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A Thoroughbred, The Microbiome, and Sore Feet

Thoroughbreds have always been one of my favorite breeds, as an owner and veterinarian.  They are unique to themselves, just as any other breed is unique, with each having positive and negative aspects. In the Thoroughbred, especially the off-track horse, one major problem that is noted is sore feet, which can originate from many causes.  It was a struggle for many of my past clients and also for many farriers, trying to maintain soundness, usually resorting to metal shoes.  As a rehabilitation veterinarian, I too see this problem very commonly, and despite my efforts, there are cases that really push my brain to the limits.  Here is one case from a recent rehabilitation that I have learned a lot from and could potentially benefit other horses.

We were presented a 6 y.o TB gelding for rehabilitation.  He originally had a decent racing career but was retired due to an ongoing superficial flexor tendon injury on the right front, that failed to respond to traditional therapies.  After being retired, he was sent to an Eventing facility, in the hopes of giving him a new career, however, their efforts failed when he could not maintain soundness.  The cause of his ongoing soundness issues were being blamed on failure of the original tendon injury to heal, even after 12 months post injury.  He was placed in elevated keg shoes with full pads, silicon injection, and a toe clip.  Despite, he continued to be unsound.  In addition, he did have a history of gastric ulcers, which were managed by using traditional ulcer medications.

Toe Defect and Quarter Flares

Toe Defect and Quarter Flares

On presentation, this gelding shoes were removed which allowed us to see the entire sole for the first time in a long time, and gain a better overall feel for foot health.  Most Thoroughbreds are very flat footed, often under-run, out of balance, and have poor sole growth which makes them very tender at times.  This gelding was no different, however, he also demonstrated some laminar or wall separation in the toe and quarter regions.  There was evidence in the hoof wall of abnormal growth rings and defects in the toe wall consistent with past abscesses.  There were also ongoing flares in the quarter region, consistent with wall separation. He also demonstrated marked increase in digital pulses in both fore feet, which is indicative of inflammation and potential stagnancy of blood flow to the foot.  He was given a grade 3 lameness on a hard surface, much worse on gravel.  Soft surfaces he was graded a 1-2 and obviously was more comfortable.

His personality was quiet, more reserved, internal almost to a degree.  He was willing, but somewhat suspicious or cautious of what was asked of him.  His prior feed regimen was a commercial grain blend, typical grass hay, a vitamin-mineral supplement, hoof supplement, and pasture access.  His right front exhibited a traditional ‘bow’ effect, seen with chronic tendon injuries, and he was sensitive to palpation of the superficial flexor tendon.

An ultrasound was performed and indicated fluid accumulation within the superficial flexor tendon, a core defect, and also some scarring.  Radiographs of the feet indicated a low palmar angle, no rotation of the coffin bone, and very thin soles measuring about 3 mm in thickness.  The ideal sole depth is around 10 mm but can vary from one horse or breed to the next.

The Therapy Plan

I was suspicious, based on the overall exam of this horse and past experience, that the tendon condition was not the main problem, but more so was likely secondary.  In my experience, tendon injuries are often a result of not only over-straining, but poor foot imbalance which adds to the strain.  To me, the feet were the main problem.  In theory, if the feet are the main problem and are painful, not only do they contribute to lack of healing with the tendon, but also contribute to overall discomfort in the horse and increased stress response.  The more stress, the more inflammation, the more GI problems including ulcers, the less healing that occurs.

The plan for this Thoroughbred was to tackle health and soundness from many levels.

First, his shoes were removed, the feet were trimmed, balanced and walls rolled.  In the process, his break-over point was brought back, to ease movement, foster heel growth and overall balance.  He was left barefoot mainly for the reason that shoes were not helping this horse.  What he needed was to grow a normal foot out, as much as possible, maintain balance, and encourage sole growth.  This could only be accomplished by going barefoot.  Shoes only mask the problems and cover up the sole, not allowing the sole to come into contact with the environment.  If we continue to protect the sole, it will likely never grow thicker or become callused.

Second, his diet was addressed.  He was placed on alfalfa hay, about 2% of BW per day along with daily turnout for 8-10 hours with other horses at our facility.  In terms of grain, he was placed on whole grains, which included whole oats at 1 lb per feeding, along with 1 lb of alfalfa pelletes, 1/2 cup carrots, and 1/2 cup of dried peas.  He was placed on our traditional therapy plan at the time, which included using Cur-OST EQ Plus to target the inflammatory process and Cur-OST EQ Rejuvenate for added nutrients.

