Diseases of the Horse's Foot

by H. Caulton Reeks

E. GROWTH OF THE HOOF.

We will conclude this chapter with a few brief remarks on the growth of the hoof. That the rate of growth is slow is a well-known fact to every veterinarian, and it will serve for all practical purposes when we state that, roughly, the growth of the wall is about 1/4 inch per month. This rate is regular all round the coronet, from which it follows that the time taken for horn to grow from the coronary edge to the inferior margin will vary according as the toe, the quarters, or the heels are under consideration.

As might naturally be expected, the rate of growth will depend on various influences. Any stimulus to the secreting structures of the coronet, such as a blister, the application of the hot iron, or any other irritant, results in an increased growth. Growth is favoured by moisture and by the animal going unshod, as witness the effects of turning out to grass. Exercise, a state of good health, stimulating diets—in fact, anything tending to an increased circulation of healthy blood—all lead to increased production of horn. With the effects of bodily disease and of ill-formed legs and feet on the wear of the hoof, and the growth of horn, we shall be concerned in a future chapter.

CHAPTER IV

[METHOD OF EXAMINING THE FOOT]

As a general rule, it may be taken that most diseases of the foot are comparatively easy of diagnosis. When, however, the condition is one which commences simply with an initial lameness, the greatest care will have to be exercised by the practitioner.

What remarks follow here should rightly be confined to a treatise on lameness. This much, however, we may state: As compared with lameness arising from abnormal conditions in other parts of the limb, that emanating from abnormalities of the foot is easy of detection. With a case of lameness before him, concerning which he is in doubt, the practitioner remembers that a very large percentage may safely be referred to the foot, and, if wise, subjects the foot to a rigorous examination.

Much may be gathered by first putting the animal through his paces. When at a trot, notice the peculiarity of the 'drop,' whether any alteration in going on hard or soft ground, and watch for any special characteristic in gait. At the same time inquiry should be made as to the history of the case; its duration; whether pain, as evidenced by lameness, is constant or periodic; the effect of exercise on the lameness; and the length of time elapsed since the last shoeing.

This failing to reveal adequate cause for the lameness in any higher part of the limb, one is led, by a process of negative deduction, to suspect the foot. If 'pointing' is a symptom, its manner is noticed. The foot is compared with the other for any deviation from the normal. In some cases the two fore or the two hind feet may differ in size. Though this may not necessarily indicate disease, it may, nevertheless, be taken into account if the lameness is not easily referable to any other member. Measurement with calipers will then be of help, and a pronounced increase in size, especially if marked in one position only, given due consideration. The hand is used upon each foot alternately to look for change of temperature, to detect the presence of growths small enough to escape the eye, and to discover evidence of painful spots along the coronet.

At this stage the method of percussion recommends itself, and in many cases no more useful diagnostic agent is to be found than the ordinary hammer. As a preliminary, the foot of the sound limb should be always tapped first. This precaution will serve to bring to light what is frequently met with—the aversion nervous animals sometimes exhibit to this manner of manipulation of the hoof. Unless this is done, the ordinary objection to interference is apt to be read as evidence of pain. No aversion to the method being shown, the suspected foot is gently tapped in various places round the wall, a keen look-out being kept for any manifestation of tenderness. This may vary from a slight resentment to each tap, indicated by a sudden lifting and setting down again of the foot, to a complete removal of the foot from the ground, and a characteristic pawing of the air that points out clearly enough the seat of pain.

Evidence of pain once given, the tapping is persisted in until, in some cases, the exact position of the tender spot is definitely located.

Failing evidence obtained from percussion, attention should next be given to the shoeing. We may add here that, even when difficulties have to be encountered in doing it, it is always a wise plan to have the shoe removed.

The nails should be removed one by one, the course they have taken, their point of emergence on the wall, and the condition of their broken ends all being carefully noted as they are withdrawn.

The removed shoe should next be examined as to the coarseness or fineness of its punching and the 'pitch' of its nail-holes, and close attention given to the shape of its bearing surface.

