Detecting a Possible Future for Shoeing?

In Fair Hill, Md., the recent site of a large international equestrian event, several farriers gathered, not necessarily an unusual occurrence where events that involve horses are concerned. However, this day lacked the usual sights and sounds that horse people have become accustomed to when considering farriers: no ringing anvils, no screeching grinders or sounds of clinches being blocked. The assembled farriers did not unpack toolboxes from their rigs or unload any horseshoes; nonetheless, the group descended upon the Fair Hill show grounds only armed with cameras, measuring devices, laptops, sensors, and a desire to push their skill into the 21st century. A nearby sign encouraging participation in the study simply read, “Farriery and Gait Assessment…Free Analysis!” The pot was sweetened for the skeptical, reluctant, and resistant, with a $1,000 raffle for participants, including other inducements donated by Dover Saddlery and the American Farriers Journal.

The gathering of farriers moonlighting as researchers and data collectors turned out to be a mini reunion of sorts, with the majority being recent graduates of the Royal Veterinary College's (RVC) Equine Locomotor Research (ELR) program, some traveling great distances to attend. Overheard conversations included a recount of the last resident weekend for the course (hosted in February 2020) on the eve of some new coronavirus outbreak elsewhere on the globe and the resulting effects on travel, while another member of the group was heard expressing their disappointment with failed attempts to encourage some rider/horse combinations participation, attributing resistance to cynicism or a possible jog mishap on the eve of a major competition.

In attendance, farrier Doug Anderson of Mount Airy, Md., informed onlookers and potential partakers that in the field of hoof-related research, which includes approximately 159 studies examining the hoof and shoeing, only five were authored by farriers. He explained that the RVC's ELR program was created with the goal of providing the tools and knowledge to facilitate changing this narrative.

The Fair Hill study, the brainchild of Pat Reilly, another RVC graduate and Chief of Farrier Services at University of Pennsylvania's New Bolton Center since 2006, explores potential correlations of symmetry and performance using a sensor-based gait analysis (EquiGait). The New England native, who has a life-long family connection to horses and their business which retrained off-track Thoroughbreds for eventing, segued into shoeing after a four- or five-day stint as an exercise rider and a trainer's recommendation to seek out another line of work. Explaining the origin of the U.S. version of the ELR Program, Reilly shared that his plans to attend the UK program were derailed by Brexit and visa restrictions, resulting in his lobbying hard the program's creators (Dr.'s Renate Weller and Thilo Pfau) to implement a satellite program in the U.S.

Reilly analyzes the data | Jude Florio

“All farriers have different ways to shoe, and in the absence of facts everyone has an opinion. [Farriers] don't have to prove it,” Reilly said, explain the need for improving farrier education and increasing evidence-based shoeing through research.

In choosing the Fair Hill venue to perform his study, Reilly explained that it offered a “good opportunity” to measure top performance horses, while seeking possible correlations of hoof morphologies, symmetry of movement, and any resulting effects on performance. Ensuing observations, images, and simple measurements were recorded (i.e.: hoof angles, toe lengths), as were the types of shoes, including any possible additional interventions (pads, glue-ons, pour-in materials).

The study's primary focuses are based on the results of measurements using the EquiGait system, an inertial measurement unit (IMU) sensor-based technology developed by Pfau. EquiGait is similar to existing devices commonly known as “lameness locators.” However, Pfau, who was recently appointed Professor to the University of Calgary's Departments of Veterinary Medicine and Kinesiology, explained his system goes one step further than the lameness locator, which uses sensors placed on the pole and sacrum to detect asymmetry. In comparison, EquiGait additionally incorporates the withers, offering the ability to pinpoint asymmetries occurring in front or behind. Pfau added that these systems' main characteristic seek to identify asymmetry of motion, a possible sign of lameness. Measurements of the upper body, movement, and the interaction between the sensors capture function of the legs, including weight bearing, pushing off, and indirect conclusions about force distribution between limbs.

An example of some of the sensor-based technology data | Jude Florio

When asked about the usefulness relating to Thoroughbred racing, Pfau referred to knowledge gained from studies and routine use of this technology by Dr. Bronte Forbes, previously based in Singapore and presently in Hong Kong. He noted Singapore's use of sensor technology as an objective assessment of lameness and confirmation after a veterinary check results in a visual detection. The technology's use has been widely accepted as a trusted veterinary tool. Pfau explained racing's biggest challenge is the reality of horses being pushed to their limits, and asymmetries connected to potential issues are never quite the same, with huge variations in measurements and data. However, both Pfau and Reilly believe using sensor technology in racing may quantify farrier interventions and its measured effect, while identifying existing asymmetries and quantifying why one may enhance performance and another may precipitate a breakdown. Additionally, they agree that farriers do play a huge role in affecting horse's movement and symmetry and the use of this type of technology can only be beneficial.

