1

Foot
A multitude of disorders affect the equine foot. When the problem is
diagnosed, a decision has to be made whether to treat it conservatively or
surgically. In some conditions, surgery becomes necessary after
conservative management has failed to bring about improvement. For
other problems, surgical intervention is the best or even the only
treatment option.

DISORDERS OF THE HOOF CAPSULE

Thrush
Etiology and Diagnosis
Thrush refers to infection that leads to necrotic processes in the frog
area, especially in the central and lateral sulci.3 The sulci become soft
and slimy and emit a characteristic foul-smelling odor commonly
recognized with this disorder. Horn damage can progress to involve the
sensitive lamina; then it is referred to as pododermatitis. As a result of
the soft nature of the altered horn, foreign body penetration is more
likely.
Manure and urine accumulation in the foot dissolve horn in the frog area
in association with bacteria and fungi. Therefore, this condition is seen in
conjunction with poor stall hygiene and neglected hoof care. However, a
contracted hoof and lack of exercise can also predispose a hoof to thrush.
Different bacteria and fungi have been shown to colonize the horn of the
frog and eventually destroy it.
Treatment and Aftercare
Meticulous hoof care and good stall hygiene are important
considerations in the management of this condition, along with
local treatment of the altered horn in the frog area. Box stalls should be
thoroughly cleaned at regular intervals, and all urine soaked bedding
material should be removed. Intially, the sulci of the frog need to be
cleaned twice daily to remove any manure packed into the hoof sole.
All damaged horn is removed, which effectively reduces bacteria
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and fungi colonization and provides better contact of locally applied

medications to the affected tissues (Figure 90-1).
After removing the diseased horn, the sulci are cleaned with a
disinfecting solution.7 In cases where the sensitive lamina is involved, a
protective bandage containing sponges soaked in povidone-iodine
(Betadine) should be applied for a few days.
Subsequently, the sulci are treated with solutions possessing
disinfectant, drying, and hardening properties.7 In most cases, solutions
containing formalin in one form or another are used. These solutions are
applied to gauze sponges or small cotton balls and pushed into the
affected sulci.

White Line Disease

Etiology and Diagnosis

White line disease refers to deterioration of the white line of the hoof
capsule, resulting in the loss of the bond between the hoof wall and the
sole (Figure 90-2). White line disease is incited through the presence of
poor-quality horn, which allows the colonization of different bacteria and
fungi.8 These microorganisms are not able to grow in normal horn of the
white line. They are more commonly encountered in geographic
regions with a warm and humid climate. When the hoof wall begins to
separate from the sole, the hoof wall is exposed to increased tensional
forces, which leads to the development of inflammatory processes in the
sensitive lamina and results in lameness. Additionally, the selective
placement of hoof nails into the white line is jeopardized, preventing
solid attachment of horseshoes to the foot. If the necrotic processes
extend farther proximad, entire parts of the hoof wall may become
undermined and eventually form a hollow wall.

Treatment and Aftercare

Treatment consists of meticulous stall hygiene and local management
of the affected hooves. All the altered and necrotic horn must be
removed and the defects treated with solutions to destroy the remaining
bacteria and fungi. The solutions used are the same ones used to manage
3

thrush (see earlier). The dibridement might need to include hoof wall
resection (see later). The horseshoe nails should be placed higher than
normal to prolong the duration the shoe is firmly attached to the sole.
Additionally, the nail holes and the underside of the cleats should be
sealed with bactericidal and fungicidal substances.

Hollow or Loose Hoof Wall

Etiology and Diagnosis
A hollow or loose hoof wall develops when the the most axial layers of
the hoof wall, near the sensitive lamina, become separated
(Figure 90-3).9 A loose, hollow wall can develop from an extension of
white line disease. In other cases, bleeding into the hoof wall seems to be
the inciting cause. Chronic tearing as a result of continuous excessive use
can lead to a separation within the hoof wall. As an example, many years
ago, hollow walls were commonly diagnosed in pulling horses. Soil,
bacteria, and fungi can get access to the dead space between the hoof
wall layers and induce a local infection. As long as no infection is
present and the sensitive lamina is not involved, it is possible to apply
horseshoes to the foot. However, there is always a risk that the hollow
wall will continue to extend proximal, which makes treatment more
difficult. Therefore, effective treatment of a hollow wall should be
initiated early in the course of events, especially in the presence
of an infection.

