Diseases of the Horse's Foot Part 17

Unskilful shoeing also plays a part in the causation of sand-crack. Removal of the periople by excessive rasping of the wall is most certainly a predisposing cause. Cracks, or their starting-points, may also be caused by using too wide a shoe, or by the use of nails too large in the shank. Also, they may arise from unskilful fitting of the toe-clip, especially in the hind-foot of a heavy animal. It must be admitted, however, that the part shoeing plays in the causation of sand-crack is not a large one; far more depends upon the state of the horn and the animal's conformation than upon the exciting cause.

So far, our observations on the causes of sand-crack have referred to that form occurring in the wall. Sand-crack of the sole or frog we have already said is but seldom met with, and then it is always in connection with some exceptionally deteriorated quality of the horn, as in the case of badly pumiced feet, or occurs as a result of direct injury. Extensive slit-like cuts in this region, when deep enough to lacerate the keratogenous membrane, are sometimes followed by the growth of a fissure in the horn, and what might almost be termed a permanent sand-crack results. Such cuts may be occasioned by sharp flints, broken gla.s.s, or other sharp objects picked up on the road, or may result from the animal treading on the toe-clip of a partially cast shoe.

_Symptoms_.--In every case the fissure, or evidence of its commencement, is a diagnostic symptom. It is well to remember, however, that this may be easily overlooked, especially when the crack is one commencing at the coronary margin. The reason is this: Sand-cracks in this position often commence in the wall proper, and not in the periople. They may, in fact, be first observed as a fine separation of the horn fibres immediately beneath the perioplic covering. A crack of this description may even show haemorrhage, and have been in existence for some time, without the periople itself showing any lesion whatever. Thus, unless lameness is present, or a more than specially keen search is directed to the parts in question, the sand-crack goes undiscovered, until of greater dimensions.

Further, the fissure may be hidden, either accidentally or of set purpose.

It may be covered by the hair, filled in and covered over with mud, or intentionally concealed by being 'stopped' with an artificial horn, with wax, or with gutta-percha, or, as is more common, be hidden by the lavish application of a greasy hoof-dressing.

In this latter connection it is well to warn the veterinary surgeon, especially the beginner, when examining for soundness, to be keenly critical before pa.s.sing an animal who is presented with feet smothered with tar and grease or any other dressing. More especially should this warning be heeded when examining any of the heavier breeds of animal with an abundance of hair about the coronet.

Referring again to the search for the crack, it is well to know that with toe-crack the fissure is the more readily seen when the foot is lifted from the ground. With quarter-crack, on the other hand, the fissure is wider, and consequently the easier detected with the foot bearing weight.

Although commencing in the insidious manner we have described, the lesion is not thus often seen by the veterinary surgeon. Usually, the animal with sand-crack is brought for his inspection when lameness has arisen from it.

In this case the cause for the lameness will reveal itself in the crack, which is now too large to escape observation. The coronet is hot and tender to the touch, and a sensation of warmth is sometimes conveyed to the hand by the horn of the surrounding parts of the wall. It is hardly necessary to say that, with accompanying conditions such as these, the sand-crack is a _deep_ one.

Where the lameness is but slight, we may attribute it almost solely to the pain occasioned by the mere wounding of the keratogenous membrane, and to no very extensive inflammatory changes therein. By some authorities this is said to be due to the pinching of the sensitive structures between the edges of the fissure in the h.o.r.n.y covering. In our opinion, however, pinching does not occur unless inflammatory exudation into the sensitive structures adjoining the crack has led to sufficient swelling to cause them to protrude. In other words, the movements of the h.o.r.n.y box, communicating themselves to the structures beneath, and so occasioning movement in the wounded keratogenous membrane, are quite sufficient to give rise to the lameness without actual pinching of the structures implicated.

The severity of the lameness will vary with the rapidity of the gait, and with the character of the road upon which the animal is made to travel. For instance, many animals in which the lameness is imperceptible at a walk become 'dead' lame at a fast trot. It is sufficiently explained when one remembers the greater movements of expansion and contraction of the posterior parts of the wall brought about by the increase in the rate of progression. The same animal, too, will go distinctly more lame upon a hard than upon a soft surface.

In like manner the lameness from toe-crack also varies in degree with the rate of progression and the character of the travelling, though not to such a noticeable extent as in the lameness from quarter-crack. A greater variation may in this case be brought about by moving the animal on ascending and descending ground. Descending an incline, with a more than ordinary share of the body-weight thus thrown upon the heels, the lameness is most marked. The reason would appear to be that the greater expansion of the wall of the heels thus brought about leads to a proportionate contraction of the wall at the toe, especially at the edges of the crack, thus causing undue pressure upon the exact spot of the wound in the sensitive structures. Ascending--the weight in this case transferred from the posterior to the anterior portion of the foot--the expansion of the heels becomes a contraction, with a corresponding lessening of the contraction at the toe and a distinct decrease in the lameness.

