Vets, barefoot, evidence-based medicine...........

If it wasn't about being barefoot.... But it was about horses actually needing time out of shoes, would that curry a different attitude from vets?

I still can't see why a vet, who can clearly see a deformed foot in shoes, can actually say try another type of shoe. Why is not commonly taught that the best thing is to rest the foot?

If its because the owner wants a horse to ride then shame on them. Shoeing a crippled horse in wedges and still competing it is much more cruel than taking its shoes off and letting it have a winter or summer off.
 
tallyho! said:
If it wasn't about being barefoot.... But it was about horses actually needing time out of shoes, would that curry a different attitude from vets?

I still can't see why a vet, who can clearly see a deformed foot in shoes, can actually say try another type of shoe. Why is not commonly taught that the best thing is to rest the foot?

If its because the owner wants a horse to ride then shame on them. Shoeing a crippled horse in wedges and still competing it is much more cruel than taking its shoes off and letting it have a winter or summer off.
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To put a slightly different spin on these points I wonder if keeping the horse working is often the driver. I mean as opposed to stopping and saying...hang on a minute this isn't right, what is causing all these problems...
 
reborn amandap said:
To put a slightly different spin on these points I wonder if keeping the horse working is often the driver. I mean as opposed to stopping and saying...hang on a minute this isn't right, what is causing all these problems...
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I agree. For me it is broke (as in the hoof needs shoes) so I would want to try and "fix " it or at least see if it could be made stronger.
 
Tallyho - im guessing because when you take shoes off horses on the average pre bagged mix diet they will be lame? So vet would get blame and bf would be bad etc etc?
 
TigerTail said:
Tallyho - im guessing because when you take shoes off horses on the average pre bagged mix diet they will be lame? So vet would get blame and bf would be bad etc etc?
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Yes but what I was precluding to was time out of shoes, rested in a field. This is what used to happen to the hunters and they came back sound and were shod sound ready to be fittened up for the season.
 
cptrayes said:
Errrrr - this is a UK based forum? What I wrote is true of the UK. The fact that it may not be where you live is of no help whatsoever to all of us who keep horses in Britain. Though I am glad it may be better elsewhere :D
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Actually many vets qualified elsewhere do work here, so it is very relevant. Certainly the local small animal practice where I live uses Australians quite a lot! Also, due to the EU freedom to work regs, vets can work here if qualified elsewhere in the EU (Hollycatt is in Budapest).

Below are some references to shoes and the effects on horses with regards to way of going and injury. Further references for vets to look up would be Dr James R Rooney DVM (RIP, what a guy!), Dr Robert Bowker VMD, PhD and to an extent Gene Ovnicek. Dr Rooney in particular submitted many articles to the American Farriers' Journal and is also the author of The Lame Horse, one of his finest achievements. :)
I found those below referenced in an article on IVIS (International Veterinary Information Service, of which I'm a member). The article was:

Review of Some Past, Present and Possible Future Directions in Biomechanics of the Equine Hoof
Jeffrey J. Thomason PhD
Author’s address: Department of Biomedical Sciences, University of Guelph, Guelph, Ontario

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Thomason JJ, Cruz AM, Bignell W, et al. In situ strain measurement on the equine hoof, in
Proceedings. Soc Exp Mech 2008;1636-1642.
^Marked differences in hoofstrain in midstance observed during a study. Not included in detail in the paper, but referenced on IVIS:
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Benoit P, Barrey E, Regnault JC, et al. Comparison of the damping effect of different shoeing by
the measurement of hoof acceleration. Acta Anat 1993;146:109-113.

Back W, van Schie MHM, Pol JN. Synthetic shoes attenuate hoof impact in the trotting
warmblood horse. Equine Comp Ex Phys 3(03):143-151.
^^Metal shoes increase the magnitude of the ‘impact strike’.
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McClinchey HL, Thomason JJ, Runciman RJ. Grip and slippage of the horse's hoof on solid
substrates measured ex vivo. Biosys Eng 2004;89(4):485-494.

Vos NJ, Riemersma DJ. Determination of coefficient of friction between the equine foot and
different ground surfaces: an in vitro study. Equine Comp Ex Phys 2006;3:191-198.

Pardoe CH, McGuigan MP, Rogers KM, et al. The effect of shoe material on the kinetics and
kinematics of foot slip at impact on concrete. Equine Vet J Suppl 2001;(33):70-73.

