A difficult case of lameness presented at the University of Illinois Veterinary Hospital recently highlighted the importance of teamwork between farriers and veterinarians.
The University of Illinois College of Veterinary Medicine in Urbana acquired Middlefork Forge in February, recognizing farriers’ crucial role in treating lameness.
An unusual case of bilateral keratomas in a 6-year-old Holsteiner mare treated at the University of Illinois Veterinary Teaching Hospital illustrates how veterinarians and farriers work together from different angles to develop comprehensive treatment plans.
“Veterinarians and farriers bring different perspectives to the problem of lameness,” says Dr. Santiago Gutierrez-Nibeyro, an equine surgeon at the teaching hospital.
Steve Sermersheim, head farrier of Middlefork Forge at Illinois, works with three other certified farriers at the hospital, as well as throughout central Illinois and Indiana. Sermersheim worked with Gutierrez to treat the Holsteiner mare.
The mare was referred to the hospital after 10 months of being intermittently lame in both front legs. Radiographs were inconclusive because the keratomas were located symmetrically on both feet.
“Keratomas are a type of benign tumor that appear as a roughly circular mass, ivory to white in color,” says Gutierrez. “They are made of tough keratinized tissue and grow inside the hoof capsule, protruding into the underlying distal phalanx, the final bone in the hoof.”
The consequent discomfort can cause lameness.
“This presentation is very unusual,” says Gutierrez. “We couldn’t tell based on the X-rays whether these were lesions or a normal anatomic variation for this horse.”
Gutierrez diagnosed the keratomas through magnetic resonance imaging.
Surgery was necessary to remove the keratomas. Sermersheim and Gutierrez worked together to determine the best surgical approach and to develop a custom-made shoe to protect the hoof after surgery.
“A partial hoof wall resection was performed in each hoof centered over the toe using a Dremel rotary tool,” says Gutierrez. “The keratomas were easy to see after the hoof wall was removed.
“Then the tumors and adjacent tissue masrgins were carefully cut away. In addition, surface of the distal phalanx bone was debrided to ensure that all affected tissues were removed.”
The surgical site was then thoroughly rinsed with antiseptic solution, packed with sterile gauze soaked in the same solution and kept in place by stretchable elastic adhesive tape.
The mare was prescribed antimicrobial and anti-inflammatory medication. The owner was instructed to keep both front feet wrapped and change the wraps and packing every 2 days until the surgery site had dried and hardened. Throughout recovery, Sermersheim applied shoeing packing comprising impression material with a frog support pad.
“We modified a keg shoe to alleviate pressure from the ground to the bottom of the hoof by partially cutting out the toe,” Sermersheim explains, adding that a treatment plate was also applied.
After the surgery, the mare was able to bear full weight on both front feet. Although Gutierrez reports that she showed some mild lameness in her front feet on the first day, the mare regained full athletic function and returned to dressage competition in the months after surgery.
Both the farrier and the veterinarian are to thank for the operation’s success.
“Having the farrier and the veterinarian in the same room with the patient to discuss treatment plans and diagnostics eliminates confusion and ensures optimal patient care,” says Gutierrez.
