Hi everyone, Alicia here. I wanted to take a second to announce the official release of the Humble Hoof Rehab Guide, which is a progress journal to track changes in hoof health, comfort, and soundness for your hoof rehab case. You can find the book at thehumblehoof.com. There are worldwide shipping options and podcast listeners get 10% off by using the code THEHUMBLEHOOF at checkout. Thank you and I hope you find it useful.
Welcome to the Humble Hoof Podcast. My name is Alicia Harlov. This is a podcast for both horse owners and hoof care professionals, offering discussions into various philosophies on the health of the hoof and soundness of your horse. Please check us out on Facebook. Dr. Neil Volk is a board-certified veterinary surgeon with a special interest in podiatry and hoof care. He has been working on growing healthier hooves on horses for a few decades now.
But what's even more interesting to me than his impressive vet background is the fact that he is a certified natural hoof care practitioner and he incorporates a holistic approach to hoof care in his daily practice. He even teaches classes to veterinary students with this in mind. I reached out to him and asked if he would spend some time talking with me about hoof abscesses and how he approaches them in his work.
So obviously, as an equine vet, you had to go through years and years of schooling. And I wanted to ask a little bit before we got into the main bulk of our interview. You know, now it seems that you've taken quite an interest in hoof care. And did you get a lot of that education in vet school or did you have to kind of pursue that after finishing your degree? Yeah, no, most of 99.9% of what I know about equine hoof care and podiatry and all of that, I learned after graduation.
Unfortunately, you know, we're in a program here in veterinary school. We've got four years to try to learn everything about all species. And there's just not time, for the most part, for us to delve very deeply into anything. And especially with equine hoof care, you know, and equine foot pathology and that sort of thing.
structured so that we can set aside a block of time to say okay now we're going to focus on equine hoof diseases there are opportunities to spend some extra rotations two weeks at a time with like the farrier service, for example, and you get a lot of experience.
education there, but very few people choose to do that, again, because there's so much we're trying to cram into these little brains in such a short period of time. So unfortunately, we don't get a lot of that in the educational curriculum that exists today. Yeah. And so then how did you get into hoof care and where did you get that education? I've always had an interest in equine hoof care. I've always had an interest in podiatry. And fortunately for me, I had an opportunity in 2004.
to be exposed to the idea of barefoot trimming and natural hoof care and that sort of thing by hosting, for a client of mine, hosting a Pete Ramey clinic at my veterinary hospital. And that was kind of my introduction to natural hoof care. Before that point, most of what I knew I'd learned from veterinarians with whom I'd worked and also from farriers.
who I had worked with, always been very fascinated with farriery and have admired those professionals because of the talents and skills they have that obviously I didn't have coming out of vet school. I was kind of envious of that. Most of it began kind of organically and then I pursued and after 2004 pursued.
barefoot hoof trimming, went through a course and certified and just immediately applied it to everyday practice and the podiatry and foot issues that I was seeing on a daily basis in practice. And it worked. It worked beautifully. And so it's kind of been my favorite thing ever since then. I do quite a lot of it. That's awesome. Yeah. And it sounds like we're both.
Pretty passionate about, you know, similar things when it comes to hoof care. And something that always bothers me when I hear people talking about their horse's feet. is when they say something like, oh, yeah, well... you know, my horse can't be barefoot because it has really soft soles or like, oh, it gets abscesses if it's barefoot or...
You know, they have all these reasons why their horses, you know, aren't comfortable. And so I was wondering if we could kind of tackle a conversation about abscessing. I've had people actually ask about... what they can do if their horse has chronic abscesses or what causes them. And I thought that that would be a good topic to kind of ask you about. I do quite a lot of teaching to various and sundry barefoot courses.
interested audiences, put it that way. And I always address abscesses when I talk about pathology because they're so common and we just see them all the time. And so I think it's something that everybody, including horse owners, should know about. Awesome. Well, why don't we get started with that? And, you know, maybe some people don't know what abscesses are. I hope that those who are listening to a Hoof Care podcast do. But how do you typically see abscesses present?
And do you see something as the main cause of the ones that you see? So usually, and I'll just go through this like I'm talking to the veterinary students because I give them the same spiel when we talk about abscesses. More often than not, the clinical signs associated with an abscess are very acute onset, very rapid onset of significant length.
