ADAPTION OF THERAPEUTIC SHOEING ON THE REHABILITATION STATUS OF THE ORTHOPEDIC PATIENT LETS GET SPECIFIC ABOUT IMPLEMENTING BIO-MECHANICAL PRINCIPLES
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NORTHEAST ASSOCIATION OF EQUINE PRACTITIONERS
from our practice to yours emagazine
FEBRUARY 2021
ADAPTION OF
THERAPEUTIC SHOEING
ON THE REHABILITATION
STATUS OF THE
ORTHOPEDIC PATIENT
LETS GET SPECIFIC
ABOUT IMPLEMENTING
BIO-MECHANICAL PRINCIPLES
VETERINARIANS DEALING WITH
DISSATISFIED CLIENTS
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Northeast Association
of Equine Practioners
FEBRUARY 2021
VOLUME 11, NUMBER 2
WWW.THENEAEP.COM
EXECUTIVE COMMITTEE
President
Sarah Cohen, DVM
Equity Performance Equine
Vice President
Stuart Muir, NZCEF, CJF, DIPWCF, APF
Rood and Riddle Equine Hospital
Treasurer
Gregory S. Staller, DVM, DACVS
Running ‘S’ Equine Veterinary Services
Past-President
Jim Zeliff, DVM, MBA
Allegheny Equine Associates
BOARD OF DIRECTORS
Ronald B. Gaeta, DVM ABOUT THE COVER:
Dunbarton Equine This large pony is healthy and sound thanks to the quick-thinking
and proactive actions from both her vet and farrier, who together
Sasha N. Hill, DVM recognized her symptoms had the potential to lead to severe
Christopher Penola, APF, BS, MBA laminitis or death.
Bob Pethick, APF, CJF
Bedminster Forge
Katherine Chope, VMD, DACVSMR
contents
Veterinary Industry Council Rep 6
Mr. Keith Wacker Adaption of therapeutic shoeing on the
Sound Technologies Inc.
rehabilitation status of the orthopedic patient
Farrier Industry Council Rep Assoc. Prof. Dr. habil. med. vet. Jenny Hagen
Remco van der Linden, CF
Executive Director/CEO
David G. Dawson
18
Lets Get Specific About Implementing
Bio-Mechanical Principles
Stuart Muir Nzcef, Cjf, DipWcf, Apf
26
Veterinarians Dealing with Dissatisfied Clients
Amy L. Grice, VMD, MBA
t h e c l i n i c i a n february 2021 3
PRESIDENT’S MESSAGE
from our practice to yours
Welcome
GREETINGS PRACTITIONERS! YOU, the practitioner. We are building a platform to house
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and commend you for your work. Doing the jobs are hard and excited to offer the best of education to the professionals
enough, the frozen equipment, icy conditions and hairy that we serve, we are adapting to our changing world and
horses just add to the challenge. improving our position within it.
This month our message is hopeful. We are watching If there is a takeaway message this month it’s, STAY
the vaccine rollouts across the country and feeling a TUNED! The NEAEP is very close to an announcement that
possible sense of return to “normalcy”. That being said, is going to be game changing and crucially transformative
our organization is ready for whatever the rest of 2021 has for education within our professions. If that does not keep
to dole out. As we did last year, we are ready to meet the you on the edge of your frozen seat...
changing needs of continuing education head on. Stay warm my friends and see you next month!
Whether it be virtual or live, we are providers and offerors
of a vast amount of easily accessible education that is Dr. Sarah Cohen
about to be showcased in a brand new format tailored to President, Northeast Association of Equine Practitioners
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LAMENESS
Adaption of therapeutic shoeing
on the rehabilitation status
of the orthopedic patient
Proceedings for the annual Symposium of the
Northeast Association of Equine Practitioners 2020
By Assoc. Prof. Dr. habil. med. vet. Jenny Hagen (certified farrier)
Practice for Equine Orthopedics and Chiropractic and
Institute of Veterinary Anatomy of the Leipzig University, Germany
VARIOUS INJURIES AND DISORDERS How long can the shoe modifications be applied and
affecting the equine distal limb or the equine hoof require when or how can a return to “standard shoeing” be achieved?
treatment with special shoeing. Specific orthopedic concepts
have been developed for several diseases over time. By shoe FACTORS INFLUENCING
modification or use of different materials relief of affected
tendons, ligaments, joints, or hoof regions can be achieved to
THE CHOICE OF THE
support healing of a specific structure. In the best case, the ORTHOPEDIC MEASURE/
clinical situation of the patient improves by application of SHOE MODIFICATION
therapeutic shoeing. Still, the following questions are of To answer question 1, different factors have to be clarified
interest in the daily practice: before choice of treatment strategy.