Treatment and Aftercare

Successful therapy can be achieved only if all diseased, necrotic
horn is removed. The remaining hoof defect must be treated with
solutions effective against bacteria and fungi, using moist hoof bandages.
Depending on the extent of the hollow wall, a considerable amount of
horn may have to be removed (Figure 90-4, A), which can result in a
prolonged convalescent period. Treatment can last several months and
the problem must be completely resolved before the horse can be ridden
again. Several artificial hoof products are on the market that allow the
lost hoof wall to be effectively replaced. Such products as Keralit,
Sigafoos, or Vettec have properties similar to normal hoof wall in respect
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to stability and flexibility, and they are ideally suited to replace horn
defects.10,11 The artificial horn products contain two components that
are mixed together and, when polymerized, develop into a sticky, easily
moldable mass. After it is molded into the clean and dry hoof wall
defect, artificial horn is shaped to the contours of the hoof wall (see
Figure 90-4, B). Within a few minutes, the material hardens into hornlike
material. The hoof replacement material can be reinforced with
fiberglass webbing for additional strength and resistance to wear.
The advantages of these products are that the susceptible laminae are
covered with a durable protective layer, which increases the stability of
the entire hoof wall. The artificial hoof wall also allows the placement of
horseshoe nails (see Figure 90-4, C).
There is a potential danger that an infection can develop under the
artificial horn, necessitating its immediate removal. Therefore, careful
monitoring of the healing process is required until the defect is
completely replaced by new hoof wall, which will grow down from the
coronary band. In less severely involved hooves, instead of removing the
entire wall, just the affected portion of the wall should be eliminated
(Figure 90-5).

Hoof Wall Cracks

Etiology
A hoof wall crack occurs as a longitudinal disruption of the hoof
wall parallel to the horn tubules and lamellae. It can involve the entire
length of the hoof wall, only the proximal hoof wall near the coronary
band, or only the distal hoof wall (Figure 90-6). The crack can penetrate
the superficial layers only or can extend into the sensitive lamina. The
latter cracks are called deep or perforating hoof cracks, which result in
inflammation and lameness (Figure 90-7). Horizontally oriented hoof
defects parallel to the coronary band are called hoof crevices, but they
have the same etiology and treatment as hoof cracks. The causes of the
hoof cracks are diverse. Poor horn quality or a horn wall that is too thin
are predisposing factors. Abnormal hoof angles can produce significant
tension gradients within the hoof wall, which develop into cracks.12
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DISTAL HOOF WALL CRACKS

Poor horn quality associated with excessive workload and poor hoof
hygiene can lead to development of hoof cracks at the distal hoof wall
(see Figure 90-6). Usually, these cracks are superficial initially and do
not cause lameness unless they extend and develop into a perforating
crack. A horizontal groove may be cut at the most proximal aspect of the
crack, and the foot should be trimmed very short to prevent proximal and
deep extension of the crack. If these management practices do not stop
the progression of the crack, more aggressive surgical techniques will be
required (see later).

PROXIMAL HOOF WALL CRACKS

Proximal hoof wall cracks develop as a result of local trauma (Figure 90-
8), inflammation, or scar tissue formation near the coronary band.
Because of such damage, horn of poor quality is formed, promoting the
development of a hoof wall crack These cracks slowly extend distad with
concomitant horn growth.

HOOF CRACKS INVOLVING THE ENTIRE LENGTH OF THE

HOOF WALL
There are many etiologies of hoof cracks along the entire hoof wall,
aside from local trauma to the coronary band. Most likely, tension
gradients inside the hoof wall combined with extensive use and poor
horn quality are major predisposing factors in their development. Often
such hoof cracks are found in hooves with excessively long sidewalls
(Figure 90-9). Hoof cracks are more commonly seen on the medial hoof
wall than on the lateral wall. Uneven heels and displaced bulbs of the
heel are predisposing factors. Hoof wall cracks can also be caused by
faulty shoeing practices, such as shoes that are too short, branches that
are too narrow or side clips applied too far back, uneven hoof soles,
and hoof nails inserted too far caudally. When unphysiologic conditions
such as these are present for several months, poor quality horn can grow,
predisposing the hoof wall to form cracks. The combination of long
shoeing intervals and excessive work foster hoof crack development.13
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Diagnosis
Most of the time the diagnosis is made on close visual inspection
of the hoof. The deeper layers of the crack often are impacted with dirt
and manure. Lameness is a prominent feature of deep or perforating hoof
wall cracks. Conversely, superficial horn cracks are not associated with
lameness and many do not require treatment. Nevertheless, there is
always a risk that a superficial crack will extend into one that eventually
initiates an inflammatory process.