And by significant, I mean either the horse that's obviously slightly lame at a walk to the horse that's non-weight bearing. It just, it doesn't want to put the foot on the ground. That's typically the history, almost without exception. The phone call or the phone conversation I have with the client prior to or before I go out and see the horse is, well, he was fine yesterday and today he's unable to walk on his right front or his left, whichever.
It is more often in the front than behind, but it occurs in both front and behind. And the first question I ask the client is, have you looked at the bottom of the foot? And they'll say, more often than not, a good owner anyway, will say, yes, I've looked at the bottom of the foot, I cleaned it out, and there's nothing there.
And I'm like, okay, if there's not a nail stuck in there, there's not another foreign body lodged in there, anything like that, then this is a subsolar abscess. This is a foot abscess until proven. And then as far as working it up, once I see the horse, most of the time I do the same thing the owner has done. Pick up the foot, clean it out, check it, make sure I don't have a wire or a nail or some other foreign body stuck in the foot.
Feel for the digital pulse. The digital pulse almost without exception in these horses is going to be very strong. It's going to be bounding. Not fast, mind you, but very, very strong pulses. And that tells me that, okay, it may be an abscess, maybe something else. But what that does tell me is that I've localized the source of lameness or the likely source of lameness in this animal to the hoof capsule based on that elevated, bounding, booming.
And then depending on the foot, depending on the horse, depending on a lot of different things, I may or may not put hoof testers on the horse. Most of the time I don't need them. And usually I'll start just by holding the foot off the ground. I put it.
uh in a comfortable place either on my lap as a hind foot or between my thighs if it's a front foot and i will apply pressure just with my thumbs all the way across the soul all the way around the soul and over the frog everything on the bottom of the foot Very, very often with a subsolar abscess, they're painful enough that just thumb pressure will elicit a response from the hole.
And if that's not the case, then I'll reach for the hoof testers. I never use the hoof testers first because very often you don't need them. And if you apply them first. then you may cause excruciating pain unnecessarily. So that's kind of the second thing. And I can use the hoof testers to gently squeeze. and realize when I'm using hoof testers, one end of the pinchers is on the sole, the other end of the pinchers is on the hoof wall somewhere.
So it's not specific for pain in the soul. It could be pain up the hoof wall, for example. So they're not very specific, but they're helpful in kind of localizing where the most intense pain is in the hoof kit. And then after that, because I'm a trimmer as well, I'll go ahead, if the hoof hasn't been recently trimmed, I'll go ahead and do a trim on it. Very often that will allow me to identify with a problem.
Causes of subsolar abscesses. There are three primary causes that are responsible for 99.99% of the garden variety subsolar abscesses or hoof abscesses that we see in the horse. Number one, foremost, the most common is some kind of abnormality in the connectivity of the white line. There's going to be a tract, more often than not, a T-R-A-C-T, a tract. And it looks like a dirt spot.
the hoof and I trim it and I run the rasp across it and I've got a good visualization of the white line and the bars because the bars are just a forward continuation of the white line. I'll look in the area where the animal is most sensitive to either thumb pressure or hoof testers. I will look there for a dark spot, a dirt spot. And that's just the opening of a tract. Most subsolar abscesses, in my experience, gain access or allow bacteria because that's the culprit of the subsolar abscess.
allow bacteria to gain access to the interior aspect of the hoof capsule through a defect or a not so normal connectivity between the dermal and epidermal lamellae in the white line. You'll very often see a dark spot. And when I see that, that's where I'll start to follow that track, start to dig down. So that's the number one cause is entry through the white line or the bar.
More often, the white alignment can also occur through the bars the exact same way. The second most likely cause is a puncture wound. through the soul not as common not nearly as common as the white line but if a horse steps on a sharp object and pierces the soul and then comes off of it
And very often when you look at the sole before you clean it up or trim it or exfoliate the dead sole, you won't notice anything. But oftentimes, if it is a puncture wound through the sole, when you clean that sole up, you will see a dark spot. in the area where the horse is most sensitive. And that's also probably a tract. That's where bacteria and debris were injected, if you will, through the soul. And then the third most common cause, and this is...
Not very common at all, but I do see it occasionally as what we call a stone laceration. So instead of a puncture, the horse... steps on something hard presumably a stone uh could also be a piece of uh of metals on the ground or something like that a stake sticking out of the ground and the horse steps on that usually at a counter or trot and one
It does. It causes the sole literally to fracture. The sole will fracture and open up as the horse is weight bearing. And then when they pull their foot off of it, the sole will snap back. And with those, usually the history is the same as an abscess. Sometimes an owner will say, well, I saw him trotting through the field, and all of a sudden he pulled up lame, took three or four really bad strides, but then was fine.
