Horse Health

Based on Black & White

This veterinarian and farrier team relies on digital radiographs to eliminate guesswork in achieving soundness.

This veterinarian and farrier team relies on digital radiographs to eliminate guesswork in achieving soundness.

If you travel to a new state, new city or even a new part of town, chances are you will rely on your phone’s GPS to assist in getting you where you need to go. Why? Because no one enjoys being lost, wasting time, making a mistake and having to start over. Having clear directions makes any journey easier.

Which is why Reese Hand, DVM, steers his clients into taking routine radiographs of their horse’s feet. It’s a clear direction, in black and white, of where a horse’s foot care needs to go.

“Every horse has different feet,” says Hand, co-owner of Equine Sports Medicine and Surgery in Weatherford, Texas. “There’s no cookie-cutter foot — each structure varies. Then you go into different disciplines — barrel horses, race horses, jumpers, cutters, rope horses — every one of those do different things: sliding, turning quick, working laterally or working off their hind end. Every discipline puts different stresses on their feet.”

This veterinarian and farrier team relies on digital radiographs and x-rays  to eliminate guesswork in achieving soundness.
The proper angle of the coffin bone should be roughly a four-degree tilt downward.

Those differences make diagnostics and treatment unique to each animal. One thing, however, is universal: soundness starts from the ground up. As the old adage goes — no hoof, no horse. Hand says nearly every new client, or client with a new horse, asks his opinion on how their farrier is doing.

“I always tell those clients, when they ask about their horse’s feet, that the X-ray is the deciding factor [on answering that question],” Hand says. “It’s black and white, literally. It can’t lie; It’s not subjective; it’s not opinionated. And for us, it gives us direction when it comes to shoeing and over-all soundness of the horse.”

Hand appreciates how Lee Olsen — an American Farrier’s Association certified journeyman farrier who owns and operates Olsen Equine, a multi-farrier practice in Brock, Texas — is always looking to set up a horse for success through its feet.

“If you brought a new horse to him, I guarantee the first words out of Lee’s mouth would be, ‘do you have X-rays?’ ” Hand says. “That’s a farrier who cares and wants to start out on the right track. I tip my hat to the farriers who do that. That’s where a farrier can really make a difference.”

Olsen uses his education and experience to do what is best for each horse. But he knows he can navigate a horse’s foot best if he can see it from the inside, out.

“A lot of farriers have a great eye and come close to an ideal shoeing,” Olsen says. “But there is no way to see exactly what’s in that hoof capsule without the X-ray. That is where before and after shoeing X-rays can truly be life-changing; so many times we see an issue on an X-ray that we cannot see without them.”

This veterinarian and farrier team relies on digital radiographs to eliminate guesswork in achieving soundness.
Farrier Lee Olsen (right) often works alongside veterinarian Reese Hand at his clinic. There, the two can take X-rays before and after Olsen shoes a horse. Photo by Lizzie Iwersen

Preventing Problems

Taking radiographs before a problem arises will provide the owner, veterinarian and farrier a baseline picture. In this case, Olsen can use the radiographs to work from when shoeing the horse and Hand can use them to monitor any changes or pathologies that develop over time.

“If you don’t know the horse, which would be the case in a pre-purchase exam, then we are able to find out what we are working with — we see the angles, if he’s balanced and shod correctly,” Hand says. “That gives you a good platform to work off of down the road. Most farriers, if they’re progressive and trying to always do the right thing, they will want that information when you go to have them shod.”

When owners come to Olsen to have their horses shod for the first time, he likes to have as much information as possible before he starts on their feet.

“If I have those X-rays, I’m ahead of the game,” Olsen says. “I can eliminate guess work. I can see if something is not right and work with Dr. Hand to fix it.

“For example, if the horse doesn’t have any sole depth, or has some sort of laminitis [indications] or rotation of the coffin bone at all, I know it’s imperative that I don’t mess with the bottom of the foot,” Olsen continues. “A lot of times I’ll just brush that part of the foot, lower the heels, set the shoe back and the foot will align properly.”

Armed with an X-ray, Olsen can do that work with confidence and drastically lessen the chance for error that could lead to an is- sue immediately or down the line.

“Often we have to make our best educated guess, judging on the exterior of the hoof and the limb,” he says. “And if you do it long enough, you can get really close; but, that doesn’t mean we get it right every time.”

For Hand, a radiograph is the definitive way to see if a horse is out of balance, has the wrong support, a joint issue, or mal-alignment of the bone structure. No matter how much education, training, experience a veterinarian or farrier have, there is just no way to see inside a hoof with the naked eye.

