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Such a Pain in the Foot!

      Getting out to your farm and seeing your horse reluctant to walk and even bear weight on one of his limbs is a heart-stopping moment for many owners. It is easy to let your mind jump to the worst case scenario; leg fracture? Catastrophic tendon rupture? Thankfully, there is a more common diagnosis that we can help you rule out. The foot abscess.

     Wet conditions can soften your horse’s feet, which will allow bacteria to gain access to the interior of the hoof. The abscess forms around the infection, walling it off. The pressure of the pus in this pocket is extremely painful to the horse as the hoof does not have much flexibility to accommodate this fluid. Severe lameness is often seen. Horses with an abscess occasionally show swelling above the fetlock (possibly from not using the leg), and mild fever.

     The first step in diagnosing such a severe lameness is to use hoof testers to see if there is an area in the hoof that is painful upon pressure. In certain cases, we may perform a diagnostic nerve block to determine that the pain is, in fact, coming from the foot. If your horse is shod, we will tap each nail individually and assess pain response to see if a ‘hot nail’ is the cause of your horse’s pain. We will also thoroughly palpate the coronary band to feel for any soft, painful or swollen areas. The abscess will eventually rupture out the path of least resistance, which in some cases is at the coronary band.  When we can locate which part of the hoof is painful using hoof testers, we will sometimes dig along a necrotic tract in order to allow drainage of the abscess. Drainage usually results in an improvement in comfort over 24 hours, but not instantly. When paring away the foot to allow drainage, we are conservative, as any defect we create must grow out over time. Since the average hoof growth is only 1cm per month, this can be painfully slow. 

     If drainage is not obtained, we advise soaking the foot in Epsom salt to help soften it and draw out the drainage. We also recommended bandaging the foot with poultice, or in some cases, ichthammol. Boots have been made specifically for this condition, but we find a homemade boot of duct tape and baby diapers does just as well for a fraction of the cost. During the soaking and bandage, the lameness can wax and wane. The prognosis is generally good for all foot abscesses for a full return to work but the time frame for recovery is frustratingly variable. It is very important to maintain adequate pain management during this time. Unfortunately oral antibiotics don’t generally reach the abscess as it is walled off in the hoof and has minimal blood supply. Aside from the fact that we don’t want your horse hurting, pain can slow down the gastrointestinal tract and lead to colic. 

     If you are ever confronted with a severe lameness, stay calm and contact your Triangle Equine team to help you determine if your horse may have a foot abscess. Certain conditions such as laminitis and equine Cushing's can cause increased incidence of hoof abscesses, so a more thorough work up may be required if hoof abscesses begin to cause chronic problems.

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