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Habronemiasis: A Sore Summer Topic
Habronemiasis goes by many names such as summer sores, jack sores, swamp cancer or bursatee. Habronemiasis is very common in horses in the South Eastern U.S., but can be seen in other areas of the country. Larvae of the stomach worm Habronemaspp. cause this skin disease. The adult nematodes cause parasitic infestation in the stomach of the horse, which is part of the nematode’s lifecycle. Infestation of the adult stomach worms is called gastric habronemosis, and it rarely causes clinical signs aside from a mild gastritis (stomach inflammation). The cutaneous form of the disease is caused by larvae of the stomach worm that get deposited into a wound or moist areas of the body by the fly (the intermediate host), and cause significant skin reactions. The larvae emerge from flies that feed on wounds or secretions from around the eyes or genital region. The most commonly affected areas are the corner of the eye (where tearing occurs), the sheath and urethral process of the male horse, and occasionally the lower extremities. These are also the areas where horses cannot ward off these vector flies by the swishing of their tail. The migration of the larvae in the tissue causes a hypersensitivity reaction as the larvae start to die. This reaction is granulomatous in nature. Horses are very good at developing what is colloquially known as ‘proud flesh’, which is an excessive development of a type of very vascular tissue called granulation tissue. It is part of the horse’s immune defense but often causes delayed wound healing due to the exuberant, extensive nature and overgrowth of the tissue. Thus, these sores take on the characteristic of ulcerative, nodular and tumorous masses (See Figure 1).
Figure 1: Cutaneous habronemiasis at common locations in the horse. From left to right ocular habronemiasis at the medial canthus of the eye, genitalia habronemiasis on the urethral process and sheath of a male horse. Photos courtesy of Atlanta Equine Clinic.
Diagnosis is based on clinical signs of non-healing ulcerative granulomas, which occur normally in the aforementioned locations. They often appear greasy, and reddish-brown in color. Occasionally you can see small (rice-sized) yellow calcifications, which are the dead larvae residing in the lesion. The only way to truly confirm habronemiasis is to take a biopsy of the affected tissue. Other skin lesions that can have a similar clinical appearance include squamous cell carcinoma, equine sarcoids, overgrowth of granulation tissue (proud flesh) following a wound, rain scald or ringworm. Thus, definitive diagnosis obtained by a skin biopsy is ideal in guiding treatment and future prevention. Skin scrapings and cytology rarely show larvae, and confirm a diagnosis. Biopsies, however, often show the larvae as well as an eosinophilic infiltrate, which is a type of local white blood cell reaction that occurs with parasite infection.
Treatment by prevention is ideal as these skin lesions can be very difficult to eliminate. Prevention predominantly involves fly control. By decreasing the horse’s exposure to flies this disrupts the Habronema lifecycle. These prevention measures include the frequent use of fly repellents, and adequate and careful disposal of horse manure. The eggs reside in the manure, and therefore, removal of manure will decrease the incidence of flies ingesting the egg, and then incubating the larvae until infection in the horse occurs. Regular anthelmintic (de-worming) treatment is another method to prevent the lifecycle from perpetuating. There are some topical treatments that have varied effects. Organophosphates have been applied topically in attempt to kill the larvae. Topical corticosteroids and anti-inflammatories are often not curative, but may control inflammation in the area. At times surgical removal or cauterization of the exuberant granulation tissue is necessary. The treatment of choice is Ivermectin, which is an anthelmintic. After one dose any infection of the species in the stomach will be resolved, and subsequent doses will help to promote healing in the cutaneous tissue. Rarely, if the migrating larvae are not already dead at time of treatment, and Ivermectin is administered then there may be temporary exacerbation of the lesions as the larvae presumably die. Spontaneous healing can be expected at times after such administration.
Cutaneous habronemiasis that affects the genital area such as the prepuce (sheath) or the urethral process, and glans penis can be particularly difficult to treat. They appear as thick or firm and irregularly shaped masses, and are often referred to as ‘Kunkurs’. Clinical signs in this area can include bleeding readily on manipulation due to the vascular nature of the infected tissue, itchiness, and spraying or frequent and difficult urination. Spraying is especially common if the urethra is affected. It is common in colder regions for the lesions to disappear in the winter and recur or increase in size in the warmer summer months. Despite the similar pathogenesis, these lesions are difficult to treat and often require surgical removal or amputation. Again, Ivermectin treatment can prove beneficial in these cases.