From that we may pass to a consideration of the underneath surface of the foot. The drawing-knife should be run lightly over the whole of its surface, the first thing to be noticed being the point of entrance of the nails as compared with the coarseness or fineness of the punching, and the staining or otherwise of the horn immediately around. We may thus be guided towards mischief arising from tight nailing apart from actual prick of the foot.

This done, more than usual care should be taken in following up any other small prick or dark spot that may show itself upon the white surface of the cleaned sole. In any case, a suspicious-looking speck should be followed up with the searcher until it is either cut out or is traced to the sensitive structures.

While this is done, we should also have noticed the condition of the horn at the seat of corn; should have noticed the shape of the heels, contracted or otherwise; and the appearance of the frog, clean or discharging.

A point to be remembered in making this exploratory paring of the foot is the peculiar consistency of the horn of the frog, and its tendency to hide the existence of punctures. In like manner, as a pin pierces a piece of indiarubber, and leaves no clearly visible trace of the hole it has made, so does a nail or other sharp object penetrate the frog, leaving but little to show for the mischief that has been done.

After all, even though we may have fully decided the foot is at fault, our case of lameness may remain obscure so far as a cause is concerned. Nothing remains, then, but to acknowledge the inability to discover it, to advocate poulticing, or some other expectant palliative measure, and to bring the case up for further examination at no distant date. Where, though we may have suspected the foot, we have not been able to definitely assure ourselves that there the mischief is to be found, a further method of examination presents itself—namely, subcutaneous injections of cocaine along the course of the plantar nerves.

The salt of cocaine used is the hydrochlorate, 2-1/2 grains for a pony, 4 grains for a medium-sized animal, and 6 grains for a large horse. A solution of this is made in boiled water (about 3 drams), and injected at the seat of the lower operation of neurectomy.

It is advisable to first render aseptic the seat of operation, and to sterilize both the needle and the syringe by boiling. A suitable point to choose for the injection is exactly over the upper border of the lateral faces of the two sesamoids, the needle being introduced behind the cord formed by the nerve and accompanying vessels, and parallel with it.

It is possible that the vein or the artery may be wounded, but such accident is of little importance. All that is necessary in that case is to partly withdraw the needle and again insert it. It is advisable to use a twitch.

When the needle is in position, the injection should be made slowly, and at the same time the point of the needle should be made to describe a semicircular sweep, so as to spread the solution over as wide an area as is possible.

Anæsthesia ensues in from six to twenty minutes, and if the cause of the lameness is below the point of injection the animal moves sound.

Regarding this method of diagnosis, Professor Udriski of Bucharest, after a series of trials, sums up as follows:

1. For the diagnosis of lameness cocaine injections are of very considerable value.

2. These injections should be made along the course of the nerves.

3. Solutions heated to 40° or 50° C. produced quicker, deeper, and longer anæsthesia than equally strong cold solutions.

4. In the sale of horses cocaine injections conceal fraud.

Cocaine being an irritant, it must be remembered that after the anæsthesia the lameness is somewhat more marked than before.

To the cocaine other practitioners add morphia in the following proportions:

Cocaine hydrochlorate	2-1/2 grains.
Morphia	1-1/2 "
Aqua destil	1-1/2 drams.

As a diagnostic this mixture of the two is said to be far superior to either cocaine or morphia alone.

In connection with this subject, Professor Hobday has published, among others, the following cases illustrating the practical value of this method of diagnosis:[A]

[Footnote A: The Journal of Comparative Pathology and Therapeutics vol. viii., pp. 27, 43.]

CASE I.—Cab gelding. Seat of lameness somewhat obscure; navicular disease suspected. Injected 2 grains of cocaine in aqueous solution on either side of the limb, immediately over the metacarpal nerves.

Five Minutes.—Lameness perceptibly diminished.

Ten Minutes.—Lameness scarcely perceptible.

CASE II.—Mare. Obscure lameness; foot suspected. Injected 30 minims of a 5 per cent. solution on either side of the leg just above the fetlock.

Ten Minutes.—No lameness, thus proving that the seat of lameness was below the point of injection.