“That’s the thing with a hoof, you cannot see inside of it,” Hand says. “With palpation and flexion, there are a lot of things you can feel with your hands in the leg. But that foot — you can’t put your hands on the coffin bone, no matter what you do.

“The X-ray is the one thing that will tell you if you’re right on or not right on.”

This veterinarian and farrier team relies on digital radiographs and x-rays  to eliminate guesswork in achieving soundness.
Hand and Olsen are ultimately working toward putting the horse’s bones in proper alignment.

Cheap Insurance

Hand and Olsen cite cost as one of the main deterrents for owners getting routine radiographs of their horses’ feet. If the horse isn’t lame, many people question spending money on taking X-rays. Both Hand and Olsen advise clients to consider radiographs as a form of insurance.

“For the horses that have a pretty normal uncomplicated foot, I usually recommend people spend the $120 or $200 twice a year [for X-rays],” Hand says. “In the bigger picture, that’s a small amount as a maintenance practice. Just like you’d bring your horse in to get their routine vaccines, take two views of each foot. If the X-rays tell you that your horse’s foot looks good and your farrier is right on the money, maybe you can go to X-rays just once a year for maintenance.”

If there is an issue developing inside the hoof, it can sometimes be years before it presents itself as a problem. But when it does, it can be costly to diagnose and treat.

“The x-ray is the deciding factor. it’s black and white, literally. it can’t lie; it’s not opinionated.” — Reese Hand, DVM

“No one wants to go down the [expensive] road of things like MRI or stem cell treatments if you don’t have to,” Hand says. “They are upwards of $10,000 versus a couple hundred dollars in X-rays. And you have to think about the time off that horse might need, also.”

The frequency with which to take radiographs varies on each horse and your veterinarian should be able to guide you in the best direction.

“On a horse that we know has a problem because of their conformation, an old injury or arthritis that makes them wear their foot improperly, I think more frequent X-rays are beneficial to stay on top of the issue,” says Hand.

Look Down

Hand says that often a horse will come to his clinic, or to Olsen, with an issue that might not appear to be foot-related. For example, he says in the last few years, back issues have been a hot topic.

“Everybody wants to talk about kissing spine [inadequate space between vertebrae], sore SIs [sacroiliac joints] and sore hind suspensory ligaments,” he says. “I see so many of those horses — either after someone else has treated them or they come in for the first time — and the owner says the horse’s back is sore.

This veterinarian and farrier team relies on digital radiographs and x-rays  to eliminate guesswork in achieving soundness.
Lee Olsen, an American Farrier’s Association certified journeyman farrier, often looks at radiographs sent from the vet clinic on his phone in his shop. Photo by Lizzie Iwersen

“It might be a barrel horse that throws his head in the air or wants to buck in the pattern, a cutting horse that won’t stay in the ground, a reining horse that isn’t stopping or any number of issues related to a discipline. When we palpate the back and it’s sore, we can inject it and probably make things better. But, more than likely, two months later the horse is going to be back sore again.”

These are issues Hand believes can often be traced back to the horse’s feet. When the back injections don’t seem to be as effective, veterinarians and owners can take a different approach.

“[For example,] we’ll X-ray the feet and discover what’s called a negative plantar angles in the hind feet,” Hand says.

A correct coffin bone should naturally tilt down gradually about four degrees. When anatomically correct, the tendons that run behind the coffin bone will have a gliding surface where everything functions smooth. If not correct, however, soreness will present itself.

“Upwards of 50 percent of horses that have persistent SI problems or persistent hind suspensory problems, have negative palmar angles,” Hand says. “So instead of the back of the bone being higher, the front of the bone is higher, tilted up where the coffin bone is actually sitting lower in the back than it is in the front. That is stressing all of those tendons and will make that horse carry himself differently.

“X-rays can be truly life-changing. so many times we see an issue that we cannot see without them.” — Lee Olsen

“The suspensory is going to get sore, his hips are going to get sore, because again, he can’t move the way he’s made to move. It’s one of those cases where you look at the foot and probably 80 percent of the time nobody would have guessed that was the problem.”

That’s when Hand brings Olsen into the equation to balance the foot.

“There are multiple horses where we’ve done nothing more than just balance the feet to help eliminate sore backs and hind end suspensory problems,” Hand says. “It’ll seem like a miracle because it’s like a whole new horse, but again, it’s because we started at the ground.”

Back To Balance

Hand and Olsen are constantly working to- ward achieving balance in a horse’s foot for all soft tissue and bone structure to func- tion correctly.

When taking radiographs, they will take two views of the lower leg and foot to look at three factors.

