Thursday, September 10, 2009

Abscesses Revisited.

I think I get it now and I'm so excited!!

I wrote an article last year about abscesses. But I’ve since had an epiphany about them, what causes abscesses, treatment and how to keep them from starting in the first place.

I once thought there were two types of abscesses: The kind that start in the white line and work its way up the hoof wall; and another type, subsolar that start under the sole and work its way up and out the heel bulb or rupture out of the sole.

That’s only partly correct.

Recently I read an article by a farrier who was certain sole abscesses start with stone bruises. The sole doesn’t bruise. The sole tissue has no blood as the farrier suggested, causing bruising. A farrier of all professionals should know that. Farrier’s, vets and trimmers often cut into the sole (even when they shouldn't) and it would seem to me that if the sole could bruise, the result of cutting into it would be a bloody mess.

Some suggest abscessing is diet related, but I don’t think that’s true either.

There is only one kind of abscess. And maybe “abscess” isn’t even the best word to use to describe what is happening, but for now, lets use it because that’s the word we are most familiar with.

Abscesses begin only in the whiteline of the hoof. I’ve only ever seen sole abscess start in the area of the bar. The bars of the hoof are an extension of the hoofwall and the bars have a whiteline, just like the outer hoof wall.

I didn’t put this together until I attended a seminar recently with Swedish natural hoof care practitioner, Ove Lind.

So what I used to think was a very complex topic, I now realize is VERY SIMPLE.

When we allow separation of the white line to take place, we are going to get abscessing. Bacteria invade the white line and works its away up the whiteline/laminae until it reaches soft tissue where it can erupt and relieve the horse of pain. Abscesses that start in the outer wall, erupt at the coronet band and abscesses that start in the white line of the bar erupt at the heel bulb.

It’s that simple! Separation of the whiteline allows abscesses to start. Separation is caused by neglect or improper trimming whether a hoof is shod or not.

Shod hooves can abscess. But a shod hoof is locked down restricting flexibility and circulation. That conditions impedes the abscess from working its way to soft tissue were it can erupt - resulting in pain relief for the horse.

Shod horses with abscesses, I know, are very often misdiagnosed with mystery conditions like navicular and laminitis. Translation: Your horse is lame and we don’t know why.

Either the horse is put into corrective shoes, (more constricted) put down, or the shoes are pulled and the horse is put out to pasture where it very often becomes sound again on it’s own. Also a mystery as no one noticed the abscesses finally ruptured.

So now I believe I really get it! Correct and frequent trimming, as well as not allowing the bars to be weight bearing will keep your horse from abscessing. It’s just that simple.

When I hear my horse abscesses over and over again. I know that the hooves of that horse aren’t being trimmed correctly. That’s all there is to it!

Abscesses in the hind hooves often cause so little pain we don’t even know it’s happening until we notice a rupture site at the soft tissue above the hoof.

Or abscesses can be so painful, the leg swells, the joints lock up and the horse can’t put any weight on the hoof for days.

What is the correct treatment? There is none. Once the abscess starts, it must be allowed to run it’s course. It erupts when it gets to soft tissue and the white line it invaded on its way up is now dead and the rupture site must grow out. As for the abscess that starts in the bar, that very often means the horse may lose a large section of bar and sole in the heel area or even the entire sole depending on how much of the solar papillae was invaded.

We have to give the horse time to grow out a new hoof often times, before we see complete soundness again. As this is happening we often see off and on again lameness. No lameness at the walk, but lameness at the trot and this can go on for months even years of the horse isn’t allowed time for the abscess to rupture.

What is the worst thing we can do for the abscess? Dig it out? If we did at something that’s on it’s way up, all we are doing is giving the horse a secondary problem to grow out. And if the dig site becomes deep and wide, more debris is allowed to enter the hoof and possibly cause bone infection as a result.

So when your horse abscesses, make sure it’s barefoot, has time to heal and no digging.

That’s where I stand on abscesses now.