Three days later, that horse presents as an abscess. And what's happened is it takes about 72 hours on average or so for the bacteria that have had access to the interior of the hoof capsule to start causing the problem to start. forming an absence and that's on the part of the bacteria and also the body's response to the bacteria in a place where they shouldn't be. That's what actually causes the absence.
in most cases. So I'm either looking for a dark spot in the white line or the bars in the area of sensitivity with pressure, or I'm looking for a dark spot or a linear defect. in the soul, in the area of sensitivity to prayer. Yeah. And so, you know, if you come to a horse and you diagnose an abscess, what is your typical port of call for treatment and care for...
Okay, let me back up a little bit and go back to the exam. So the history fits that of an abscess. The bounding digital pulses support that. I find something on the bottom of the foot, usually, not always, but the vast majority of the time, I'll see some kind of abnormality on the bottom of the foot that leads to suspicion that this is where the problem started. Before I do that, especially if the history is this horse has been laying for three or four days.
As part of my exam, I'll also... palpate the cornet band the entire cornet band from heel bulb all the way around the heel bulb very very uh very i don't want to say aggressively but i apply a lot of pressure either with the tip of my index finger or my thumb the reason i do that is If the horse was sound yesterday and it... lame today, very likely in my practice, that's going to be a subsolar abscess. If it's been going on for a few days, then that abscess will start the process of resolving.
the horse will begin to resolve it by allowing the abscess or the abscess will continue to grow in size and then it'll start to track up. the hoof wall and head towards the cornet band, which is the path of least resistance, and they'll pop out usually after five or six days at the cornet band if they're not drained from the bottom. And if I can find an area of very...
focal sensitivity at the cornet band, then I can follow the direction of the horn tubules from that point down to the bottom of the foot. And more often than not, if I look right there in the white line, I'll see that dirt spot or I'll find an area where bacteria have gained access. And so that's another thing that I do when I'm looking at these guys. So I'm looking at a horse. I'm pretty much convinced that it's got a subsolar abscess. I see a track.
I want to try to treat that. How do I proceed? And I have some very small root-proof knives and I have picks and bone curettes, which are like... little tiny, tiny, mini ice cream scoops and that sort of thing. And usually what I'll do is I'll begin to just excavate or cut down on that tract, T-R-A-C-T, that dirt spot. And I'll follow it. And if it ends, then I stop digging. If it ends, then it's done. It's very superficial. That's not the thing. If that is the root or the cause of the abscess.
more often than not, I can continue to follow that until I am counterpart. And so my goal there is to open that abscess up, if I can, from the bottom of the foot and allow the pressure to be relieved. A lot of people, a lot of horse owners, a lot of... just people in general deal with horses every day, don't understand what's going on with an abscess and why it causes pain, why it causes such excruciating pain in the horse. And because there are bacteria involved,
People think it's an active infection. It's actually not bacterial infection that causes the pain in a horse that has a foot abscess. What causes the pain is... In the normal situation, there is no space between the hoof capsule or the sole and the core. so you've got the laminar corium and the sole corium and if it's a frog eggs that's the frog corn everything there those two sides are sandwiched together and adhered very tight
There's no space there normally. But once bacteria gain access to the interior of the hoof capsule, they begin replicating. They begin multiplying. Many of those, if not most of those, abscesses or bacteria that cause subcellular abscesses are anaerobic bacteria, meaning they don't need oxygen to survive, and they tend to produce gas. And as they are reproducing and producing gas,
it starts to create a space between the corium and the hoof capsule where none existed before. Now, at the same time, the body recognizes that, hey, we've got foreign invaders here. We need to fight this off. So the body is sending... white blood cells into that mix and also inflammatory mediators and things that are meant to fight the bacteria, if you will, well, that results in the production of pus.
So pus is part bacteria and part body fluid that is in there trying to clear up that bacterial invasion. So you've got this growing accumulation of pus and gas. in an area where there was not a space before. And as it expands, it detaches, if you will, or causes a separation between the sensitive corium and the hoof capsule. And it is that pressure. on the corium that causes the pain.
That's the whole reason for the pain in the vast majority of horses with abscesses. That's why if you have a horse that's diagnosed with an abscess and someone's able to open it up and drain it, that horse might go from non-weight-bearing lame to walking sound in 24 hours.