In the case of a deep but recent crack there is always more or less haemorrhage. This favours risk of infection of the lesion with pus-forming organisms, and so leads to a more or less p.r.o.nounced lameness, a degree of swelling, heat and tenderness in the coronet above, and a certain amount of surgical fever.

The acute symptoms subdued, but the fissure still remaining, gives us the crack we have cla.s.sified as 'old.' This may in every case be distinguished from a more recent lesion by the amount of thickening of the overhanging coronet, and the presence of an increased quant.i.ty of sub-coronary horn in the region immediately about the crack. The previous inflammatory changes in the adjoining sensitive structures have here led to an increased secretion of horn, and a greater or less deposition of inflammatory connective tissue in the wounded coronary cus.h.i.+on.

Sand-crack of the toe always follows the direction of the horn fibres. That of the quarter, however, may on occasion run a course that is somewhat zigzag, first following the direction of the horn fibres for a short distance, then travelling in a horizontal direction, and finally continuing its course again in a line with the horn fibres, commonly at a point posterior to that at which it commenced.

In a quarter-crack that is old, and when contraction of the heels exists (which in this case it usually does), then will often be found overlapping of the edges of the crack. The expansion of the wall brought about when the body-weight is on the heels, cannot, by reason of the break in it, continue itself anterior to the crack. As a consequence, repeated expansion of the wall posterior to the crack, with the portions anterior to it in a state of enforced quiescence, leads in time to the posterior edge of the crack coming to lie over that of the anterior.

_Complications_.--The first complication likely to arise in a case of sand-crack is that attending simple laceration of the sensitive structures in a _deep_ lesion. With the laceration all the phenomena of a repairing inflammation make their appearance. As a result, there is more or less heat according to the degree of inflammatory hyperaemia, swelling according to the amount of inflammatory exudate, and pain according to the amount of pressure the two foregoing bring to bear on the nerves in the inflamed area.

A second and more serious complication is the greater inflammation set up by the introduction into the crack of foreign substances. Small portions of gravel and flint, both by the irritation set up by their friction and by the infection they carry in with the dirt surrounding them, are responsible for the mischief.

When, from direct communication with the blood-stream, due to extensive haemorrhage, bacteria from the outside gain entrance, this simple inflammation is further complicated by the formation of pus, or a limited gangrene of the keratogenous membrane.

In cases of great severity the gangrene of the keratogenous membrane spreads until the deeper structures are involved. We then get a necrosis (in the case of toe-crack) of the extensor pedis, and sometimes caries of the os pedis.

In like manner the necrotic changes occurring under these circ.u.mstances may invade the deeper structures in the region of quarter-crack. As a result of this, we may have the starting-point of suppurating corn, or necrosis of the lateral cartilage--in other words, cartilaginous quittor.

Commonly accompanying quarter-crack is the condition of contracted heels and atrophied frog. Sometimes described as a complication of sand-crack, it appears to us more rational to rather regard the sand-crack as a result or complication of the vice of contraction.

The overlapping of the edges of the crack before referred to occasionally gives rise to the condition known as false quittor. A probe or a director pa.s.sed beneath the overhanging ledge of horn reveals sometimes a fissure of 1 inch or considerably more in depth, and quittor is diagnosed. A careful paring away of the overhanging horn, however, reveals the true state of affairs, and exposes to view the original cause of the mischief--a simple fissure in the wall.

A serious complication--one fortunately met with but rarely--is that of keraphyllocele. This is a tumour-like growth of horn, varying in size from the thickness of an ordinary quill pen to that of one's middle finger, growing down from the coronary cus.h.i.+on, and attached to the inner side of the wall of the hoof. With this lameness is always present, and more or less deformity of the hoof results. This condition will be found described at greater length in Chapter IX.

_Prognosis_.--In the case of sand-crack this should always be guarded. It may be taken as a general rule that cracks commencing from the coronary margin are more troublesome to deal with than those originating below. The reason is not far to seek. They here affect the wall just where the bevel in it for the accommodation of the coronary cus.h.i.+on has rendered it weakest. Not only is it weakest, but being more resilient than the portions below it, it suffers more from the alternate movements of expansion and contraction of the foot than does the horn below.

Although in many cases a cure of the existing crack may be easily accomplished, regard should be paid to the possibility of its recurrence, either in the same position or elsewhere. Really, in offering an opinion as to the future usefulness of an animal so affected, a greater attention should be directed to the animal's conformation than to the crack itself.

Where the vice of conformation giving rise to it (as, for example, contracted heels or upright hoof) gives hope of being remedied, then naturally it may be safely said that the liability to sand-crack goes with it.

A like favourable prognosis may be given in the case of cracks occasioned by purely accidental causes.

Ordinarily, however, cracks once commenced tend rather to increase than decrease in size and severity. From being superficial and incomplete, they become complete and deep, with every unfavourable circ.u.mstance that an increase in size and depth brings with it.

