The Natural Angle presented a group of questions regarding vet/farrier relations to Stephen O’Grady, DVM, MRCVS. His thoughtful responses may give you some guidance when confronted with various foot problems and sensitive issues involving lameness and lower limb problems. Dr. O’Grady’s background as a farrier before becoming a veterinarian and his continued work with lower limb problems offers a unique perspective on questions facing the farrier, veterinarian and horse owner.

	Live tissue exposed or bleeding
	Quarter crack
	Extensive white line disease
	Deep abscess

When should a farrier call a vet?
The farrier should call when:

1. Any unexplained lameness is observed when the horse is brought out to be shod.
2. Any situation occurs in which live tissue is exposed or blood is noted such as: sole punctured with hoof knife; bleeding quarter crack or infected toe crack; infected corn; extensive white line disease; and canker.
3. There is a puncture wound in sole or frog of foot.
4. There is a deep abscess.
5. Radiographs are needed: to assess sole depth; to assess conformation of foot, i.e. long toe/low heel syndrome, hoof pastern axis; suspected rotation; to determine the extent of white line disease; and to rule out solar margin fractures that can mimic sole bruising.
6. There are limb abnormalities in foals, i.e. angular limb and flexural deformities.

When should a veterinarian call a farrier?
A veterinarian should call when:

1. The veterinarian feels that the present shoeing may be implicated as a cause of or a contributing factor in a given lameness (This should generally be done without the owner’s knowledge).
2. Lameness or disease is localized to the foot and shoeing is part of the therapy.
3. Hoof conformation needs to be corrected in order to prevent lameness.
4. Extensive hoof wall defects resulting in lameness that need to be repaired (especially if defect involves live tissue).
5. Farrier input is necessary on a particular problem such as building a shoe or brace to treat a problem above the foot.
6. To have a cup of coffee.

	Sole bruise
	Club foot
	Markers for good radiographs

How should consultation be conducted?
Consultation should be conducted in person with the case (horse) if possible, so diagnosis can be discussed and a treatment agreed upon.

What are common problems in consultations?

1. Lack of adequate discussion.
2. Resentment of either party by the other.
3. Disagreement over therapy.
4. Treatment by “fad” by either party instead of looking at individual case.
5. Level of skill: Farrier - extent of training equals ability to build required shoe, experience, practicality, innovation, and lack of continuing education; and Veterinarian -  amount of lameness work performed and familiarity with farrier profession and the newest concepts.
6. Continuing education: Veterinarian - lack of attendance of veterinarians at meetings devoted to podiatry, i.e. Laminitis Symposium, AFA Convention, etc.; and Farrier - lack of attendance at local farrier clinics, FPD clinics, etc.
7. Egos- both sides.

There must be a mutual professional respect between the veterinarian and the farrier in order to have a successful vet/farrier relationship.

How should the vet and farrier handle disagreements on proposed treatment?

1. Disagreements should always be handled through discussion if possible.
2. If the case cannot be competently handled by either the veterinarian or the farrier, that individual should refer the case to a party more experienced to handle the situation in question.
3. With most lameness or disease related problems of the hoof, there is the medical aspect which makes the veterinarian responsible for the overall case and places him or her in charge.

From your perspective, what (and when) are important steps necessary to get the best radiographs?
Radiographs should always be top quality. This requires:

1. Good foot preparation (without shoes)
2. Good x-ray cassettes and screens.
3. Good radiographic techniques.

Radiographs are useful for:

1. General foot conformation.
2. Hoof/pastern axis.
3. Long toe/low heel.
4. Club foot.
5. Flat feet to determine sole depth.
6. Laminitis.
7. White line disease.
8. Heel lameness.
9. Lameness localized to the foot without obvious diagnoses (fractures, foot bruising, keratoma, osteomyelitis, etc).

What are some important reference points in radiographs?

1. Wire embedded in surface of radiograph block.
2. Wire on dorsal (front) hoof wall.
3. Thumb tack 3/8” back from point of trimmed frog.
4. Small screws at coronary band.
5. Markers at heels, if necessary.

It should be noted that, for accuracy, the opposite foot from the one being radiographed should be placed on a block of equal height.