September 2019 - Hoof Insights
Written by CRM
Saturday, 31 August 2019 21:49
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Balance radiographs offer valuable views of issues impacting long-term hoof health.

The “no hoof no horse” adage is a hallmark of Mark Silverman’s, DVM, MS, life’s work. The San Diego-based sporthorse veterinarian has a passion for equine podiatry that keeps him at the forefront of ways to maintain hoof health and to capitalize on the hoof’s role in supporting overall horse health and performance.

California Riding Magazine editor Kim F Miller checked in to see what’s new in that world and he suggested hoof balance radiographs as a topic all horse owners would do well to understand. From their role in a pre-purchase exam and through all phases of a horse’s career, these detailed digital images of the hoof’s internal bone structures are a great diagnostic and maintenance tool. They are important to a horse care approach that considers the whole horse and engages all of its care providers in the process.
Based at Sporthorse Veterinary Services and the Southern California Equine Podiatry Center in San Diego County’s Rancho Santa Fe, Dr. Silverman travels with portable digital x-ray equipment to provide immediate viewing of the images in the field.

Kim: Why are balance radiographs valuable in your practice?
For a lot of the horses I treat, the horse’s value is achieved when they are older. They might be purchased as a 2- or 3-year-old, but their monetary value in the form of their skills is achieved when they are 10 or 12. It’s a long haul to keep a horse sound and effective. Anything we can do to optimize his shoeing is valuable.
Balance radiographs enable you to see into your horse’s feet and, if taken regularly, to re-evaluate those images over time. The basic information you get is never a waste of time.

Kim: Is a balance radiography different from a basic hoof x-ray?
The technique is similar, but a balance radiograph is a little different than looking at basic bone in an x-ray. This podiatry shot is a horizontal view, from the outside, in, or from front to back, and shot to be about level with the bottom of the coffin bone. In a lameness x-ray, if we were concerned about pain in the navicular bone, I’m going to aim the beam at the navicular bone.



How the horse stands is extremely critical in a podiatry x-ray. I stand the horse on two wooden blocks, so their feet are matched. The horse has to be facing ahead, with his feet placed in a natural stance: not too wide or too narrow, and he needs to be standing the same way for the series of shots. Any change in the way the horse stands can affect the alignment of the bones.

Kim: Ideally, how are these x-rays best incorporated in long-term horse care?
It’s ideal to have these images taken annually and looked at and discussed by the vet and the farrier. Some owners do that, but that doesn’t happen often. It’s a great tool for determining the best trim for the horse and monitoring bone changes. I love when a farrier asks me for radiographs. Maybe it’s a small concern – a slight flair on a hoof, for example – and this is a way we can visually track what’s going on. There are farriers who recognize the benefits of this technology and there are cases where the vet needs to sell the farrier on the idea of using it.
A good farrier kind of develops x-ray vision. On a relatively normal foot, a good farrier can tell you, with reasonable accuracy, where things are going with that foot. The challenge is when there is a variation on normal: a twist, a toe in or out, a disease state or anything else that challenges the hoof capsule. When that is present, the signs the farrier uses will lie to them because they cause distortions.
In a diagnostic context, these images are a great follow-up to the rider noticing an early indicator of a problem through the horse’s performance: maybe the horse is having an issue in a small left-hand turn. These images can be a great way to see what’s going on.  If caught early enough, it’s possible the problem could be addressed with a shoeing and/or trimming change, which is ideal.
Maybe you knew the horse had a slight abnormality when you purchased him. He was sound then, but two years later he went off. If you had the initial x-rays, you could go back and look at how he was trimmed then and that could be useful information.

Podiatry lateral to medial image.

Kim: What is the status of veterinary education on podiatry?
There still is no “specialty” in podiatry and, in my opinion, there is not enough education offered. When I went to veterinary school, CT scanners and MRI machines existed in a couple of places in the country. Now there are 30 MRIs and multiple CTs. The education requirement seems to expand but the time to learn it all —four years—stays the same.
Those who are passionate and dedicated – vets and farriers alike – need to keep on learning throughout our entire careers. We need to get information by experience, by consulting with others and staying abreast of the latest research and thinking.  

Kim: Beyond the importance of these x-rays to see what’s going on inside the hoof, what can a regular owner see and monitor to catch problems early?
Look at the growth rings on the outside of the hoof. Are they symmetrical, compressed, expanded or divergent in some way? Is your horse losing a shoe or shoes constantly? Is there a difference in the hoof angles, from front to back and side-to-side, or uneven wear patterns? Any of these could be normal for your horse, and it may be that you can’t correct them, but by observing these things carefully, you can help the farrier and vet optimize their approach to your horse’s well-being and performance.

Kim: Thanks, Mark!