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Evidence-Based Farriery: The Proof is in the Hoof
|Created:||April 17, 2015|
Don’t rely on hearsay when it comes to caring for your horses’ hooves
“Go to Dr. Google and ask him, ‘What’s the best treatment for a skin rash?’” says Stephen O’Grady, DVM, MRCVS. “You can get anything from a well-documented pharmacologic process to homeopathy to supplements and more, some of which have no proof behind them whatsoever. So which would you rather use: That which has been consistently beneficial, or one that’s somebody’s hearsay?”
The same question applies when you’re managing horses’ hooves: Would you rather treat these important weight-bearing structures using methods based entirely on word of mouth, or would you opt for evidence-based farriery?
O’Grady, a farrier, veterinarian, and owner of Northern Virginia Equine, in Marshall, and Renate Weller, DrMedVet, PhD, MRCVS, MScVetEd, FHEA, professor of comparative biomechanics and imaging at the Royal Veterinary College (RVC), in Hertfordshire, U.K., weigh in on the importance of this concept when managing our horses’ hooves.
What is Evidence-Based Practice?
Simply put, evidence-based practice is using data, often from research reviewed by independent groups of people (termed peer-reviewed research), in decision-making. “We need evidence because human beings are prone to bias,” Weller explains. Historically, she says, people learned skills—including veterinary medicine and farriery—from their predecessors in an apprentice-type arrangement.
“And while what that one guy taught you might be the correct thing to do” in a particular scenario, Weller says, “it may well have not been the right thing to do.”
For instance, medieval doctors bled people to treat a variety of health conditions for centuries, she says, a practice we now know is probably more detrimental than helpful.
“If you read the literature, you’re essentially reducing the amount of mistakes made due to bias,” she says.
O’Grady believes that some farriers base their practice more on tradition, what works best for them, what an authority says, or the “drink of the day,” rather than on the current published evidence, which can lead to a disconnect in practice among farriers. “If you put a survey out and directed it at 10 farriers, you’d get 10 different thoughts on how to trim the heels—but you’ve only got one set of structures,” he says.
On the other hand, he says, “You can take biomechanical principles and establish the center of rotation in a horse’s foot. You can trim the horse’s foot according to biomechanical principles, and that way you can put some standardization into each trim. That’s evidence-based because … we have the support saying that biomechanical forces can be applied to the horse’s foot and therefore used as guidelines in trimming.”
The Owner’s Role
While owners might not have easy access to all the texts and research that veterinarians and farriers use to make evidence-based decisions regarding hoof care, they can still take steps to ensure their horses are receiving quality care from a qualified professional.“As a horse owner, I would never let an untrained person deal with my horse,” says Renate Weller, DrMedVet, PhD, MRCVS, MScVetEd, FHEA, professor of comparative biomechanics and imaging at the Royal Veterinary College, in Hertfordshire, U.K. “And I think it’s up to the horse owner to … ask, ‘Where did you train? What’s your background?’ ”
Stephen O’Grady, DVM, MRCVS, a farrier and veterinarian from Marshall, Virginia, agrees: “If an owner looks at their horse’s feet and it’s losing a shoe, or the hoof wall consistency is poor, or the frog is way up in the foot, or they have continual thrush, ask the farrier, ‘Why, and what are you going to do about it? How is that going to work?’ And if someone can’t answer, you should probably give the job to the next guy outside your driveway revving his engine.”
Always ask for the best when it comes to caring for your horse’s hooves.
What’s the Current Research Landscape Like?
By far the most researched hoof topic is laminitis, Weller says. “There’s a tremendous amount of really solid science out there,” she says. “But then, laminitis is a systemic disease that just happens to manifest itself in the foot. When you look at the papers purely focused on the foot, the situation is a bit more dire.”
In a recent presentation at the 2014 British Equine Veterinary Association (BEVA) Congress, Weller relayed that there were fewer than 200 peer-reviewed papers focused on the horse’s hoof indexed on PubMed.gov—157 to be exact.
And, while the current body of research is relatively small, it contains some strong studies with information veterinarians, farriers, and owners can use in their horse care practices.
“There are numerous good, practical articles that have been published in Equine Veterinary Education or the AAEP Proceedings,” O’Grady says. “There are also various articles in the (American) Farriers Journal written by credible people, and these are the ones that have references,” which offer proof that what the author says is reliable.
He also says there’s good information in farrier texts that were written and published around the turn of the century: “These were really, really good books. The authors trimmed and shod horses according to their conformation, their structures, and their use. Now, in the last 20 years or so, we’ve gotten so far away from that with all the modern methodology and products or gimmicks on the market.”
“One of the issues (preventing research) at the moment is that most farriers don’t have a background in science.”
Dr. Renate Weller
Weller says two of her favorite farriery-related research papers proved things that veterinarians and farriers had suspected for years. “My favorite paper was done by Ehud Eliashar (BSc, DVM, MRCVS, Dipl. ECVS), a former colleague of mine at the RVC,” she says. “It’s a biomechanical paper that shows that for every degree you change the solar angle, you’re changing the strain on the deep digital flexor tendon and the stress on the navicular bone.