Third, his feces were cultured to obtain a base level for microbiome imbalance.  He was given a score of 4, on a scale of 1-4 in regards to degrees of lactic acid bacterial growth.  This level was very high and likely was connected with his current condition on many levels.  My hopes were that the EQ Rejuvenate would not only help with nutrient provision and hoof growth, but also impact the microbiome as it has in other horses.

He was maintained on this regimen for 2 weeks with a re-evaluation at that time, along with re-trimming of the feet.

He appeared to be making progress, slowly but surely.  He was no longer painful in the tendon and repeat ultrasounds indicated resolved fluid accumulation and overall size to the superficial flexor tendon.  His soundness was now restricted to the feet. His gastrointestinal microbiome had not budged much, which is not uncommon, and indicates to us that either more time is needed or the wrong path is undertaken. This is to be expected to a degree because it takes time to grow out a foot and it won’t happen overnight.  The main thing is to determine if we are moving forward or not?  I believed we were making progress, so we continued.

The Next Month and Progress

Over the next month, we went into the dramatic heat and humidity of the summer.  What progress was being made appeared to quickly disappear.  This gelding began to react to the heat in a very negative fashion with profuse sweating while standing idle in the pasture, increased irritability, increased sensitivity to the feet and walking, and even became hard to catch in pasture avoiding us at every move.  What was odd was that despite the heat and the sweating, this guy didn’t seek out shelter or shade, he stood in the direct sun.  Interesting and yet another piece to the puzzle.

His feet were being trimmed every 2 weeks approximately and were picked out on a daily basis.  He was exhibiting hoof growth, but seemed to be restricted to the walls with little improvement in the sole.  The toe wall was growing out nicely and obvious defects were now seen emerging out of the coronary band and moving downward, associated with past abscesses.  This coincides with the wall separation seen in this area, in combination with ongoing toe landing, which further stresses those structures.

Sole Shedding in Thoroughbred Foot

Sole Shedding in Thoroughbred Foot

What was really interesting was that he was shedding his sole in the toe region, which is a good sign, indicating the sole is becoming responsive to the environment and routines.  However, the new sole underneath was not callused and tough, but was more sensitive and pliable.  This made matters worse.

Looking at him further, he was housed in a stall at night and was becoming more over stiff in the morning upon exiting.  Was this joint related?  Ongoing pain?  Circulatory?  Feet?

The heat in the environment was making matters worse.  Instead of just avoiding it, let’s use that as a key, a light bulb and see how it fits into the equation.

The Second Line Approach

The original approach with this patient, regarding supplementation, was to target the inflammatory response, provide nutrients and promote gastrointestinal health.  This is a typical first line approach and really benefits many patients, however, this guy needs a closer look.

Let’s dig deeper. . .

If we have a horse that overly reacts to the external heat, this usually means that for lack of a better word, they are already too hot inside, inflamed, which is producing more heat.  This level of inflammation equates to pain, which creates discomfort, gets the emotions going and further elevates the level of heat in that animal.  Okay, so break the pain cycle, reduce the heat…right?  Nope, that approach is not working.  In this horse, we could give Phenylbutazone intermittently to aid with foot pain, to which he would improve, but he also got worse clinically with decreased appetite and reduced personality.  That indicates to me that the medication is hurting an area that is already compromised, which is the gut.  We knew this originally, based on cultures, but our approach wasn’t working.

This our new approach to this gelding:

  1. Placed him on Cur-OST EQ Tri-GUT to modify the microbiome and inflammation
  2. Continue the Cur-OST EQ Plus for inflammation
  3. Continue the Cur-OST EQ Rejuvenate
  4. Add in Cur-OST EQ Adapt & Recover to modify the stress response and enhance circulation
  5. Continue feed regimen as outlined above, using EQ Veggie Blend, as part of his meal.

Flash forward two weeks and he is improving,  now having ‘good days’ and ‘bad days’, versus only bad days before.  Something is still not right in his regimen, whether if it is supplements, feed, or a combination.   His sweating was improved, but still present and considered excessive.  He was improving with the feet, but not to the level I desired or expected.   His microbiome had improved, going from a score of 4 to a level of 3.  This is progress, but I needed to dig deeper….

The Third Approach

This horse was constantly on my mind, because he represented many other Thoroughbreds that we had struggled with in the past and many that other owners battle each day, month to month.  This foot issue was the main problem, but was actually secondary to the microbiome problems. If I was to correct the feet, I had to do it via the microbiome and gut health. If I could stabilize and improve the microbiome, then this would then aid with his overall systemic inflammatory response, aid in digestion, alter circulatory patterns, and in the end foster healthier hoof growth.

