Use of wedged pads and boots - "Sun"
In this article, learn how we assessed, trimmed and provided ongoing stimulus without compromising on balance and protection in a 21 year old TB mare with a broken back hoof pastern axis (HPA) and history of mild, chronic grade 2 laminitis.
"podiatry is both art and science - the need for balance without compromising on protection and support"
Author Beccy Smith
Whats the problem?
We love Metron-Hoof for more detailed analysis and objective documentation but "in the field", we often use HoofmApp iPhone app to help us assess and formulate a solution. Below is the LF hoof on a 21 year old 16.2 TB mare under vet care for chronic lameness issues. She recently came out of Formahoof (more on this at a later date) and has developed much needed sole depth, caudal foot and hoof structures and is sounder.... but still has a way to go!
From our full assessment and with the help of HoofmApp used on the lateral view as seen above, we have identified the following issues:
The heels are long and under run
There is a marked broken back HPA (which indicates the phalanges are not aligned - this was previously confirmed on radiographs of the same view)
In addition the palmar angle will be low for the conformation of this horse (note the upright, short pastern)
the toe:heel ratio is poor (more then 60:40 toe:heel ratio is inadequate in a barefoot horse)
There is too much foot and hoof forward of the limb axis and increased strain on the caudal foot and limb
The depth of the hoof is adequate and Sun is sound on a level or slightly stony surface
The ratios and proportions indicate Sun is at risk of tissue breakdown, pathology and lameness; primarily in the foot and above.
They also indicate Sun is at risk of secondary issues created by compensatory posture associated with this hoof morphology
What's the solution?
In hoof care, there is a need to ensure optimum balance without compromising on protection. This is particularly important in a reductive trimming approach (eg, barefoot and without the application of a "shoe"). Removing too much material in order to achieve "improved balance" compromises on protection and comfort, which can lead to pain, lameness, pathology and reduced balance. Likewise, removing too little can create further imbalance and lead to a similar outcome.
The solution we formulated in this case was influenced by the history and health status of the horses, her environment and what is currently available! Assessment of the hoof only has NO place in efficacious hoof care so we assess the whole horse and carefully consider the anticipated environment the horse is exposed to currently and what she might be exposed to in the coming days and weeks.
Our ideal solution would be to have a suitably qualified and experienced farrier fit a modern composite shoeing package and support the caudal hoof with dental impression material (DIM). This would be fitted in a way to reduce break-over further and provide closer to 50:50 toe:heel support around the center of rotation (COR) of the coffin joint. It would also provide a straighter HPA and therefore improved phalangeal alignment. This would also provide optimum protection on all surfaces and continue to stimulate the return and maintenance of healthy ideals in terms of hoof shape and posture. Over time, the caudal structures should continue to develop and in an ideal world, she could return to barefoot or barefoot and booted.
Currently, we don't have access to a farrier who can apply the ideal shoeing package so we created a solution based on trimming and booting which would help her hoof rehab without compromising on protection and comfort.
Step 1 - apply a trim without compromising on protection
Step one was to remove as much hoof material as safely as possible then provide ongoing support to assist in balance and caudal hoof development in the form of a wedged pad contained within a well fitted and adapted hoof boot. As all hoof flare was previously removed prior to formahoof application, we are careful not to remove any more outer hoof wall (flare) from the top two-thirds of the hoof. As this horse is retired and lives on a very conforming surface in boots, a cast or shoe isn't necessarily to provide stability and protection to the capsule following outer wall removal. If this horse was expected to perform however, we would advocate for additional support beyond barefoot and booting.
In the above image, we can evaluate that we have achieved improved proportions and ratios associated with what is considered a healthier hoof in terms of morphology, and its association with resilience and soundness. In summary, there is;
healthier HPA associated with improved balance, phalangeal alignment and palmar P3 angle
shorter toe and less under run heel with improved toe:heel ratio
more hoof under the limb axis
associated less risk of pathology, lameness and compensatory posture
So this horse requires additional support to assist with current and ongoing static and dynamic balance and for protection.
