Medial displacement followed by quarter crack

Part 1 of the story. This horse has had multiple laminitis episodes over the years. He is a 23 yr old gelding. The latest episode was about 3 months ago. Owners didn't even know it and said he hasn't taken a bad step. The worst foot is by far the right front. Two shoeings ago, when I noticed the latest laminitic episode, this crack appeared on the left front. It hasn't gotten any bigger, but it hasn't gotten any smaller either. It feels like an ossification of a lateral cartilage right behind the origin, but I wouldn't bet on it...feels like a marble behind the coronary. I dug around the crack today thinking I would carve it out, bar shoe, equilox over the crack, etc. Didn't get 1/8" deep and realized that the crack (at least at this point) doesn't go any deeper. It still isn't sensitive to the horse, even when you squeeze the point of origin. No heat, no exudate, no pain...really, nothing besides the obvious cosmetic...yet.

The white line clearly shows displacement centered over the medial toe and a little bruising on the medial side also. Decent HPA but angle of dorsal wall and heel angle is way off. At the origin of the crack, the coronary pretty much falls off. This is pretty much all dressed up and ready for the burn. Got the rest of the distended medial toe out after the fit...cheated the shoe around the medial toe.

My question for this part: Is this a pressure crack from GRF or is there something going on in the foot (i.e.. lateral cartilage ossification, lateral cartilage infection, etc.)?

(I'll have the rest of it up asap)

you might like me; but there might be a infection. you might want to get x-rays. just a thought.

Part 2 - In effort to try to determine approximately where the GRF vector was in this foot, I did a little mapping. The old shoes were heavily worn to the lateral toe on both. I drew the line across the WPF to find approximate COA and get a better idea of how much distortion was in there. Also drew a line 1" in front of the apex of the frog. WPF corresponded with 3/4" behind apex.

I drew the line 1" in front of the apex close to parallel to the line I drew across the WPF (I was off a little). Interestingly, this direction was the same direction as the wear on the old shoes (forgot to take pictures of them...but they are in my truck so I might dig them out tomorrow and take some if I remember).


Since the area on the toe where breakover occurs is largely determined by the angle of the knee (at least that is my current understanding), does anyone else find it a bit curious that not only is the direction of the wear on the shoe (also represented by the line across the toe), but the WPF both run almost perpendicular to the knee? I realize this is going to lose a bit in translation here, but the foot is breaking parallel to the flat of the knee, the WPF on this foot is also parallel to the flat of the knee. Look at the lines on the foot, then follow them up the leg to the knee.

Obviously, the spatial orientation of the foot is a product of the conformation and the weight bourn by it.

Question #2 - Do you correlate the orientation of the WPF with direction of break over/direction of the flat of the knee?

Forgot to add that I told them this very thing today. She already has a call in to the vet and I will post those, good or bad, when I get them. I told her that I wanted to be there to get markers on the feet prior to.

Forgot to add this shot looking down the leg. It shows a little better shot of the bulge behind the coronary band, just over the crack.

I am not sure; at this point in my opinion or if it was my client; I would wait for what the x-rays; then go from there.

ps educated guess......a gas pocket/pressure point behind the quarter crack??? a gravel? could be a simple as that.

Part 3 - I took a Sharpie and traced over three of the rings as best I could. Growth rings show a slight bit of more rapid wall movement on the lateral side. (which is usually correlated with more pressure on the medial). Also shows an accelerated heel growth pattern on both medial and lateral sides. This is fairly typical of a laminitic event, but the occurrence is usually further forward in those events. Ie. really concentrated rings in the front of the foot slowly tapering further and further apart toward the heels. The bulge over the coronary is screaming obvious in the A/P shot here.

Question #3 - Why the acceleration in growth just in the last inch or so in the heels?

Part 4 - I rockered the toe off to the lateral side where I thought it corresponded with what the last shoes and foot where showing. (Tried to shine that spot up with the grinder so it would show in the pictures better) Also shows how much more of the toe I took off afterward...which is probably exactly where it would have been anyway were the white line not stretched out so far.

Part 5 - When I put the foot down, the horse just stood with it out in front like this long enough for me to get these shots.

no x-rays?

Part 5 - Last but not least, the shot down the leg. If a T square were used, this one would be high on the lateral side. Foot depth was certainly more on the lateral side.



This is it. Let the comments, critiques, and further discussion begin.

Umm...remember post #4?

Q: do you think with the acceleration of the heels is the beginning of a sinker starting??
Agreement......I would have rolled the toe to like you did.
Comment........I feel the quarter crack is secondary to something else going on in foot; rads needed.
Q: IR or Cushings starting????

Thank you Scruggs, while I cannot follow this too well yet.... I am going to try.

My question is why isnt there any relief cut out from the bottom in line with that crack?? Just to edit what I asked...I would do the undercut just about where the clip is? Do you always clip this foot in the same spot? I am thinking I would pull a clip farther back to stablize the heels ? But thats just me...

Why would accelerated even heel growth indicate sinking?

Do you always clip this foot in the same spot? I am thinking I would pull a clip farther back to stablize the heels ? But thats just me...[/quote]

Good point. I forgot to add that on the last two shoeings, I cut about 3/16" of relief out below the crack (3/16" at the buttress tapering down to contact just ahead of the crack). Both times, the foot was resting on the shoe at the end of the cycle. After looking at the coronary band, this got me to wondering if cutting the relief was causing the crack to continue...or at least not helping stop it. If it gets better I might stay the current course...or go back to undercutting it if it gets worse. The rads will be the biggest determining factor.

Good idea. I just may do that next time...or just patch over it...or both...or neither...

I had a game plan developed last night. Had straight bar shoes made up and everything was ready to go. Got there today and after looking at it and scratching my head for way too long, I threw all that out the window and started over. Maybe I looked at it so long, my brain followed the previous game plan right out the window.

Gary,
After looking at it a bit more, the lateral side is doing the same thing. Which is now leaning me back more toward pressure being a causative factor. Maybe next time I will stick a pad with some impression material under the back of this one and see where that gets me. I go to this barn every Tuesday, so I might even do this next Tuesday...unless the rads show some reason not to.

In addition to radiographs directed toward soft tissue parameters I would want to see two lateral venograms, loaded and flexed.