Use of a Radiograph to Use of a Radiograph to Assist with Therapeutic Assist with Therapeutic Shoeing and TrimmingShoeing and Trimming

Debra R. Taylor, DVM, MS, DACVIMDebra R. Taylor, DVM, MS, DACVIMAssociate ProfessorAssociate Professor

Department of Clinical SciencesDepartment of Clinical SciencesCollege of Veterinary MedicineCollege of Veterinary Medicine

Auburn UniversityAuburn University

Equine PodiatryEquine Podiatry

The specialty dealing with the equine The specialty dealing with the equine hoofhoof the hoof capsulethe hoof capsule coronary bandcoronary band all anatomical structures with in the all anatomical structures with in the

hoof capsulehoof capsule all tendons that affect the hoof all tendons that affect the hoof

Requires the veterinarian and Requires the veterinarian and trimmer or farrier to work togethertrimmer or farrier to work together

What does the horse need?What does the horse need?

A veterinarian and a trimmer or A veterinarian and a trimmer or farrier team who are willing to work farrier team who are willing to work togethertogether

A team that enjoys podiatry and is A team that enjoys podiatry and is committed to doing their best work committed to doing their best work

What does a farrier or What does a farrier or trimmer need from the trimmer need from the

veterinarian?veterinarian? A veterinarian A veterinarian

who understands what is healthy and what is notwho understands what is healthy and what is not who understands diseases affecting the hoofwho understands diseases affecting the hoof who can consistently take an informative who can consistently take an informative

radiograph of the footradiograph of the foot who is willing to work as part of a teamwho is willing to work as part of a team

Take the time to show him the radiographs Take the time to show him the radiographs Pre- and post- trimming or shoeingPre- and post- trimming or shoeing

Learn to speak the same languageLearn to speak the same language Many overlapping termsMany overlapping terms

““Quality radiographs are to podiatry Quality radiographs are to podiatry what ultrasound is to reproduction” what ultrasound is to reproduction”

Learning curve

Abilit

y to

mak

e a

posit

ive c

hang

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Time Time

Without ultrasound or radiographs With ultrasound or radiographs

Why do you need a radiograph to monitor shoeing or trimming a horse?

Traditional Traditional Radiography of the Radiography of the

digitdigitGoals • To evaluate the proximal and distal interphalangeal joints, integrity of bony structures, and to view radiographic degenerative changes in the foot.

Traditional RadiographyTraditional Radiography

Beam focused at Beam focused at coronary bandcoronary band

Foot packed Foot packed Ground surface not Ground surface not

always demarcatedalways demarcated Dorsal hoof wall Dorsal hoof wall

marked with rigid marked with rigid objectobject

Apex of frog and Apex of frog and heels not markedheels not marked

Hoof not always Hoof not always directly against directly against cassettecassette

Is this what we are after?Is this what we are after?

Lacks information for the Lacks information for the farrier trimmer!farrier trimmer!

Radiographic GOALS Radiographic GOALS

Consistent informative films Consistent informative films Take the same view every timeTake the same view every time

Ability to monitor small changes with accuracyAbility to monitor small changes with accuracy Evaluate the soft tissues of hoofEvaluate the soft tissues of hoof Evaluate P3’s relationship to capsule and groundEvaluate P3’s relationship to capsule and ground Evaluate how the bone and the soft tissues relate to Evaluate how the bone and the soft tissues relate to

each othereach other How the bone and soft tissue relate to the ground How the bone and soft tissue relate to the ground

Learn common parameters of breeds Learn common parameters of breeds What is common is not necessarily healthyWhat is common is not necessarily healthy Horses have only rarely been bred for hoof qualityHorses have only rarely been bred for hoof quality

Popular breeds are notorious for poor hoof healthPopular breeds are notorious for poor hoof health

Radiography for Shoeing and Radiography for Shoeing and TrimmingTrimming

Center on bottom of P3, not coronary bandCenter on bottom of P3, not coronary band measure sole depthmeasure sole depth Palmar/plantar anglePalmar/plantar angle medial to lateral balance of P3medial to lateral balance of P3

Clearly demarcate (with barium paste)Clearly demarcate (with barium paste) Dorsal hoof wall – care to start paste exactly on hairline Dorsal hoof wall – care to start paste exactly on hairline Lateral heel bulb – care to start paste exactly on hairlineLateral heel bulb – care to start paste exactly on hairline Apex of frogApex of frog

Clearly demarcate ground surface – lead in wooden blockClearly demarcate ground surface – lead in wooden block Hoof touching cassetteHoof touching cassette Heel bulbs parallel to primary beam and perpendicular to Heel bulbs parallel to primary beam and perpendicular to

cassettecassette Do not pack the footDo not pack the foot

Measure sole depthMeasure sole depth Standardize distance from film to machineStandardize distance from film to machine

