Wrapping it Up

Over the past twenty odd years, I've had reason to wrap a lot of hooves.  I've tried just about every wrap horse people have dreamed up, including diapers, inner tubes, casts, duct tape, vet wrap and assorted layers and variations of all of the above.  I've had a lot of practice wrapping hooves.

I'm not going to go into exhaustive detail about all of those wraps.  There are as many variations on hoof wraps as there are reasons for needing them in the first place.  Everyone has their favorite and certain situations may require something specific.  However, I have come up with a go-to default hoof wrap that I use as my first line of defense for hoof ailments.

My favorite wrapping material these days is a 2 inch wide Elastikon bandage.

These sell for around $4-5 a roll, which may seem a bit pricey if you have to buy a lot of it.  However, I generally get between one to four weeks out of each wrap I put on, depending on the size of the hoof and the environmental conditions.  Really wet, muddy ground will chew these up pretty quick.  I have had them last as long as five weeks in really dry conditions.

For treating abscesses, bruises, minor puncture wounds or for simply conditioning weak hooves, I like to use Magic Cushion under the wrap.  The stuff kills germs, relieves pain and forms an air-tight, water-proof, antiseptic seal over the bottom of the hoof.

I apply a generous layer over the sole and frog, but I am careful not to get it on the outside of the hoof wall or the heel bulbs.

Wear gloves for this as Magic Cushion is a sticky, tar-like substance that will stick to everything.  At the same time, it will prevent the Elastikon from sticking to the hoof wall.  I want the bandage to stick to the outer hoof wall.

While holding the hoof up, I start the bandage at about the 10 o'clock point on the medial side (toward the middle of the horse) of the outer hoof wall and make a full circuit around the hoof....

When the bandage gets back to the 11:00 point, in front of my thumb, I pull it snug against the front of the toe.  As the wrap comes over the sole or behind the heel, I loosen the tension just a bit so that I do not over-tighten the wrap.  Let the bandage flow smoothly around the hoof without pulling it tight.

I make several, overlapping passes across the sole to seal in the Magic Cushion (which is going to ooze out the back no matter what you do), and form a pad on the bottom of the foot...

I use the remainder of the bandage to make overlapping layers around the foot with half to a third of the bandage folding over the sole with each pass.  Always keep mild tension on the bandage when coming across the toe, but do not pull tight over the heel.  Just let the bandage roll around the back of the foot with neither slack or pressure...

To finish the wrap I bring that last bit of bandage across the bottom of the foot and make sure it ends there even if I have to cut a few inches off.  This ensures that the tail end of the bandage is always on the bottom of the foot and won't come unraveled.

For added durability, this can be covered by a further wrap of duct tape.  The duct tape wears out after a few days, and can be peeled off or reapplied depending on how long the wrap is needed.  Duct tape can add a week or two to the life of the wrap when it is used as a sacrifice layer.

If the foot needs to be medicated daily, then longevity is not an issue and a lighter wrap may be appropriate.  However, if you need a bandage to stay on, this is the best choice.  Wraps fall off because the hoof expands and contracts with every step and every wrap will eventually loosen as a result.  This will stay on because the Elastikon adheres to the hoof wall and flexes with the foot.

If you are treating an abscess, the longer the wrap stays on the better in most cases.  If there is a hole in the foot, this wrap will prevent further injury or reinfection.

From the outside, the wrap should cover most of the outer hoof wall so that the Elastikon has plenty of surface area to adhere to.  However, it is never a good idea to cover the coronet band.  Doing so will restrict blood flow to the hoof and can seriously impair hoof growth.

The wrap should stay at least half an inch below the hair line and if the wrap accidentally extends up too far, cut it back so it is below the hairline.  If the wrap is only going to be on for a short time, it is OK.  However, for a wrap that will be on for any length of time, keep it off the coronary band.

Once the animal puts weight on the hoof, some of the magic Cushion will ooze out the back...

