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Discussion on Protecting a hole in the sole.
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Member:
Sswiley
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Posted on Saturday, Apr 15, 2006 - 11:42 pm:
I thoughtI would run this one by the HA folks. My daughters pony had an abcess that had to be pared out from the bottom. It was a classical crack up the white line that started an infection. It never popped out the top. After we pared out the hole, it drained and I have been keeping it wrapped.
She has been sound for 5 weeks now. The hole in her foot is still quite deep. I am thinking at least 1/2 inch and a little wider than a pencil lead. She has little pony feet so 1/2 inch is a good portion of her sole.
She really needs to be getting out and ridden but I am leary about exposing that hole to dirt. I imagine it was a similar crack that started the infection in the first place.
I have a Davis soak boot and another protection boot that will allow dirt in. She hates them both. She will tolerate them in the stall but if she is out she will try to kick them off(the abcess is in the hind hoof).
Does anyone have any ideas about possibly sealing that hole so we can start getting her out again, If I wait for that hole to grow down it will be several more weeks.
I am guessing that either a temporary barrier that can be removed to inspect the hole or possibly a permanent arrangement like a shoe with a pad, either way I would like to seal up that hole so dirt wont migrate up it.
any ideas would be greatly appreciated.
Shelley
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Moderator:
DrO
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Posted on Sunday, Apr 16, 2006 - 8:24 am:
Normally a case like this we would only keep protected with bandaging and boots for maybe 3 or 4 days and 2 weeks max because a small hole like this should hold cotton pretty well. I would pack it with betadine soaked cotton and change the cotton daily and ride.
DrO
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Member:
Sswiley
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Posted on Saturday, Apr 22, 2006 - 11:33 pm:
OK, the weather has dried out and I can get the boot off her. The cotton is working well. The concern is , she is still quite off and its been 5 weeks. I think she has gotten worse since I changed my protection method. It was hard to tell earlier cause she had to stay in with all the water and when I took her out she had to wear the boot which she hates.
I am worried about a more severe infection and am hoping it has not gotten into the coffin area. She does have a pulse. What would an x-ray show, will it show an infection or just a foriegn body.
She is not three legged lame but she is very limpy and does not like to trot. It is a hind leg.
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Moderator:
DrO
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Posted on Sunday, Apr 23, 2006 - 10:08 am:
If she is still quite off you either you have not drained the abscess well (I thought the hole a bit small for proper treatment) or you have another problem. Radiographs might be helpful if the problem remains undiagnosed, but a good set of hoof testers all that is needed if the abscess unresolved.
DrO
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Member:
Sswiley
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Posted on Saturday, May 20, 2006 - 12:08 am:
Update
May 6 the abscess popped out at the corenary band. Flushed it out twice before it healed over. Then I watched it start growing down the wall, probably with the hoof growth. She has a white hoof and there is an obvious dark area. Still lame, still has pulse and you can feel heat right over the dark area. Soaked it and pultised it, trying to get it to come back to the top. No luck.
May 17 Vet pared out a BIG hole in the bottom. Followed the original path of affected horn but never found a pocket of pus or anything you would expect to cause that much pain. It basically runs right up the white line. At that point she quit and said to wrap her and bandage the area with betadine and formaldahide. She wants to dry the hoof out because her theory is to dry out the infection, also a damp hoof will swell and seal up all the little cracks and potential pathways. Dr O. what do you think about this approach.
The pony is still lame, she has good days and bad day but she is about 4-5 on a scale of 1-10. There is a pulse, and there is heat most of the time.
Today she came out again and we decided to go at it from the outside of the wall. So she went in at the dark area and headed down till she intersected the big hole at the sole. Never found a pocket, she is still quite sore. So now I am wraping it and using the betadine and formaldyhide packing in the two holes.
We can only assume that there is another pocket in deeper or there is just some smoldering infection in the compromised tissue. When she originally pared it out the first time there was no point of entry and she is quite sure there is nothing foreign in there. The tenderness seems rather severe to have just an infection in the tissue. There is really no place for a pocket to form.
Dr. O, Can you think of anything else to treat this with that would pull out the infection.
I think the next step will be x-ray. She also mentioned the rare possibility of some kind of tumor(cant remember the name).
Any thoughts ?
Thanks
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Moderator:
DrO
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Posted on Monday, May 22, 2006 - 6:55 am:
Trapped infection is always very painful.
I don't place formaldehyde where it can come into contact with sensitive tissue as it is irritating and destructive. If an abscess is the problem, really the only way to speed up drainage is to localize the pain and removing the overlying horn.