Pratt GW. Model for injury to the foreleg of the Thoroughbred racehorse. Equine Vet J Suppl
1997(23):30.
^^^^Reducing slippage time (using shoes/toegrabs) is potentially dangerous in horses. Friction between show and surface can be an influential factor.
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Thomason JJ. Variation in surface strain on the equine hoof wall at the midstep with shoeing,
gait, substrate, direction of travel, and hoof shape. Equine Vet J Suppl 1998;26:86-95.
^Orientation of strains differs significantly in shod hooves (the magnitudes of the strains do not)
 
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my old farrier (I now use a trimmer) used to recommend a yearly shoe 'holiday' to all owners-but he said that when he wanted the holiday to be long enough for the nail holes to grow out most owners balked. Basically, most owners these days want their horses in low amounts of work year round. Back in the day most working horses such as hunters and jumpers would get properly let down and have 24/7 turnout while being unshod (and then properly legged up but thats a different thread).
Of course a 3 month holiday while paying for livery costs may make some balk but there are plenty of good boots available now and most people I know only ride in a sandbox anyway-especially in the winter.
 
Have not read all the posts but I imagine there might be an insurance issue with recommending treatment for which there is no peer reviewed evidence based clinical trials if it goes wrong and person decides to sue vet.

With regard to clinical trials they are difficult to run properly as you need a control group with the same injury and with horses of a similar type age and size and both need to ideally be on the same premises and on the same diet to prove it is actually shoes off and trimming techniques that is causing the improvement not the lifestyle/diet of barefoot horses which can be different to shod ones. You also need to have owners who are willing to take the risk of letting their horse be in the clinical trial where one treatment might be not as good as the other.

Rockley has had a good success rate but my understanding is that Nic only takes on cases if she thinks that they have a good chance of recovery. Ethically this is the right thing to do as it means people do not waste money when there is little hope of improvement. However in terms of how successful barefoot is on the whole in terms of curing problems it would be fair on this evidence to say that not all horses will be suitable candidates for this sort of rehabilitation in the same way as not all horses will do well on traditional methods recommended by most vets.

I think another problem is that a lot of the barefoot advocates can come across as closed minded to other forms of treatment and possibly the way that they communicate does not help them build up relationships with vets who come from a more traditional background. For example you have to think how you would feel if you had been mainly recommending a certain practice for years and felt it had been successful and then someone with no qualifications or training in your subject came along and told you in maybe quite a forceful way that what you were doing was detrimental to the welfare of the animals you were trying to treat. People often find change quite challenging and it is something you have to introduce gently to get people used to the idea, with plenty of evidence to back it up.

The only other thing that might be useful was if a database was set up in which people could store information about successful outcomes of using barefoot which could be accessed by vets. The cases would have to be approved by a vet with before and after videos before they could be added to verify that improvement had taken place. In terms of sponsorship/funding you would ideally want to be independent from organisations that would make money from the results such are feed companies that supply barefoot feeds etc . Ideally you would want funding from an academic institution as project.
 
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I don't think the insurance has that much relevance to vets. Cartrophen isn't even licensed (or wasn't last I heard) but neither vets nor insurance have a problem with it. The only insurance complication is that most of them like as many reasons not to pay out as they can think up.
 
littlelegs said:
I don't think the insurance has that much relevance to vets. Cartrophen isn't even licensed (or wasn't last I heard) but neither vets nor insurance have a problem with it. The only insurance complication is that most of them like as many reasons not to pay out as they can think up.
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I think you are right many untested treatments are used on horses however time pressure does I think pay a roll in how vets act .
 
TigerTail said:
Tallyho - im guessing because when you take shoes off horses on the average pre bagged mix diet they will be lame? So vet would get blame and bf would be bad etc etc?
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For years I fed my horses pre bagged food and they where not lame when I removed shoes( unless of course they had a lameness) and have always regularly removed shoes however once I started to work the horses without shoes I had to make changes to how I fed them to get them working BF.
 
Very good point re feed. My mare never had diet changes when her shoes came off. And I haven't ever fed a barefoot diet in shoes either. But, being connie x tb, she's a very good doer with lots of energy, so her feed was always managed for that, rather than the typical mixes etc. At 14 its not like I was thinking of healthy hooves when I avoided most feeds. Just her weight & behavior. Which no doubt goes a long way to explain why her transistion to shoeless consisted of removing shoes one day & very little else.
 
tallyho! said:
If its because the owner wants a horse to ride then shame on them. Shoeing a crippled horse in wedges and still competing it is much more cruel than taking its shoes off and letting it have a winter or summer off.
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Very sadly I come across this all the time, not daily, but pretty close.
 
SO1 said:
Have not read all the posts but I imagine there might be an insurance issue with recommending treatment for which there is no peer reviewed evidence based clinical trials if it goes wrong and person decides to sue vet.
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Well I assume that if a vet is recommending a shoeing treatment then it's going to be remedial shoeing. Is there actually any peer reviewed evidence that remedial shoeing works? And I don't mean shoes on, horse sound for 12 months. I mean long term evidence.
 
Fransurrey said:
Actually many vets qualified elsewhere do work here, so it is very relevant. Certainly the local small animal practice where I live uses Australians quite a lot! Also, due to the EU freedom to work regs, vets can work here if qualified elsewhere in the EU (Hollycatt is in Budapest).
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In over 30 years of multiple horse ownership I have met only two equine vets who did not qualify in this country.