Which orthopedic measure or shoe modifications fit for It is of main interest in which status of disorder the patient
the specific case? is initially presented for correct choice of shoeing or
To which extent can the shoe be modified/how strong can orthopedic measure. In my practice, I divide the presented
the modification be - how much is necessary to achieve the horses into:
intended effect and when do secondary damages have to be l acute disease or injury
expected due to unintended side effects of the treatment? l chronic disease or injury
How can side effects be reduced? l no healing possible
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l healing in progress welfare. Primary aims in the acute phase are
l successful rehabilitation with beginning load prevention of further damage, improvement of
and training the prognosis, and pain reduction in the context
l low-level, controlled load of animal welfare. The owner should be enlight-
l training and athletic use ened about risks and chances of success. The
expectations, compliance, and the financial limits
Dependent on the status of disorder different of the owner need to be clarified. There should
requirements and aims have priority. In the acute be an agreement about the extent of the thera-
status of disease/injury, collaboration between py. Particularly in the acute status of disorder
farrier and vet is crucial to identify the affected treatment intervals can be frequent, which means
structure. In addition, it is important to know high costs and effort for vet, farrier, and owner.
where the lesion is located, how big the structur- The chronic status of a disease/injury can
al damage is and how much functional insuffi- start days or weeks after the beginning of the
ciency exists. One of the most important factors disorder. For example, in the case of laminitis the
for future prognosis and therapeutical success is chronic status is defined with first observations of
the pain level of the patient. In some cases, an morphological changes at the hoof (rotation/
effective pain management is required to enable sinking of the distal phalanx…). Is the structural
orthopedic treatment of the patient and improve damage manifested (bone loss, arthrosis) or is
the prognosis. Manipulations at the hoof correlat- the lesion so extended, that neither conservative
ed with severe pain, or in cases when loading nor surgical treatment shows improvement
the contralateral limb is only possible with pain, (complete tendon ruptures), then the injury is
systemic pain killer or local anesthesia have to untreatable. Still, application of orthopedic
be administered in advance. Any painful treat- measures/therapeutic shoeing can enable a
ment without pain therapy is against animal worthy life to the animal. Relevant factors to
Each stage of
disorder has
an important
impact on
the choice of
each specific
orthopedic
measure.
t h e c l i n i c i a n february 2021 8
The chronic
status of
disease/injury
is the most
challenging
for the correct
application of
therapeutic
shoeing.
clarify before choice of treatment are: The next stage in the progress of rehabilita-
l stability of the injury/structural damage tion of the equine patient is the reintroduction into
(sinking of the distal phalanx after elimination use and training. Factors influencing the choice
of the cause for laminitis) of orthopedic measure/shoeing are the compli-
l is worsening of the damage expected ance and sensitivity of the owner, frequency
(arthrosis) and intensity of training, and management of
l different phases have to be expected the horse. in this phase, the main aim is to enable
(podotrochlosis) a sustainable use of the horse and minimizing
l pain level the risk of recurrence. In the end, athletic
l management and use of the horse longevity and sound performance of the horse
shall be given.
Main aims in the chronic status of disease/ The described stage of disorder has an
injury are improvement of animal welfare, important impact on the choice of each specific
stabilization of the damage and deceleration of orthopedic measure.
progress of the disorder. In many cases healing In the acute stage of disease/injury, horses
of the disease/injury is possible. For shoeing are in box rest or only controlled motion in walk
horses in this situation, it has to be considered in is permitted. To achieve a relief of the affected
which phase of rehabilitation the horse is and structure, more extreme modifications or mea-
how stable progress of healing is. In some cases, sures are possible to be applied due to static
conservative therapy and controlled locomotion management of the horse. However, it has to be
is enough to enable healing of the lesion (tendon considered that the extremer the manipulation is
lesions). In other cases, intermittent worsening of the higher are the unintended side effects. To a
the symptoms occurs (arthritis). Dependent on certain degree the use of cushion, pads, bandag-
this, the orthopedic measure/shoeing has to be es or painkillers can minimize these side effects.
