Puncture wounds of the sole and frog by nails, screws, or other sharp objects are common hoof injuries in horses.
The penetrating object might be contaminated with soil, manure, or rust, which can lead to infection, said veterinarian Nolton Pattio.
Clinically, puncture wounds can be misleading because they can appear small and insignificant. Aggressive medical therapy or appropriate surgical treatment might be delayed until signs of infection or lameness occur.
Depending on the depth and location of the puncture wound, several hoof structures can be affected.
Puncture wounds are critical injuries if the coffin bone, coffin joint, digital cushion, flexor tendon, or navicular bone are involved.
“Deep puncture wounds of the sole and middle third of the frog are emergencies,” Pattio said. “They should be treated aggressively to prevent infection of bones, joints, and soft tissue structures in the hoof.
“These cases are challenging to treat and should be referred to an equine hospital for surgical treatment, if needed,” Pattio added.
Wound management and treatment options are based on the location, depth, and direction of the penetrating wound.
Minimally invasive penetrating sole and frog injuries can be managed conservatively with broad-spectrum antibiotics, anti-inflammatory drugs, hoof soaking, and bandaging.
If the injury penetrates deeper hoof structures, the horse should be referred to an equine hospital for more aggressive treatment.
The “street nail” surgical procedure is used to create a surgical window between the frog surface and navicular bursa.
That promotes adequate wound drainage and allows for subsequent treatment of the affected area.
Surgical management can also involve supportive care, anti-inflammatory treatments, bandage changes, and a medicine plate shoe to promote healing.
Ongoing clinical evaluation is needed to direct patient management decisions in adjusting use of antibiotics, wound care options, and bandaging.
Some hoof puncture wounds complications, lameness, swelling, heat, and infection occur when the surface seals over restricting drainage. Therefore, veterinary care is needed for ongoing supervision and intervention.
“The prognosis for penetrating wounds of the hoof sole and frog is guarded,” Pattio said. “But generally, those horses that have fewer deep structures involved and receive timely and appropriate treatment experience more favorable outcomes.”
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