Assessment and farriery treatment for chronic foot pain

Whilst diagnostic capabilities within veterinary medicine have witnessed a quantum leap with the emergence of MRI in particular over the last decade, sadly, farriery still relies on anecdotal references rather than evidence-based research when considering appropriate shoeing techniques for chronic foot pain.
The suggested treatment of such cases can often be as a result of personal interpretation given a ‘generic approach’, rather than attempting to isolate the lameness to the ‘primary cause’ and then attempting to offer a specific farriery treatment to the affected structures.
The management of chronic foot pain requires a thorough understanding of a wide range of areas from soft tissue through to any skeletal changes that may present themselves, and an understanding of the effects on ‘functional anatomy’ when offering a change in treatment procedure. Farriery treatment in many cases fails to target the primary cause of the lameness and instead often ends up treating the secondary effects. It is relatively easy, for example, to assume that by just offering protection in the form of solar pads to a foot that has increased sensitivity, the problem has been resolved. However, it may be appropriate to consider why there has been an increase in compression to the caudal aspect of the solar plane and target the approach in terms of treatment to the affected area, despite the fact that the recovery is likely to be longer. Should we be offering a quick fix or be more proactive in reversing the engineering that creates the eventual lameness?
A reverse rotation of P3 can and does compromise the underlying structures over a prolonged period of time. But likewise an anterior rotation of the articular surface of P1 relative to P2 can also have a dynamic effect increasing pressure to the caudal aspect of the solar plane. Difficult in some cases to address the change, but none the less often achievable over time given the appropriate treatment. Asymmetric front feet are another example with the 2 hoof capsules possessing 2 very different angles at the toe and overall general shape, one being flat and having a compressed heel, whilst the other one being smaller in diameter and more upright with a high heel. On the balance of probability, it would be acceptable to assume that the negative heel and broken back hoof pastern axis would almost certainly result in caudal third foot pain due to the increase in caudal pressure, whilst the upright ‘club foot’ would be more susceptible to changes involving the coffin joint and associated structures in particular. Whilst the soft tissue structures will certainly be affected, little regard is placed on the differential in lever arm positioning and biomechanical effect that has on limb/foot loading.
• Can shoeing have an effect on lever arm positioning?
• Should the emphasis on trimming and shoeing be on gaining level and even footfall?
• What ± effects can solar packing have on some soft tissue structures?
• Can we influence dynamic joint loading?

These points plus others will be illustrated using examples during the presentation.