MethodsMethods Center on bottom Center on bottom

of P3 of P3 Blocks match machineBlocks match machine

metal wire in topmetal wire in top

Barium paste on Barium paste on dorsal dorsal hoof wallhoof wall

Barium on apex of frogBarium on apex of frog Barium on heelBarium on heel

Much betterMuch better

Centered bottom of P3Centered bottom of P3 Dorsal hoof wall markedDorsal hoof wall marked Ground Surface MarkedGround Surface Marked Not packedNot packed Heel markedHeel marked Apex markedApex marked Note: -ok that bone is Note: -ok that bone is

too light, not as worried too light, not as worried about boney detail here about boney detail here as relationship of the as relationship of the bone to the soft tissues bone to the soft tissues and groundand ground

NOTE: Trimmers and farriers appreciate viewing the hoof in the direction it would be if they were looking at the horse, RF point toe to right, LF point toe to left

Equine Podiatry RadiologyEquine Podiatry Radiology

Primary beam is 1 cm off top of blocksBuild blocks to match your machine so can Set the machine on the ground and horseWill be in correct positions

NOTE: need two blocksSo horse is standing level

Breakover

BreakoverBreakover

Podiatry Radiology Podiatry Radiology Measurements Measurements Breakover

- The horizontal distance from the tip P3 to where the hoof “breaks over” or pivots. - 0 – 3.5 cm is ideal, depending on the horse- optimizing breakover

-decreases sheer force on P3 and hoof wall-decreases tendon and muscle strain

Palmar/plantar AnglePalmar/plantar Angle

Podiatry Radiology Podiatry Radiology Measurements Measurements

Palmar Angle

-The angle that is formed from the palmar/plantar surface of P3 and the ground. - 2- 10° degrees normal (Adams)

Sole DepthSole Depth

Podiatry Radiology Podiatry Radiology MeasurementsMeasurements

Sole Depth

- Soft tissue opacity just distal to the plantar surface of P3- The sole should be greater than 10mm in depth.

Horn: Laminar ZoneHorn: Laminar Zone

Podiatry Radiology Podiatry Radiology Measurements Measurements

Horn: Laminar Zone- Distance from the dorsal hoofwall to the dorsal surface of P3. - Measured at both the dorsal proximal and dorsal distal ends of the foot. -Should be uniform and < 20 mm

CE ZoneCE Zone

Podiatry Radiology Podiatry Radiology Measurements Measurements

CE Zone

- The CE Zone is the vertical distance between the Coronary Band and the Extensor Process. -Ideally < 1cm.-Need great care in marking the hairline, because plan to monitor change in this number

CupCup

Podiatry Radiology Podiatry Radiology Measurements Measurements

Cup

-The radiolucent area distal to the sole-Measure to the ground surface-Some horses have none

Bone AngleBone Angle

Podiatry Radiology Podiatry Radiology Measurements Measurements Bone Angle

- Angle formed at the junction of the dorsal and palmar/plantar surface of P3

Parameters on a lateral viewParameters on a lateral view

Evaluation of Lateral ViewEvaluation of Lateral View

Horn: Laminar ZoneHorn: Laminar Zone Should be uniform ( < 20 mm)Should be uniform ( < 20 mm)

CE zone - <1 cmCE zone - <1 cm coronary band - extensor processcoronary band - extensor process ““halo effect”- coronary band invaginationhalo effect”- coronary band invagination

Sole depthSole depth mass (> 10 mm)mass (> 10 mm)

CupCup Black area between sole and ground surfaceBlack area between sole and ground surface

Evaluation Lateral ViewEvaluation Lateral View

Palmar Angle Palmar Angle Angle formed between palmar surface of P3 and Angle formed between palmar surface of P3 and

groundground The horse wants it positive 3-9 The horse wants it positive 3-9 ºº

Digital BreakoverDigital Breakover distance from the tip of P3 to where hoof breaks distance from the tip of P3 to where hoof breaks

forwardforward The horse wants it short, maybe even negative?The horse wants it short, maybe even negative? The horse wants it optimized.The horse wants it optimized.

Bone AngleBone Angle angle formed between dorsal and palmar surfaces of angle formed between dorsal and palmar surfaces of

P3P3

Horse in a Cast with digital Horse in a Cast with digital radiographyradiography

Anterior – Posterior Anterior – Posterior projectionprojection

Looking for medial lateral balance of Looking for medial lateral balance of P3P3

Uniformity of joint spacesUniformity of joint spaces Is the medial and lateral coronary Is the medial and lateral coronary

band levelband level Evaluate growth rings if use bariumEvaluate growth rings if use barium

Anterior posterior viewAnterior posterior view

MoralMoral

TAKE the radiograph the correct wayTAKE the radiograph the correct way Evaluate the parametersEvaluate the parameters Use the film to make goalsUse the film to make goals Evaluate whether goals were metEvaluate whether goals were met Work together!!!!Work together!!!!