The 'Bone Referenced Trim'

The ‘Bone Referenced Trim’ Monique Craig The Epona Institute www.Epona-Institute.org www.EponaShoe.com www.EponaBook.com www.Metron-Imaging.com

To start….

I would like to start by showing a 7 minute video that I have prepared to explain a few of the basic ideas in my ‘Bone Referenced Trim’.

This video is narrated in English and has Spanish subtitles.

Overview of the Rest of the Talk • Brief look at the Structure of Wall Keratin • Discussion of Hoof Distortion and Wall Compression ( case studies: Buddy, Tango, Jackson ) • Packing and Sole Support • Hoof and Bone Asymmetry • Shoe Placement ( case studies: Smirnoff, Tom TB ) • EponaShoe and Equine Athletes • Rehab Case Studies: Sterling, Monty.

• Laminitis Cases

Hoof Wall Structure: Keratin ( From Kasapi & Gosline “Design Complexity and Fracture Control in the Equine Hoof” 1997)

The hoof wall has an amazing, beautiful, and complex structure.

Hoof Wall Structure: Keratin ( From Kasapi & Gosline “Design Complexity and Fracture Control in the Equine Hoof” 1997)

Hoof Distortion and Wall Compression • The hoof wall can change due trimming, shoeing, riding, weather, etc.

• Hoof capsule distortions are often reflected in soft tissue distortions • Things can improve if given the opportunity

Case Study: Buddy Buddy, Aug. 2000

Buddy, Jan 2001

Another trimming and shoeing system‌

Buddy, May 2001

Hoof distortion and wall compression near the medial toe quarters

Buddy, Jun 2001

Distortion starting to grow out‌

Buddy, July 2001

Distortion growing out…

Buddy, Aug 2001

Buddy, Mar 2007

Many years later – long term maintenance

Buddy, Legs

Trimming for medial-lateral balance, trimming to the bone column, and supporting the frog and bars can help with stance and can reduce stress.

Case Study: Tango

LF

Apr 2004

Nov 2004

Aug 2005

Jan 2007

LF

Apr 2004

Sep 2004

Jan 2007

As the distortion came out, the shape of the bulbs became more normal, and continued to improve over the long term.

Compressed and distorted wall growing out over 5 months‌.

Hoof Capsule Distortions Cause or Reflect Soft Tissue Distortions.

5.33 cm 0.76 cm

Case Study: Jackson

Packing: Supporting the Bars and Frog I have found the use of packing material to be very beneficial. Lets consider what it means to pack the foot to support the frog and bars.

In Nature: Packed with Dirt

I think it is natural for the hoof to be packed with supportive material. The hoof function evolved in this environment, and one might say the hoof is probably ‘designed’ to be packed.

Packing with ‘Artificial Dirt’

I use specially-designed packing material for almost every hoof that I shoe. It may be that the packing is mimicking the natural function of a barefoot hoof packed with dirt and mud.

The packing is ‘clean dirt’ – gives us a chance to control the environment under the foot.

Movement of the Sole under Load

Movement of the Sole under Load

Movement of the (packed) Sole under Load

Movement of the (packed) Sole under Load

Summary of Packing & Sole Movement So, it is clear that packing makes a difference to the function of the hoof.

One can argue which function is ‘better’ for the hoof.

I believe hooves in nature tend to be packed, and so this is more natural and beneficial.

Not to mention, the great results I see when using packing.

I prefer to leave sole in the foot. I do not trim all the way down to the “moisture line�. The dry part of the sole is a natural insulator and is natural packing.

Asymmetry in the Bones and Hoof 3.8cm

6.7cm

4.6cm

6.2cm

Frog as Marker Reliability

Pedal bones are slightly asymmetric – wider to the lateral side.

If you drill a hole at the tip of the exterior frog (blue dots) or at the tip of the live frog (red dots) you can see how the frog tip maps to the bone.

Shoe and bevel placement should follow the bone, not the frog.

Shoe Placement As you saw in the video, one component of the Bone-Referenced Trim is to help in shoe placement.

Very often, shoes are set in a ‘peripheral position’ – along the white-line (A). It can be beneficial to eliminate this restriction and place the shoe so as to best support the boney column (C).

