Puncture Wounds
This is from the 1999 AAEP proceedings, Andrew H. Parks, MA, Vet MB writes in his paper, Equine Foot Wounds: General Principles of Healing and Treatment:
“Most equine clinicians are familiar with the healing and treatment of traumatic wounds to the distal limb, proximal (above) to the foot, because the general principles of wound healing are well taught in veterinary schools. This receives constant reinforcement as these wounds are a weekly if not daily occurrence in general practice. Foot wounds, although less frequently encountered, are not uncommon. Unfortunately, they are often treated hesitantly by practioners, presumably because of misunderstanding or unfamiliarity, so that the treatment is ineffective. This is probably because :
(1) little time is spent relating the principles of healing to the treatment of foot wounds in already overcrowded college curricula,
(2) the morphologic differences between the integument of the foot and skin is confusing, and
(3) experience with management of such wounds in practice is less common. Unfortunately, there is little or no information from research on the way foot wounds heal, so that practical treatment of foot wounds must be based on experience and extrapolation from research on skin wounds.”
The difference between the sole horn and the skin is too "confusing"? This is a top veterinarian telling us that most vets don't know how to treat hoof wounds. Could that be because the basis of veterinary understanding of the foot is based on a contracted shod hoof as their model of health? Look in any veterinary text book and see photos and drawings that depict contracted and shod feet as "healthy".
I learned this the hard way several years before I took all my horses barefoot. I had a nice 5 yr old Han/TB that got a puncture wound. After conventional treatment, including 4 surgeries, the vet advised me that the horse needed to be destroyed! If your child got a splinter in her foot, would you in your wildest dreams expect the doctor to tell you the chance of her surviving this injury was not good?
“Most equine clinicians are familiar with the healing and treatment of traumatic wounds to the distal limb, proximal (above) to the foot, because the general principles of wound healing are well taught in veterinary schools. This receives constant reinforcement as these wounds are a weekly if not daily occurrence in general practice. Foot wounds, although less frequently encountered, are not uncommon. Unfortunately, they are often treated hesitantly by practioners, presumably because of misunderstanding or unfamiliarity, so that the treatment is ineffective. This is probably because :
(1) little time is spent relating the principles of healing to the treatment of foot wounds in already overcrowded college curricula,
(2) the morphologic differences between the integument of the foot and skin is confusing, and
(3) experience with management of such wounds in practice is less common. Unfortunately, there is little or no information from research on the way foot wounds heal, so that practical treatment of foot wounds must be based on experience and extrapolation from research on skin wounds.”
The difference between the sole horn and the skin is too "confusing"? This is a top veterinarian telling us that most vets don't know how to treat hoof wounds. Could that be because the basis of veterinary understanding of the foot is based on a contracted shod hoof as their model of health? Look in any veterinary text book and see photos and drawings that depict contracted and shod feet as "healthy".
I learned this the hard way several years before I took all my horses barefoot. I had a nice 5 yr old Han/TB that got a puncture wound. After conventional treatment, including 4 surgeries, the vet advised me that the horse needed to be destroyed! If your child got a splinter in her foot, would you in your wildest dreams expect the doctor to tell you the chance of her surviving this injury was not good?
Holistic Treatment of Hoof Wounds is Successful!
|
Fast forward to my having all barefoot horses. This shows a puncture wound to the sole (see directly below the tip of the frog) The horse was severely and immediately lame after stepping on a sharp hidden piece of glass or metal while I was riding her. Puncture wounds are not uncommon in both shod and barefoot horses. The difference is, in a shod horse, this kind of injury would be life-threatening!
I trimmed the hoof to allow the wound to heal from the inside out. Trimmed for maximum blood flow and kept clean by soaking in a mild solution of apple cider vinegar and water, the wound took only a few weeks to heel to the point that the horse was sound again. As the wound healed, it grew toward the toe. I used only ACV water, scrubbed the wound with soap and water, and used propolis and Tea tree oil in the wound itself. I used NO Betadine or any kind of caustic (chemical burning) or pain killers. I did not put the horse in a stall but kept her out with her herd. I had the foot x-rayed to determine that there was no metal in the wound but mainly to document the extent of the wound which went all the way to the coffin bone. The wound is shown 4 months later completely filled in with new sole tissue. I have found that any kind of leg wound, even severe, heals faster and without accompanying proud flesh, just by keeping the wound clean and keeping the hoof flexible for maximum blood flow by trimming and soaking. The lesson I learned from this is that hoof boots are a very good investment, that "ounce of prevention". And although a barefoot horse is healthier, no horse, shod or barefoot, domestic or wild, is immune to a puncture to the hoof. The main difference with a shod horse is that sometimes there is alot more dead horn built up on the hoof (causing decreased sensitivity) and the contraction forces an un-natural vaulting of the sole. A wild horse has a lot more dense horn than can be created in the environment of a soft pasture like I have. I can compare it to the fingertips of a guitar player verses someone who swims a lot. The guitar player has denser skin on his finger tips than the swimmer does. THE BIG DIFFERENCE IS: A barefoot horse, when treated holistically, will likely heal completely, while a shod horse will most likely have to be euthanized, even with the best veterinary care! |
 Puncture wound just below tip of frog  One month later  2 months later  4 months later |
Another Puncture Wound
 After surgical removal of the wood splinter  Rehabilitation  3 months later Close up of healing Puncture wound.