Lastly, in ocular habronemiasis the lesions can progress to the conjunctiva of the medial canthus, the third eyelid, and the eyelid proper. Clinical signs in this manifestation include blepharospasm (excessive squinting), and severe epiphora (excessive tearing). Horses tend to rub these areas, and this causes more tissue damage, which in turn, creates more sites for potential larvae deposits. Again, corticosteroids may provide temporary relief, but the best method is prevention. A fly mask or roll on fly repellents for around the eye are an ideal way to prevent further spread, and infestation. Chronic sores may require surgical intervention.
Overall, it is important to closely inspect your horse in the summer months for any new wounds and skin abrasions. Quick and effective cleaning and topical treatment of these wounds can prevent Habronema larvae from seeding, and causing a much greater problem. In addition, fly control and regular anthelmintic therapies are key to preventing this difficult and debilitating skin condition.
Radostitis, Otto. Verterinary Medicine: A Textbook of the Disease of Cattle, Horses, Sheep, Pigs and Goats, 10th ed. Philadelphia, Saunders, 2007. PDF.
Knottenbelt, DC. Diseases and Disorders of the Horse, Saunders, 2003.
Kahn, C. The Merck Veterinary Manual, 10th ed. Kenilworth, Merck sharp and Dohme Corp, 2015.
The Lipizzan Stallions are coming to New Hampshire
The Lipizzan Stallions are coming to New Hampshire September 2-5, 2016 to benefit UpReach
Therapeutic Equestrian Center, Inc. UpReach is a non-profit organization dedicated to inspiring
hope, fostering independence, and improving the physical, emotional, and psychological well-
being of individuals with and without disabilities by partnering with the power of the horse.
Founded in the 16th century for the exclusive use of the Hapsburg Royal family of Austria, the
Royal Lipizzans are unquestionably the rarest, most aristocratic breed of horses in the world. The
pride of the Hapsburg Empire, the Lipizzaner breed was first established by Archduke Charles at
Lipizza (now part of Yugoslavia). Only a few hundred have ever existed at any one time. It is a
contemporary miracle of sorts that this precious bloodline is not extinct.
In a clandestine mission, Colonel Ottomar Herrmann, Sr. assisted General George Patton by
smuggling a handful of stallions out from behind enemy lines.
When surrounded in battle, the Lipizzaner rider would give the signal for a maneuver called the
Capriole and the stallion would leap in the air kicking out at the top of the leap about the height
of a man’s head. Herrmann’s Royal Lippizaner Stallions are trained to execute the Capriole and
other battle maneuvers as the stallion’s centuries ago. With great strength, intelligence and
endurance they will perform classical dressage; exquisite Pas de Trois; dramatic Airs Above the
Ground-including such exceptionally difficult measures as the Courbette, the Capriole and the
Levade. The spectacular 90-minute performance will conclude with a complex military
Quadrille. As a family descendant, Gabriella Herrmann presents audiences with what she calls
“the art of the horse world, a symphony in white.” They are also known as the “ballet dancers of
the horse world.” Gabriella Herrmann believes horses must be trained with kindness, patience,
and love. They are truly magnificent and the spectacular leaps and plunges executed by the
horses and learning about their history will leave you awestruck!
Don’t miss the only 2016 New Hampshire performances to be held rain or shine in UpReach’s
indoor arena at 153 Paige Hill Rd Goffstown, NH on September 2 at 7pm, September 3 at 3pm,
September 4 at 5pm and September 5 at 3pm. General admission tickets are available in advance
for $20 adult and $15 child (6-12 yrs. old) with tickets at the door for $25 adult and $20 child (6-
12 yrs. old). Advance ticket purchase is recommended due to limited capacity. For more
information on sponsorship or to purchase tickets, please check out www.upreachtrc.org, or call
Local Horse Trainer Selected for Extreme Mustang Makeover
Kendra Hillier from Rockport, MA has been selected to compete in the Extreme Mustang Makeover held August 5-6, 2016, at the Topsfield Fair Facility in Topsfield. Trainers will have approximately 100 days to gentle a randomly assigned wild horse they picked up in April and compete for an estimated purse of $20,000 in prize money as well as a custom-made Gist belt buckle.