selected to enable support of healing, to flexibly But most of the times it is impossible to fully
react to clinical changes, and to improve the compensate side effects, which limits the dura-
functionality of the hoof and the distal limb step tion of use of the orthopedic measure/shoeing.
by step. Anyway, even in the acute phase, positive
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equimanagement.com/the-business-of-practice-podcasttherapeutic influences should exceed the impact management of the horse becomes more
of negative side effects. Examples for quite dynamic.
extreme orthopedic manipulations in acute Usually, in the chronic phase of disorders,
phases of disorders are glued foal shoes for club patients move more and less controlled. In this
foot correction or application of pattern bar stage the orthopedic measures/shoeing has to
shoes for horses with severe deep digital flexor be adapted dependent on the keeping, manage-
tendon (DDFT) injuries. Glue shoes with a toe ment, and rehabilitation status of the horse.
extension are an effective measure to increase Modifications and manipulations become less
tension of the DDFT causing improvement of the extreme. Safety of the horse during locomotion
toe conformation, but on the other side they needs to be ensured. Side effects need to be
narrow the hoof capsule and cause pressure on minimized to enable long-term use of the treat-
the fine and thin part of it. Therefore, glue shoes ment. An example for the adaption of therapeutic
need to be changed after 7 – 16 days and the shoeing in the chronic phase is the use of a long
amount of extension needs to be adapted to eggbar shoe in the acute phase of tendon injury.
avoid damage of the hoof capsule and too much During the chronic phase and progress of
strain on the DDFT and the navicular region. The healing, the length of the bar should be reduced
use of a pattern bare shoe in adult horses and with increasing locomotion of the horse a
enables a very steep toe angulation combined change towards a shoe with extended heels until
with long palmar support which means optimal back to “standard shoeing” might be a good
relief of the DDFT. However, side effects are concept. In practice it is very common that horses
extreme load on the tip of the distal phalanx and are reintroduced to use and training much too
strain on the dorsal suspension of the distal early. In these cases, the treating vet/farrier
phalanx. In addition, there is a high risk of needs to enlighten about the increasing risks of
stepping into the shoe with the hinds when recurrence. Is the horse back to athletic use and
Application of
pads, packing,
soft wedge
pads, or light
bars can help
reduce the risk
of recurrence.
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duration of
specific shoe
modifications
for orthopedic
treatment is
limited as
long as it is
necessary
and useful.
competition, ideally no extreme modifications at recurrence. But in general, only sound horses
the shoes are present. Sometimes, application of should be competing with a good, discipline-spe-
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love of animals and the people who love them.disease/injury is the most challenging for the correct applica- heel wedges might have been required to reduce strain on
tion of therapeutic shoeing. In this phase, the treating vet and the DDFT and rotation of the distal phalanx. During the
farrier need to expect steady changes of the disorder towards chronic phase, lowering of the heels is indicated to reduce
positive or negative. In addition, side effects need to be strain on the dorsal hoof wall and the suspension of the distal
monitored critically, to avoid that secondary damages dash phalanx and to avoid bone loss of the tip of the distal pha-
first success of the treatment. Dependent on the progress of lanx. This recommended reorientation of the toe angle should
healing and the pain level, high flexibility in adaption of the not be done abruptly. particularly in horses which were
orthopedic measures is required. Quite often in practice, no shoed with heel wedges over a longer period, lowering of the
diagnostic control of the progress of healing is possible. heels should be done gradually dependent on the clinical
Clinical status of the horse (pain, lameness, secondary symptoms. In addition, side effects caused by wedges, such
damages) are the references for the choice and adaption of as crushed, overloaded heels, can be minimized by using soft
the orthopedic measure/shoeing. Furthermore, amount of wedge pads with frog support. Another example is the use of
motion and load of the animal (motion in walk, trot, controlled, eggbar shoes to increase palmar support in combination with
uncontrolled…) as well as management of the patient (pas- a change of toe angulation in horses affected by injuries of
ture, small paddock, bell boots, keeping alone or in groups…) the suspensory ligament. In the progress of healing with
play an important part for adaption of the treatment. increasing motion of the horse, reduction of the length and
For example, in the acute phase of laminitis, use of high the weight of the bar is recommended until application of a
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t h e c l i n i c i a n february 2021 16shoe with extended heels is enough. Tendon injuries or requires application of medicine, the management of the
disorders of the suspensory ligament in particular, often patient is adapted too (bed rest, no smoking, less load…)!