That wouldn't happen if you had infected soft tissue or infected bone or something like that. It wouldn't happen that quickly. It's purely the pressure exerted by that growing accumulation of pus and bacteria inside the hoof capsule that causes the pain. And that's one of the reasons why, in my experience, phenobutazone or banamine is typical non-steroidal anti-inflammatory drugs we use in horses all the time.
don't usually help a horse. They don't usually relieve the pain or the lameness in a horse that has a subsoar abscess because it's that pressure exerted on the corium that causes the pain. And the nonstrelos don't touch that. Until you relieve that pressure, there's not going to be a lot of relief. And that's why I, as a veterinarian, if I can, and I can't always, but if I can.
I choose to go ahead and drain those things and relieve that pressure because I know that patient's going to be markedly more comfortable within 12 to 24 hours. Yeah, and so that's the crux of it. That's what I'm going to do. I'm going to drain it. So what do we do after I've opened this thing up and drained it? I have a hole on the bottom of the foot. The horse walks.
with the bottom of his foot in contact with the ground, in contact with dirt, in contact with manure. What am I going to do with that hole in the bottom of the hoof? Well, I have to protect it somehow. And there are all kinds of different ways you can do that. You can put boots or you put a boot on the horse. You can put a duct tape bandage on the horse. You can do this, that, and the other thing. What I do is I take a piece of cotton.
depending on how deep and how large the cavity that I've created in the process of opening up that abscess is. usually it's about a half a cotton ball, half a standard cotton ball. And I'll just wet that thing down with a povedone iodine solution, betadine solution, and I'll jam it in that hole. And what that does is the cotton is actually quite porous. If I put it in that hole wet, as it dries, it will kind of wedge itself in that defect in the hook.
And that will prevent dirt and debris and other yucky stuff from getting packed into that hole that I've created and coming into contact with the corium, which is not a good thing. But at the same time, it's porous enough that the pressure will be allowed to release through that cotton. Now, I've opened it up. It's drained. Now I put the cotton in. It will continue to drain for a few days, but not very much bother.
And then that's it. That's what I do. Make sure the horse is up to date on its tetanus toxoid. And that's it. There you go. The vast majority of them, that's all you need to do. I'll ask the owner if they're capable, and most of them are capable, if they can pick up a foot and pick it out and brush it off, then I will ask them.
Okay, once a day, for the next five days, I want you to pull this cotton ball out and replace it with an identical cotton ball. And just do that every day for five days. And then after the fifth day, leave it in place. and the farrier or the trimmer will encounter it the next time the horse has its hooves trimmed. By then, the whole problem will be resolved, and you're good to go. Now, veterinarians tend to, most of it,
tend to be much more aggressive in the way they treat them. Very often, they'll ask the owner to soak the hoof in some sort of solution. More often than not, some Epsom salt solution. something like that. They'll want them to poultice the open area. They'll want to keep some kind of protective bandage or wrap or maybe a boot.
over addressing and they want to do that for 10 days or two weeks or so and keep the horse in the stall and I believe I believe that's overkill I don't have a problem with that but it's a lot more work than you need to do and I think it counterproductive to take a horse with a sub-solar abscess. and put it in a stall because once I put that piece of cotton in there, I want that guy out moving around. Every time he bears pressure on that foot, and he's going to do that more and more.
in 12 to 24 hours, every time he exerts pressure on that foot, he's helping to discharge that pus and that drainage and all that stuff and push it out that hole that I made in the bottom of the foot. And so I think it's important that they have the opportunity to start moving around as soon as they want to. Yeah. And that's what I've always heard, too, is get them moving to get everything out of the foot that's, you know, infected.
Yeah. Yeah. And so if you have that hole in the bottom of the foot that the abscess is draining out of, do you worry about a secondary infection or is that why you pack it? No, that's why I pack it. What will happen sometimes, very rarely, but sometimes that cotton will become dislodged. inadvertently and the horror will then have dirt pack into that hole. And when dirt gets tightly packed up into that hole,
If the abscess has not run its course, it's not finished draining, then what will happen is the horse will get acutely lame again. In which case, if the owner calls into that situation and says, well, lost the cot and he got a bunch of dirt in there and now he's... He's back to lame again. Well, it's because we've stopped the drainage and the pressure has built up again. Again, it's the pressure that's causing the pain.
