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Special, Special, Special
Author, Dr. David Jolly, DVM
Step Ahead Farm
www.stepaheadfarm.com
501-844-5050
Day 1 - When the bandages on the injured leg were removed, the entire hoof came off and P3 (third metatarsal
bone) was protruding through the sole and had turned black (necrotic tissue).  Also, the sensitive lamina was
decayed to a blackberry jam consistency. There was no sensation of pain so the filly could stand and walk on the
stub.

The following therapy was instituted on Day 1 upon removal of the bandages:

  1. The necrotic sensitive lamina was scraped off and washed with a non-cytotoxic wound wash spray (Eclipse®).
  2. The stub was wrapped in gauze saturated with wound wash liquid and the sloughed hoof was placed on the
    stub as a temporary prosthesis. The hoof was used for the first six days of treatment, until the stub became too
    big to be fitted in the sloughed hoof.

Photograph "Day 1-a" shows the condition of P3, the sensitive lamina, and the skin 20 minutes after the hoof was
removed and the necrotic blood washed off with Wound Wash.
In photograph "Day 1-b" Farrier Grady Hawthorne is replacing the hoof on the stub after an attempt is made to fill
up the hole in the sole that was created when it was penetrated by P3.
Day 1-a
Day 1-c
Day 1-b
Day 2 - After treating the sole that P3 was protruding through the sloughed hoof was used as a protective mold for 6
days before the stub of the foot swelled too much for the hoof to be used. Special was also administered antibiotics
for three days and then switched to a sulphur antibiotic pill. In photograph "Day 2-b" we attempted to use Equilox®
to seal the hole in the hoof sole.

Day 3 - We cleaned the sensitive lamina, treated the entire foot with Platelet Rich Plasma Gel after spraying with
Wound Wash, placed a sponge pad under the hoof, and bandaged the lower leg. At this time, antibiotic therapy IV
gentocin and IM penicillin were discontinued and we switched to Trimental Sulphur tablets. These were the only
antibiotics administered for the next 30 days.
Day 2-a
Day 3
Day 2-b
Days 4 & 5 - We continued antibiotic therapy and wrapped the foot in gauze soaked with Platelet Rich Plasma.
Aside from a bad odor, the skin tissue was healthy pink indicating blood flow and no necrotic tissue or purulent
exudate (puss) was present. Life Blood was pulled on day 6 (Photograph "Day 6")

Day 6 - The sloughed hoof would not fit over the stump due to extra gauze added with Platelet Rich Plasma Gel so a
Power Flex bandage wrap was used, a sponge and Styrofoam pad were put on the bottom of the foot for cushion.  
In addition, a stiff-topped boot (Soft Ride®) with an excellent durable pad was utilized. The P3 bone and the
navicular bone were starting to displace and it was decided to let them totally detach. The detachments were
completed by day 10.
Day 6
Day 8-a
Day 8-b
On Day 10, both the P3 bone and the navicular bone detached from the leg. In photograph "Day 10-a", P3 has detached
from P2 and can be seen as the white shiny tissue that is anchored to the front part of the foot. Due to an anemic horse
and the profuse bleeding that occurred, it was determined to allow the navicular bone to detach at their own pace.
Note the redness of granulation tissue that is beginning to appear. In photograph "Day 10-b", this is P3 with only one
wing attached. The missing bone was cut out later from the tissue in the bottom of the Hoof. However, the remaining
tissue was bright red indicating the hoof has a good blood supply. We now have a stump with a hole in the center
surrounded by bright red granulation tissue. A sponge saturated with Wound Wash was utilized to decontaminate the
exposed tissue in the central hole.  Extra padding in the bottom of the foot was also utilized.  This is a critical step
since a solid granulation bed greatly reduces the possibility of tissue infection. Note the amount of granulation tissue
present and the fact that it indicates a profuse blood supply present. Another point to begin to follow in this series of
photos is the budding tissue of the digital cushion on the posterior part of the foot. P2 is still within view at this time
but later on completely contracts out of sight. Now we have an exposed end of P2, so this being beyond my experience,
I called Ric Reddin, DMV/Farrier, for consultation and prognosis.  
His counsel was:  
  1. Raise the heel on the opposite rear leg 18 degrees. When this was done, the filly immediately quit dancing while
    we were treating her because the tension was reduced on the tendons.
  2. P2 should be removed since the blood supply source is obscure and if disrupted, a vascular necrotic bone results
    (Due to economic restraints this counsel was not pursued but still may have to be done in the future.)
  3. Do not turn this filly out in a large paddock with a prosthesis.  “She will gallop off sound and come back lame.”