require changes between different versions of palmar support Success of the medical treatment is only given if the manage-
shoes and adaption of toe angulation. ment of the patient is supporting the treatment. It is all the
In general, the duration of the application of specific shoe same with the use of therapeutic shoeing. Just because a
modifications for orthopedic treatment is limited as long as it previous disorder needed the application of heel wedges or
is necessary and useful. each orthopedic measure/shoeing is eggbar shoes, it does not mean that the horse has to walk
equal to application of medicine (for example antibiotics). with it for the rest of its life. Eventually, secondary damages
Prescription of an antibiotic requires a specific diagnosis (for exceed the positive effects of the initial use of the shoes.
example pneumonia). However, it is known that the intake of a In the oral presentation, different disorders are presented
therapeutic drug causes an intended influence correlated in the context of the adaption of different orthopedic mea-
with unintended side effects (sickness…). These side effects sures/shoe modifications on the status of rehabilitation and
should be reduced and limit the duration of intake. Usually, management of the patient. I am looking forward to discuss
medication is adapted to the progress of healing and be- this topic with you!
comes less harmful (change of antibiotics to expectorants and
bronchial dilatators). After full reconvalescence, the medicine Acknowledgement: Friederike Leske
is discontinued. In addition, if a disease or injury exists which
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t h e c l i n i c i a n february 2021 17FARRIER
Lets Get Specific About Implementing
Bio-Mechanical Principles
By Stuart Muir Nzcef, Cjf, DipWcf, Apf
Resident Farrier, Rood and Riddle Equine Hospital
WITHIN THE PROFESSIONAL so far, especially when lameness enters the equation.
Lameness is one of the situations where Hoof Care
EQUINE COMMUNITY, there wouldn’t be
Providers require assistance in the form of diagnostic imaging
much debate in accepting that offering a multi-dimensional
from Veterinarians. Having the opportunity to take an inside
approach to equine therapy would bring value when an
look at the affected limb can give both professionals the
equine healthcare provider is hoping to expedite the healing
ability to reflect upon and/or redirect the shoeing plan.
process of differing equine lameness. The greater equine
Through MRI imaging, the equine Veterinary community
community has felt the benefit of the ever-evolving world
observed a large number of horses carrying multiple sites of
of Veterinary medicine and Farrier science, and there has
pathology, even within one limb (1). The Hoof Care Providers'
never been a time like this when both Veterinarians and
approach in navigating such lamenesses must be focused,
Farriers are looking to integrate their respective therapies
and the potential passive and negative consequences are
to combat lameness.
considered (2). After diagnostics are done, ensuring clear
Undoubtedly, both professions are seeing the value in
communication between the equine health care providers
working together. So, how do we continue to make the
is essential so all parties can appreciate the full extent
process of working together seamless and effective?
and detail of each individual lameness, and make the
As a Hoof Care Provider, I’ve spent hours doing personal
appropriate choices.
research and attending educational events to fully compre-
It’s not unusual that a shoeing package may be multifac-
hend and appreciate the therapeutic value of my craft and
eted in an attempt to address numerous concerns that are
profession. I strongly rely on my shoeing prescription to be
identified at the time of evaluation. Thin soles and hoof
relevant and specific to each case. And, while I can appreci-
capsule balance could be a good example of this. On one
ate all of the variables that come into play when a complicat-
hand, any additional toe length, outside of “normal”, redirects
ed shoeing case is presented, it’s the details of each case
stress and load to other structures within the distal limb. It is
that matter the most. Unfortunately, my interpretation of a
also common that the leveraging effect of toe length can, in
case, from an external point of view, is only going to get me
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*Psome instances, reduce the ability of horses to retain sole overdone it. I believe that’s the craft of Farriery; managing the
mass (3). For this reason, retaining structural integrity of the fluid nature of a deformable structure while trying to positively
foot while rehabilitating the balance issues could be consid- influence the distal limb with bio-mechanical applications
ered important. In this case, and others, Hoof Care Providers and principles.