Treatment and Aftercare

Because hoof cracks are encountered often and have been a common
problem for hundreds of years, many treatment methods are described.
However, although many methods and techniques exist, successful
management of hoof cracks demands close cooperation among the
clinician, the farrier, and the owner.
The type of treatment selected depends on the location and depth of the
crack, and the length of treatment can be from a few days to several
weeks or even months. The first line of attack involves improvement of
hoof care and shoeing.14 The repair of the hoof crack without initial
dйbridement can reduce the movement of the two sides relative to each
other, effectively protecting the underlying sensitive laminae. In these
instances, lameness will be attenuated. In rare cases, the crack can heal
completely, allowing regrowth of normal horn from the coronary band
distad.15 In most cases, however, more-involved techniques are
necessary to bring about healing of the defect, especially if the crack is
accompanied by infection and lameness.
First, the condition of the shoes has to be assessed, correcting present
abnormalities, such as uneven heels and abnormal hoof angles. The old
shoe is removed and the hoof is properly trimmed. By cutting the heels
on the affected side short, local pressure in the hoof wall can be partially
reduced. Subsequently, the horn adjacent to the crack is carefully
removed with a Dremel tool (Figure 90-10).16 All altered horn down to
the sensitive lamina is removed, taking special care to establish smooth
transitions toward the sides. When completely cleaned, the defect is
covered with gauze sponges, and a hoof bandage is applied.
7

The foot is shod with a bar shoe, and the sole is filled with silicone and
covered with a metal plate. This reduces pressure in the heel region,
which is especially beneficial if the crack is located in this area. In some
cases, the coronary band immediately proximal to the crack is displaced
dorsad. Trimming the hoof wall short just below this crack reduces the
continuous movement at the coronary band and leads to the production
of better-quality horn Last, a fixation device should be applied over the
crack. If the crack was dйbrided down to the sensitive lamina, fixation
has to be delayed until a subtle layer of horn covers the defect. An
effective repair unites the two separated hoof parts and reduces
individual movements at the transition to the normal horn proximally at
the level of the coronary band. There are a variety of methods that can be
used to repair a hoof crack (Figure 90-11). The introduction of the two-
component hoof replacement materials mentioned earlier have
significantly improved the effectiveness of hoof crack repair.17 These
materials provide a natural covering of the crack with a material having
properties similar to the normal hoof wall. These materials cure with an
exothermic reaction. Therefore, it is important that at least a thin layer of
horn be present to protect the sensitive lamina. It is even possible to
install a drainage system underneath the artificial horn. Even so, hoof
abscesses can develop after application of the two-component hoof
replacement materials. The hoof wall must be covered with artificial
horn material over almost its entire length to prevent a recurrence of a
crack (Figure 90-12). Poor horn quality might dictate that a covering of
artificial horn be maintained for several months. New horn growing from
the coronary band eventually completely replaces the repaired hoof wall.
Immediately after the repair, the patient should be kept in a stall for a
few days before gradually being returned to exercise. Depending on the
quantity and quality of new horn production, the patient may go back to
light exercise after 4 to 8 weeks.
Prognosis
The prognosis for a successful treatment of a hoof crack is guarded to
good. Often, the crack recurs, especially if the predisposing factors are
not abolished (Figure 90-13). Because the properties of the horn vary
with the location on the hoof, the prognosis varies as well.18-20
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Keratoma
Etiology
A keratoma represents a columnar thickening of the hoof horn that
extends toward the inside of the hoof (Figure 90-14). Because it is rare,
the disorder is often overlooked. In addition to the classic keratoma, with
its cylindrical appearance and protrusion parallel to the horn tubules, a
spherical form of keratoma has been described that can develop
anywhere in the hoof capsule.21 Most keratomas are found in the dorsal
or dorsolateral aspect of the wall. A local inflammation reaction or
trauma at the transition of the new horn produced at the coronary band
and hoof wall is the most likely inciting cause. This results in the
formation of scar tissue in that location, which gradually grows distad as
new horn is produced. A hoof abscess also can lead to the development
of a keratoma. Because of the expansiveness of the keratoma,
unphysiologic pressures are exerted on the sensitive laminae and the
distal phalanx, leading to inflammation and lysis of the underlying distal
phalanx. The keratoma consists of poor quality horn (Figure 90-15),
which decays early, allowing bacteria and fungi access to the inside of
the hoof wall. Therefore, keratomas are often associated with local hoof
wall infections and are the reason horses are presented to veterinarians. If
a patient is presented with a chronic recurrent hoof abscess, it is prudent
to assume a keratoma is the actual cause of the problem.
Diagnosis
Careful inspection of the sole is important for the diagnosis.
Trimming and cleaning of the sole surface is necessary to recognize the
abnormal configuration of the white line. Typically, the lamellar horn of
the white line is replaced by tubular horn and scar tissue (Figure 90-16,
A). The pathologic tissue displaces the white line toward the sole. In
advanced cases, a circular lytic area of the distal phalanx can be
recognized radiographically (see Figure 90-16, B). This area should not
be mistaken for the naturally occurring crena at the dorsal aspect of the
distal margin of the distal phalanx. Often, a sclerotic border delineates
the lytic area (see Figure 90-16, B). If the diagnosis is unclear, a
computed tomographic (CT) examination will show the defect in the
distal phalanx very clearly (Figure 90-17).
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Treatment and Aftercare