 |
This is after the vet surgically removed a stick which had punctured the sole at the tip of the frog. The owner called me when she returned from hunting in the Sandhills of Carolina. She was riding out with a vet that told her the horse probably had a pulled suspensory ligament and needed stall rest. No one picked up the foot and looked at it until I was called a couple of days later. The stick was the diameter of a dime and was deeply impailed into the sole. I told the owner to call a vet as I was unable to remove the wood from the horse's foot as long as he could feel what I was doing. The vet looked at the injury, said it was the worst puncture wound she had ever seen, and set up an appointment in her hospital for the next morning. (poor horse! another day with that pain!) She removed a significant amount of sole and we could see exactly how deep the wound was. It was to the bone. The vet wanted the owner to put the horse in a stall and keep the foot in a dry bandage with medications. The owner decided to use holistic healing: keeping the foot in a boot with clean ACV water changed every hour or so for the first few days. Then she brought the horse to me while she went out of town. I kept him trimmed for maximum mechanism and soaked while I walked him. Interesting to note that this horse had very thick soles and bars which had been left thick for hunting prior to his injury.
I believe this puncture wound took longer to heal because the wound went about 3 days before it was discovered and the splinter removed. Also I think the fact that the vet used caustic Betadine and may have removed healthy tissue along with the damaged tissue. It did heal eventually and the owner still fox hunts the horse. The prognosis by the vet when it first happened was that it would likely result in infection to the bone and the horse would need to be destroyed. That didn't happen thanks to holistic hoof trimming and rehab!!! |
The Necrotic Burden Prevents Healing
Healing a puncture wound in a shod, contracted foot is a very difficult proposition. "Eschar tissue" is necrotic tissue. In shod contracted hooves, it may comprise a greater portion of the back of the hoof, including, but not limited to, the frog and digital cushion.
Shod contracted hooves have necrotic tissues appearing as dull black tacky ragged tissue in the area of the frog extending to the skin above the frog. It continues deep into the interior structures of the foot.
The first photo of the hoof used in the article, " An In Depth Look at Puncture Wounds to the Foot" is a perfect example of this necrotic frog tissue. This paper was presented in 2010 at the AAEP. It explains the veterinary approach to puncture wounds for shod horses.
The accumulation of necrotic tissue is of major clinical significance when trying to heal any wound, including a puncture wound. The eschar tissue is thought to promote bacterial colonization and prevents healing. The necrotic burden is already in existance, even before the puncture injury, and severely hampers any attempt at healing the puncture wound.
A contracted shod foot is similar to a chronic wound. The existing necrotic burden can prolong the inflammatory response and mechanically obstruct the process of reepithelization.
The whole process of healing a puncture wound is severely complicated by the fact that it occurs in a shod, contracted foot with necrosis.
Shod contracted hooves have necrotic tissues appearing as dull black tacky ragged tissue in the area of the frog extending to the skin above the frog. It continues deep into the interior structures of the foot.
The first photo of the hoof used in the article, " An In Depth Look at Puncture Wounds to the Foot" is a perfect example of this necrotic frog tissue. This paper was presented in 2010 at the AAEP. It explains the veterinary approach to puncture wounds for shod horses.
The accumulation of necrotic tissue is of major clinical significance when trying to heal any wound, including a puncture wound. The eschar tissue is thought to promote bacterial colonization and prevents healing. The necrotic burden is already in existance, even before the puncture injury, and severely hampers any attempt at healing the puncture wound.
A contracted shod foot is similar to a chronic wound. The existing necrotic burden can prolong the inflammatory response and mechanically obstruct the process of reepithelization.
The whole process of healing a puncture wound is severely complicated by the fact that it occurs in a shod, contracted foot with necrosis.