12/01/2025
🚨✨CASE OF THE MONTH! ✨🚨
In mid-November, 2024, a nine year-old Friesian gelding from out of state presented for a previous diagnosis of refractory-to-treatment thrush all four. Upon examination, the sulci of all four frogs were found to have deep abnormal tissue that was foul, moist and undermined beneath the frogs, bars and caudal soles. The left hind was most affected followed by the right hind and left/right fore respectively. A diagnosis of canker was made based on the character of the tissue, although the presentation was not typical as the outer sole, superficial frog and other hoof structures appeared relatively normal. The caudal sub-mural (beneath the wall) and sub-solar spaces were greatly undermined. That space was disconnected from the superficial keratinized structures of the hoof and the deeper germinal tissues or corium of those structures by a layer of pearly white, friable tissue consistent with the appearance and character of canker.
A very serious conversation was had with the owners with a guarded prognosis and the overwhelming amount of care required to treat this level of disease. They were determined to pursue treatment, no matter the chances. All four feet were shod with steel shoes and specialized extended heel hospital plates to accommodate large amounts of packing and protect the heels bulbs from long term pressure in preparation for the extended aftercare ahead. The hind shoes were three quartered to allow access to the medial heels and sub-mural space with a complimentary section of bar stock welded in place of the missing shoe to support the areas of unsupported hoof wall.
Abaxial sesamoid nerve blocks were performed all four, followed by arduous sharp debridement and hot-iron cautery of the affected areas.
Words cannot express the emotional rollercoaster, effort and expense of an endeavor such as this. This case was kept at a local layup facility because he was from six hours away. The Podiatry team on his case saw this horse every two to three days for ten and a half months.
Initial debridement and treatment was thought to be effective for a while. No outward indicators of canker were visible and the tissue was going through the expected stages of healing but the shear amount of cauterized tissue made it difficult to distinguish various stages of granulation tissue from areas of suspected canker sites. Many topical medications were tried during this time. Compounded canker paste made from Oxytetracycline and Metronidazole was used initially. Some broad areas remained weepy and were slow to keratinize. Zinc Oxide and unflavored meat tenderizer (a blend of salts), 10% Benzoyl Peroxide in Acetone, and ultimately powdered acetylsalicylic acid were used as well.
During shoeing reset, areas of moisture and canker recurrence were encountered deeply beneath the medial wall despite diligent exploration and a multitude of spot cauterization over the course of time. Extensive resection and cauterization of the medial wall and heel was performed, and ultimately extended up to the coronary band L/RH. The exposed medial parietal face of the left hind coffin bone suffered thermal damage during one of these treatments and formed a slab sequestrum. This area of bone was surgically curetted to remove the dead bone just short of the margin of the coffin joint. Remarkably, the horse never foundered and maintained the ability to resist significant distortion in the face of compromised hoof wall integrity and asymmetrical loading for months on end. At ten and a half months the horse was finally able to go home. He has since shipped back once for reset and no areas of canker were found.
The owners are to be commended for their steadfast dedication in saving this special horse. The emotional and financial toll they endured is not for the faint of heart, but they never wavered even in the darkest hours. Lastly, this horse is a rare individual and exceedingly kind, he was a true gentleman through all the countless hours of adversity and we wish him a long and happy life.