In selected cases, it is possible to temporarily abolish the signs of a
keratoma with the help of conservative management. However, even
with meticulous hoof care and good hygiene it is not always possible to
prevent the formation of a hoof abscess. Therefore, an early surgical
approach toward solving the problem is advised. For successful
resolution, two main principles must be observed21,22: the keratoma
must be completely removed up to its origin, and support has to be given
to the hoof wall. The timing of the surgery depends to a certain extent on
the condition of the patient and the intentions of the owner. The main
dilemma is whether to first manage the inflammatory processes
medically and remove the keratoma after it has resolved, or to
immediately enucleate the structure. The choice should be based on the
amount of pain shown by the patient; early intervention may be indicated
in very lame patients to avoid the development of laminitis in the
contralateral foot. Aside from the altered horn, the altered sensitive
laminae also must be removed. The hoof wall defect may be filled with
artificial horn as soon as the sensitive lamina is healed. Additionally, a
special shoe with large clips placed on either side of the defect should be
applied to the foot. The surgery is performed in two steps, with a
tourniquet applied above the foot. First, as much horn as possible is
removed with the horse standing until the Dremel tool has to be
exchanged for the scalpel and curettes. The second stage of the
procedure is carried out under aseptic conditions, and the altered lamina
and the entire keratoma are removed in toto(Figure 90-18). This
procedure also may be carried out on the standing horse if a ring block at
the level of the metacarpophalangeal joint is used. The advantages of
performing the removal under general anesthesia include the more
comfortable position for the surgeon and immobility of the patient. It is
of utmost importance to remove all pathologically altered tissue in
addition to the altered hoof horn. The keratoma usually has a
characteristically round appearance at its origin. At the end of the
procedure, an antiseptic pressure bandage is applied to the phalangeal
region, and the tourniquet is removed. The bandage is changed at 3- to 4-
day intervals under aseptic conditions. As soon as the bone is covered by
10

granulation tissue, a medication plate shoe is applied. The horse remains

confined to a box stall for 4 to 6 weeks, during which the wound is
treated routinely with dressings. After this time, a new shoe is applied.
Depending on the healing process, differentavenues may be taken. If
healing progresses normally, the
defect may be filled with artificial horn and the patient subjected
to light walking exercise and, after approximately 2 to 4 months, light
riding work. If signs of infection recur, all affected tissues have to be
removed and the process of postoperative management started again.
unphysiologic pressures are exerted on the sensitive laminae
and the distal phalanx, leading to inflammation and lysis of the
underlying distal phalanx. The keratoma consists of poor quality horn
(Figure 90-15), which decays early, allowing bacteria and fungi access to
the inside of the hoof wall. Therefore, keratomas are often associated
with local hoof wall infections and are the reason horses are presented to
veterinarians. If a patient is presented with a chronic recurrent hoof
abscess, it is prudent to assume a keratoma is the actual cause of the
problem.
Diagnosis
Careful inspection of the sole is important for the diagnosis. Trimming
and cleaning of the sole surface is necessary to recognize the abnormal
configuration of the white line. Typically, the lamellar horn of the white
line is replaced by tubular horn and scar tissue (Figure 90-16, A). The
pathologic tissue displacesthe white line toward the sole. In advanced
cases, a circular lytic area of the distal phalanx can be recognized
radiographically (see Figure 90-16, B). This area should not be mistaken
for the naturally occurring crena at the dorsal aspect of the distal margin
of the distal phalanx. Often, a sclerotic border delineates the lytic area
(see Figure 90-16, B). If the diagnosis is unclear, a computed
tomographic (CT) examination will show the defect in the distal phalanx
very clearly (Figure 90-17).
Treatment and Aftercare
In selected cases, it is possible to temporarily abolish the signs of a
keratoma with the help of conservative management. However, even
with meticulous hoof care and good hygiene it is not always possible to
11