DrO
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Member:
Sswiley
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Posted on Monday, May 22, 2006 - 10:09 am:
Dr O, Thanks for the response.
This has been going on for months. I cant imagine digging more of her foot out. She already has a compromised structure. We followed the path from both directions. Other than going more towards the center of the hoof, we cant find any more compromised hoof material.
Dr O., what do think about the approach of drying the hoof rather than doing more soaking. I worry that soaking might allow more dirt into the hole due to the fact that you have to soak the whole foot together and it is hard to get it that clean. However, that has always been my approach in the past with less severe abscesses.
Also, what medication would you recommend that would penetrate the hoof tissue and find that elusive infection. We have certainly allowed access to the soft structures so we dont have to penetrate the hard outer hoof.
Last question, how much of the hoof can you take out without increasing the risk of further complications.
Thanks you so much,
Shelley
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Member:
Sswiley
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Posted on Monday, May 22, 2006 - 7:29 pm:
One more thing. Should she be on antibiotics if she has had so much horn removed? I want to soak her some more but I worry about introducing something else in there.
She has had a tetnus since this all started.
I will take a picture when I go out in a few minuets and show you how much exposed hoof we have now.
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Moderator:
DrO
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Posted on Tuesday, May 23, 2006 - 8:18 am:
I don't typically use antibiotics with abscesses as proper drainage is curative, but this is a clinical decision to be made by the examining veterinarian. I do soak foot abscesses with the idea the infection is worse than the contamination and softening the horn helps it find its way out. I use a betadine soak in cool to slighthly warm water but not because I think it penetrates horn, I don't know anything that would work that way, you have to get the puss draining out for a dependable cure.
DrO
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Member:
Sswiley
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Posted on Monday, Sep 25, 2006 - 5:18 pm:
Months later. . . .
Just to update you, we ended up doing a hoof resection on our poor pony. Xrays showed coffin bone demineralization and we could not reach any pockets of infection. Resection was performed 1st of June. She had a hoof cast on for a month, then was fitted with an egg bar with a rim pad to relieve the local wall area. The wall was removed just shy of the cornonary band.
She has been very sound ever since the surgery, of course she has only been stalled and hand walked most of the time. We have since reset the egg bar without the pad(Sept 6). We waited one week after the shoe was reset to make sure there was no sorness. Since then we have been increasing her excercise every few days.
I now have a conflict of opinion regarding how quickly she can return to work. My shoer and local vet(neither which have dealt with this extent of hoof resection before) think I should wait till her hoof completly regrows to resume any regualar work. Mind you she is a beginner child pony and wont be doing much more than walk/trot and possible trotting poles in a months time. I am keeping her off rocky trails and only turning her out or working her on soft footing. The surgeon, who has not seen her since the cast was off but I have had several conversations with, thinks I should bring her back to work according to the plan of one week progress for every month off. This means that she will be doing regular work in about five weeks time(I am counting the last two weeks because we have been increasing her work). Of course her hoof still has more than an inch to grow back so she will not have a normal hoof. Of course all of this assumes that she is still completely sound. I would like to put a regular shoe with toe clips on the next time and shoe her all around so she will be even. The next post will have some pictures to put this into more perspective.
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Member:
Sswiley
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Posted on Monday, Sep 25, 2006 - 5:37 pm:
Here are pics of today
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Member:
Sswiley
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Posted on Monday, Sep 25, 2006 - 5:40 pm:
one more
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Member:
Sswiley
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Posted on Monday, Sep 25, 2006 - 5:46 pm:
I forgot to add my question . . 
Do you see a problem returning her to work with her foot still growing out?
Obviously we have a bit of an underrun heel we will have to deal with, I guess that got messed up after the cast was taken off.
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Member:
Dres
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Posted on Monday, Sep 25, 2006 - 6:55 pm:
Shelley, I personally haven't a clue on the exercise protocol BUT with all the time and money you have now spent.. why push it? why chance a problem if he hits a deep pocket of sand or anything..? What's a little bit more time to be sure... That would be my thinking .. But then I am an over worrier at best...
On the first day God created horses, on the second day he painted them with spots..
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Member:
Sswiley
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Posted on Monday, Sep 25, 2006 - 7:16 pm:
Yeah I hear ya Ann. I guess the truth is that the pony is starting to get a little wild with all this confinement and some cooler days. She actually started bucking two weeks ago while being lead. she bucked so hard I think she made her back sore. She is better now but she really needed to move some more. In my eyes, the most important thing is to keep the shoe on. The wall on either side of the resection is actually very thick, and the exposed area is completly cornified. Although I still keep tape over it to prevent sand from being packed hard into it.