Magic Cushion is great for hooves, but not so good for bare skin, so try to wipe the excess off.  A bit of ooze is inevitable, but won't make too big a mess if the extra is removed after the first few steps.

The 2" bandage works for small feet like Ramsey's....

....as well as larger hooves.  For a draft horse, I would opt for the 4 inch version.

The big advantage of this wrap, is that it won't fall off.  In fact, it can be tough to remove.  I recommend wire cutters to cut through it.

The wrap will wear away at the toe within a few days.  Unless the toe is where the injury is, don't worry about it.  The rest of the wrap will generally adhere to the sole and the frog, which is where it is most often needed.  It will get ratty and nasty looking, especially in the mud, but you will find clean hoof under it when you peel it off.

The wrap pictured above was on for ten days in a wet environment.  It looked like hell, but was still protecting the frog when I pulled it off.

The Canker

I've been meaning to write more about the canker issue in Ben's foot and answer some of the questions I've had about it.  At the same time, I have been trying desperately hard not to dwell on it and make myself crazy worrying about it.  I have already done everything it is humanly possible to do to get Ben the care he needs.  Writing about it and not dwelling on it have become mutually exclusive.  However, today was the day for the vet to come out so we could try to tackle this so it is time to address the issue on all fronts.

The most common question about canker is: what is it?

The answer to that is, despite what you may read, no one really knows.  When I was in college, studying equine science, I was taught that it was a type of cancer.  These days, many researchers believe it is a type of bacterial infection that triggers out-of-control growth.  The problem with this theory is that it does not respond to antibiotics and canker can't be reproduced even when the suspected bacteria are injected into a foot.

There is also an environmental component, although it is not hygiene (despite that often being cited, canker occurs in the most immaculate settings as well as dirty ones).  I had never heard of canker occurring in donkeys, but clearly it does.  Canker can occur in any horse, of any size, but it most often occurs in draft horses and is seen most frequently in the southeast US.   Because of this, it seems there has to be some kind of environmental factor, but no one knows what that is.  Ben did spend time in North Carolina before coming to New York, for what that is worth.

Fiona asked if canker is related to sarcoids and there is some evidence to support that, but again, no one yet knows.  There is speculation that both sarcoids and canker may be triggered by bovine papiloma virus.  There is an interesting article about the correlation between sarcoids, canker and BPV that can be found here along with a discussion about using chemotherapy to treat canker.  It has shown some success.

When I ever bother to think about canker (which was very rare up until Ben entered my life) I take a more practical view of the problem: if it looks like cancer, acts like cancer and has to be treated like cancer, maybe we should just call it cancer until someone figures out what the hell it really is.

The reality is that canker is a rare, mysterious, bizarre hoof disease that has semi-randomly plagued horses (and donkeys) for centuries and will likely continue to do.

The next question everyone asks is:  how do you treat it?

That too is a topic of great debate.  Fortunately, despite not knowing exactly what it is, there has been some progress on this front.  Canker often used to be a death sentence.  Canker still has a guarded prognosis, but the success rate for treating it is now about 70%.  What it really comes down to for successful treatment, is that the canker has to be gotten rid of entirely.  How that is done is (of course) a matter of controversy.

Just about every chemical you can imagine (and some I'm sure you haven't) has been used to try to treat canker.  Sometimes they work.  However, the miracle cure for one horse often has no effect whatsoever on another, making topical treatments a frustrating matter of guess work, anecdotal stories and hope.

The treatment that has the most consistent and highest success rate so far, is radical excision of the canker followed by topical treatment.  The most important aspect is to make sure that all of the canker has been removed with a clear margin all around it - just like cutting out a tumor.

