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Pus & Us
© F. Thomas Breningstall
Let's talk about pus bags. No! No! I don't mean your in-laws. I'm talking about abscess in the horse's hoof. We all know the names - subsolar abscess, gravel, pus pocket, puncture wounds. Some come from laminitis and bruises; others come from the all-dreaded quicking; or hot nailing by us. As Bob Reaume once told me, "Anybody who says he never quicked a horse hasn't shod very many horses." Given all the possibilities for an abscess to develop, the actual cause is an invasion of anaerobic bacteria through any opening into the sensitive tissue or the blood system. Prevention of abscess is another big topic for another time. Here, we can just remember to keep our tools clean and to be sure to wash up well after working with any sign of infection.
I have found abscess to be the cause of lameness in many horses diagnosed with anything from a broken coffin bone to stringhalt and many things in between. X-rays are of little help in diagnosing abscesses, and symptoms are not always reliable clues. So the veterinarian should never be criticized for misdiagnosing an abscess. And yes, the opening and draining of an abscess is surgery - the treatment of disease, injury or deformity by manual or instrumental operation, as in the removal of diseased parts or tissue by cutting (Webster's New World Dictionary, Second College Edition). So is the trimming of hoof wall, sole and frog, and so is hoof repair. A question arises: where does the work of the farrier leave off and the work of the veterinarian begin? A universal protocol has never been established. As a result, each situation, and every farrier/ veterinarian relationship must be developed from scratch. One thing for sure, veterinarians can do it all - trimming and shoeing as they see fit and are so trained. In my practice, most abscesses that are found by the veterinarian or myself are drained by me. Many veterinarians leave this operation in the hands of us farriers. However, any time the sensitive tissue is involved, notification of the veterinarian is in order.
If an accident happens, lie or run! No, just kidding. Please, by all means, tell the owner and advise of cautions he or she needs to take. You know them. The veterinarian may want to give tetanus or other medications. If you suspect or discover an abscess, tell the owner and talk to a veterinarian.
If the wound or the exit spot is in the frog or bulbs of the heel, the drain hole should be as small as possible, the hoof should be soaked in epsom salts, treated with topical disinfectants, bandaged, and a veterinarian called in to treat the wound and the horse's systemic needs.
A few years ago I began draining abscesses differently from any way I had seen or heard of before, and it works well most of the time. I stopped cutting the sole out to drain the abscess through the bottom of the hoof.
As we know, pus and all liquids will take the path of least resistance. In the case of the hoof, this path is through the laminae, exiting through the white line or the coronary band (as a gravel) or out through the wound if caused by a puncture.
The white line is the most common exit site for the pus. In this case, I first clean the bottom of the hoof with a hoof pick, knife and wire brush. Sometimes the drainage spot reveals itself; other times you need to probe a little with hoof testers, hoof knife or a nail cleaned with alcohol.
The pus we find shows up in one of five colors: clear (not very lame); pink (fresh puncture), white (seeping and sore) gray and black (three-legged-lay-down lame).
Abscesses all have some things in common. They don't belong in the hoof and sometimes need our help to be removed. They can cause a systemic infection, and because of their sometimes-elusive behavior, they are misdiagnosed by even the most competent of veterinarians.
Putting the horse first, I'm a firm believer in trying the easiest, least disruptive and kindest methods of treatment. If one doesn't work, then I move on to the next treatment, and so on. It's my experience that most things respond to K.I.S.S. (Keep It Simple, Stupid).
After I locate the exit spot or make one, I notch the hoof wall at that spot if it is in the white line. Or if the spot is in the sole area, I notch the hoof wall closest to the wound. The notch is just deep enough to drain the pus from the abscess, but not deeper into the blood line.
I leave the sole intact to protect the underlying sensitive tissue. The horse's own immune system capsulizes the pus pocket and you can sometimes see large openings between the sensitive and insensitive tissue. If you remove the outer layer of sole in an attempt to drain the abscess from the bottom of the foot, you will leave the sensitive tissue exposed. Then the horse has to try to walk around on exposed raw meat. In this case, the horse will be very lame for weeks and will need intensive care to recover until the new sole is formed.
In contrast, if you just notch the hoof wall to drain the abscess, the sensitive tissue will be protected by the old sole until the new sole grows out. By notching the hoof wall, the drainage opening is self-cleaning. I have even put shoes back on some horses that are show-sound the next day.
Show the owner how to clean and disinfect the notch, to be done daily for a week or two. Some will; some won't. But either way, I have never had a reinfection with this treatment. It's best to keep the hoof as dry as possible during this healing period. In six to eight weeks, sufficient growth is obtained to remove the old sole. The horse is sound with very little discomfort.
So, by notching the hoof wall 1) you drain the abscess; 2) you keep the sensitive tissue covered; 3) the notch is self-cleaning; 4) with each step the pus is forced out the notch; 5) recovery is faster; 6) lameness is abated; 7) the horse is happy; 8) the owner is happy; 9) you're a hero, and that makes you feel good. I have done this treatment hundreds of times. It works.
F. Thomas Breningstall is an AFA and MHA certified full-time farrier living in Fowlerville, Michigan. This article first appeared in Rural Heritage magazine and is reprinted here with permission.