Subsolar abscess: This mare was lame in shoes for years with no obvious signs so she was diagnosed as a founder case. The owner's comment was that she should have been dog food long ago. Sad. We pulled shoes and abscess was allowed to rupture. She was slowly becoming sound again and owner was advised by her vet that natural trims cause abscessing. She was put back into shoes before she had a chance to fully recover. I haven't heard anything about her beyond that, but it wouldn't surprise me if she's been digested by a dog by now.

You can see the rupture site of an abscess that started in the bars, here just above the center sulcus between the heel bulbs. This horse was never shod, but he went too long between trims and separation of the white line resulted. I hate to admit this is my horse and he was a gravel cruncher before I allowed this to happen.

Lesson learned. A year later, he's much improved, but still not the cruncher he was. Boots solve that.

Rupture site at coronet band from abscess that started in the white line. Separation of the white line was the cause. This abscess started at the same time as the one that started in the bar so that tells me there was a large section of separation that went into the bars.

A horse will usually exhibit more pain if the abscess is in the front hoof rather than a hind. The leg and fetlock joint can swell and the no weight can be put on the leg without the horse exhibiting intense pain.

Does this resemble a founder stance? Yes it does. And a huge diagnositc mistake could have easily been made on this horse. Thankfully, I was certain it was an abscess and I was right. He was laying on the ground for 4 days before the rupture. I just allowed him to rest and the abscess to rupture and he gradually recuperated. It's been a long road for this poor guy. Due to the abscess, he foundered in all four feet. A full recovery has taken just over a year.

It's important to note that we probably won't even realize our horse is abscessing until it gets close to soft tissue where it can erupt. That's why digging at the abscess is a mistake. By the time the horse is experiencing pain, the abscess has made it's way so far up the hoof to get past it. NO DIGGING!


RandomBucknellian said...

How do you feel about "helping" the abscess resolve through gentle walking?
Like, if my horse comes up dead lame overnight and I suspect an abscess(no apparent injury, no pain response higher up on the leg), do you suggest short walks to help work it out?
Or is it best to let it run its course on its own out in the pasture?
I guess my concern is that some people (like me) would prefer to have them up in the barn to keep an eye on food and water intake, since some horses (a couple of my guys) do not react well to pain and wouldn't budge in the pasture unless physically forced to.

Pat said...

That's a really good question. Thank you. I won't walk a horse that is experiencing hoof pain for any reason.

When Danny was suffering with his abscess, it was a challenge to get him to take a few steps. I took water and feed to him where he laid on the ground.

Horse owners I've noticed get become agitated when they see their horses laying down to ease hoof pain. It's really okay. When my feet hurt, I like to get off them too..

I think I would leave them to do as much as they think they can do. And I would offer pain control meds during the worst of it, which is 2 or 3 days prior to the rupture.

After the abscess ruptures, the horse is still experience some amount of pain, but it dissipates gradually in a few weeks. You won’t see lameness in the walk, but you will at the trot, another week goes by and you don’t see lameness at the trot, but you will if you try to ride.

When an abscess starts in the bar, the lameness can be seen at gaits faster than a walk for months.

Reddunappy said...

Years ago when I had my bay mare shod by a new "farrier" she abcessed so bad after he put shoes on her that I had to pull them. When I was able to finally open up the abcesses, in both front feet! they were as big as a pencil bent and layed where the white line is! The #$% had way over clinched the nails and bruised the laminea, and caused that infection in the white line, never never have I recommeded this man again, recently he came up in a group I belong to and I told them what I think of him, he says he does natural barefoot work now, yeah right! Someone else in the group said he lamed one of her horses too.

Mustang Heritage said...

Hi Pat,
i e-mailed you a few questions.

Kalae said...

I have a mare I just put barefoot 2 months ago. She has chronic abcess problems especially in the wet winter. But this summer when it was dry she was abcessing. the new trimmer looked at her feet and says "Its her bars, they have overgrown the sole,creating a pocket for the bacteria to grow in." It was amazing, she trimmed the bars and just toe side of the bars were nasty black regions on all 4 feet that you did not see on normal cleaning. I have been soaking her feet in apple cider vinegar and water and apply teatree oil when I clean her feet. and she is doing great. On her 2nd trimming there was a large U shaped growth around the frog which was explaned as the bar over growth. Fascinating.

J Croake said...