Pfau asserted, “Shoeing is the most powerful thing that we can do; it has huge consequences.” He underscores shoeing adjustments can be directly quantified, as well as having the potential to redistribute forces highlighted by ongoing examinations of upper-level dressage horses. The study investigates the effects of shoeing on multiple surfaces and attempts to distribute forces symmetrically which without intervention may have longer-term implications with negative ramifications. According to Pfau, for now, sensors are a great resource for veterinarians, assisting in the detection of potential causes of lameness and identifying an area of concern. He also believes the continued collection of data is necessary and imperative, as there is a likelihood that long-term goals will have future sensors used as a preventative measure with an ability of early detection.

Whatever the outcome of Reilly's study, Pfau adds, it's good the conversation continues, forcing the art of shoeing closer to the science of shoeing, and is a great start in providing more facts and fewer opinions. Reilly stressed that he was extremely proud that out of the 10 or 12  graduates, seven or eight took time out of their busy schedules to participate and assist. Of the 40,000 farriers in North America, there are presently 10 or 12 with research training.

“Imagine if we had 10,000 or 12,000, 1,000 or 1,200 even… We have an incredible ability to help our horses and become better at what we do by using evidence and changing how we teach,” said Reilly.

As a lifelong horseperson, rider, farrier, I am unsure of the logic–nor do I understand–the resistance or objections to exploring and unearthing potential issues with the use of noninvasive sensor technology, which objectively measures and assesses gait(s), perhaps detecting a need for an adjustment in shoeing and/or training. The resulting data could potentially enhance or improve performance or, more importantly, detect and derail a potentially catastrophic issue before it's too late.

At the end of the day, what do I know? I hold an inverted unnatural position for hours on end bending metal for a living.

Jude Florio, who has served as a professional farrier for over 20 years, earned a graduate diploma from the University of London's Royal Veterinary College in Applied Equine Locomotor Research. He is among the current MSc Equine Science cohorts studying at the University of Edinburgh, Royal 'Dick' School of Veterinary Studies (June 2023).

 

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Embracing New Technology

Periodically I find myself on the other end of a call with a client seeking a nonexistent 'tool' in my bag of tricks. It can be awkward to expose one's own ignorance on a topic, not to mention uncomfortable. In these instances, I suspect most farriers don't make it a habit of turning away 'good' clients and some of them reply, “Oh sure, I do that, or use that product all of the time.” Shoeing sometimes requires a certain degree of salesmanship; I believe the Irish call it malarkey.

Given the range of innovation and abundance of out-of-the-box thinkers attempting to bring new ideas and products to market within the farrier industry, it has become essential to have Google and/or YouTube on your speed dial (if that still exists). One click of a button, 'virtually' makes you an expert. When necessary, I'm not ashamed to say, that's what I do too.

Recently, I was advised about a client horse, “Ellie,” who was returning home from an extended stay at the clinic after a severe bout with laminitis. Laminitis, also commonly known as founder, is a painful condition affecting the tissue (laminae), which bonds the hoof wall to the coffin (pedal) bone. The root cause and remedy continues to elude investigators. The mare was reportedly comfortable and stable enough for the van ride home. Additionally, I was advised that she was due, and that a product called 'FormaHoof' was successfully being used by the clinic's farrier. In truth, I was initially skeptical. After multiple phone calls with veterinarians, followed by calls to the clinic's farrier, and activating my online speed dial to view multiple application videos, I acquiesced.

FormaHoof had already been on my radar. After some further investigation, the concept seemed interesting and possibly useful in certain cases. However, when a new product or concept makes landfall at your doorstep, there also can be some level of anxiety. In an industry that is built on sayings like, “you're only as good as your last horse,” undoubtedly there is some pressure to perform.