So take a hoof pick, gently pick that out, soak the foot to get that dirt plug out of that hole. Drainage will be reestablished and then the horse will be fine again. More often than not. I would say, too, that the cotton ball trick works great for those abscesses that you open up. uh in the white line or in the bars because usually in the process of of excavating that opening that up you're going to make a fairly deep defect in the bottom of the hoof it's not unusual for that to be
three-quarters of an inch or an inch deep into the hoof capsule before I open the abscess proper up and actually get some drainage. Depends on sole thickness, obviously. But if I have a stone laceration or a puncture wound in the soul, I can't open up the soul. I don't create a deep enough defect in the soul to do the same thing with a cotton.
I'll usually just put a beta guide solution in a cotton ball or a gauze pad or something over the defect and then put a duct tape wrap. Or if the owner has a boot, put a boot on it. That works, that cotton ball trick works great in a white line of bars, but it doesn't work very well in the soap. You know, owners seem to generally understand that the abscess is caused by bacteria. And a question I get very, very often is, do we need to put this horse on antibiotics?
And my answer overwhelmingly is no, not always, but the vast majority of the time, my answer is no, because it's not an infected soft tissue problem. It's just this pocket that's creating pressure. against the corium. And once that pressure is relieved, the problem's over. My analogy is it's a zip. It's a zip. Pop it and it's gone. It's done. Okay. Just protect the corium.
until it has a chance to heal. And I should touch on that briefly, too, when I'm done with this rant. There's so much to talk about. We could talk about subsolar absences for two weeks. But antibiotics are generally not indicated. If I get to the point, and I rarely radiograph horses' feet when I'm dealing with a subsolar abscess because it's just straightforward. It's straight up. It is what it is.
If the horse doesn't respond, then if I have to look at him again, I might then radiograph him, especially with a stone laceration, because there can be something else going on. But when I see him initially, I don't tend to... I don't tend to put them on antibiotics. People will put their horse on antibiotics if it has a subcellular abscess. I know of some veterinarians that will do that. I'm opposed to that because... The antibiotic concentration in that.
pool of pus inside the hoof capsule never gets high enough to eliminate it what it can do sometimes is it kind of slow down the progression of the maturation of that abscess and so the horse may look some better while it's on antibiotics. But then once you stop the antibiotics, it comes roaring back. And so you're just delaying the inevitable by putting the horse on antibiotics. And this is with just a straight up garden variety.
subsolar abscess. We don't have any kind of soft tissue infection or no bone infection or anything like that. Those are completely different. Owners will ask me about nonsteroidals. And like I said earlier, my experience has been that if the horse has a subsolar abscess that has not. been drained, the pressure's not been relieved, then non-steroidals don't tend to improve the comfort of the horse at all. And as a matter of fact,
It's not uncommon. Maybe once or twice a year I'll be faced with a horse and I'm looking at it and I'm going... This looks like an abscess. It smells like an abscess. It tastes like an abscess, but I can't find a defect in the white line or the bars or the bottom of the foot. I can't find a track to open up and try to drain this abscess.
I'm 99% sure it's an abscess, but not 100% sure. In that instance, very often I'll ask the owner to put the horse on butte for two days. Put the horse on butte for two days, call me and tell me what happened. If they call me in two days and they go, oh, he's markedly better, then that was not an abscess, unless an abscess has popped out at the cornet band since I saw them.
More often than not, I'm dealing with a bad stone grooves or something like that. If they say after two days, no, it didn't make any difference. He still is lame. That's an upset. That is an upset. you know, or a fractured coffin bone. But fractured coffin bones are much less common in my practice than an abscess. And so... don't tend to medicate them with anything after the fact. One exception, occasionally I'll have an abscess that arises from the white line in the toe region.
and it's been cooking for a while. And for whatever reason, instead of tracking straight up the dorsal hoof wall and popping out of the coronet band in the middle of the foot, it will decide to go rogue and migrate backwards towards the back of the foot. And what happens with those guys is it lifts the entire soul and frog off of the corium and then pops out over the heel bow.
And those horses, when the abscess pops out, they don't get comfortable in 24 hours. They will be sore for seven or eight days because... the entire bottom of the foot basically is detached from the corium. And now, every time they walk, they're pushing that sensitive corium down on that detached sole and frog.