*If you decide to take on a project like growing back a foot, I suggest that you get all the experienced counsel that you
can get since a sloughed hoof involves a lot more pathology than a hoof wall resection.
Day 10-a
Day 10-c
Day 10-b
On Day 11, the stiff-topped boot caused a pressure sore on front of the ankle so the boot type was changed to a
canvas top that was cooler and reduced pressure. Gauze pads and Platelet Rich Plasma Gel were added to heal the
pressure sore (Photograph "Day 10-c"). This photo begins to show the amount of growth down from the lateral
vertical surface of the hoof. It also demonstrates the necessity for repeated bandage changes since the pressure
sore on the front of the pastern was due to the stiff surface of a boot that being put over the end of the foot stub
that had an excellent cushion or padding below but was too firm on top.
Day 10-d
Day 23-a
Day 26-b
Day 26-a
Day 23-b
Days 28 - 37 I call your attention again to the left side of this foot where on Day 23 we only have a white line and now
we have ¾ inch of sole.  The digital cushion had come forward to the back side of P2 which is now retracted.
(Photograph "Day 37-a") This fulfills one of our great needs to have tissue that can bear weight and not become
necrotic. The tissue which is present on the front part of the hoof is not only sole but is also hard (cornified beyond
the tissue on the lateral left and center in the rear).  
Day 28
Day 37-b
Day 37-a
Day 35
Day 30
Day 45-47 Due to the constriction of space, the only treatment that was administered at this stage was to pack
4x4 gauzes soaked in Wound Wash or Platelet Rich Plasma up into the cavity remaining below P2 in the center.
The sulfur antibiotic pills were discontinued at this point based on the belief that they may have been part of the
ongoing anemia that is still a part of this filly’s blood condition.  An external brace fashioned out of quarter inch
PVC pipe 4 inches in diameter was utilized to help stabilize the stub of the foot which allowed P2 to rotate to a
horizontal rather than a vertical position.
Day 45-a
Day 47-d
Day 47-c
Day 47-b
Day 47-a
Day 45-c
Day 45-b
Day 55 showed that the digital cushion had developed to the point of completely covering the cavity left by
the retraction of P2. This fulfilled one of the original goals of getting a cornified covering over the distal end
of the exposed P2 bone.
Day 55-a
Day 57-b
Day 57-a
Day 55-b
Day 60 Shows a healthy growth of new outer hoof wall.

Day 66 We are now on our third brace fashioned out of aluminum based on what we have learned from PVC
pipe.  (One of our braces was broken when the filly was put in the round pen and started bucking.)  We intend to
follow P2 with x-rays since the size of the ankle and leg continue to change, a prosthesis that can be adapted to
different sizes will be necessary.  We hope this becomes our final challenge.
Day 60
Day 66-a
Day 66-b
WHAT IS REALLY SPECIAL ABOUT “SPECIAL”?

Watching Mother Nature grow the different tissues back on this filly’s foot has been one step short of a miracle.  If
you compare the amount of net granulation tissue and overlying cornified tissue on Day 37 (Photograph "Day 37-a")
with the amount of cornified hard yellow sole that exists on Day 45 (Photograph "Day 45-c") and on Day 66
(Photograph "Day 66-b"), you can’t help but believe that with some help, Mother Nature can work wonders. I was
amazed when the sensitive lamina growing down the side of the hoof turned inward and started growing sole.  For
those who doubt this is sole tissue, it is too hard to be penetrated by a finger nail.