Kendra Hillier has had a lifelong passion for horses. She grew up riding as many horses as she could in Rockport, MA, and gained much experience from riding a huge variety of horses not having the funds to purchase her own until her mid twenties. At 30, Kendra manages a horse farm on over 120 acres in Berlin, MA, she teaches horseback riding lessons at several locations to students of all ages and experience levels, and she has a few horses in training- both Dressage and Western disciplines. In addition, Kendra has been investing several hours per day with her wild mustang, Allura, who is boarded at a quiet, private stable in Lunenburg, MA. Kendra picked up her untouched mustang on April 16, 2016 in Orange, MA and the journey began. It took about a week and a half before Kendra was able to get a halter on the fearful and unsure mare, and even then, Kendra had to create a custom halter for her that she could get on without touching the horse’s most guarded area- her muzzle. About 2 months later, the little mustang mare follows Kendra everywhere. Allura nickers for treats and attention, and gently rubs her face on Kendra when she’s got an itch. The bond of trust and respect that these two have built is something very special. Recently, Kendra was able to take her wild mustang out to a Reining competition at the Big E in Springfield for a long weekend- Allura was great under Kendra’s lead, and the pair even entered the ‘sit a buck’ class, where the rider walk, trots, and canters their horse bareback, trying not to lose a dollar bill that’s placed under the rider’s leg. Kendra has fallen in love with her 6 year old mustang mare from Divide Basin, WY, and hopes to adopt her at the end of the competition.
The purpose of the competition is to showcase the beauty, versatility and trainability of these rugged horses that roam freely on public lands throughout the West, where they are protected by the BLM under federal law. The BLM periodically removes excess animals from the range to ensure herd health and protect rangeland resources. Thousands of the removed animals are then made available each year to the public for adoption. Over 6,200 Mustangs have been adopted through Mustang Heritage Foundation events and programs since 2007.
The Mustangs competing in the Extreme Mustang Makeover challenge are mares, and the horses, which were virtually untouched prior to the April pick-up, will compete in Topsfield in August. The trainers and Mustangs will compete in a series of classes that will showcase their new skills. The horses will compete in handling and conditioning, a pattern class and a combined leading and riding class. The top-10 competitors will then compete in the freestyle finals. Tickets and event information about the Massachusetts Extreme Mustang Makeover are available at http://extrememustangmakeover.com/extreme-mustang-makeover-massachusetts/
Mustangs competing in the Extreme Mustang Makeover will be available for adoption through an adoption auction on August 6. Adoption fees will be set by competitive bid. To qualify to adopt, individuals must be at least 18 with no record of animal abuse. In addition, adopters must have suitable facilities and can adopt no more than four animals. Adoption applications will be approved on site by the Bureau of Land Management during the event.
The Extreme Mustang Makeovers are made possible through a partnership with the Bureau of Land Management and the generosity of sponsors Western Horseman, Ram Rodeo, Vetericyn, Martin Saddlery and Classic Equine, Resistol, and RIDE TV.
About the Mustang Heritage Foundation
The Mustang Heritage Foundation is a 501 (c)(3) public, charitable, nonprofit organization dedicated to facilitating successful adoptions for America’s excess mustangs and burros.Extreme Mustang Makeovers are designed to showcase the recognized value of Mustangs through a national training competition. The Mustang Heritage Foundation is celebrating the 10th Anniversary of the Extreme Mustang Makeover in 2016 with 10 national event stops! Train, adopt or attend to show your support for the American Mustang. For more information, visit http://www.mustangheritagefoundation.org
About the Bureau of Land Management
Since 1971, when Congress passed the Wild Free-Roaming Horses and Burros Act, the BLM has successfully placed over 235,000 wild horses and burros into private care.The BLM manages more than 245 million acres of public land, the most of any Federal agency. This land, known as the National System of Public Lands, is primarily located in 10 Western states, including Alaska. The BLM also administers 700 million acres of sub-surface mineral estate throughout the nation. The BLM's mission is to manage and conserve the public lands for the use and enjoyment of present and future generations under our mandate of multiple-use and sustained yield. In Fiscal Year 2014, the BLM generated $5.2 billion in receipts from public lands. For more information, visit blm.gov.