Is there any evidence that vets who qualify in other countries are taught any more about hardworking barefoot horses and barefoot rehabs for caudal hoof lameness than UK vets are?
 
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SO1 said:
Rockley has had a good success rate but my understanding is that Nic only takes on cases if she thinks that they have a good chance of recovery. Ethically this is the right thing to do as it means people do not waste money when there is little hope of improvement. However in terms of how successful barefoot is on the whole in terms of curing problems it would be fair on this evidence to say that not all horses will be suitable candidates for this sort of rehabilitation in the same way as not all horses will do well on traditional methods recommended by most vets.
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This may be true but it is a misleading thing to read unless you know the horses that she takes on. Many of them have been very long term lame in spite of the best that farriery and medicine can provide. Many of them are going to Rockley as a last resort before they are shot or put out to grass. But she knows that there is a good chance that a barefoot rehab will work, so she takes them on.

As an example, her one she did free this summer was an ex racer, lame for over a year, already barefoot and failing to improve with "typical" flat and underrun TB feet. The horse is back in work for the first time in many months.

So to say that the results are skewed because she only takes on horses she knows it will help is not correct. The truth is that she takes on almost any horse with soft tissue damage inside the feet (and many with additional bone and cartilage problems) which does not have metabolic disease which will prevent it from forming good feet. And most of those horses recover, where the success rate for conventional treatments is much, much, much lower.

My own impression, having followed every horse that appears on the Rockley blog, and part way through my own second rehab that was long term unsound in remedial shoes, is that if a horse does not recover with a barefoot rehab it's got almost no chance with remedial shoeing and medication.
 
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SO1 said:
Rockley has had a good success rate but my understanding is that Nic only takes on cases if she thinks that they have a good chance of recovery. Ethically this is the right thing to do as it means people do not waste money when there is little hope of improvement. However in terms of how successful barefoot is on the whole in terms of curing problems it would be fair on this evidence to say that not all horses will be suitable candidates for this sort of rehabilitation in the same way as not all horses will do well on traditional methods recommended by most vets.

.
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But to be fair the cases she takes on have often already gone through and been failed by tradtional treatment so if she is not taking a representative sample it is arguable she is taking on all the failures and worse cases; the write offs and loss of use and horses the vets have said pts. A random sample would actually include alot of easier cases not so far advanced but the reality of where things stand is that people turn to barefoot after all else has failed.

As for traditional treatments, let's just look at the stats in this study http://onlinelibrary.wiley.com/doi/10.1111/j.2042-3306.2010.00081.x/abstract

For one of the injuries Frankie had the recovery rate was 10% and that's before you consider that horses with combined pathologies had a worse prognosis and he had two other issues. If I'd seen these figures before, I wouldn't have gone down the traditional route with that kind of success rate.

Plus I also took part in a study that followed up horses with foot injuries from where he had the MRI. This study took the highly rigorous approach of asking owners to fill in a questionnaire assessing their horses. No follow up with the vets, no work ups, no videos or picture, just a questionnaire to the owners asking to assess how many tenths lame at various points. No doubt this will be published to great acclaim because it comes out of a highly respected clinic.

Having said that I think that posters have been a little harsh on vets, I know mine tried to do the best with limited tools and would have done anything he could to help me. He admitted some treatments (Cartrophen) had limited justification but on the basis they would not do any harm it was worth a try if it would get my horse sound for me.

When it came to refer him to Rockley he did so despite no experience of it, he knew there was nothing else he offer me. He warned me not get my hopes up but not because he was being anti barefoot but because he did not want me pin too many hopes on it.

If you've always been taught a certain way it is very difficult to stand against everyone and take an opposing stance and vets have to be very careful because I've seen owners be very quick to come back and blame if something doesn't work.

For the OP and the other potential vets who want to investigate, get in contact with Rockley and other trimmers/farriers who are doing work in this field and make your own mind up.
 
Cptrayes you beat me to it about the free horse Nic took on this year. After all the comments about how Nic was 'sure' to pick an easy horse, those saying so should really take a look at the pictures of this horse's feet. He's working well now though! Having also seen another HHO forum member's horse arrive at Rockley and seen just how crippled he was when he arrived to how he's been in recent pics on facebook I'd have to say nobody would have said he was going to be easy to rehab.

The fact is Nic doesn't offer guarantees, but like Criso's horse above my lad had a 10% chance of recovery with conventional treatment, for just one of his issues, yet thanks to Nic and the barefoot people on here I have a sound and healthy horse who's enjoying life to the full.

Incidentally as well, I mentioned this thread to Nic and she's more than happy for any vets or vet students to contact her about going to see what she does, so please do contact her. Lots of us on here can help if you need an email address etc. :)
 
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