prevent the formation of a hoof abscess.Therefore, an early surgical

approach toward solving the problem is advised. For successful
resolution, two main principles must be observed21,22: the keratoma
must be completely removed up to its origin, and support has to be given
to the hoof wall. The timing of the surgery depends to a certain extent on
the condition of the patient and the intentions of the owner. The
main dilemma is whether to first manage the inflammatory processes
medically and remove the keratoma after it has resolved, or to
immediately enucleate the structure. The choice should be based on the
amount of pain shown by the patient;early intervention may be indicated
in very lame patients to avoid the development of laminitis in the
contralateral foot. Aside from the altered horn, the altered sensitive
laminae also must be removed. The hoof wall defect may be filled with
artificial horn as soon as the sensitive lamina is healed. Additionally,
a special shoe with large clips placed on either side of the
defect should be applied to the foot. The surgery is performed in two
steps, with a tourniquet applied above the foot. First, as much horn as
possible is removed with the horse standing until the Dremel tool has to
be exchanged for the scalpel and curettes. The second stage of
the procedure is carried out under aseptic conditions, and the altered
lamina and the entire keratoma are removed in toto (Figure 90-18). This
procedure also may be carried out on the standing horse if a ring block at
the level of the metacarpophalangeal joint is used. The advantages of
performing the removal under general anesthesia include the more
comfortable position for the surgeon and immobility of the patient. It is
of utmost importance to remove all pathologically altered tissue
in addition to the altered hoof horn. The keratoma usually has
a characteristically round appearance at its origin. At the end of the
procedure, an antiseptic pressure bandage is applied to the phalangeal
region, and the tourniquet is removed. The bandage is changed at 3- to 4-
day intervals under aseptic conditions. As soon as the bone is covered by
granulation tissue, a medication plate shoe is applied. The horse
remains confined to a box stall for 4 to 6 weeks, during which the wound
is treated routinely with dressings. After this time, a new shoe is applied.
Depending on the healing process, different avenues may be taken. If
12

healing progresses normally, the defect may be filled with artificial horn
and the patient subjected to light walking exercise and, after
approximately 2 to 4 months, light riding work. If signs of infection
recur, all affected tissues have to be removed and the process of
postoperativemanagement started again.