CASE III.—Cab gelding, aged, free clinique; Messrs. Elme's and Moffat's case. Obscure lameness; foot suspected of navicular disease; very lame. Injected 30 minims of a 5 per cent. solution of cocaine on either side of the leg over the metacarpal nerves.

Six Minutes.—Lameness perceptibly less; there was no response whatever on the inside of the leg to the prick of a pin. On the outside, which had not been injected so thoroughly, there was sensation, although not so much as in a healthy foot.

Ten Minutes.—Lameness had almost disappeared; so much so, that the opinion as to navicular disease was confirmed, and neurectomy was performed. Immediately after this operation there was no lameness whatever.

The same author also reports numerous cases among horses and cattle, dogs and cats, pointing out the toxic properties of the drug. The symptoms following an overdose are interesting enough to relate here, and I select the following case of Professor Hobday's as being fairly typical:[A]

[Footnote A: Loc. cit.]

CASE IV.—Cart gelding. Free clinique; navicular disease. Injected subcutaneously over the metacarpal nerves on each side 6 grains of cocaine in aqueous solution. During the operation the animal manifested no signs of pain whatever, not even when the nerve was cut. This animal received altogether 12 grains of cocaine (3 grains were given on either side first, then fifteen minutes afterwards the same dose repeated). The effect was manifested on the system in ten minutes after the second injection by clonic spasms of the muscles of the limbs (the legs being involuntarily jerked backwards and forwards at intervals of about twenty seconds), which materially interfered with the performance of the operation. The animal was also continually moving the jaws, and was very sensitive to sounds, moving the ears backwards and forwards. This hyperæsthesia, as evinced by the movement of the ears, lasted for some considerable time after the animal had been allowed to get up.

Cocaine hydrochlorate solutions, if intended to be kept for any length of time, should have added to them when freshly made 1/200 part of boric acid in order to preserve them. Even then they are liable to spoil, and should, for subcutaneous injection, be made up just before needed for use.

CHAPTER V

[GENERAL REMARKS ON OPERATIONS ON THE FOOT]

A. METHODS OF RESTRAINT.

Many of the simple operations on the foot, such as the probing of a sinus, the paring out of corns, or the searching of pricks, may most suitably be performed with the animal's leg held by the operator as a smith holds it for shoeing. According to the temperament of the animal, even the operation for the removal of a portion of the sole, or the injection of sinuses with caustics, may be carried out with the animal simply twitched.

When the operation is still a simple one, casting inconvenient or impossible, and the animal restive, the twitch must be supplemented by some other method. The most simple and one of the most effective is the blind, cap, or bluff (Fig. 38). With it the most vicious animal or the most nervous is in many instances either cowed into submission or soothed into quietness.

At the same time, more forcible means than the operator's own strength must be taken to hold the animal's foot from the ground. If the foot is a fore-foot, and the point desired to be operated on is to the outside, the pastern should be firmly lashed to the forearm by means of a thin, short cord, or a leather strap and buckle. Much may then be done in the way of paring and probing that would otherwise be impossible.

Fig. 38—The BLIND.

Fig. 39—THE SIDE-LINE.

If the foot is a hind one, one of the many methods of using what is termed by Liautard, in his 'Manual of Operative Veterinary Surgery,' the plate-longe, must be adopted. This, in its most useful form, is a length of closely-woven cotton webbing, from about 2 to 2-1/2 inches wide, and from 5 to 6 yards long, provided with a small loop formed on one of its ends, and perhaps better known to English readers as a 'side-line.' If webbing be not available, a length of soft cotton rope, or a rope plaited and sold for the purpose, as Fig. 39, will serve equally well. One of the most convenient methods of using the side-line for securing the hind-foot is depicted in Figs. 40 and 41.

FIG. 40.—THE SIDE-LINE ADJUSTED PREPARATORY TO SECURING THE NEAR HIND-FOOT.

FIG. 41.—THE NEAR HIND-FOOT SECURED WITH THE SIDE-LINE.

Here the side-line has formed upon it a loop sufficiently large to form a collar. This is placed round the animal's neck, the free end of the line run round the pastern of the desired foot, and the foot drawn forward, as in Fig. 40.