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Moderator:
DrO
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Posted on Monday, Sep 25, 2006 - 7:36 pm:
I don't think there is quite enough support at the heels to insure very active work will not break it out Shelley. It might hold up but if that dark spot behind the pared out area represents where the abscess previously broke out remember all of that wall is undermined. If you are talking walking and trotting a little that might be OK but just judging from these images, until the defect grows out a bit more I would take it easy.
DrO
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Member:
Sswiley
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Posted on Monday, Sep 25, 2006 - 8:29 pm:
Actually the heel is unusaly thick, that is why my shoer put a nail in behind the resection. The darkness is iodine that probably leaked through the nail hole from the bottom. I still iodine the resection everytime I wash it to keep it hard.
The wall on either side of the pared out area is exceptionaly thick and strong. My shoer and I thought it was strange because this pony does not have the greatest walls on any of her other feet.
Is that your main concern ?
Now one other thing I should ask, does riding her with a nail back on the heel where expansion should be happening set us up for other problems? I suppose with enough time you could have contracted heels.
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Member:
Savage
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Posted on Tuesday, Sep 26, 2006 - 4:27 pm:
Shelley and Dr. O, what if you stuffed the hole with some cotton balls dipped in betadine gel and put a few rounds of duck tape around that area, it would keep the hole protected and clean, "but" would that be a decent amount of support to lets say, turn the horse out in a round pen for a short time each day under supervision to keep the excitement edge off?
or maybe a chin strap that is buckled tight and secured with some duck tape to hold that area for short periods of controlled turn out?
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Member:
Sswiley
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Posted on Wednesday, Sep 27, 2006 - 10:44 am:
Well I just talked to my shoer last nite, I wanted to move up the ponys next shoeing because she is already so long. Apparently I misunderstood him last time. He is actually very comfortable with me adding more work to the ponys schedule. He even suggested that I consider letting her go bare foot next time to help with the underrun heel. (Not sure I am that brave.) He also stated that the heel nail will be fine for short term.
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Moderator:
DrO
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Posted on Thursday, Sep 28, 2006 - 7:19 am:
Double check the barefoot recommendation with the surgeon Shelley.
DrO
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Member:
Sswiley
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Posted on Thursday, Sep 28, 2006 - 9:32 am:
Thanks Dr O., I will.
I will ask him if I can email a photo. I feel that I am bugging him too much with follow up questions. Of course that won't stop me
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Member:
Sswiley
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Posted on Thursday, Sep 28, 2006 - 9:34 am:
Linda, I meant to say, I am intrigued by the chin strap idea. Will have to try it.
Thanks Shelley
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Member:
Savage
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Posted on Thursday, Sep 28, 2006 - 6:27 pm:
You're welcome Shelley, if you try this let me know how it works out ok? it appears in theory that it could help a bit, if it slides maybe make some double sided tape from the duck tape for more "grip" on the hoof.
I understand your frustration with this situation, I have dealt with a resection and it is important to make sure you keep it clean and protected from dirt and debris to keep infection from happening.
I would personally keep the shoe on, right now it's your stabilizer and you don't know how hollow the wall is from the abscess and cover the hole so nothing can get in it, you can use gauze or cotton etc to put in there and put a piece of duck tape over it to keep it covered and just do walking around the property. As the hoof grows down you're going to have a nail hole that will be a weak spot between the front and back of that rear section of hoof so be careful.
(boy, do I sound like somebodies mom or what! haha)
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Member:
Sswiley
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Posted on Thursday, Sep 28, 2006 - 7:51 pm:
Just curious Linda.
How long did you have to keep the resected area clean. My surgeon is pretty casual about it now that it is cornified. I have found that if I put cotton, then duct tape over that, the cotton will absorb moisture from the stall and it will end up wetter than if I just tape over the area. Of course just taping over the resected area does still allow some debris to get in, but my surgeon is of the opinion that if I keep the dirt from packing in there and periodically flush it with iodine it will be fine.
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Member:
Savage
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Posted on Thursday, Sep 28, 2006 - 10:14 pm:
Hi Shelley, I kept it clean for about 6 to 8 months or so until it grew out pretty hard and solid and the ridges got to be more round and smooth looking. Remember that infection is your enemy.