“It was the first paper that actually put some really hard science behind the fact that what we do to the foot when we change its shape has huge implications in terms of changing the load structures within the foot,” she adds. “And farriers have known that for, probably, centuries. But this was a very fundamental paper that provided the scientific evidence for those beliefs.” (Review the study’s abstract at ncbi.nlm.nih.gov/pubmed/15253085.)
Weller’s other favorite research paper is one in which Alan Wilson, BSc, BVMS, PhD, MRCVS, and colleagues showed that horses suffering from palmar heel pain (originating in the rear half of the hoof) use their legs differently than healthy horses. Ultimately, she says, this altered movement increases the heel pain and puts the horse in a “mechanically vicious cycle.” She also says it shows that providing pain relief not only improves the affected animal’s welfare but also helps disrupt the mechanical cycle. (Find this study’s abstract at ncbi.nlm.nih.gov/pubmed/11266066.)
O’Grady does not work in a research laboratory, but he has published dozens of peer-reviewed studies on the hoof and hoof-related conditions based on his clinical practice and experience as a farrier.
“By doing clinical work, you take X number of horses that fit into a certain category,” such as horses with canker or quarter cracks, he explains. “You treat them in a specified manner, and then you look at the results. The results give you a trend, and that’s what I publish.”
In his study on canker, for example, O’Grady evaluated records from more than 100 horses he’d worked or consulted on that had been diagnosed with this condition, then treated all cases with a specified protocol: debridement of the affected tissue followed by daily applicaton of topical therapy until the disease resolved. He determined that the approach provided consistent results.
O’Grady also compared different methods for treating white line disease in more than 100 horses to see which was most effective. Ultimately he determined that simply cleaning the affected area daily with a wire brush was more effective than using commercial remedies.
Despite the accumulation of a strong (albeit small) body of farriery research, Weller and O’Grady agree that, on the whole, farriers don’t adhere to researched principles as often as they could.
“These are not necessarily easy papers to understand,” Weller says of biomechanics research. “A lot of people think, ‘Oh my gosh, it’s physics! I don’t understand that anyway, so I’m not going to read it.’ So, unfortunately, they’re not often read by the group that could make the most use of them.”
O’Grady says many peer-reviewed veterinary meetings, such as those hosted by the American Association of Equine Practitioners, offer continuing education and farrier programs for those interested.
Why Aren’t There More Studies?
Simply put, “this is not easy research to do,” Weller says. “And, there aren’t a lot of people who have the clinical background, along with the research background, to publish research. There are five or six laboratories or working groups in the world that are well-equipped to publish hoof research studies—compared to other aspects of horse health, that’s not many.”
Another issue, she says, is the length of time it can take to complete a hoof-related study: “You can affect a horse a little bit in one session, but we’re talking sometimes years to get a deformed hoof back. That’s a difficult, long-term project.”
She also says it’s difficult to find funding for hoof-related studies, pointing out that while less-expensive research in practice can also produce quality information, “obviously, funding helps.”
And finally, Weller says, communication between farriers, veterinarians, and researchers is crucial: “We really, really need to work together here.”
Still, she believes we’ll start to see more farriery-related research surfacing in the future. “On the basis of my talk at BEVA alone, I’ve had over 20 people contact me about research,” she says. “And one of the issues at the moment is that most farriers don’t have a background in science—they’re not taught how to do research. That, I think, is where people like me and my colleagues come in. We have the background in research and the tools at hand to advise on it.”
She also says the Fellowship of the Worshipful Company of Farriers—an organization in the U.K. that certifies farriers—now includes a research component for their advanced certification.
“I think there will be studies that are robust enough that they can withstand peer-review, and we will see more papers coming in,” she says.
Future Research Topics
O’Grady believes researchers need to focus on “evaluating the horse’s foot, evaluating the structures in the foot, the appropriate trim, and finding your way about the foot.” He says he also hopes to see additional research on anatomy, foot function, and biomechanics published.
Weller’s research ambitions center on treatments for a variety of foot-related lesions: “What’s the best method for dealing with chronic navicular bone changes? Or, what do we do with a horse with deep digital flexor tendon lesions? It makes sense that we should use wedges on those hooves, which unloads the tendon. But wedges crush the horn tubules (the structures that make up the hoof wall). So I want to see some evidence here—what’s the best protocol for those horses?”
Until we see the results of that research, there are still many places farriers, trimmers, veterinarians, and owners alike can turn to for quality evidence-based information on the horse’s hoof.
“They can be encouraged to look up credible information and to attend credible functions,” O’Grady says. “They can research the early texts on horse shoeing. They can study the structures of the foot and how they work. If you have a good knowledge of foot structures, how the foot is put together, and how it functions, all the farriery answers are there.”
About the Author
Erica Larson, News Editor
Erica Larson, News Editor, holds a degree in journalism with an external specialty in equine science from Michigan State University in East Lansing. A Massachusetts native, she grew up in the saddle and has dabbled in a variety of disciplines including foxhunting, saddle seat, and mounted games. Currently, Erica competes in three-day eventing with her OTTB, Dorado, and enjoys photography in her spare time.