The loose end of the line is then twisted once or twice round the tight portion, and finally given to an assistant to hold (see Fig. 41). The foot is thus held from the ground, and violent kicking movements prevented.

Where the operation is a major one, restraint of a distinctly more forcible nature becomes imperative. Many of the more serious operations can most advantageously be performed with the patient secured in some form or other of stock or trevis, and the foot suitably fixed. It is not the good fortune of every veterinary surgeon, however, to be the lucky possessor of one of these useful aids to successful operating. Perforce, he must fall back on casting with the hobbles (Fig. 42).

FIG. 42.—CASTING HOBBLES.

With the use of these we will assume our readers to be conversant, and will imagine the animal to be already cast. It remains, then, but to detail the most suitable means for firmly fixing the foot to be operated on.

Here the side-line is again brought into use. Care should previously have been taken when casting to throw the animal so that the portion of the foot to be operated on, whether inside or outside, falls uppermost, and that the buckle of the hobble on that particular foot is placed so that it also is within easy reach when the animal is down.

In the case we are illustrating the point of operation was the outside of the near hind coronet. We will, therefore, describe the mode of fixing the near hind-foot upon the cannon of the near fore-limb.

FIG. 43.—PHOTOGRAPH ILLUSTRATING METHOD OF ADJUSTING THE SIDE-LINE PREPARATORY TO FIXING THE HIND-LEG UPON THE FORE.

The side-line is first adjusted as follows: It is fixed upon the cannon of the near hind-leg (A) by means of its small loop. From there it is passed under the forearm of the same limb, over the forearm, under the rope running from A to B; from there over and under the thigh, to be finally brought in front of the thigh, and below the portion of rope running from arm to thigh. The loose end of the side-line is then given to an assistant standing behind the animal's back, the buckle of the hobble restraining the foot unloosed, and strong but steady traction brought to bear from behind upon the line. The operator should now stand in front of the fore-limbs, and, by placing a hand on the rope passing round the arm, prevent the line from slipping below the knee.

By this means the hind-limb is pulled forward until the foot projects beyond the cannon of the front-limb. When that position is reached, the operator grasps the hock firmly with one hand, and, directing the side-line to be slackened, gently slides downward the coils of rope round the arm and thigh until they encircle the cannons of both limbs. The cannon of the hind-limb is firmly lashed to the cannon of the fore, and the foot firmly and securely fixed in the best position for operating (see Fig. 44).

FIG. 44.—PHOTOGRAPH SHOWING THE NEAR HIND-FOOT SECURED UPON THE CANNON OF THE NEAR FORE-LIMB.

Similarly, with the horse still on his off side, the off hind-limb may be fixed to the near fore, and the near fore and the off fore to the near hind.

With the animal on his near side, we may fix the near hind and the off hind to the off fore, and the off fore and near fore to the near hind.

The points to be remembered in fixing the limbs thus are: (1) The side-line should always commence upon the cannon of the limb to be operated on; (2) it should next pass under and over (or over and under, it is immaterial which) first the arm and then the thigh, or the thigh and the arm, as the case may be; (3) in every case, whether rounding the thigh and the arm from above or below, the piece of rope completing the round should always finish below that portion preceding it, so that traction upon it from behind the animal's back should tend to keep all portions of it from slipping below the knee and the hock.

With the uppermost fore-limb secured to the hind-limb in the manner we have described, we have the underneath fore-limb suitably exposed for both the higher and lower operations of neurectomy. The position for this operation will be made better still if the lowermost limb (the one to be operated on) is removed from the hobbles and drawn forward by an assistant by means of a piece of rope fastened to the pastern.

Taking what we have described as a general guide, other modifications of thus securing the foot will suggest themselves to the operator to meet the special requirements of the case with which he is dealing.

Regarding the administration of chloroform, no description of the method is needed here, as it will be found fully detailed in most good works on general surgery. Where great immobility is needed, it is one of the most valuable means of restraint we have. Apart from that, its use in any serious operation is always to be advocated, if only on the score of humane consideration for the dumb animal helpless under our hands.