There are various protocols for this as well.  The one with the highest documented success rate involves excision followed by cryo or laser therapy to kill any missed cells.  That is then followed by daily topical application of a drug (metronidazole) that is both an antibiotic and anti-protozoal combined with benzoyl peroxide (the acne medicine) mixed in acetone.  It is a bizarre combination that certainly covers all the bases.  It is hard to imagine a bacteria, fungus or protozoa that would survive this combined onslaught.  The full protocol can be found at: 
http://www.equipodiatry.com/canker1.htm 

Like cancer, early detection greatly increases the likelihood of successful treatment.  Unfortunately, canker often hides under healthy seeming tissue and is usually only discovered when the animal shows lameness.  By the time this happens, the canker has grown large enough to invade the inner structures of the hoof.  Even if successfully excised and treated, it may have caused too much damage for the animal to recover.

Maybe it is fate, destiny, luck or a guardian angel that brought Ben to the home of a true hoof nerd because I did catch it fairly early.  Hopefully, it will make a difference.  

On first acquaintance, Ben's foot looked very normal with the exception of a small, narrow crevice in the center of the frog.  It looked exactly like sulcus thrush, which is what I assumed it was when I first saw it.  

Ben had a complete veterinary checkup two days before coming to my house, he is not lame and he has always had regular farrier care.  I don't hold the previous owner responsible for this as he had no way of knowing it existed.  I certainly missed it until I took a knife to the foot.  

I do think the previous farrier should have at least seen that there was some kind of issue, but I know the farrier in question and this is just out of his depth.  He does a fair job on healthy feet, but just does not have the skills to deal with odd problems like this.  I could rage against that, but there is no point.  He is what he is.  As are we all.  

My first real hint that something was seriously wrong came when I used my hoof knife to open that sulcus crack up a bit to expose the area to air.  This is what I found....

That wet, grey, nasty looking area right in the top center of the hoof is canker in it's oozing, smelly, gross state.

Be warned, the pictures get more gross from here.

The canker is a fleshy, damp growth that bleeds profusely with the tiniest of scratch.

It has a very odd, musty, fungal sort of smell.

At this point, I trimmed Ben's feet and wrapped the affected hoof with a liberal dose of Magic Cushion, which is my go-to cure-all for hoof problems.  I love that stuff.

A week later, I removed the bandage and you can get a much clearer picture of the canker itself.  The Magic Cushion cleaned up the nasty, grey ooze and now you can see the white canker growing in the center of the frog.  There is a small amount of blood because I just barely scraped it with my knife.

By the time the vet got here yesterday, I had had the foot wrapped with the Magic Cushion for two weeks and the canker had actually shrunk because, hey, it's magic.  I am even more fond of Magic Cushion now.  Although, I will in no way say that this topical treatment will work on all cankers because it helped on this one.  I am a big fan of Magic Cushion, but it would be remiss of me to say it will work on every case.  It would certainly be worth trying, but remember what I said earlier about topical treatments either working or not with no obvious rhyme or reason.

Despite some progress with the Magic Cushion, we proceeded with the excision and cryo-therapy.  Ben was sedated, given a nerve block to the foot and a tourniquet was wrapped tightly just above the hoof because cankers bleed like crazy. I don't have many photos as I was holding the foot and wielding the hoof knife, but this was taken after we cut out the canker and done the cryo treatment. The white is actually frost from the freeze spray.

This was followed by application of the crushed metronidazole pills.  That was covered by gauze soaked in the benzoyl peroxide/acetone mixture and the whole wrapped in a pressure bandage.  As long as the weather stays clear and the ground dry, Ben does not have to be locked in.  The foot has to stay bandaged and dry, but exercise is a vital part of healthy hoof growth and he is better off outside.  He is still not lame and is, in fact, feeling quite well and full of himself.

From here, I will be doing daily bandage changes to medicate the foot.  If we start to see healthy tissue taking over, I will continue the medication for one-two weeks and then switch back to the Magic Cushion until the area is completely healed.  If that happens, then we can put this whole crazy episode behind us and ride into the sunset.

If the canker comes back.........?

A Little Bit of Magic

I changed Tessa's bandage this morning and found some interesting things.  I've also had a number of people send me emails wanting to know more about how I am treating Tessa's foot so I thought to share it all here. 