Good

Bad

Try to set the shoe ‘to the boney column’ as much as possible given constraints.

For the purposes of orienting the shoe and its bevel, be sure to project forward correctly – the blue lines are perpendicular to the red line.

Bone-Referenced Trim

These points are absolutely the most distal bone reference one can hope to find without radiography.

This explains my interest in them.

Without reference points‌

‌you might set the shoe like this.

With reference points visualized‌.

‌ you might set the shoe like this.

Improvement caused by proper trim and shoe placement.

I have developed and used EponaShoes over the past 14 years. Let me just give the briefest possible mention about them (only 2 slides!), prior to showing you some case studies.

Mechanical Properties of Keratin It’s not ‘rocket science’ that plastics are a better match to the properties of the hoof.

EponaShoe

Ground Side

Sole Side

Before I show you Case Studies of Horses with Problems‌

I want you to know that my trim and EponaShoes go onto very athletic performance horses as well!

100-Mile Tevis Race

Several competitors over past 5 years

Steffen Peters riding Ravel won the National Championship in 2008, and rode in the Beijing Olympics (4th place) He also won at Aachen in Germany, the world championship in Las Vegas in 2009.

All in EponaShoes.

Beijing 2008

Case Study: Sterling

How the horse came to me‌

5.3cm

RH

2.9cm

13.9cm 14.8cm

April

November

14.1cm

16.4cm

Morph showing changes to Left Front Foot

How to rebuild “support to the coronary band� (Note: this is not Sterling)

Sterling back in competition!

Case Study: Monty

As he came to us…

Hinds

After about 2 months….

LH Progression

RH Progression

March

August

November

Changes over one year interval

March

LF Progression

November

March

RF Progression

March

November

March

(2.03cm)

(1.93cm)

(1.80cm)

(2.36cm)

“Before” Trot…

April 2015

After…

July 2015

Body “before”

March 2015

Body “after”

Febuary 2016

Laminitis • In previous work*, reported on a management protocol for a group of 29 founder cases.

• Glue-on Polyurethane shoes (EponaShoe) and our trimming protocol.

• We rarely perform tenotomy of the DDFT. This is a ‘last resort’ measure. *Craig, M., and Burd, M., “Long Term Study Of Rehabilitation From Laminitis In 29 Horses Utilizing Composite Shoes.”

Proceedings of the 5th International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine, Minneapolis, MN, 2008.

Accurate Before/After Measures in Metron

In our previous study, and in all our shoeing cases, we take calibrated radiographs and photographs and make measurements in the Metron software system which we have developed over the past 15 years.

Very Comprehensive Data (and too much to discuss in this talk)

Case Study: Feisty

At the age of 3, she was brought back to the hospital and was diagnosed with severe laminitis of unknown etiology. At the referral hospital, foot care consisted of corrective trimming and application of ‘banana’ shoes for one shoeing cycle. The filly did not respond and the owner elected to bring the horse to the Epona Institute for hoof management. We have managed the horse for 4 years now.

Changes

Improving Medial-Lateral Balance

From a talk presented by M. Craig at the “No Laminitis Conference� in Texas, November, 2015.

Restoring Palmar Angle to more Normal Range (10 weeks ) I believe in restoring the foot to a more normal ‘palmar angle’ as soon as is possible.

This is quite the opposite of treatments that involve the use of wedge pads.

Winnie

Restoring Palmar Angle to more Normal Range ( over 3 months )

Kharifa

Restoring Palmar Angle to more Normal Range ( over 8 weeks )

Arial

Restoring Palmar Angle to more Normal Range ( over 3 months )

Lazarus

Restoring Palmar Angle to more Normal Range ( over 3 months )

Mo

Restoring Palmar Angle to more Normal Range ( over 3 months )

Chili

Restoring Palmar Angle to more Normal Range ( over 3 months )

Chili

Restoring Palmar Angle to more Normal Range ( over 2 months )

Paint

Alladin

Restoring Palmar Angle to more Normal Range ( over 5 months )

Nina

Restoring Palmar Angle to more Normal Range ( over 2 months )

Tiara

Changes

The End

Smirnoff 1984 - 2011