View of the sole with a FormaHoof barefoot mold | Jude R. Florio photo

FormaHoof essentially creates a glue cast, by the use of a mold and a type of fast-set glue which encapsulates the hoof. The process basically creates a cuff, with the glue covering the outer wall to a midway point, as well as the sole and frog. Additionally, there are multiple types of molds: barefoot, traction, or performance. Fortunately, Ellie's front hooves were a similar size which only required the purchase of one mold. (It should be noted: a horse with differing hoof sizes may require the purchase of an additional mold, making the undertaking costlier).

The application requires glue and tips for every application, with the one-time expense of the applicator glue gun. Also provided was a length of plastic/fabric mesh, which is cut and inserted into the mold prior to the hoof and acts as an additional structure for the glue to adhere to. Theoretically, the mold should also be a one-time purchase, however, that is dependent upon hoof size and growth which may require the future purchase of a larger or smaller-sized mold. Multiple applications seem likely for reuse, especially when care is taken ensuring the proper maintenance and storage of the mold(s), which in this instance consists of one horse, two feet, once a month.

A degree of patience is necessary for both the applier and horse, as there is a slight learning curve for correct application. Additionally, some degree of agility and maneuverability are required. The application process requires contorting oneself with steps that include elevating the hoof with the mold and injecting glue into multiple points, followed by lowering the hoof to the ground and maneuvering around the foot to additional glue injection points. Throughout the duration of this hoof/mold/glue ballet, cartridges and tips will likely need to be exchanged, including keen observation of the glue's path and attempting to predict where to move next. I definitely recommend giving oneself some extra time when first attempting this process, and I would advise the purchase of extra glue cartridges and tips until your technique is perfected. It is probable that a few spots will need touching up, but with additional attempts, it does get slightly easier. Admittedly, the ability to perfect the application on the initial go around continues to remain elusive after multiple attempts.

Residual product after removal | Jude R. Florio photo

A cost benefit analysis is recommended as some may consider the investment cost prohibitive.

There are multiple scenarios where FormaHoof use would be appropriate, specifically on a barefoot horse where the ability to conventionally affix a shoe is difficult and/or impossible. However, 'flat-footed' horses may not be able to take sole or increased frog pressure as a result of the hoof's encapsulation, an unfortunate reality which may not be initially apparent until after the product is applied requiring the product's immediate removal. In my conversation with the clinic's farrier, he mentioned occasionally experiencing the pressure problem and indicated it was alleviated by the placement of some impression material. Additional concerns may include a horse's transition out of the product and the experience of possible soundness issues with the removal of a 'cuff' glue-on or a hoof cast, when the hoof wall has a negative reaction to the loss of the artificial support created by those interventions. Lastly, the hoof's preparation is key to ensure reducing opportunity for bacteria promotion and/or eliminating the possibility of abscessing which would require the product's removal.

FormaHoof's barefoot mold | Jude R. Florio photo

On hand for the initial application for Ellie, Dr. Mark Ketner, DVM of Ketner and Associates, a seasoned practitioner and Monmouth Park veterinarian since 1987, admitted he was “very impressed” with the product. When discussing other scenarios that might warrant the product's use, Ketner said, “[FormaHoof] should be great in situations with significant hoof wall defects, or prolapsed soles.”

He added, “There should be minimal soft tissue effects.”

When asked specifically about the appropriateness for racing, he replied, “Not sure about racing; it would depend on the reason the horse needed the product, assuming significant rotation and sole prolapse would preclude a racehorse from being sound.”

As with all stories, the hope is that they will end happily. Unfortunately, far too many stories of laminitis most often don't. Fortunately for Ellie, this story does. Recently while turned out in the paddock, she decided to take a number of trot steps and then proceeded to successfully exit the paddock with a jump over the four-foot gate! I think it's pretty clear she is feeling good and at the end of the day that's what every farrier strives for.

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Shoeing: A ‘Balancing Act’

Full disclosure, for anyone who knows me or has spotted my videos (Farrier Tales), I am not a 'plater,' but I am guessing that would be a foregone conclusion given the rotund nature of the horses featured. In fairness to them, they do go fast, but tend to have a few obstacles in the way.

As one might expect, there is a significant amount of client crossover with the racing and show worlds; I've spent a fair amount of time at the farms, handling broodmares, wrestling babies and shoeing my fair share of newly 'broke' young horses getting their first set of training plates.

It goes without saying, I tip my hat to all of the track shoers of the world. I have wheeled my toolbox into stalls, with my stall jack, dropping nails, wondering how in the heck do these guys do this? As Seamus Brady (legendary U.S. Equestrian Team Farrier), my mentor, would often cry out when I was under a horse for a while, “You need to come up for air.” Of course, this is a reference to the bent-over position platers endlessly hold as they pull, trim, shape and nail on shoes, seemingly in one motion. Fortunately, shoeing show horses has me coming 'up for air' more frequently.

