monly used to combat this. Baby powder applied to a felt pad works surprisingly well and is the author’s preferred method. In very moist environments it is beneficial to have a spare set of boots allowing care- takers to rotate to a dry pair. Interestingly, some horse owners use human


socks on their horse’s hooves prior to applying boots. There are several benefits to using socks with hoof boots. Socks minimize rubs and sores and the moisture-wicking properties of some socks seem to promote better overall skin health. The author routinely dusts socks with baby powder prior to ap- plying them for even better moisture control. In addition, the upper portion of the sock can be folded down over the boot’s straps. This protects the straps from chewing or loosening by the patient (Fig. 11).


3. Results


Over the period of 1 full year from March 2014 to March 2015 the author used modified hoof boots to treat 16 horses with chronic laminitis. Modified hoof boots were used primarily when other shoeing


AAEP PROCEEDINGS  Vol. 61  2015 239


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