Step 2 - provide ongoing support for balance and protection
We decided to use cloud hoof boots which we believe most horses find comfortable and can be ideal for prolonged periods of use. Cloud hoof boots come supplied with wedged EVA pads. Over time these compress and the wedged effect reduces. In this instance, we fitted a firmer 3 degree wedge under the compressed cloud pad. This assists with balance, protection, support and comfort.
We adapted the boots too - The boots' solar surface was bevelled with a sharp hoof rasp to reduce break-over in the toe and quarter region.
For additional comfort and to assist with fit, we used scoot boot gaiters which sit under the hoof, cover the bulb of the heel and wrap around the pastern. We find more air is circulated around the coronet band and hoof wall when we combine this boot with a gaiter and less material finds its way into the boot.
Hoof boots should be removed daily and the hoof checked and allowed to dry. Sun is turned out on wood chip during the day and stabled on wood pellets overnight. Her boots are checked twice daily but they are worn almost all the time. This suits Sun and the environment she lives in.
Below shows the break-over in the adapted cloud hoof boot (right) compared to the unadapted boot (left)
This is what it looks like on the underside... note the bevel is extended all round the boot. In this instance, the heel area was left alone to maximize the base of support.
Here the soles on the unadapted boot (left) and adapted boot (right) are side by side for comparison.
The new cloud pad (left) and compressed, used one (right)
We have placed a flexible but firmer 3 degree Stromsholm Supersole wedge pad under the used, compressed pad. Note: the very back of the pad isn't under pressure and in reality, the heel compresses into the pad in a short space of time, particularly in larger horses. Therefore the actual wedge only raises the caudal hoof by around 3-4 degrees. The EVA pad conforms to the sole and frog and provides caudal hoof support. Additional support and stimulus can be provided by use of the correct density DIM material in the caudal foot
The wedge and pad are fitted closely to the boot to avoid spinning and the scoot boot gaiter is placed inside the boot before fitting to the horse. This one has been well used!
The boot should be a snug fit, free from hard areas and unable to spin freely.
The gaiter of the cloud boot ready to close with a snug fit around the pastern. This stops the boot from being pulled of easily.
The well fitted cloud hoof boot, complete with custom beak-over and wedged heel support, ready for action!
The same boot from the side. Note the break-over and heel support assisting with improved balance and toe:heel ratio. Along with the wedged insole, this solution offers a useful intervention where modern shoeing packages are not accessible.
Are wedges suitable for all horses?
Wedges are an extremely useful tool for hoof carers and when used appropriately and many horses benefit or would benefit from wedges within an integrative approach to hoof rehab. As with any tool, the way it is used is paramount in whether it is considered successful and is therefore viewed as a "useful" tool. There are many types and forms of wedges and ways in which wedges can be used and we have outlined only one way and in one particular case, where the ideal solution isn't currently accessible.
We highly recommend that before using hoof boots, please consult with a suitably qualified hoof carer (equine podiatrist, farrier or barefoot trimmer). We also recommend that you consult with your horses team (vet/hoof carer/therapist) before fitting wedged pads, and ALWAYS consult with your vet and hoof carer first before fitting wedged pads if your horse is lame or currently being treated by a vet.
Finding a solution which is practical, useful and accessible
Sometimes, solutions are limited by cost (eg formahoof) or accessibility (eg farriers who can apply modern shoeing packages or an appliance isn't available!). Sometimes, a solution is needed there and then and we have found ourselves being creative, eg packing less than ideal hoof boots with sheep's wool collected from the paddock next door in order to provide comfort to a horse in need.
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We take an integrative and holistic approach to whole horse hoof and body health. We appreciate the relationship between body, limb and hoof and seek to address imbalances while positively influencing appropriate static and dynamic hoof balance and biomechanics.