While the disciplines are different, including shoe types and styles, the science of shoeing and its practice are universally the same. When we say, 'beauty is in the eye of the beholder,' we should also consider (relative to horseshoeing), 'balance is in the eye of the beholder,' since not all farriers see the foot the same way. Every farrier brings varying levels of skill, education and experience which affects their ability or inability to read, trim and balance a foot. Of course, the horse's overall behavior, including its patience and cooperativeness for shoeing, should never be overlooked.

Lateral radiographs of the same hoof which highlight pre- and post- shoeing with interventions and observable/measurable changes. Top image demonstrates subluxation of the bony column (bending line), as well as improvement in the shoe's caudal placement, enhanced breakover, increased palmar angle and corresponding hoof angle. | Courtesy of Dr. Isaiah Robinson, DVM, Miller & Associates

Defining Balance and Alignment

'Balance' exists when phalangeal or bony column alignment is achieved. Bony column alignment refers to the relationship of coffin/pedal (P3), short (P2) and long (P3) pastern bones. This relationship, while attempting to achieve equilibrium, should be the most important consideration for farriers. Failure to address these issues will undoubtedly affect many other mechanisms and

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may likely lead to soreness, lameness and, of even greater significance, lead to a career-ending injury.

Failure to address the hoof's 'forward' migration 'off the horse's leg,' increases stress and strain on the soft tissue aspects of the leg and may negatively affect the duration of unrollment (breakover), which science believes can be directly influenced by farrier interventions. Unrollment referring to the hoof's rotation, loading and unloading with breakover being the final moment when the toe leaves the ground.

Incorporating Radiography for Shoeing

Pre- and post-shoeing balance radiographs have become fairly commonplace in the pleasure/show world. Perhaps one can cynically argue, it is another 'billable opportunity' for veterinarians and, in some instances, I might agree. However, there have been many occasions where balance radiography has been a great tool to have when trying to read what Seamus often referred to as 'comical' or unusual feet.

The harsh reality is there are only two ways to find something out as it relates to a horse's foot: going too far (which is always discouraged) or taking a picture and seeing where things stand. (Of course, this excludes doing the same thing [wrong] repeatedly, which I am told is the definition of insanity.) Radiographs will likely highlight what is needed to effect reasonable changes, attempting to modify breakover and improve alignment and ultimately performance.

An image of a 'high/low' hoof presentation post shoeing; the 'high hoof:' left front (on right) and 'low hoof:' right front (on left). With radiography, a veterinarian/farrier can determine their ability to make possible changes to correctly address this hoof presentation. | Courtesy of Jude Florio

Furthermore, radiography may reveal 'false' soles, the misleading appearance that a farrier is looking at the 'bottom' (sole) of the foot. Some horses can naturally build up sole, a protective property of the hoof, which makes reading a foot difficult without going too far. More importantly, radiographs can provide a visual aid to identify the coffin bone's vertical depth (distance from bottom of bone to sole/ground surface) on the low heel/long toe hoof presentations which can aid a farrier's decision to take a foot 'down' (trimming from the bottom) or take a foot 'back' (pulling a foot forward and rasping the outer wall back) (See Figure 2).

I certainly recognize the Thoroughbred hoof is not easy. Frankly, for someone who drives nails as high as I tend to, which is a non-issue but necessary with heavy jumping warmbloods, a Thoroughbred foot is a landmine, thin walled and sensitive. A bit of sage advice that I once received and often repeat: 'I get paid for what I leave on and not for what I take off,' as it relates to trimming and shoeing. That statement is most appropriate when considering the task at hand for the racing Thoroughbred shoer, however, we should always be open to seeking out new techniques, increasing our knowledge which we can only hope improves our skill.

When considering this topic, I reached out to a well-respected veterinarian whose practice covers a variety of performance horses, including those which frequent the track and show ring. He said he deals with foot-related issues often and encourages farriers to 'back toes' with the goal of improving alignment. I asked him, “Do you shoot any balance rads for shoeing?” His answer, “Jude, it's just not done [in racing].” Adding, on the rare occasion that foot radiographs are taken, “Most of the time the farrier doesn't even look at them.” Perhaps they should.

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