And that causes impact. I will put those horses on view, but I can tell the owners, look, this is going to take seven or eight days for the process of quantification, which I want to talk about very briefly afterwards.
to occur. And once that occurs, then this horse is going to be comfortable. And not the next hoof trim, but the one after that, the farrier is going to lift the whole frog and sole right off the bottom of the foot. And underneath, you're going to have brand new sole and frog that has replaced it. All right, so this question, I feel like I get this question a lot. Do you see health, I mean, other than puncture wounds, do you see healthy hooves getting abscesses?
Not often. Not often. And I would add to healthy herbs, Alicia, I would say healthy, well-maintained. So what causes what causes a weakness in the connectivity of the white line? And if you ask that question, you know, it's like, what can cause the white line? to become more susceptible to invasion. And it's going to be a defect in the white lining. And examples that I see very often is in the neglected overgrown hoof, where the hoof wall...
flares away as it reaches the ground and continues to grow, it flares. You've got a hoof wolf there anywhere. anywhere you see that, it's going to cause an increase in the mechanical forces that are pulling the hoof wall away from the sole. And between the hoof wall and the sole is the white line. So anything that increases that mechanical force... is going to weaken or stretch or open that white line. That's going to make the horse more susceptible to abscess.
So I see it very commonly in that situation. It might be a quote-unquote normal healthy hoof that's just neglected. The second most common reason I'll see it is secondary to laminitis. We see a lot of laminitis here, and so I see a lot of P3 rotation, a lot of stretched white lines. When that white line is stretched because of the rotation of the coffin bone, secondary to a laminitic event, it does the same thing. It kind of pulls that junction apart and creates a weak spot.
where it's more likely for bacteria to gain access to the inside of the hoof capsule. I think that's the number one reason why it's really not unusual four to six weeks after a pretty significant laminitic episode to see the horse get really lame on one foot. And you find out, oh, it's a subsolar.
It's something that damages the integrity of the white line is the most common thing I see. And I was asked once, I think a student presented a paper at Rounds we were having, and the paper concluded that horses, barefoot horses, are more likely to develop subsolar abscesses than shod horses. And one of the internal medicine people looked at me because everybody here knows I'm a foot guy. And she said, they know I'm barefoot.
She said, well, Neil, has that been your experience? And I thought about it for a moment. And I said. Because if we maintain those hooves, we keep them well-proportioned and well-balanced, and we keep the flares worked off of them, we're mitigating those abnormal mechanical forces that are driving.
that change in the white line that allows bacteria to gain access through a less than perfect white line. And the other side of the coin is too, I see not infrequently in shod horses, I see nail hole abscesses.
where an abscess has developed where a nail has been driven. It doesn't mean the nail was poorly driven. It could have been driven fine. But as the hoof, particularly the heels of the hoof in a shod horse, continued desperately to try to expand and contract, there's kind of a sawing effect of
the hoof wall on a rigid nail that doesn't want to move, and eventually you can open up the hoof wall, if you will, and bacteria can invade again into that space in the interior of the hoof capsule and start an abcet. I've never seen, obviously, a nail hole abscess in an unshod horse, in a barefoot horse, but I see them in shod horses with some regularity. Yeah, and I guess, you know, something that I'll often talk about with my...
owners in terms of creating a strong white line connection is also proper diet. And I don't know if that's something that you talk about in terms of preventing abscesses or if you see that as important as well. I include that just in my talk on hoof health. Alicia, and that's one of the things I try to instill in the students here. It seems that in veterinary medicine, we have this laser focus on the issue, and the issue today is a subsolar abscess.
And that's what all our attention is on. And I tell them that it's fine. It's fine to do that for a bit, but then back up. Back up and look at the whole picture. Look at the horse's body condition. Look for evidence of equine metabolic syndrome. Look for evidence of insulin dysregulation. Look for evidence of PPID. ask about the diet, ask about the lifestyle, because all of that is responsible directly for hoof health. And if something's out of whack with that,
I preach to them, you can do whatever you want, particularly with laminate, of course, you can do whatever you want to the hoof. But if you don't identify the triggers and eliminate the triggers that are driving that pathology, you're wasting your time and wasting the client's money. And a lot of farriers, a lot of veterinarians, when they open up abscesses, they'll make a big honking hole in the bottom of the foot because they'll say, I want good drainage. I want to establish good drainage.
You don't have to do that because unlike the soft tissue, if I get a horse with an abscess, say, and it's cheap. And that is going to expand, expand, expand. If I make a hole in there and drain it. then I'm going to have to make a pretty big hole because that tissue will begin to heal almost immediately. And it's possible for the drainage hole that I've made to close up before it's done healing and it's done draining and healing from the inside out.