Please advise on further treatment for a horse with abscess that has erupted in the middle of heel bulbs. 1 week has past with no relief from pain, continual poulticing to help draw out the huge amount of pus. Working with a vet and has had course of antibiotics (after eruption). I am very worried about the stress on the other foreleg as he is extremely lame. thanks

seahorse said...

My recently adopted mustang has sesamoiditis, my vet tells me. She had an abscess since i got her, and infection set in even with da
ily soaks and disenfection treatments with wrapping. I cannot afford surgery , not sure how to proceed?

Pat said...

If your horse needs to be put on antibiotics if there really is an infection which could be from the abscess itself. Usually not, but it happens at times. I generally wait out the process. Allow the hooves to grow out and trim correctly so as to stop more abscesses from processing. Sometimes there is so much pain when abscesses are about to rupture and no obvious cause, that other possibilities are looked at besides what is actually happening. If you cannot afford the surgery, I personally would take a "wait and see" approach. But you have to do what feels right to you. Please keep me posted. Via my email if you wish.

Lauren scoines said...

Found this such an eye opener. My horse was extremely lame also in pain and vet suspected an abcess and dug away at the sole (I was away on holiday when she did this) and didn't find any abcess or puss. So much of what you have written has cemented my thoughts and gut instinct. I would not have allowed a vet to dig out her hoof as I feel anything foot related is for a farrier. And I would have never allowed it to happen should I have been there. But she was so lame and in pain the vet was convinced that there would be an abcess even though though no sign of one. She is still not sound after 6 weeks however this may be due to the extremely large hole still healing. Thanks again for such an informative piece

Noelle Oldsen said...

Hello i just had a new farrier trim my 10 year old OTTB gelding, he had pulled his right front show about 5 days before the farrier came so he was a little sore. After he was shod i noticed he was limping badly and i called him to come back and check for a hot nail. he claims that he has abcesses in both front toes poor horse is so sore he has a extreme noticable limp. Farrier came back and wrapped both front feet and said to leave him on stall rest after three days no better actually limp is worse any recommendations? I have contacted our vet and he said he needs to be seen

Pat said...

Hi Noelle, Th only reason I ever recommend stall rest for an abscessing hoof is when it's so painful, we need to keep the horse near his feed and water so he doesn't have to take any more steps to get to feed/water than necessary. That is usually a temporary situation. But as you read in the article, the cause of the abscesses is what needs to be addressed. Why are your horse's hooves processing abscesses in th whiteline of both his at the same time? Likely there is a long toe condition and that is typically associated with underrun heels. I would get those shoes off as shoes can stall out the processing of abscesses and get someone to trim his feet correctly. Too often the long toe/underrun heel syndrome is corrected with a shoe, but the hoof then is left to deal with the fall out of that syndrome. It has to be corrected in the hoof with proper and frequent trimming.

Kylie Macleod said...

I have a tb and have had him for 5 months. When I got him his feet were terrible and last month he burst a abcess out his heel on right front. Now he is brewing a abcess in other front but it has been 5 days and nothing has come of it. He is very lame non weight bearing and swelling in his leg. Can you offer advice on how long it can take to burst and best way to help draw it out. I have tried acv soaks, Epsom salt soaks homeopathics, and will use a poutice tomorrow. Any advice appreciated thanks

Pat said...

Hi Kylie. Sorry your boy is dealing with this. Abscesses go with neglect so no surprise that he's got this going, but glad he is in your hands now. It doesn't seem like soaks of any kind push abscesses along any faster than not soaking. It may offer the horse a bit of comfort though. A poultice is likely to help a bit more, with ichthamol (sp) possibly? The process time is always different. I feel it takes longer in drafts and the only reason I can think of is because of the distance from the ground to the hairline that it has to travel in additional to additional weightbearing. And the lameness accompanied with abscesses after expression seems to last much longer in drafts I'm sorry to say. Just keep him comfortable as possible. Get pain meds on board if you can during the worst of it. Allow him plenty of time. At some point he will be walking better, but you will likely see favoring at the trot for much longer. Not always, but that seems to be the case quite often. Please email me at and update me. We can discuss further.