2016 Extreme Mustang Makeover Schedule
March 11-12 Gonzales, LA
April 22-23 Queen Creek, AZ
May 6-7 Jacksonville, FL
May 20-21 Ft. Collins, CO
June 18-19 Reno, NV
July 14-16 Sedalia, MO
July 29-30 Nampa, ID
August 5-6 Topsfield, MA
August 25-27 Virginia Horse Center
September 15-17 Fort Worth, TX
From Breeding to Foaling
The essentials to properly managing your broodmare
The first step of deciding to breed your mare or buying a brood mare is to determine whether she is able to conceive and if she is able to maintain a pregnancy. A breeding soundness examination is an important step to ensure you have a fertile mare to breed. Your veterinarian can perform this and it will consist of a detailed general and reproductive history, a thorough general physical examination, body condition scoring, and a comprehensive reproductive examination. Good body condition is necessary for fertility and maintaining a pregnancy. Research indicates that mares with a body condition score (BCS) of 6-7 have higher pregnancy rates. This is based on a scale from 1-9 with 1 being emaciated and 9 being severely obese. Additionally, overall good health is necessary as any illness or injury can result in decreased fertility.
The reproductive examination will include evaluation of the external genitalia, a speculum examination of the vestibule, vagina, and cervix, and a transrectal reproductive ultrasound to examine the uterus for fluid, cysts, or any other abnormalities. A uterine cytology, culture, and biopsy will be performed as well to determine if endometritis (inflammation and infection of the uterus) is present and if the endometrium is capable of maintaining a pregnancy. The endometrial biopsy is probably the single most important indicator of a mare’s ability to conceive and maintain a pregnancy. The biopsy results are placed into 3 categories: 1) 80-100% chance of pregnancy 2a) 50-80% chance 2b) 10-50% chance 3) Less than 10% chance.
Once your mare has “passed” the breeding soundness examination, you may start the breeding process. You first have to choose the stallion and decide whether you would like to breed via live cover or artificial insemination. Your veterinarian will need to check your mare with transrectal ultrasound periodically to determine when she is in estrus (heat) and the best time to breed. Depending on the tendency of the mare to develop post-breeding endometritis, she may need non-steroidal anti-inflammatories (NSAIDs) or corticosteroids at the time of breeding.
The vulvar conformation of the mare is very important in maintaining a pregnancy. If 2/3 of the vulvar lips are above the pelvic brim fecal contamination of the vestibule and vagina is more likely, which can result in inflammation and prostaglandin release that is not compatible with pregnancy as well as provide an avenue for ascending infection. Additionally, mares that are windsuckers will also have inflammation of the vagina and vestibule resulting in prostaglandin release. A caslicks procedure can be performed on these mares at the time of breeding or at pregnancy diagnosis. A caslicks is where the edges of the vulvar lips are incised and sutured together to prevent fecal contamination and/or air irritation. The caslicks will need to be removed just prior to foaling.
The mare should be checked for pregnancy around 14 days after ovulation. The uterus should be thoroughly evaluated for the presence of twins. If two pregnancies are present, one will need to be reduced at that time, as the equine uterus does not tolerate twins well. At the time of reduction, it would be wise to administer a NSAID and supplement with altrenogest (ex. Regu-Mate) in order to provide a healthy uterine environment for the remaining embryo. Normal healthy broodmares do not require altrenogest supplementation; however, if any irregularity is present at the 14-day pregnancy check, such as poor uterine tone, increased uterine fluid, decreased progesterone, odd appearance to the corpus luteum, or any other worrisome finding, altrenogest supplementation until day 120 of gestation may be warranted.
14-day equine pregnancy ultrasound
The fetal heartbeat is present by day 25 of gestation. An ultrasound to evaluate the presence of fetal heartbeat should be performed around that time. Fetal sexing can be determined via ultrasound in two windows: day 58-73 or day 110-120 of pregnancy. Further recheck ultrasounds can be performed periodically throughout pregnancy; the frequency depends on the individual mare and veterinarian preference.
