by Jennifer A. Miller-Bailey, DVM, MS, CVA
Equine podiatry has seen many changes and advances over the past decades. One of the more exciting recent changes has been more direct collaboration between veterinarians and hoof care practitioners. While this is sure to yield better results for the horse, it presents some challenges for the collaborators. The main challenge I see is effective communication.
In veterinary school, the model I learned for veterinarian-hoof care practitioner communication was the vague, often unrealistic shoeing prescription which the veterinarian would give to the owner to pass on to their hoof care practitioner. No direct communication, no real collaboration.
As my career evolved, as I sought more education in podiatry and was privy to the perspectives of multiple farriers regarding the average vet’s knowledge of the foot, I experienced more effective vet-farrier collaboration models and worked hard to improve my own communication skills.
Common terminology and clear requests
One thing I’ve learned over the years, and continue to learn, is that anatomical and other terms I use need to be consistent with those used by farriers. One top-of-mind example is reference to the toe.
Veterinarians are used to looking at the foot from a bird’s-eye perspective. It’s not uncommon for a vet to look at a foot and say that the toe is “too long”, the toe needs to be “shortened”. I used to say that, and still do, but with more understanding now and more detail as to what exactly I mean.
The horse’s foot is shaped like a cone, with the toe being an angular structure when viewed from the horizontal perspective. When we say that the toe needs to be shortened, to which dimension are we referring? Length – coronet to ground surface? Or distance from, say, the center of rotation to the ground surface of the dorsal toe?
Fact is, you can’t change one without altering the other, unless you change the shape of the toe. Changing one without understanding how the other is affected can have very negative consequences for the horse.
The veterinarian’s requests for change should include a description of how much change is desired. “More” and “less” are not helpful terms for the hoof care practitioner. How much does the lateral side need to be lowered in order to achieve balance? How much more sole depth do I want and why? Or how much sole depth can the farrier trim and where? How much do I want to raise or lower the palmar/plantar angle and why? What toe length is desired and why?
Avoid playing Monday morning quarterback
As a veterinarian, I must understand that my desires for change in a foot are not always possible with every foot at the time I desire it. Maybe I’d like the horse to have more heel, better medial-lateral balance, or a certain type of shoe. However, various factors such as conformation, sole depth, horn quality and structure, healthy versus compromised areas, environment of the horse, management of the horse, use of the horse, financial limitations of the owner, skill of the farrier, willingness of the farrier, materials required, etc. may significantly alter my desires at that time.
This is where that vague shoeing prescription we learned in vet school gets thrown out the window.
So before we air our criticisms of a foot to the owner, we need to consider a few factors.
Where is this horse in their trimming/shoeing cycle? Maybe the toe is long because it’s been 10 weeks since it was last seen by the farrier. Are the negative attributes of the foot expected for where the horse is in the trimming/shoeing cycle? How many opportunities has the farrier had to try to implement positive change in the foot? It’s possible the farrier has seen it once or twice and made the same observations we did, but the foot hasn’t had enough growth to see the desired improvements. Alternatively, maybe the farrier has made huge improvements and just needs more time to reach the goal.
The rate of change is often directly related to the rate of growth. It takes many horses over a year to regrow their foot from coronet to the ground. Veterinarians and owners should remember this when placing demands upon the foot…and the hoof care practitioner.
The value of both being horse-side
I’ve learned to set overall goals for the foot – whether for the foot itself, or the foot’s ability to support or alleviate a problem above the foot –, and then discuss the details with the hoof care practitioner, after we both have information on all of the above-listed variables that could require altering our initial plan.
This typically means that the hoof care practitioner and I are both horse-side when all this information is gathered and where each of us can air, validate and address our concerns. It’s quite possible that the farrier has very similar goals, but that some of the above-listed limitations have hampered their efforts. Being horse-side alongside the hoof care practitioner as the foot and horse is evaluated for a possible podiatry plan is critical.
Radiographs
Hoof care practitioners tend to look at the foot from the bottom more than from the top. They typically use landmarks in the frog, sole, white line and wall to formulate their assessment of the foot and their plan for hoof care. These landmarks give an estimate of where the coffin bone lies, how much sole depth is present, where the center of rotation and articulation are.
However, these are estimates based on one of several foot mapping techniques. While estimates are certainly helpful and can be quite accurate, they become corrupt and can lead one astray when the landmarks are distorted.
With modern radiographs, exact measurements make it easy to provide an accurate architectural markup of the foot. Radiographs provide all this information literally in black and white – no guessing.
However, in my experience, many hoof care practitioners don’t have the opportunity to see radiographs taken in real time. Many cannot directly relate the information in the radiograph to the foot in their lap. I believe that piece is the veterinarian’s responsibility and something that can be easily done with proper calibration of measurements and markup of the foot.