And people tend to think about things like that when they're working on the hoof capsule. What they fail to realize is that hoof capsule doesn't heal. If you get a crack in the hoof wall, it doesn't grow back together. If I make a hole in the bottom of the foot, it's not going to grow closed. Once I do that, it's permanent, and the body heals the hoof by replacing it.
And so I don't need a big hole. I just need a hole big enough to relieve the pressure and get the drainage out of there. So I intentionally make those holes as small as possible. Once that's drained, once the bacteria, the pus, everything's out of it, what happens? How does that heal? Well, if you look inside an abscess, and sometimes you can, most of the time you can't, but if you look inside the abscess, you've immediately opened it.
you'll see the corium. It'll be bright red. It'll be fleshy looking. If you just lightly touch it with your fingertip or with a cotton Q-tip, anything, that horse will react. Because that hurts. It's like ripping your fingernail off and then touching quick. It's very, very painful. more like seven or eight days.
that corium will go through a process whereby it starts to cornify. And all cornify really means is that it goes from being red and flashy and very sensitive to being kind of tan or yellowish and not so sensitive. What's actually happening? It's not a change in the court. That's new soul.
new horn that the corium is growing and once that new horn fills in and that corium that was previously exposed is completely covered up then you don't have to worry about the cotton because if dirt gets packed up in there it's not going to go anywhere you've got a nice protective layer of new horn And that's how they heal. They heal by replacement. And again, so if I open up an ab set.
and I drain it and the horse gets better and everything's fine. Not the next hoof trim, but the one after that. The trimmer is going to be trimming along and all of a sudden there's going to be this big opening in the sole. And if you're not ready for it, it kind of takes your breath away sometimes. And inside of that's going to be some inspissated, kind of stinky, usually black or dark gray pus. That's the after effect. That's history. That's not what's happening.
So everything deep to that is new horn that has replaced the defective part. Do you ever see abscesses that end up turning into like osteomyelitis or a coffin bone infection? I do. I do. There's a couple of things that I see and I want to. really emphasize that those are very rare. I can count on one hand the number of those types of cases that I've seen in 33 years of practice.
They're not that common. And that's kind of a worst case scenario. But it happens so infrequently. I've seen four of them in 33 years. And during that time, I've seen. 3,000 subsoar abscesses. The incidence of that happening is very, very low. But that's what I start thinking about if I have a horse that looks like it's got a garden variety abscess. And I treat it and it doesn't. It doesn't resolve. It gets worse. So I'm going to jump on that pretty quickly, looking for that.
And I would like to emphasize this as well. We as veterinarians are very quick to take x-rays and that sort of thing, which is fine, in my opinion, very often unnecessary. But if we're talking about bone infection, it takes a minimum of two weeks. for bone to change on an x-ray. So if I'm looking at a horse that's acutely laying with an abscess and I take an x-ray of it today,
barring an incidental fracture or something like that, the coffin bone should look perfectly normal. Now that doesn't tell me what it's going to look like in two weeks. So it's not very helpful for me to take an x-ray of the horse. on day one if it doesn't respond if it doesn't resolve that's going to be part of my backup plan i'm going to come back and look at that again later
I don't mind taking radiographs, but I don't like taking them unnecessarily. If the information contained in that radiograph is not going to change the prognosis or my treatment plan, then I'd rather not spend the money on it. However, the one exception is with these stone lacerations. If they occur near the periphery of the foot, in the sole near the periphery of the foot, I have seen several of those that will chip a little piece of bone off the coffin.
And as a part of the process of that soul being opened up, and now you've got this little chip of bone, this little chunk of bone. It's usually very small, that size of a piece of pea gravel. that is no longer attached to the parent bone. It doesn't have a blood supply anymore. Sometimes that can get infected, or it will act as a nidus for infection, which means it'll keep the infection there. Those horses typically Once you open the abscess and drain it, typically they don't get better.
And so if I have a horse with a stone laceration and I don't radiograph it on day one, which I normally don't. I'm going to tell the owner, if this guy's not walking sound in two to three days, call me back and we'll take some radiographs because there's a possibility we have a little bone fragment off there, a little bone chip. And we call that a sequestrum. It's just a piece of bone that gets broken off from the parent bone and it won't heal back.