Vaccinating broodmares is imperative for disease prevention, passing immunity to the foal, and prevention of abortion. Equine herpes virus one (EHV-1) is a major cause of abortion in mares. The virus is inhaled and without adequate local immune protection it can cause viremia (systemic illness), which results in uterine ischemia (lack of blood flow) and death to the fetus. Pregnant mares should be vaccinated at 5, 7, and 9 months of gestation. It is possible, although rare, for properly vaccinated mares to abort due to EHV-1. Therefore, it is essential to institute management tactics to prevent infection as well. Such methods include separating all pregnant mares from the rest of the herd as well as isolating mares that have aborted and any horses those mares have come in contact with.
It is important to booster all routine vaccines 4-6 weeks prior to the expected foaling date so that adequate antibodies are transferred to the foal in the colostrum. Routine vaccination includes tetanus, rabies, eastern equine encephalitis, western equine encephalitis, Venezuelan equine encephalitis (if it affects that area), and west nile virus. Additionally, if the farm has a known problem with Rotavirus, which causes profuse watery diarrhea in foals, then the mare should be vaccinated at 8, 9, and 10 months of gestation. Other vaccinations, such as influenza, strangles, botulism, and Potomac Horse Fever, can be discussed on an as needed basis with your veterinarian.
Excellent nutrition based on the mare’s metabolic needs for her reproductive stage is a necessity. Mares have to be in good body condition for fertility and they must maintain the body condition throughout pregnancy. Mares have similar metabolic needs through the first 8 months of gestation. Late gestation dramatically increases metabolic needs of the mare due to the fact that 60-65% of fetal growth occurs during this period. Consequently, the mare will need a significant increase in feed during late gestation (9-11 months). Lactation is also a very metabolically demanding time. Mares will produce 3% of their body weight in milk on a daily basis during the first 12 weeks of lactation; this means the mare needs 70% more calories than her maintenance diet. Determining a feeding regiment that is right for your mare(s) can be done with the consultation of your veterinarian and/or an equine nutritionist. Ensuring the mare has an oral exam annually and teeth floated as needed is important to assist in the maintenance of body condition.
One crucial aspect of nutrition is to keep the mare off of tall fescue grass during breeding and throughout gestation. There is as symbiotic relationship between fescue grass and an endophyte fungus, Acremonium coenephialum, which results in a variety of negative effects on gestation and the foal. Mares who consume this grass can have decreased fertility rates and/or early embryonic death. Pregnant mares consuming the grass can also suffer from prolonged gestation, abortion, dystocia, premature separation of the chorion, placentitis (thickening of the placenta), retained placenta, and agalactia (suppressed milk production). Negative effects on the foal include abnormal maturation, weakness, reduced immunity, and starvation from agalactia. If it is not possible to prevent the broodmare from grazing fescue, there are drugs available to counteract the effects, such as domperidone and reserpine.
Routine deworming of the mare is important prior to and during gestation to produce a healthy foal. The best deworming protocol for your horse/herd should be determined with your veterinarian. It is recommended to deworm at least twice a year. Most dewormers are safe to use during pregnancy; however, it is critical to check the label before administering any drug to a broodmare. It is a common practice to give the mare ivermectin on the day of foaling to decrease the transmission of Strongyloides westeri, which can be spread via nursing four days post foaling.
Lastly, it is essential to properly prepare your mare for foaling. It is wise to move the mare to a clean and dry location that can be closely monitored 4-6 weeks prior to the expected foaling date. This will allow her to acclimate to her environment as well as build up an immune response to that particular environment that she can then pass on to her foal. The mare’s udder and her underside where the foal may try to nurse should be cleansed. If a caslicks was performed, the vulva should be opened to prevent tearing at parturition. Knowing the signs of impending parturition will help to better predict the time of foaling. Physical changes include relaxation and edema of the vulva, mammary gland development, scant vulvar discharge, relaxation of the tailhead, and changes in the udder secretions.