This much, however, may be promised to the owner. A simple crack, even though originating from the coronary margin, is, in the vast majority of cases, curable. Under a rational treatment its increase in size may be prevented, and a sound wall caused to grow down from the coronet.

_Treatment_.--The principles governing the treatment of sand-crack are simple enough in themselves, if not always followed by success.

1. _Preventive_.

This, as a rule, does not suggest itself until a crack of greater or less extent has made its appearance. Then, simultaneously with the treatment proper of the lesion, preventive measures should be adopted, to aid both in the healing of the fissure already present, and to ward off the occurrence of others that might be likely to form. The hoof, if abnormally brittle, should be regularly dressed with a suitable ointment (one containing glycerine for preference), and its horn kept as nearly as possible in a normal condition. When the condition of the horn predisposing to its fracture is brought about by excessive wet, then the appropriate preventive measures to be adopted suggest themselves.

With regard to the lesion itself, we may term 'preventive treatment' all those measures having for their object the prevention of increase in the size of the crack. They are as follows:

_(a) Blistering the Coronet_.--In a simple case, where the crack is superficial and close under the coronary margin of the wall, a sharp cantharides blister to the coronet immediately above it will have the desired effect. An increased secretion of horn is brought about, and by this simple means the crack prevented from becoming longer. Very often this is all that is necessary. In fact, we may say here that, no matter what other treatment is adopted, the simultaneous application of a blister to the coronet is always beneficial. To derive full advantages therefrom, the blistering should be repeated several times at intervals of about a fortnight.

_(b) Clamping the Crack_.--When the services of a skilled smith are at hand, one of the readiest methods of performing this is to draw the edges of the crack together with an ordinary horse-nail.

On each side of the crack a small horizontal furrow is burned or cut into the wall, leaving the horn for about 1/4 inch on each side of the crack intact. This provides a groove for the ends of the clamping-nail to rest in, and brings them flush with the outer surface of the wall. The nail is then driven carefully home through the crack, and the pointed end grasped by the farrier's pincers. The edges of the crack are then drawn tightly together, and the nail firmly clenched.

[Ill.u.s.tration: FIG. 86.--THE SAND-CRACK FIRING-IRON.]

'The horse-nails are prepared in the ordinary way as for driving, with the exception that each is pointed on the reverse side, to prevent puncturing the sensitive structures. Before being used the nails are put in a vice, and the head hammered to form a shoulder, to prevent their being driven too far into the wall, and breaking out the hold.'[A]

[Footnote A: _Veterinarian_, vol. xlviii., p. 100.]

Before driving the nail some operators burn or bore a hole for it. Opinion seems to differ as to whether this is at all necessary.

A method of clamping which, on account of its simplicity, has become greatly popular, is that of Vachette. For this operation is needed the outfit depicted in Figs. 86 and 87.

[Ill.u.s.tration: FIG. 87.--THE SAND-CRACK FORCEPS AND CLAMP.]

With the special firing-iron (Fig. 86) an indentation, sufficiently large to admit the points of the clamp (Fig. 87), is made on each side of the crack. The clamp is then adjusted, and pressed home tight by means of the sand-crack forceps (Fig. 87). According to the length of the crack, one, two, or three clamps may be necessary. Another useful clamp, though far more complicated in its structure, is that of Professor McGill (Fig. 88).

[Ill.u.s.tration: FIG. 88.--MCGILL's SAND-CRACK CLAMP.]

'The object of this invention is to arrange on a spindle, which is screw-threaded at one end with a right-hand thread and at the other with a left-hand thread, two clips or clamps, free to travel on the thread, there being a nut between the two which can be turned by a spanner. The clips are placed on the hoof, one on each side of the sand-crack, the hoof being prepared to receive the instrument by filing a groove or notch for the clamps to fit into, and by turning the nut on the screw the clamps are brought towards each other, and the crack thus prevented from spreading.'[A]

[Footnote A: _Veterinarian_, vol. lxi., p. 141.]

Still a further useful clamp is that of Koster. This is considerably broader than the clamp of Vachette, and its gripping edges are provided with teeth (see Fig. 89).

As with the clamp of Vachette so with this, a groove is burned into the wall on each side of the crack for the accommodation of the jaws of the instrument, and the clamp itself pressed home by means of a special pair of forceps. This form of clamp holds well, and has the advantage of securing a wider area of horn than that of Vachette or McGill.

[Ill.u.s.tration: FIG. 89.--KOSTER'S SAND-CRACK CLAMP.]

Clamping by any method should be advised or undertaken only under certain conditions. The horn should be moderately strong, and the wall should be thick. This practically restricts the use of the clamp to cracks of the toe, and it is there, as a fact, they are found of most benefit. While burning the grooves for the clamp, and while tightening the clamp itself, the animal's foot should be on the ground and bearing weight at the heels, thus insuring the greatest possible approximation of the edges of the crack.