The final phase of this work is to design a brace that fits the leg well enough to only require checking once a week.  
The PVC pipe was shaped by heating with a butane torch, bending to a 90 degree angle flattened on the ground
portion and tapered to the leg thickness on the vertical portion.  A pad was added to cushion the tissue.  We expect
to work on the brace for a month before we have the right design made out of the right material.  Currently this
filly walks comfortably and bears weight on the injured leg while we reset the trim and the angle on the opposite
rear foot.  She stands about 8-10 hours a day in her stall and is hand grazed for exercise and evaluation.  She lets us
know when the brace does not fit.  

Special’s mother has produced a champion barrel racer QH gelding named View This Jet who has won over
$200,000. The owners of Special would like to collect eggs from her and have them implanted into a surrogate mare
with the hope of producing another View This Jet.  

We would like to express our admiration and thanks to Lamar and Diane Quakenbush, owners of View This Jet and
Special, for having the courage to walk down this unpredictable path.  

As a veterinarian I would like to express my thanks and appreciation to the following professionals that have
contributed not only their talent and their skill but their projected opinion about how this goal could be achieved:

  1. Farrier Travis Anderson, Miles City, MT, who is involved in helping design the permanent prosthesis
  2. Farrier Mike Baldwin, Malvern, AR who built the 18 degree pads that have been an important part of her
    recovery
  3. Farrier Jay Delaney, 2nd year veterinary student at Virginia Tech, also a farrier specializing in special farrier
    work
  4. Farrier Grady Hawthorne, Mt. Ida, AR who was here on Day 2 and assisted on many other projects performed on
    this filly
  5. DVM - Farrier Ric Reddic of Kentucky, who’s council in regards to this filly was of great assistance
Video of Special walking.
Dec 11 - An effort was made to anchor the hoof brace using velcro straps. This was a mistake since it caused
pressure sores to develop on the front of the leg,  even though sponge padding was added. Our most successful
bandaging has been the w-2 wrap that has elastic stretch and a very strong velcro tab anchor.

Jan 2 - A piece of bone (P2) came out of the medial side of the ankle - the pressure hole was healed two days after
the bone was removed. One application of gel was applied.

Feb 5 - The next significant event was the creating of a trailer shoe, with a brace going up the back of the leg to
support a leg in which both tendons had been lacerated, which was nailed to the hoof. The hoof wall was solid, but
the concept of bearing weight on a section of the leg that did not have any bone was ill-fated. The trailer shoe
resulted in pulling the entire hoof off at the connective tissue at the coronary band. The surprising thing was the
perfect formation of the frog and the bars on the inside of the hoof. One piece of ligament was attached at the
posterior part of the heel in the sulcus part of the bulb of the heel. The bottom of the hoof was still attached which
demonstrated this perfect growth.
Case 182
Hoof Injury
Click on the photos to enlarge the view.
The owner sent us follow up pictures of Special getting her hoof trimmed. This occurred on day 420
Day 23 marked the first observation that the digital cushion was beginning to grow toward the center of the
stump (Photograph "Day 23-a"). From this stage note the white lead edge on the left side of the picture and on
the center in the rear. This is the beginning growth of the sole tissue that will completely cover the bottom of
this stump at Day 66. Note the healthy condition of the distal end of P2. Since our goal was to grow the digital
cushion until it would cover the end of P2, this was very significant because digital cushion does not require the
same blood supply that granulation tissue demands.
Special, a 2 year old QH filly, with an apparently unrelated injury to the left rear leg, had a hoof separation
at the coronet band of the same leg. An attending veterinarian in Tennessee treated her with antibiotics
and said if the hoof comes off, she would need to be put to sleep.  After evaluating the possibilities of
sending the filly to Kentucky or to Arkansas for additional treatment, the owners decided to send the filly
to the Step Ahead Training and Wound Treatment Center in Hot Springs, Arkansas.  Special arrived at the
center Sunday, September 30, 2007 at 8am after traveling all night.
Treatment 9-30-2007 through 12-18-2008