Mammary gland development, also referred to as bagging up, and secretions are the most useful tools to predict impending parturition. The mammary gland begins developing one month prior to foaling and has a drastic increase in size within two weeks of parturition. The udder is typically engorged within days of foaling. Udder secretions may start as early as one month prior to foaling, and they will change from a clear or yellow color to white and milk-like. The appearance of waxy secretions on the teats usually occurs 1-4 days prior to foaling but can occur as early as 2 weeks. The waxy secretions are from early colostrum formation. Colostrum is the first milk the mare produces, and it contains all of the antibodies she will pass to the foal. Therefore, if the mare is leaking a significant volume several days to weeks prior to parturition, it is strongly encouraged to collect and freeze that colostrum so that it can be fed to the foal at birth to ensure adequate passive transfer. Mammary gland secretions can provide valuable information on impending parturition. There are several milk tests available to determine the electrolyte levels, which change related to fetal maturity and viability, and therefore are informative on the proximity of foaling.
When the mare is close to foaling, she should be closely monitored throughout the day and night. Commonly used monitoring systems include camera stalls and foal alert systems. The foal alert system involves suturing a device into the mare’s vulva that will separate and produce an alarm at foaling.
When the mare is suspected of foaling that evening, it is recommended to clean and dry the perineal region as well as to wrap the tail for a cleaner environment. There are three stages of parturition. Stage one is the preparatory phase, which can last 30 minutes to 4 hours. During this phase the mare can exhibit signs similar to colic, including flank watching, restlessness, raising and swishing the tail, and urinating small volumes frequently. This phase is very important for the repositioning of the fetus into the “diving position” pictured below. Stage two begins at the rupture of the chorioallantois allowing the allantoic fluid to escape the uterus, also known as the water breaking. This phase includes the expulsion of the foal. If there is a red bag present at the mare’s vulva it should be ruptured immediately. Instantly rupturing the membrane is essential to foal survival, as this is indicative of premature placental separation and lack of fetal oxygenation. Calling your veterinarian after the membrane is ruptured is strongly encouraged. If no red bag is present, the white amnion should appear at the vulva within 5 minutes of the water breaking. The foal will normally pass within 30 minutes. If the foal has not passed in that time or if there is no significant progress over 5-10 minutes, it is strongly encouraged to call your veterinarian for assistance. After the foal has passed through the mare’s pelvis, stage 3 begins. This stage consists of the expulsion of fetal membranes and uterine involution. There is a “1-2-3” rule to follow at this point. The foal should stand within the hour, nurse within 2 hours, and pass meconium within 3 hours. The mare should also pass the full placenta within 3 hours of foaling. The placenta can be tied to itself so it hangs just above the hocks to avoid being stepped on. If the placenta has not passed within 3 hours please contact your veterinarian immediately.
“Diving position” of the foal at birth
The umbilicus usually breaks when the foal attempts to stand or when the mare stands. If the umbilicus does not rupture on it’s own, it should never be cut as that can result in a patent urahcus and/or excessive hemorrhage. There is a pre-determined break site that is evident by a pale strictured area. This point should be identified and the forefingers are used to twist above and below taking great care not to pull excessively on the cord. Once the umbilicus has been torn, the stump should be closely evaluated for hemorrhage, urine leakage, or swelling before being dipped in a dilute 0.5% chlorhexadine solution.
Once the mare has passed the placenta it should be thoroughly evaluated to ensure all pieces are intact. It is crucial to the mare’s health that no pieces of placenta are retained within the uterus as this can result in severe systemic illness. Saving the placenta in a large bag within the refrigerator is recommended so that your veterinarian can evaluate it fully to look for any missing pieces and signs of placentitis. It is strongly recommended to have your veterinarian evaluate both the mare and foal within 12 hours of parturition to ensure they are both in good health and that the foal has adequate passive transfer.
If you have any questions or concerns regarding your mare or foal’s health please feel free to contact New England Equine Medical and Surgical Center.
Kristina McGinnis, DVM
New England Equine Medical and Surgical Center
1. >Brinsko, Steven P., Terry L. Blanchard, Dickson D. Varner, James Schumacher, Charles C. Love, Katrin Hinrichs, and David Hartman. Manual of Equine Reproduction. 3rd ed. Mosby Elseveir. Print.>
Nailed it!!! Direct Penetrating Wounds to the Horse's Foot
by Dr Jordan Koivu
Uh oh... Your horse has a nail in its foot - and it’s not one that the farrier has nailed in on purpose! Many owners have found their horses acutely lame due to a direct penetrating wound to the foot. Whether it is a nail, a screw, or any other sharp object, it is imperative that you have your veterinarian come take a look before removing anything so that they can confirm the tract of the penetrating object.