One of things I used to keep bacteria and fungus at bay was Fungidye, that stuff really kept things in check. I just squirted it on and let it dribble into all the nooks and crannies. It protects very well. When things did get hard and he wasn't sore in that area I used an electric toothbrush dipped in betadine to really scrub it clean and then blasted it out with water using a large syringe, by the way the electric toothbrush is great to use on an abscess hole as well!
As for keeping stuff out of the hole, doing what your doing is great short of a putting a boot on it, but keeping some cotton with some betadine gel on it helps to keep the area protected from the urine and nasties even though it gets wet. It will also help in keeping little pebble things from packing in there. Be careful where you walk him so he doesn't get into really rocky gravely areas.
Keeping it clean the best way you can is the key to success for this
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Member:
Sswiley
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Posted on Thursday, Sep 28, 2006 - 10:42 pm:
Well I am at about 4 months, I am hoping to have a good plan before the winter rains come. I expect that to happen around November. We rarely get rain here in CA before Halloween.
My surgeon did comment that once he got a horse back a year later that had a gravel. He guesses it worked its way into one of those nooks or crannies.
How long did it take for it to grow out completely ? I am guessing a good three more months for our pony.
So you horse was actually sore in the resection for awhile? I am guessing that you took him straight home and did all the bandaging yourself.
Our vet wanted to put a hoof cast on her for a month. When we took it off the area was still wet, a little bloody but not sore at all. That was when the work started for me, I had to dry it out but also keep it completly clean. Very hard to do. It is amazing how much moisture a hoof will produce if wrapped tightly. It has been hard and completly dry for about a month now, I have been told that now cleanliness is not as much of an issue. I hope that is right.
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Member:
Savage
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Posted on Friday, Sep 29, 2006 - 11:04 pm:
Shelley it took about a year to fully grow out, the resection was done at the ranch where I kept him, my shoer and vet worked together on it and did a terrific job. He was sore because they had to get as much dead tissue as they could out, which left the tip of the coffin bone exposed with an open track, so it was extremely important that I took care of the foot very diligently, he also had rotated about 3-5 degrees so he was wearing a reverse shoe with a medicine plate to give support under the coffin bone. Constant cleaning, covering and care was needed for quite a while. I am the duct tape queen now. He also needed to walk to keep the blood flow up in the foot so I put a "Sabre Sneaker" on his hoof,this boot is awesome, it had firm support for the hoof, it kept debris out and was waterproof about 2 inches up the sides, once he started to walk in it he gave a big sigh, then smiled and walked out and enjoyed himself we took it slow for a bit then he made his own pace, when he saw the boot coming he picked up his foot and said "Hurry mom! lets go for a walk!".
He fully recovered, the rotation stopped and he was good to go. That is why I feel it's very important to keep things clean and comfortable for them until the hoof growth is strong and healthy.
it does take time and we need to do what ever it takes to bring our kids back to good health the best we can,and going that extra mile for them can pay off in sweet knickers and kisses
I am not trying to undermine what your vet says, I am just saying that going that extra step of keeping things clean will help to prevent an infection from creeping in.
I started looking for some ideas for you concerning the wet weather coming and protection for his foot, and I came across the "Equine Slipper" it's fairly new I believe and I think this just might be the ticket for you https://tinyurl.com/j5hv7
Also here is a phone number for the company that makes it (Bluegrass-Equine products) 866-859-9242
Their email is: info@bluegrass-equine.com so if you want to contact them you can
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Member:
Sswiley
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Posted on Saturday, Sep 30, 2006 - 1:08 am:
Thanks so much Linda,
I checked that site out. I think I have seen those before, not a bad price either. I used to use the Davis boots but they tend to irritate the coronary band after awhile and they really sweat the hoof. My vet really emphasizes that I should keep it as dry as possible and most of those boots dont breathe.
I know what you mean about duct tape, I know which brands stick the best, which wear the best, and different ways to make boots out of it.
Luckily, Lizzy has been completly comfortable on her foot since we took the cast off. So as long as I can keep it clean and keep the shoe on we will be OK, (knock on wood).
One thing she learned to do with the Davis boot was to kick it off. You see the resection is on a hind foot. I bet with a little duct tape, he he he, I can get the sneaker to stay on 
Thanks again for all your help
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Moderator:
DrO
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Posted on Saturday, Sep 30, 2006 - 9:06 am:
Whoa, whoa, whoa guys, a defect like above does not need bandaging, in fact bandaging will attract moisture. Neither would such a bandage offer support for the heel area. It just needs to be kept clean and dry. Topical application of persistent antimicrobials is fine (see whiteline disease for more) but I don't see the need to cover such a defect and in fact consider contraindicated in 99% of the situations.