When I took the bandage off today, I found a number of small slivers of the flower stem that had worked their way out of the foot and were captured by the Magic Cushion.  I used a sterilized horseshoe nail as a probe to gently examine the puncture and was able to remove several more slivers.  There was a small amount of pus, which drained out with the removal of the splinters.  Once that happened the wound bled cleanly just a bit. 

This is Tessa's foot after I had cleaned off all the old hoof packing and cleaned the wound.  You can see where I had to pare away a good deal of her frog to remove the stem.  the frog appears black and nasty because of the hoof packing not because of disease.

This is what I have been using to pack the wound and I do think it has worked some magic. 

It has simultaneously drawn out the offending slivers, protected the wound from contamination and prevented infection.  I don't usually go on about stuff like this and the makers of Magic Cushion don't know I exist, but I can't say enough about how this stuff works on abscesses and puncture wounds in hooves.

I used this on Ramsey's foot a few months ago when he got an abscess in his bad foot.  I have been watching that abscess slowly grow out since then and cringe when I see how much of his foot it affected.  This nasty looking black goop may very well have saved his life. 

I do hope that donkeys have as many lives as cats and I really hope Ramsey stops trying to use them up.

I won't say that this stuff is easy to work with.  It is messy, its sticks to everything except what you want it to and if it gets on something you don't want it to, you may as well throw the thing away - unless it is something you can scrub with WD-45, which will clean it up.

The strategy I have come up with to work with this is to use a gauze sponge to scoop some of it out of the jar.  You don't need a lot, a walnut sized glob is about right for a full size horse hoof.

Make sure you have everything ready before you start.  If you have to put the foot down in the middle, you'll have to start over and you'll end up with sticky, black goo everywhere.  Ask me how I know:)

As a side note, the bandage I am going to make is a real bear to get off.  I have found that the best way to cut through it is with a set of wire cutters.  Scissors won't do the job, but these will...

Make sure the hoof is clean and DRY (that makes applying the goop much easier) then use the gauze to apply the magic Cushion.  Get it down into the crevices and covering the entire frog, but push the majority of goop forward towards the center of the hoof. 

Once the animal starts walking on the foot, the goop will spread out and ooze out the back no matter what you do so even if you are only trying to protect the back of the foot, it is best to have plenty of goop in the front half of the foot.  Do not even try to remove the gauze, just wrap over it as is. I have found that this not only helps keep the cushion in place and makes it easier to wrap and work with, it also makes the wrap stick to the foot better as the goop won't interfere with the glue on the wrap this way.

I used 2 inch Elastikon here.  I am not worried about protecting the toe so I left it open.  The toe is where the bandage will fail first.  If you don't need the toe wrapped, leave it open and the bandage will hold up longer.  I try to take the wrap around the back of the heel buttresses, but NOT over the heel bulbs.  If a bandage covers the heel bulbs for any length of time, they will get very irritated and cause a lot of pain.

No matter where the roll of bandage ends, I always make sure to cut it off so that the end is on the bottom of the foot.  This is always the part that wants to unravel first, if it is on the bottom of the foot, it gets stuck back into place with every step rather than pulled loose.

I try to overlap and criss-cross the bandage as much as possible as this makes it stronger.  However, I do not like to cover the coronet band if I can avoid it....

so my final step is to trim the top back off the coronary band.

If there was not snow on the ground I would add several layers of duct tape to this.  However, that does not work well in the snow.  I fully expect this wrap to hold up for at least a week and I'll need the wire cutters and a lot of swearing to get it off.  The thing I like the most about the Magic Cushion is that, no matter what kind of mud, snow or dirt Tessa walks through, when I take this off, the wound in her foot will still be clean and protected.  The stuff is an antiseptic, a drawing slave, and a protective barrier all in one messy, sticky mass.  That's why I think Magic Cushion really is magic.