How to keep the horse with chronic foot pain going – a veterinarian’s perspective

The following discussion about ‘how to keep a horse with chronic foot pain going’ is based on the assumption that a definitive diagnosis has been achieved. Based on the diagnosis(es) (generally achieved through local analgesia and diagnostic imaging, including magnetic resonance imaging) there are a number of questions that need to be addressed. What is the diagnosis? Is it safe to try to keep the horse going? Is the problem one that is likely to get better with appropriate rest and time, e.g. bone trauma? Is it likely that the prognosis will be adversely affected if we try to keep going, with appropriate interventions, vs. rest? What is the current evidence-base for the success of management of the problem(s) identified [1–12]? The answers to these questions need to be assessed in light of a number of factors which may influence management and prognosis, including the work discipline and level at which the horse is expected to perform, surface(s) on which the horse works, the presence of unilateral vs. bilateral lameness, the severity of the lameness, foot and distal limb conformation, the skill of the available farrier, the age of the horse and its expected athletic career, drug regulations that must be complied with under competition rules and the expertise of the rider.
The selection of corrective trimming and shoeing needs to consider both short-term vs. long-term outcomes; while elevation of the heel may have temporary benefits for pain reduction, the longer term consequences on the hoof capsule may be undesirable. Biomechanical principles of trimming and shoeing for specific injuries have to be weighed up against the individual’s foot (feet) conformation and dynamic movement of the foot and distal aspect of the limb. There is not necessarily a ‘one method fits all’ solution. The principles of trimming to achieve good mediolateral and dorsopalmar foot balance and facilitation of breakover are prerequisites for all methods of shoeing. The individual merits of an ordinary well-fitted broad web shoe, egg bar shoes, reverse shoes, synthetic shoes and any other variant ± pads have not been scientifically evaluated for different injury categories. […]