DrO
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Member:
Sswiley
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Posted on Saturday, Sep 30, 2006 - 9:55 am:
Dang I am confused !! The problem is. . . when I hear the word clean, I think OK, how clean. I mean we are talking about the hoof here and it is fundamentaly a very dirty area. And yes I know how bandaging can attract moisture, so how do you keep it clean ?
And then when winter comes is she going to be confined back to her stall again? I do not have a dry place to turn her out or excercise her. That is partly why I was thinking about those boots.
I am sorry but I am a very literal person and I have a hard time interpreting these grey areas. I think that is why I keep misinterpreting my shoer and my vet.
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Member:
Savage
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Posted on Saturday, Sep 30, 2006 - 1:05 pm:
Hi Dr.O, I wasn't meaning to totally wrap the foot, just to put a piece of duct tape across the hole with some cotton or something to help keep the pebbles and the rocks out while walking and while in the stall to help keep debris out of the hole.
The idea of putting tape around the foot was a suggestion for possibly giving a bit more support on the piece of rear hoof while putting the pony in an arena to blow off steam if needed, but not to keep it on.
And I do apologize greatly if I gave misinformation. Do I have to go sit in a corner now?
In my case I needed to have protection from the wet per farrier and two vets until everything hardened up so that is why I had used the boot when it rained, and because my horses toe was sensitive I used the boot to cover it while walking so he wouldn't get a rock shoved in that area which would have hurt him at that point.
Shelley I apologize if I have confused you on this, my heart was in the right place and probably using my example of what I did for my guy was over kill for your situation. I guess you could say I was paranoid in my situation because of going through a very nasty and defiant infection over a long period of time and I wanted to take any precaution that I could.
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Member:
Sswiley
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Posted on Saturday, Sep 30, 2006 - 3:32 pm:
Linda, dont be silly, based on your explanation of your horse it was obvious to me it was more severe. I greatly appreciate your input. Sometimes we get too "chatty" on these threads and forget what our original question was.
But believe it or not I have not found any vets, shoers or even horse people that have had much experience with a resection. I am very much in unknown territory with this and I worry that there was something I did wrong last spring that caused it to get so bad.
So, everything is hardened up on her now. What does that mean for winter mud. I am not so much worried about the comfort level and hoof stability as I am how to keep it clean this winter when the mud comes. I am determined not to make her sit in a stall all winter, especially since she is so sound.
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New Member:
Cbuck894
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Posted on Saturday, Sep 30, 2006 - 9:14 pm:
Shelley,
We had a slightly different issue (nail in the sole) but it was during a wet spring and we needed to keep the area clean and dry while the colt was turned out. We used a baby diaper over the foot like a boot and LOTS of duct tape. The diaper absorbed any drainage or moisture from the hoof and the duct tape kept it on and kept it from being destroyed while he exercised. We also used Banixx Spray as an antibacterial.
He is now good as new!
Just a thought for outside time if it's wet.
Carol
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Member:
Hwood
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Posted on Saturday, Sep 30, 2006 - 9:57 pm:
Carol, this is off subject, so please, all, forgive me, but first of all, welcome to HA . . . and secondly, where are you in Kansas? We are in Wellington. Nice to have you with us.
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Member:
Savage
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Posted on Sunday, Oct 1, 2006 - 12:15 am:
Thanks Shelley, yeah I am finding that sometimes, trying to explain something in an easy way can get carried away especially when typing it haha.
welpers, getting back to the point of how to keep it clean and dry during the rainy season, if the boot is not an option you can use the baby diapers that Carol suggested, I had also used them before and they are great. I would call the doc again and point blank as him what he recommends to do for the rainy season, ask him about the use of the diapers as well and see what he says.
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Member:
Savage
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Posted on Sunday, Oct 1, 2006 - 12:22 am:
Hi Carol, and also a warm welcome to HA!
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Moderator:
DrO
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Posted on Sunday, Oct 1, 2006 - 9:42 am:
Shelly it means "as clean as you can and as dry as you can". These are practical considerations and will be different at different times. No one explanation can cover it all. However for a defect like above, when it is dry a bandage is not needed and when wet a bandage concentrates moisture in the area, not protect it. Tape applied directly to a hoof wall over time makes the wall soft and crumbly so should be avoided.
DrO
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