They have to be removed. It's usually not a big deal, but that's a possibility with something like that. As far as... My concerns over a routine garden variety abscess spreading to the cough and bone is very, very, very minimal. Very minimal. I don't stay awake at night worrying about things like that. It's just not that common. Okay. Yeah, I've actually only heard of it once, and it was a friend's horse who had, you know, a whole host of issues, and he had a lot of hoof issues. Yeah.
Awesome. And I guess, you know, typically, typically I end the episode with asking if you have any advice for owners or hoof care providers about treating abscesses, preventing abscesses or anything you want to add. Yeah, I think just... Treat your horse like a horse. Treat your horse according to its evolutionary history and maintain its feet. Realize that for most of us in the U.S.
We have to trim the horse's feet because the horse is in an environment where hoof growth almost always exceeds hoof wear. And so keep those hooves maintained. and you're less likely to have problems with abscesses and that sort of thing. There's no guarantee that you'll never have one, but if you can prevent laminitis, if you can maintain your hooves well. If you cannot overfeed your horse on starch and sugar and stuff like that, then you're much less likely to have.
issues with subsoar abscesses, but at the same time realize they're very, very common. And usually they're a minor thing. They're scary because they take this 1,100 pound animal and turn it into a cripple. And that's frightening. But at the same time, I always tell owners when I look at a severely lame horse and diagnose and drain a subcellular abscess, I tell them this is what we want it to be. this is the thing that's most likely to completely resolve and never be an issue again.
And so it's good to find a sub-cellular abscess. It's a lot better than a fractured coffin bone or an infected coffin joint or something like that. It's not a big deal. It seems like a big deal, but it's really... Yeah, I know. It's always when you see your horse that lame, you're like, I just hope it's not a fracture. At that point, you're just excited.
And there are instances where I have misdiagnosed something a bit more sinister, have misdiagnosed it as a subsoar abscess. But if I guess abscess, when it sounds like abscess, I'm going to be right. And I'm never right. 100% of the time, I never have been, I never will be. Right. I don't think anybody can be, right? No. As far as treating them, yeah, I've encountered... It seems like it occurs in certain groups of tremors. It kind of depends on which...
barefoot camp you're in. Some of them say a hoof tremor should never attempt to open a subcellular abscess because they consider it veterinary surgery. And I don't agree with that. The reason I don't agree with that is that. In my opinion, my experience, in order to classify a procedure as surgery, I think, okay, number one, there has to be blood loss involved. And number two, you're going to have to have some kind of anesthesia to perform that, right?
But if I open up a subsolar abscess and I do it correctly, there should be no blood loss. should not experience any pain. If I do it correctly. Now, if I get a little close to the corium and I quit the horse and I get a little blood, that might happen. But that's different than performing surgery. And I wouldn't, I wouldn't.
talk or try to talk any tremor who's uncomfortable doing that into doing it but at the same time understand that there are well, there's at least one of us out here that doesn't think that that's off-limit. If you are experienced, if you have guidance, if someone who knows how to do that has walked you through that process a couple of times, I would never advise anybody to go blindly hacking.
into a foot. And that's, you got to know when to say when as well. And I do that. I was a veterinarian who's seen thousands of subsolar abscesses. If I'm digging on the foot or I found an area on the foot that seems to be this is where the abscess is, if I do not see a defect or an abnormality in the bottom of that foot, I will never.
go blindly cutting into normal healthy cell because no good can come from that. And I'll tell the owner, I still think it's an abscess, but I don't see a clear cut way or place.
to pursue this uh with my knife so we're going to wait we're going to soak this foot might put a poultice around the cornet band in that case let's let's let's try to uh hasten its uh travel up the hoof wall to pop out of the cornet man i'd rather do that than open up a hole in the bottom of the foot unnecessarily that leads me nowhere so i'm very comfortable saying
It's here. I can't find it. I'm not going to cause any damage. Going on a wild goose chase looking for an abscess, I may not find it. Awesome. Yeah. And I think all of this is great. I've learned some stuff too. So thank you so much for chatting with me. All right. Well, thank you again so much for your.
Thank you. I enjoyed it. It was fun. And yeah, thanks for thanks for thinking of me. Thanks for inviting me and had fun. Yeah, me too. All right. Well, have a good rest of your day. You too. Thank you. I always say that I'm slightly more hoof obsessed than the average person. And chances are, if you're listening to a hoof care podcast, you are too. So we should probably be friends. Feel free to find me