I find this issue most pressing in cases of laminitis, negative palmar/plantar angles, and the use of full rocker mechanics. These cases require attention to detail and precision.
While radiographing a foot at some abstract point in time provides some valuable information, it leaves too much information for the hoof care practitioner to estimate when he/she eventually sees the horse – all measurements taken and their relationships will be different and thus misleading. I cannot emphasize enough the value of taking radiographs while the hoof care practitioner is present.
How the owner can help
It’s normal that horse owners don’t always think of scheduling their veterinarian and their hoof care practitioner for the same appointment.
Hoof care practitioners rarely have time to sit around and watch me perform a lameness evaluation. However, when I’ve completed that exam and have formulated an initial set of goals that include a podiatry plan, I do think this is the time to step back and consult directly with the hoof care practitioner. Experience has taught me that the farrier will give me the back story on the horse and often important details the owner failed to report.
I also try to refrain from issuing a shoeing prescription to the farrier, although admittedly, I still sometimes fail at this. The hoof care practitioner is not my technician – he or she is a teammate.
If I have not yet met this farrier, I try to get to know them a bit, what their ideology is, what approaches they might be comfortable with, do they like to do therapeutic work, and I ask for their input on my exam and goals. Hopefully this discussion helps clarify our two perspectives in a professional and respectful manner. We then mutually schedule a joint appointment to further evaluate the horse and implement our plan.
Sometimes, unfortunately, that discussion reveals that the farrier doesn’t want to participate for any number of reasons or doesn’t want to be the primary farrier but does want to come and learn. It’s better to know that up front than have that uncomfortable interaction in front of the client.
It’s important to have the team assembled prior to the joint appointment. This presents a united front to the owner that emanates professionalism, competence, and mutual respect. We should each feel like the other has our back should anything go sideways.
Making subsequent follow-up joint appointments is the best way to evaluate the success of the plan and identify and explain any negative or unforeseen developments while both team members are present and can provide solutions without blaming the other.
Owner communications
Veterinarians should be mindful when voicing criticism of the foot to an owner as that often comes across as a direct criticism of the hoof care practitioner rather than of the situation. The owner will undoubtedly repeat this to the farrier who will also take it as direct criticism, setting up a negative impression of the veterinarian from the start.
When I evaluate a foot, it’s from a veterinary perspective. However, it’s important that I qualify my perspective by putting on my hoof care practitioner hat for a minute…
I need to remember that I was not the one underneath this horse for an hour or more in the blazing heat or freezing cold.
I’m not the one having to come back and replace a shoe that gets lost every two weeks.
I’m not the one holding my breath as I pray that my nail is good on a thin-walled, crappy-footed TB that keeps yanking its leg from me.
I’m not the one constantly begging the owner to keep the horse out of the pond.
So, before I issue my ivory-tower critique, I put on my hoof care practitioner hat. That may mean having frank conversations with owners whose management decisions will negatively affect mine and the hoof care practitioner’s level of success.
In cases where the owner starts criticizing their hoof care practitioner, (1) I avoid jumping on that band wagon and (2) I consider what the hoof care practitioner has to work with and under what conditions. I make it a priority to not walk in and get a farrier fired.
Veterinarians can easily fall into that trap, sometimes even criticizing another veterinarian.
Most hoof care practitioners would appreciate us more if they see that we recognize and appreciate their struggles. For me, that often means verbalizing those struggles when conversing with the hoof care practitioner about our patient, often in front of the owner. This validates their efforts and recognizes the fact that they are humans doing their best. I can only hope they afford me the same level of consideration.
Mutual respect
Again, effective communication should come from a place of respect. We should realize that we are both professionals, working to make a living. Nobody is out there intentionally harming a horse and purposefully doing shoddy work.
We come from very different educational backgrounds, but ultimately, we veterinarians must accept that most hoof care practitioners know much more about a horse’s foot than we do. They look at hundreds of feet a month.
Sure, we know anatomy, but we don’t always know that much about the function of the hoof, load, leverage and distortion mechanics, and the effect of altering those. We sure as heck don’t know much about the materials they use, when and why, what the limitations and requirements are (unless we are also a hoof care practitioner).
Alternatively, hoof care practitioners may not understand all the internal biomechanics of the digit, limb or axial skeleton and how that relates to the problem we’ve been tasked to address.
Both perspectives have value and only serve to heighten the other if willingly received.
I find that both veterinarians and hoof care practitioners are making huge strides in coming together for the sake of the horse and horse owner. But as in most things in life, we can still do better – me included.
Four Star Equine Veterinary Services, PA, Inc
Friendsville, TN