TRAUMATIC INJURIES
Puncture Wounds
Etiology
Nail prick refers to an injury caused by inadvertently driving a nail
through the sole and sensitive laminae during shoeing.
Street nail refers to puncture of the solar surface of the hoof by
nails or other sharp objects, such as screws. A hoof is nail bound
when a horseshoe nail is driven too deep into the horn, causing
excessive pressure on the corium. All three types of injuries usually
result in pain, inflammation, and infection. Although puncture wounds of
the sole can appear small, they are often deep and can have disastrous
effects when such structures as the distal phalanx, distal sesamoid bone,
DIP joint, navicular bursa, deep digital flexor (DDF) tendon, or tendon
sheath are penetrated (Figure 90-25). The penetrating object is usually
contaminated with soil, rust, or manure, which can lead to serious
infection. The superficial wound in the sole usually seals quickly,
leaving no area for drainage. The anaerobic environment created favors
the growth of Clostridium tetani, the microorganism causing tetanus.
Depending on the location and depth of the puncture wound, various
structures can be affected (see Figure 90-25).28,29 Deep puncture
wounds are extremely serious and difficult to treat. Affected horses are
often referred to specialized clinics for surgical therapy. For these
reasons, deep puncture wounds must be treated as an emergency to
prevent the infection of bones, joints, and tendon sheaths.
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Diagnosis
Horses usually have a moderate to severe supporting-leg lameness,
often pointing the affected toe. The hoof is warmer than normal, and
there is increased pulsation of the digital arteries. The horse might have a
fever. Examination with hoof testers usually elicits severe pain. In horses
with severe acute lameness, the hoof must be thoroughly cleaned and
examined for a foreign body or puncture wound (see Figure 90-25).
Treatment and Aftercare
The nail or foreign body should be promptly removed. However, it is
imperative that the depth and direction of the tract be noted and the point
of entry marked on the sole or recorded on paper, because it will rapidly
become inapparent. The point of entryis cleaned, and the entire hoof is
bandaged. Based on the location, direction, and depth of the injury, the
horse may be treated on site or referred to a clinic. When there is
suspicion of injury to deeper structures, such as the navicular bursa, DIP
joint, or the DDF tendon sheath, the horse must be referred immediately
for surgical treatment. Broad-spectrum antibiotics are started, and tetanus
antitoxin and toxoid are administered.
Treatment in a Clinic
A thorough clinical examination is carried out, after which local
anesthesia is administered. The shoe is removed and the entire hoof is
trimmed. The decision to pursue further treatment is based on the results
of the clinical examination and radiography.The puncture tract is
carefully cleaned and disinfected. A sterile metal probe is inserted into
the puncture tract, and the hoof is radiographed in two planes (Figure 90-
26, A). Placing a needle into the navicular bursa using aseptic technique
and injecting a contrast medium can enhance the diagnosis (see Figure
90-26, B). Alternatively, a 20-gauge needle is placed in the DIP joint and
synovial fluid is collected into an EDTA tube. Approximately 10 mL of
contrast medium is injected into the joint. After a few minutes, the hoof
is radiographed again to determine whether the contrast medium is
exiting through the puncture tract.28 The same procedure is repeated for
the DDFtendon sheath.
14

SURGICAL DEBRIDEMENT AND TREATMENT OF

PUNCTURE WOUNDS
Surgical debridement of puncture wounds is usually performed with the
horse under general anesthesia. This procedure entailstwo parts: initial
dйbridement of the sole in the standing and sedated horse followed by
aseptic treatment of the puncture wound and the involved deeper
structures (Figure 90-27). With the horse sedated and standing, the hoof
is cleaned and the horn around the puncture tract is carefully removed
down to a thin layer of horn that can be cut with a scalpel blade. The
hair from the hoof to the fetlock joint is clipped. The prepared area is
cleaned with chlorhexidine scrub (Hibiscrub) and covered with a
bandage. The horse is positioned in lateral recumbency under general
anesthesia and a tourniquet is applied. Occasionally, it is necessary to
remove additional horn at this time. All affected tissues around the
puncture tract are excised. The horn around the tract is removed in an
area measuring approximately 3 Ч 3 cm. The corium and subcutis are
then removed and the underlying structures are exposed. If the foreign
body has penetrated the DDF tendon, a 1.5 Ч 1.5 cm area of the tendon is
resected. Curettage is necessary if the foreign body penetrates the distal
phalanx or the distal sesamoid bone (Figure 90-28). With perforation of
the impar ligament and penetration of the DIP joint, the ligament must be
resected and the joint as well as the navicular bursa must be lavaged.
Involvement of the digital tendon sheath requires thorough lavage. The
affected synovial structures are lavaged with copiousamounts (several
liters) of lactated Ringer’s solution to which
antibiotics have been added. A pressure bandage is applied, followed by
a hoof bandage and a wedge under the heel. Repeated regional
intravenous perfusion with an antibiotic is recommended.31 An
arthroscopic technique has been developed to lavage and treat a deep
puncture wound that penetrates the navicular bursa or DIP joint (Figure
90-29). This technique has a good outcome because it permits a less-
invasive approach to the penetrated structures, allowing debridement to
be carried out under endoscopic guidance.32,33 Also, the area is under
constant lavage during treatment, decreasing surgery time. Depending on
the severity of the injury, lavage may be repeated once or twice with the
15

horse under general anesthesia. Soon thereafter, the bandage is changed

under aseptic conditions on the standing and sedated horse. Systemic
antibiotics and anti-inflammatory drugs are administered for at least 2
weeks and regional intravenous perfusion should be repeated several
times. After horn tissue begins to cover the soft tissues, a medication-
plate shoe can be applied (Figure 90-30).