This veterinarian and farrier team relies on digital radiographs and x-rays  to eliminate guesswork in achieving soundness.
Reese Hand, DVM, is a board-certified surgeon veterinarian at Equine Sports Medicine and Surgery in Weatherford, Texas, specializing in surgery and sports medicine. Photo by Lizzie Iwersen

“We look at three components for balance: front to back, side to side and the alignment of the bony column [of the leg],” Hand says. “And we see those with two radiographic views, essentially a front to back and a side view to kind of put all the pieces together.”

First, the dorso-palmar view captures a toe-to-heel view of the foot and is taken from the front. This view provides a look at the hoof balance from left to right. Ideally, Hand wants to see the horse’s coffin bone paralleltotheground’ssurface. Hecansee some soft tissues of the coronary band, as well, which is ideally level with the ground also. This view helps determine if the horse is high on the inside or the outside, which can put more stress on different ligaments and joints.

Second, the lateral view taken from the side reveals the interior of the hoof capsule, bone structure, or bony column, as it continues up the horse’s leg. Also visible from this angle are sole depth, heel height and toe length.

“All the bones are stacked on top of each other and are redistributing that horse’s forces as it goes down the leg,” Hand explains. “The lateral view also shows us where that coffin bone sits inside the hoof capsule. And if his toe is way long, and that shoe is setting way forward, he’s out of balance from front to back.”

Olsen reiterates the importance of proper balance.

“In the horse’s leg, there is a push for every pull, every time,” Olsen says. “So, when we get that foot out of balance, it doesn’t matter if it’s front-to-back or side-to-side, something has got to pay. If we let that toe run forward, bad things happen. If we let it drift off to the side, bad things happen.”

Taking timely X-rays also helps in achieving balance. Hand and Olsen prefer radiographs be taken as close to a farrier appointment as possible.

“I always tell people to do it right before the horse is due to be shod, because if you need to make corrections, you can show the farrier, and decide what needs to be done,” Hand says.

In some cases, they will take X-rays immediately after a trip to the farrier to check how they did with the shoeing job.

Olsen is also careful not to change too much at one time.

“My goal is usually on the third cycle, or shoeing, to get them where we want them,” he says. “We’ll aim for 70 percent the first day and the rest in the next two shoeings.

“It’s not something you want to do all in one shoeing because everything in this leg is used to being one way, and you risk pulling the horse apart if you try to make too many changes at one time,” he continues.

A coffin bone with a negative angle can only be detected through radiographs and can cause many lameness issues if not corrected with shoeing.
Once identified with an X-ray, the negative angle of the coffin bone can be corrected with the proper shoes.

Good, Better, Best

Olsen feels that horses are generally very resilient, obedient and often perform even if they aren’t 100 percent sound.

“If a horse is doing good, you might be hesitant to change anything,” he says. “But what if your horse could go from just doing its job to doing its job really well? What if it went from good to ‘bad-to-the-bone?’”

Olsen has seen how radiographs can aid in making a good horse become a great horse. “We have caught so many things by tak- ing X-rays of good horses,” Olsen says. “We worked on a nice futurity colt that was doing well, but we X-rayed him and found out that it had negative plantar angles in the hind feet. We fixed that and turned it into a whole new horse, an even better horse.”

Olsen says it’s possible the horse would have stayed sound for years.

“But when he gets to his teenage years [with the problem compounded over the years], it can have the ‘straw that broke the camel’s back’ effect,” he says. “A little of that wrong alignment can progressively start to bother the horse. And when you need him at the prime of his life, that’s when these things are going to be a problem. In this case, we were able to avoid that by having X-rays to guide us early on. It gave that horse the opportunity to be the best he could be.”

This veterinarian and farrier team relies on digital radiographs and x-rays  to eliminate guesswork in achieving soundness.
Olsen and Hand feel their success rates are higher when they work together on a horse. Photo by Lizzie Iwersen

Hand and Olsen believe farrier work can be made over-complicated, especially when you are working off guesses versus what an X-ray image shows.

“I’m a big fan of keeping things as simple as possible,” Olsen says. “And, ideally a horse would be barefoot because that’s the way the hoof capsule is designed to work. But, we have to shoe them if they need to go out in rocky pastures or walk across gravel parking lots or perform in arenas where we’re asking them to turn as fast as they can and not fall down. The shoes help with all that.”

While a bare foot might not be an option, Olsen can try to get back to the naturally-balanced foot, always trying to replicate nature.

“I always say God had a good plan when he built the horse, and any time it gets away from that, bad things can happen,” he says. My take-home to people would be: stop guessing and make sure you’re doing what the horse needs.”

This article was originally published in the April 2022 issue of Western Horseman.

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