Aside from bone, there are many important soft tissue structures in the foot, including the navicular bursa, coffin joint, deep digital flexor tendon, and digital flexor tendon sheath to name a few. Therefore, if you notice that your horse has a nail stuck in the foot, it is best to call your veterinarian immediately so that they can come and take radiographs to determine the direction that the object has travelled within the foot. Once the tract of the nail has been confirmed, appropriate treatment can be instituted in order to have the best possible outcome.
While you are waiting for your vet to arrive, or if you have to walk the horse a significant distance to get tot the barn, you can always tape a small block of wood to the non affected side of the sole, or cute a hold out of a block of wood where the nail would go and tape the wood to the foot. These two methods still allow the horse to walk without driving the nail further into the sole of the foot. If the nail is unable to be left in place for any reason, the vet can use a sterile probe or contrast dye to determine the direction of the tract.
Depending where the nail has penetrated the foot, different structures have the potential to be infected. If the nail has penetrated within the sole, typically the main areas of concern include the sensitive laminae of the hoof and the coffin bone. Possible sequelae to damage in that area can include sub solar abscesses, coffin bone fractures, or pedal osteitis. If the nail has penetrated the middle third of the frog, then it could affect the digital cushion, deep digital flexor tendon, coffin joint, navicular bone or bursa, digital flexor tendon sheath, or digital cushion. If there is a concern that a synovial structure has been affected, a sample of that joint fluid can be collected and synovial fluid analysis can be performed. Prognosis is determined by the depth of penetration, size of the penetrating object, location of penetration, tissues involved and the duration of time before treatment is initiated.
Once the extent of the wound has been confirmed, treatment can be instituted.
Thorough cleaning and debridement of the wound is typically the first step, and the farrier can certainly play a role in this. If no soft tissue structures are involved and the wound does not require surgical intervention, then a hoof knife can be used to tidy up the frog and sole, and then a curette to debride the tract to allow for better drainage as well as remove any impacted debris. Concurrent treatment typically involves antibiotics to help prevent or control infection, as well as analgesics to control pain and inflammation. A culture and sensitivity can be performed to ensure that the appropriate antibiotics are used. If no soft tissue structures or bones are affected, then the foot can be bandaged as though it were a foot abscess, using poultice to draw any debris from the wound.
If deeper soft tissue structures or bones are affected and surgery is required, the horse is anesthetized and the puncture wound is debrided and all devitalized tissue is removed. The wound is usually enlarged to improve drainaige, then thoroughly lavaged. Some may choose to pack the solar defect with antibiotics and sterile gauze, before bandaging it. Following surgery, adjunctive therapies such as regional limb perfusions and continuing to pack the solar defect with antibiotic soaked gauze may be instituted. A special shoe, referred to as a hospital plate, can be made by the farrier to protect the solar defect and maintain cleanliness post-operatively.
Below are radiographs of two separate cases involving direct penetration wounds to the foot. Case 1 shows a nail that on the lateral view appears as though it is contacting the navicular bone and bursa, as well as the deep digital flexor tendon. However, when examining the dorsopalmar view, the nail is actually on the medial aspect of the sole, entering along the white line, giving this horse a good prognosis pending no complications. Case 2 shows a more complicated scenario, where the screw has penetrated into the frog and has made contact with the coffin bone. This horse underwent surgical treatment followed by intense post-operative care involving intravenous antibiotics and analgesics, regional limb perfusions, and antibiotic infused gauze packing in the solar defect as well as a hospital plate.
Case 1. Lateral and dorsopalmar views of the right front foot.
Case 2. Lateral and dorsopalmar views of the left front foot.
In conclusion, it is possible for these penetrating wounds to have good outcomes if they are treated immediately and aggressively. Both veterinarian and farrier can play an important role in the management of these cases. Finally, it is always important to remember that tetanus can be a fatal complication of these incidences. Therefore, if the horse has not been vaccinated for tetanus within the last six months, then it should receive a tetanus vaccine.
If you have any other questions concerning penetrating wounds to the foot, feel free to call New England Equine Medical & Surgical Center. >