His sweating is a response to pain and the external environment.  In the world of Chinese medicine, we have ‘excess’ conditions and conditions of ‘deficiency’.  Actually, a condition of deficiency can create an illusion of one of excess, which I believed to be occurring in this case.  This gelding was not overtly angry, not biting or demonstrating a major negative emotion.  He more so appeared more stand-offish, quiet, and almost at a state of exhaustion.  This deficiency in internal energy patterns is often linked back to digestive health, and this state of deficiency can add to the heat, inflammation, and hoof growth.

In addition, as a result of this deficiency, he did have an accumulation of excess heat.  So, what we needed to do here was regroup, take it for face value and see how he responded.  I was concerned that if we didn’t get this ‘heat’ response under control with excessive sweating, that due to the stress and other factors, he would become anhidrotic.

The third approach included:

  1. Cur-OST EQ Tri-GUT to address the digestion, microbiome, and support inflammation
  2. Cur-OST EQ Adapt & Recover to aid with the stress response
  3. Cur-OST EQ Revive to benefit digestion and improve energy production, along with circulation
  4. Cur-OST EQ Cool Down which is designed to cool the body down internally, moisturize it, and provide nutrients along with antioxidants to boost cellular health.

The EQ Cool Down formula is a new research blend we developed just for this guy and is composed of Artichoke, Blueberry, and Aloe, in their concentrated extracts.  These plant extracts are known for their ability to provide a cool down to the body, modify inflammation and oxidative stress, and provide nutrient value for cellular repair.  The added benefit to these three herbs in combination is that they provide very potent pre-biotic properties, which can further benefit our GI situation.

In a matter of a week, he was improving, now having more good days than bad, however, he was still difficult to catch at times, which was not his nature.  He was becoming sounder, less sensitive to the feet, but pulses still remained, although diminished.  His sweating was markedly reduced, more personable, and more interested in what was going on in the barn and around him.  His somewhat picky or slow appetite, taking a while to eat his grains, was also improving as he was more excited about his meals. His fecal microbiome was also improved, moving to a level or score of 2 out of 4.  Definite progress!

Could we do even more?  I somehow still felt there was a block in the path to his recovery, but had to think on it.

The Final Attempt and Road to Resolution

All of the factors were now being addressed, but sadly it took me a few attempts and weeks to put all of the pieces together.  I still felt like something was missing and maybe more improvement could be made. I took a look closely at his diet.

The whole-grain regimen he was on was fine, in a nice ratio, and designed to deliver a low volume of carbohydrates in one meal via whole-foods.  Most of the Thoroughbreds we work on do nicely on this blend, but could he be different?  Looking at the whole-grains, we were using whole oats at a low volume, 1 lb per feeding, which should deliver a suitable level of carbohydrates that would not disturb the gut and the microbiome.  However nice and wholesome this route would be, it may be that this guy in particular was just excessively carbohydrate sensitive, due to ongoing inflammation, internal stress and other factors.  Not too far removed from an insulin resistant horse.  I had not submitted bloodwork on this guy, but strongly suspected that this might be a factor.  He was not overweight or even remotely big-boned, but we need to remember that insulin resistance, carbohydrate sensitivity, is an indicator of inflammation and decreased cellular function.  Nothing more, nothing less.  So, in reality, this could happen to any horse in any situation, if the stress and circumstances are right.  But, if this horse was in this situation, of being relatively insulin resistant, it was further adding to the circulation issues, and overall health of the foot and hoof capsule.

We kept him on the same supplement regimen, but removed all grains from his meal.  He was now on 1 lb of alfalfa pellets, 1/2 cup carrots, and 1/2 cup dried peas (EQ Veggie Blend) with his supplements.  Our goal was to remove the sources of high carbs that could be potentially adding to the problem, despite them being low volume.

The results?  In 24 hours there was a definite improvement.  First, he was less stiff coming out of his stall. Second, more alert and responsive than prior.  Third, decreased sensitivity to walking on gravel. Fourth, moving around the pasture more readily, grazing, more content and about 75% reduced sweating.  He actually had a good workout in the arena that day as well, which was a first for him.

So, in this case, it was a matter of figuring out the regimen for him specifically, taking all factors into consideration.  It can take time and in many cases, we are peeling layers of the onion back, getting to the root problem.  In his case, it was centered around digestion.  I am hopeful in the progress he is making and that he is now set on the path to full recovery, including complete hoof growth.

 

Author:  Tom Schell, D.V.M., CVCH, CHN

 

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