Q&A with Dr. John Stewart, Author of ‘Understanding Horses’ Feet’
Dr. John Stewart obtained his veterinary degree from Cambridge University, then worked in mixed practice for fifteen years before setting up his own predominantly equine practice. He became interested in laminitis due to experiencing frustration dealing with the condition, which led on to in-depth study of horses’ feet, and setting up an information website. In his quest for information, John has attended numerous veterinary and farriery conferences at home and abroad and has spoken at farriery conferences in Europe and the USA, and was inducted into the International Equine Veterinarian Hall of Fame of the American Farriers Journal in 2012.
What led you to leave veterinary medicine to focus on laminitis and working on horses’ feet?
It was a combination of circumstances. I had been interested in laminitis for some time, but it was after attending a weekend course put on by Dr. Strasser that I started to study horses’ feet. She presented very different opinions on feet to the ‘traditional’ ones that I had been taught, and I realised how ignorant I was because some things she proposed I did not know enough about to have an opinion.
This particular interest in feet coincided with my aged father coming to live with me, and as he became more infirm, I had to spend more time at home caring for him and less time doing veterinary work so that by the time he died (at 90), my practice had shrunk by a third. Spending more time at home did give me the opportunity to set up my information website on laminitis.
There were a number of other factors, but having been on-call for 85% of the time for fifteen years (and 50% of the fifteen years before that) I did not have the enthusiasm to build up my vet practice again, and sold it.
I moved back to Scotland, and was able to follow my fascination for the horse’s foot by continuing my research and (while) trimming horses’ feet, and to write a book for owners.
How have your views about the horse’s hoof changed over time?
Eleven years of studying feet, reading about them, attending farrier and vet conferences in the UK, Europe, and the USA, and talking to hundreds of vets, farriers and barefoot trimmers has certainly changed my views on horses’ feet. My initial instruction about feet, at Vet School, was along ‘traditional’ lines, with the emphasis very much on shoeing, and this was maintained until I attended Dr Strasser’s course. I was intrigued by what she said, and this stimulated my interest and subsequent research.
I started to question some of the traditional ideas. It seemed to me that some things had been repeated so often that they were accepted as fact but, from my studies, did not appear to be so. It brought into question the results of research which were based on these ‘facts’. It seemed to me, from reading research papers and articles that farriers considered foot form, but those involved with the barefoot movement were more likely to consider foot form and function. It wasn’t that I fully embraced Dr Strasser’s theories, and by the time I started trimming feet, I had decided which of her ideas to use and which to reject, as with the protocols of others in the barefoot movement.
In a nutshell, can you describe your method of barefoot trimming for sound horses?
My trimming method will vary, to some extent, depending on the strength of hoof, the environment, the surface the horse lives and works on, and the type of work it is doing.
This has had to change over the past 9 months, since I moved from an environment, in the UK, where the ground and feet are ‘wet’ for a lot of the year, to a very dry environment, in southern California, where the ground and the feet are very hard most of the time.
- The sole I will generally leave alone other than to remove any loose material.
- The frog I will trim loose ragged edges where infection might develop, but otherwise do not take more off unless the amount of hoof wall trimmed causes the frog to be weight-bearing.
- The bars I probably trim more than most people, if the bars are folded and collapsed (to take pressure off the seat of corn and to try to get them to stand up more), or if they are tall and straight, since this may limit the normal functioning of the palmar (back part of) foot.
- The walls I will trim to just above the sole level at the perimeter of the foot (as one looks at the lifted foot), and the perimeter of the hoof I will round the edge only to the un-pigmented hoof that lies outside of the white line. If the sole is thick, and the superficial layer is not ready to come away, I will rasp the outside of the wall back to a higher level (no more than a cm (or ½ inch), so that when the sole sheds, this wall will be worn away easier – to end up at the right level. Quarter relief, which is often not suitable in the wet environment, appears to be needed much more in the very dry conditions.
- I always, where possible, observe the horse walk before I trim to see how this might affect foot balance, and after the trim to see what effect it has made.
When a horse develops acute laminitis, what are your hoof care recommendations?
- Confine the horse
- If shod, leave the shoe on initially – In the acute stage, pulling off the shoe may cause more laminar separation and causes the horse to load the other foot while this is done.
- Provide sole support – applying conformable material under the sole as well as the rest of the palmar surface of the foot (more required if shod) helps these structures to support the coffin bone (P3) [See * note below]
- Reduce the mechanical forces on the hoof.
- Ease break-over around the foot.
- As soon as is practical, trim the heels down, to put more load on the back part of the foot and reduce the forces on the tip of P3. [Some people then suggest that the foot should be wedged up, to reduce the forces from the deep flexor tendon. I do not agree with this. The forces from the weight of the horse are, in my opinion, far more significant and the forces from the tendon become significant when the horse moves – which it shouldn’t be allowed to do in the acute stage.
- Stabilize the hoof wall.
The method that would appear to cover these recommendations best is to cast on an EVA support (See Equicast). The EVA pad is conformable, to give sole support, and has a narrower base, to ease break-over around the foot and the Equicast holds the EVA in place and provides stability to the hoof wall.
* If it is an acute laminitic episode in a horse with chronic laminitis, sole support has the potential of putting pressure on the sole under the tip of P3, to cause pressure necrosis. In these cases, support under the back half of the foot is safer. An EVA pad may not be suitable in these cases.
What do you believe is the biggest mistake people make when dealing with laminitis?
- Under-rating the seriousness of the problem
- The over-use of ‘Bute’ (anti-inflammatory and analgesic). With the reduction in pain, the horse may move around more than it should – more than the unstable laminae can cope with, thus cause further breakdown
- Not dealing with insulin resistance, which is probably a factor in the majority of cases of laminitis. This is mainly by controlling the intake of non-structural carbohydrates in the diet. (sugars and starch)
Anything else you’d like to add?
Prevention of laminitis is the key.
Laminitis is rare in horses and ponies that have regular exercise and the feet trimmed regularly. Feed for energy requirements for the work the horse is doing and do not let your horse become overweight.
My Book–“Understanding the Horse’s Feet” (Crowood Press) RRP in the UK £25.00 from bookshops (but cheaper online). It is intended for owners, but definitely more complicated than the usual ‘books for owners’. It is not available in the USA & Canada till 1st September RRP in the US $44.05, but can be pre-ordered online, currently, for less than $30.00.
You can find more information about Dr. Stewart and his laminitis research on his website.
To pre-order through Amazon.com in the U.S., click here.