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  Discussion on Thrown shoe resulting in loss of toe esposing living tissue
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Posted on Monday, Jul 8, 2002 - 6:53 pm:

My 2yo TB mare ripped off her left hind shoe taking with it about 1.5T x 3L x 1.5D inches of prism-shaped wall, white line and the underlying tissue. The resulting wound bled for 30-45 minutes but not profusely. I gave her 10cc penicillin, 1gm bute and 1.5 cc "ACE" while I waited for the farrier. We cleaned her foot/wound with betadine, applied a powered wound dressing, wrapped with vet wrap and covered with an E-Z boot. She was 3 legged lame for about 24 hours and is now standing squarely but walking very gingerly. I am continuing with antibiotic for a week and 2gms of bute per day (until sound) and plan to change dressing twice a week. She is on complete stall rest and the farrier is coming back on Saturday (8 days after accident)for her regular shoeing and said he would see what could be done. He did not think there was enough hoof remaining to put a shoe on the injured foot.

Is this the course of action you would recommend? Can you advise me on ALL possible complications? Can you give me instructions for my farrier to relieve pressure toward toe as well as protection/support? I am concerned about her fracturing the tip of the coffin bone if she should kick or stomp her toe-which she did when I changed the dressing after 24 hours. The E-Z boot was on but she clearly was more lame again after she did that.

Thank you,
Michelle

Posted on Tuesday, Jul 9, 2002 - 7:21 am:

Hello Michelle,
I would treat this as any wound and you can find that information at Equine Diseases: Skin Diseases: Wounds: First Aid, Care, and Proud Flesh. Though there is much additional information I would need to know if you are treating this correctly, including examining the wound, the problems I see in what you are doing are:
1) You really should have a veterinarian examine this wound.
2) You need to change your bandage daily at least for a while.
3) The dosages of penicillin are too small, see the medications section for more on this.

You do not say what type powder you are dressing this wound with and this is can be critical. It would be unlikely that I would be trying to put an Easy Boot over this because of the pressure and pain it would cause. Instead I would be creating extra thick bandages on the foot with absolute stall rest in a very clean dry well bedded stall.

If a shoe can safely be put on and you can clean and bandage around it that would be OK but I would not be in a hurry to do this.

Without examining the wound I cannot guess at all the possible complications. Of course infection, possibly ascending to the coffin bone is a possiblity.

A lot depends on the depth of damage to the underlying tissues and some of your current treatment regimen that you do not include. Of particular interest is if I thought the corium was still present. If it is, this will cornify in a very short period and though the wall would need to grow down for full function to return, after cornification Easy Boot and stall rest would be all that is needed.

If a substatial amount of corium is disrupted then this wound will have to heal with recornification as a major component and this will take more time and runs the risk of poor quality horn resulting.

But take heart this wounds heal surprisingly well with very good care which is the key to preventing any posible complication.
DrO

Posted on Tuesday, Jul 9, 2002 - 10:34 am:

DrO,

Wonder Dust is the powder dressing and I will have the vet come out. Could a vet be able to tell if the corium was damaged from the piece of hoof that was torn off? I could take it to a local equine hospital that I like very much. They do not provide ambulatory services and my mare is an hour and a half away. I live in the "big city" where excellent vet care is easy to find but my mare lives w-a-a-a-y out in the country and the selection of good vets is sorely wanting. I have yet to find one that will anticipate and explain complications and prescribe treatments any other way than "here is some medicine and good luck". They do not seem very intrested in the care of my horse. I have gone through three or four in the eight months I have owned her. I think the vets in this area of Texas have been conditioned this way because the client base out there will do anything not to have to call a vet out for cost reasons. MY reluctancy to call them out comes from the indifferent care I seem to get.

Thank you for your assistance. This site is invaluable.

