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Before I start, this horse has seen a vet multiple times (new one coming on Monday) and I have worked continuously with his farrier to help him.

Long story short, My gelding and I have been dealing with a non-healing front left “hoof abscess” for 14 months. Yes, 14 months. He is an easy keeping 12 year old Missouri Fox Trotter with no prior history of injuries or hoof related issues. All other feet are 100%. He receives regular quality foot trims from my great farrier. He is kept in pasture, and in a dry lot during wet conditions and rarely standing around in mud. He also has a stall for extreme weather he’s kept in. He has a diet of grass, Hay, and very little strategy grain to put his supplements in, that are high in biotin.

This all started in May of 2018. Horse turned up randomly lame (first time ever) with classic abscess symptoms. Had vet out, dug small area near the toe to release pus. Went with typical poultice/wrap/medicate procedure. Vet also gave him oral antibiotics (which I know now we’re probably not beneficial). Horse was immediately better.

About a month later He started presenting with periods of intermittent slight lameness and soundness. Farrier came out, dug out more infection and the process repeated itself. Off and On lameness for months, with a vet visit to determine that it was just a re-occurring abscess and instructed to protect hoof longer.

As time slowly dredged on, no amount of stall rest, booting, soaking, poulticing was helping. Had vet out for Rads. Rads revealed just a very thin sole and was told that was the source of lameness. No sign of bone infection, rotation or infection. Over the next few days horse became grade 10 lame. Had farrier out who discovered a MASSIVE infection. This sucker sprayed everywhere once dug out again at the toe. We thought FINALLY the source had been released and with plenty of cleanings, topicals (seriously I’ve used everything possible from clean track to simple Epsom salts, betadine etc.) and keeping it sterile via a boot we would be out of the woods... not so much

It has become apparent that this site continuously drains. Never stops, talking months on months. If this drainage point in the hole of his toe is closed up by too much gauze, mud, natural closing with granulation tissue etc.. the horse is dead lame within hours bc the pressure builds up THAT quickly.

It seems apparent to me that there has to be something within the structures of the foot causing this... idk if it’s a foreign object, bone infection or what but nothing was seen on the last set of Rads. Vet will be out Monday to do more investigating.

Has ANYONE dealt with anything like this? Any advise on what to demand the vet to do this time around. I will not accept the answer of “it’s an abscess just keep poulticing/medicating/protecting”. It IS.NOT.WORKING. If anyone has anything insightful to share, PLEASE HELP!
 

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At the toe to me says the possibility of something traveling up the hoof wall. I would think it would have come out by now but have had a friend with one that had a small bit of gravel that traveled all the way up and it wasn't until the abscess blew out the top that the gravel came out. How she knew it was that I don't remember. Maybe it was the frequency and then relief when it blew out the coronet band and not hoof. I want to say this was over a long period with several recurrences.



Mine that had basically a hoof that looked like swiss cheese from abscessing had to be on IV antibiotics and other meds for a considerable length of time.
 

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1. Nobody wants to hear this but:

Based on personal knowledge of a friend's horse whose abscesses never wanted to go away, I suspect metabolic issues even if the x-Rays don't show anything but a thin sole.

2. If the sole is thin and your current vet feels that really is the only issue -- your "great" farrier needs to be doing something about that. If the farrier doesn't know what to do. He/she is not so great when it comes to special needs hooves. Sometimes well-intending good farrier's with healthy hooves, end up doing more harm than good with special needs hooves --- a 14 month recurring abcess issue is a special needs hoof:)

3. I am not sure you can post pictures, being a new member. The rules change on this forum from time to time.

If you can post pictures, here is @loosie 's link as to how to post clear hoof pictures. First and foremost clean the hooves throughly, and do not wash them & take pictures of wet hooves:)


https://www.horseforum.com/members/4160/album/chestnut-5339/pictures-128437.jpg

Hopefully the next vet to see your horse is a leg/hoof expert?

While you didn't mention diet, it might be important to know what your horse is eating:). High starch diets can sometimes be the culprit for issues we would never think they should be:)
 

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This is not pretty, but what we went through with a massive sole abcess. It was completely dug out, packed, padded and shod. There was still infection left that eventually burst out the back of the heel. Horse is finally sound, sole completely grew back in one trim cycle, and horse cleared to return to work.
 

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My fox trotter is suspected to have metabolic syndrome. She is an air fern and can live off practically nothing. I would cut all sugar/starch from the diet just in case... or if you want to get the horse tested, I would do so. Another thing that comes to mind is early cushings disease.

If the vet can't find anything, you could ask for an MRI. They just started doing those for lower leg problems.

I would think a keratoma would show on an x Ray though, if that was a contributing factor. Perhaps addition x rays are needed?

You are right to be concerned. That seems very serious for only an abscess.

Now my local university uses maggots for deep infections like that. Apparently they only eat dead or diseased tissue which means you can place them in the abscess tract with a hoof boot on. That could be an option as well, as you truly need to think outside the box on this issue.
 

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I'm not sure what angles the vets rads are, but if you only have pictures from the side or front on, get more. From the top, and at an angle so you can get a full picture.

That would be that I insist on!
 

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Welcome Shelbye! And welcome back Walkin - good to see you here again!

Rads revealed just a very thin sole and was told that was the source of lameness. No sign of bone infection, rotation or infection. Over the next few days horse became grade 10 lame. Had farrier out who discovered a MASSIVE infection. This sucker sprayed everywhere once dug out again at the toe. We thought FINALLY the source had been released and with plenty of cleanings, topicals (seriously I’ve used everything possible from clean track to simple Epsom salts, betadine etc.) and keeping it sterile via a boot we would be out of the woods... not so much
So 'just' a very thin sole huh? Why is it so thin? What is being done to address this? What is being done to protect that sole(well, what's above it) from further injury? It's common for extremely thin soles to abscess repeatedly, where pressure is constantly on the live tissue between bone & ground. While 'opening up' an abscess may well be necessary, it is then effectively a surgical wound on the base of the foot, so you're right, it needs intensive care, to be kept sterile and treated topically to prevent further infection until it's healed.

You can look at the abscesses of being 'just a symptom' of the thin soles, which may be due purely to mechanics, or may be due to ongoing systemic laminitis as well - from IR or such, as Walkin mentioned. So those factors need to be addressed for the problem to begin to improve. Even if the vet is sure there is no bone or deeper infection, I would strongly consider another opinion & IV antibiotics.

**Unfortunately, many disinfectants, such as betadine, will *inhibit* healing by damaging & retarding the live tissue. So it's a balancing act, to keep infection at bay but not do further damage. I believe this is the reason vets have declared probs such as pedal bone penetration are incurable. Because with normal disinfectants, it becomes so. Whereas, believe it or not, something like raw Manuka honey applied to the wound can do the job very well, and *promote* healing! It's possible that your 'after care' may have been problematic in this way.

Those pics show quite a long, stretched toe, which will be part of the prob. Not sure about excessively thin soles from those pics. If you'd like more specific info, see the link in my signature & post a full compliment of appropriate photos, and it would also help if you can include the rads.
 
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