Posted on

Farrier X-Rays – An Exercise in Teamwork

By Robert Moats DVM & Marian Moats DVM

For a number of years (since 1982), when Rick Redden introduced me to the concept, I have encouraged owners and farriers to rely on radiographs when abnormalities of the foot are involved. This is especially true when laminitis is thought to be or known to be a problem.

This can be a challenge because veterinarians and farriers often don?t cooperate very well. In my experience with these situations I usually find the procedure to be a positive knowledge building and bonding experience where all three parties ? the horse, farrier and veterinarian benefit.

With the advent of modern radiology and crucial knowledge of laminitis and the foot from the likes of Redden, O?Grady, Chapman, and Pollitt, the only x-ray you?re sorry for is the one you didn?t take. To quote Mark Twain ?It isn?t what you don?t know that hurts you, it?s what you know for sure that?s wrong that really hurts you.?

This article is a brief outline of a number of reasons why ?farrier x-rays? are important.

In my practice ?farrier x-rays? historically refer to views of the foot to detect front wall thickness and rotation and accurately measure both. It also detects other details of laminitis and look-alike disorders.

Positioning and aiming the x-ray beam is critical to accuracy. The system I use is to stand both forefeet on lazy susan round blocks. This is amazingly well tolerated. The block is custom built so the top is exactly plumb with the horizontal ?cross hairs? of the collimator of my x-ray machine. The collimator is a lighted site like the crosshairs of a rifle scope. My blocks are round (never out of line to position the cassette). They have lazy susan bearings so that the horse can adjust to small misalignments and have a wire ring embedded in the top. (Figure 1 & 2).

Figure 1 & 2

The reason for the wire is to confirm that the aiming is exact. If the positioning is correct the ring appears as a straight line under the foot. (Figure 3). If the floor is off level or the operator (me) makes a mistake the ring appears as an oval and has to be repeated. (Figure 4)

All laminitis is not created equal and is not always obvious. Sometimes an increase in front wall thickness is th only sign. One of the gems of knowledge from Dr. Pollitt?s lecture is the geometry that allows calculation of the normal front wall thickness. Everything above this thickness is abnormal and laminitic and as stated above can be the only sign.

By measuring from the tip of the coffin bone to the navicular joint and dividing by 4, the maximum normal front wall thickness for that foot is calculated.

Prior to Dr. Pollitt?s work, all we had were breed approximations which were inexact in marginal cases. These measurements are now very precise.

The side bonus of farrier x-rays is detecting related abnormalities that may otherwise be hidden.

Seedy toe which often masquerades as laminitis or is combined with it. The separation in these cases occurs from the ground up and often intrudes close to the coffin bone. (Figure a)

Laminitis with separation between sensitive and insensitive laminae which is a much more serious situation when present. (Figure b)

Club feet with contracted deep digital flexor tendon (Figure 6)

X-rays of these cases look dramatic and terrible but often have a much better outcome than laminitis. The case here responded very well to check ligament desmotomy to decrease the tendon pull and allow lowering of the heel and reshaping of the toe. (Figure 7)

With fairly routine follow-up farrier care this horse went from three legged lame to a mid-level riding horse and brood mare.

Additional changes seen on farrier x-rays:
i. Club feet often have remodeling of the ?point? of the coffin bone
ii. Marginal (on the edge) fractures of the coffin bone
iii. Osteomyelitis ? which are changes caused by infection

The above information shows the truth of the adage ?Knowledge is power?. Knowing what you?re dealing with gives much better opportunity for a good treatment outcome.

Posted on

Billing is a Privilege

By Cindy Eldstrom

In today’s world of credit, many people have come to expect a “charge account” procedure. In the farrier industry, client credit is becoming rare. Farriers are receiving bounced cheques, and other clients ignore billing terms, paying at their own convenience. Clients have even blatantly refused to pay for services they contracted or disappear from boarding barns with their horses, and can’t be traced for collection. 

The results are obvious: losses increase farrier costs. Carrying charges increase farrier costs. Some farriers discontinue service until payment is made-many farriers now demand payment upon service, or will only work for cash payment. I have experienced all of the above billing problems, and each client pays in increased fees for losses, administration, paperwork and legal fees.

Since billing is becoming more of a nuisance than a benefit, I am giving serious consideration to payment upon service, or cash service only. If you find billing a convenience, there are some things you can do to ensure that the service continues:

1. Be aware of your horse’s six-week schedule, and budget for it.
2. Leave a cheque or cash ahead, when you can.
3. Mail payment when you receive the bill. All billing terms are: Payable upon Receipt.

Most horses need their feet attended to every six weeks, and in a few cases, more often. The average, well-established farrier regularly attends to about 200 horses and services approximately 100 horse owners. It is not uncommon to receive 30 to 40 phone calls per day during the busiest season, which is April to October. This is before factoring in time considerations for emergency services (pulled shoes or lameness), public interest service (lectures or show farrier) and educational upgrading (conferences, certification testing, etc.).
It is easy for anyone to see that routine scheduling is a must, or a farrier would be running helter-skelter day and night, without a moment’s peace.

The average horse needs its hooves attended to on a six-week basis, so I run a six- week schedule. After one appointment, I book my clients for their next appointment six weeks later. A very limited number of horses need to be done more often and I try to do everything possible to accommodate them. Any horse owners who do not wish to follow the six-week scheduling have the option of phoning one or two weeks in advance to see if there are available openings. If you choose this option, you must understand that there may not be available time, since all clients who follow six-week scheduling are given priority.

“The best-laid plans of horseshoers and horse owners…” There are rare times when you may need to change an appointment. Except in cases of extreme urgency, changes should be made NO LESS than 24 hours in advance. This allows me to adjust my scheduling by contacting clients who may be waiting for service. Calling the night before, or worse yet, waiting until I arrive to change an appointment, leaves large gaps in my scheduling and therefore directly affects my ability to earn a living. Although your horse is your hobby, farrier work is my business, and mutual consideration of one another is a necessity for everyone to feel satisfied. If you cancel an appointment in advance, your appointment will be rescheduled at the first available opening.

To trim a horse and put four shoes on can take between an hour or two hours. A trim only requires 1/3 of that time, and costs much less. Please give advance notice if you wish to change the amount of work required at your next appointment.