Michelle

Posted on Tuesday, Jul 9, 2002 - 2:26 pm:

I am back again. The reasons I chose Wonder Dust as the hoof wound dressing are as follows: label said for slow healing wounds-hooves heal slowly; thought a dry dressing better for hoof than a water-based or petroleum-based salves that would remain wet and bandaged up. I did not want to promote any additional yuckiness as a result of too much moisture in the hoof area; also thought best to stop bleeding/oozing.

I can't find any specific information about wounds in the hoof that have exposed the underlying structures-lots of abcesses, hot nails, bruises, etc. but this is not the same, is it?

I have talked to vet and received prescription for oral antibiotic with his recommended dosage. However, I am still confused as to appropriate daily care-irrigation; cleansing; dressing (nitrofurizone salve or spray, neosporin?); soft, thick bandage; clean bedding and stall rest. I guess I am asking for direction as to which type of wound I am treating-a skin laceration/wound or a hoof bruise/abcess type? Can I expect proud flesh in this area?...?...?

Thanks again for your help.

Michelle

Posted on Tuesday, Jul 9, 2002 - 8:25 pm:

A QH mare of mine, once managed to stick her front foot through a metal gate. In her attempt to free herself, she bent the smooth rolled edge up - creating a razor sharp edge. She must have panicked then, and ripped her foot free. Looked as though someone had taken a sword and sliced off her outside heel bulb down to the frog on one side, and through the coronary band down into the hoof on the other side. It was hanging on by a piece of hoof. The vet had to amputate the piece ( which included the bulb - better than half an inch thick ) because, as he put it,"You can't sew hoof to hoof, my dear."

As I remember, the dressing was changed daily for a week. We soaked it in mild betadine solution after gently cleansing it. Then we applied either antibiotic ointment or it could have been Novalsan ointment, mixed with a little DMSO. We then covered it with sterile 4x4's and bandaged them to the wound with sterile bandage. Next, we put on a small baggie, pulled on a man's athletic sock and vet wrapped the whole thing. We finished off with a complete covering of duct tape.

After a week, the vet said we could let it go for 2 to 3 days. He wanted us to keep this up until the wound grew a decent cover. There were many set-backs such as her stepping off the dressing once and opening up the wound. Another time, after weeks and weeks of wrapping, we wanted to try getting air at it because the frog was getting stinky. The vet agreed that we had no choice. We surely did not want to chance thrush. We dressed it lightly with gauze and vet wrap, but it was fly season, and in no time, she had maggots in the wound. Later on, proud flesh - debridement, proud flesh - debridement, etc. etc. It was a nightmare of a year for us. You shouldn't have it quite as bad.

17 yrs. later, we are still enjoying our girl. She was young ( about 5 ) when she did this, so she healed well, regrowing the heal bulb - it does look a little different - and the hoof. The hoof has a definite line right from the coronary band to the hoof bottom, but it has never been a problem neither as a "weak" area nor in shoeing.

Posted on Wednesday, Jul 10, 2002 - 5:07 am:

Hello Michelle,
Immediately discontinue the Wonder Dust and thoroughly wash it off. It contains copper sulfate and will do ongoing damage to the very tissues you will need for proper healing.

No this is not treated like an abscess, it is treated like a laceration or deep wound, and after following the article on first aid you should be treating this just like the recommendations in the long term wound care article both at the location referenced above. If you cannot find the Nolvasan (chlorhexidine) creme, Betadine (povidone) ointment will do. If the corium is intact then then proud flesh will not be much of a problem, if it is not then it will form. Articles on taking care of this are covered at the above location also.

Thank you Elizabeth, I am sure this will help give M some ideas on easier bandaging and encourage her. For more on bandaging see, Equine Diseases: First Aid: Bandaging Horses.
DrO

Posted on Wednesday, Jul 10, 2002 - 10:44 am:

Thank you both. The farrier thinks "Lady's" prognosis looks very good, in his opinion, and the vet is scheduled for this afternoon. She is showing marked improvement and putting more weight on the foot with less lameness every day. I am confident it will heal nicely, barring an unlucky complication, and we will surely get plenty of time to work on ground manners.

Best of luck and good health(human and equine),

Michelle
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