will identify the hoof capsules' strongest structure, and try to We’ve all heard the term “balance” within the confines
redirect force or weight distribution to that location to alleviate of the industry. We hear sentences that include: Coffin Bone
compromised aspects of the foot. Angle (7), Hoof/Pastern Axis (7), and Shoeing Around The
Like any equine professional, Hoof Care Providers want Center of Rotation (8).. or is it Shoeing Around The Center
to see immediate improvement but experience tells us that of Articulation (8)? … They’re all talked about, so which one
that’s not always possible, or logical. Repair of the injury of is right?
hoof distortion is going to depend on the extent of damage to If you ask, Hoof Care Providers are divided at best as to
the structures we are targeting (4). In contrast, once Hoof Care which form of “balance" they adhere to. “Balance" is a vague
Providers do see an improvement, there’s also a chance that term and it doesn’t always reflect the true intention or the
we are going to want to change the shoeing package to concept of what Hoof Care Providers are trying to provide
reduce the therapeutic value, to allow compromised areas of when trimming or shoeing. One of the primary roles of a Hoof
the foot to rejuvenate. Care Provider is maintaining “balance” (6), and it can seem
almost unachievable for many professionals when the hoof
has been neglected, over-saturated, or simply distorted from
adapting to the overt symptoms of lameness. Sometimes,
The craft of Farriery is to manage
the fluid nature of a deformable
structure while trying to positively
influence the distal limb with
bio-mechanical applications
and principles.
adopting more of a pragmatic approach to foot care can be
advantageous, thereby artificially manipulating these horses
into a “balanced state”, but the hoof capsule remains, strong
The hoof capsule is well designed, and it is capable of and functional. We have to consider the capsules' primary
dispersing large amounts of energy efficiently (5). I believe all role of bone protection when we are using therapeutic
equine professionals can appreciate the value of altering or principles, so ensuring the capsule can perform to its
redirecting the forces that are dissipated to the capsule during full capacity is an item that needs careful thought and
locomotion to offset lameness issues. Having a healthy, consideration.
functional capsule will help distribute and disperse the Some Hoof Care Providers appreciate some trimming
vibrations caused through locomotion to their intended region principles over others. It may also depend on whether they
effectively. see the value of static balance or dynamic balance. Either
Hoof care fundamentals adhere to Newtons' 3rd Law, way, it is always worth asking your Hoof Care Provider
“For every action, there’s an equal and opposite reaction”. which principles they personally adhere to. At a minimum,
The hoof capsule won’t be slow in letting you know if you’ve this may help you see their point of view, and from there, you
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1 Data on file.
2 Adequan® i.m. Package Insert, Rev 1/19.
3 Burba DJ, Collier MA, DeBault LE, Hanson-Painton O, Thompson HC, Holder CL: In vivo kinetic study on uptake and distribution of intramuscular tritium-labeled polysulfated
glycosaminoglycan in equine body fluid compartments and articular cartilage in an osteochondral defect model. J Equine Vet Sci 1993; 13: 696-703.
4 Kim DY, Taylor HW, Moore RM, Paulsen DB, Cho DY. Articular chondrocyte apoptosis in equine osteoarthritis. The Veterinary Journal 2003; 166: 52-57.
5 McIlwraith CW, Frisbie DD, Kawcak CE, van Weeren PR. Joint Disease in the Horse.St. Louis, MO: Elsevier, 2016; 33-48.
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PP-AI-US-0372 02/2020can both make advancements with the shoeing concepts look like a disaster. But in my opinion, this hoof capsule
you want to employ. misalignment doesn’t always present the same. Sure, some
The goal of hoof capsule rehabilitation should be consid- horses have large amounts of vertical depth or foot mass left
ered a high priority when the horse is at a rehabilitation under the toe region, and these are easy to fix through
facility or taking a break from demanding work. A functional radiographically guided trimming. Others, not so much.
capsule is paramount to ensure that the vibrations caused Negative Palmar/Plantar Angle can often exhibit near destruc-
through locomotion are directed to the appropriate region tion of the Digital Cushion and Collateral Cartilage (4). These
and structures(4). We often see a reverse situation, where the cases can be very difficult to see any significant improvement
horse eventually becomes lame and the hoof capsule is and, can mean practitioners do not see the bigger picture of
considered a secondary problem. When in fact, it was preserving the internal composition of the foot. This is made
probably the exact opposite. If therapeutic concepts are used possible by creating short-term shoeing packages that aren’t
to facilitate rehabilitation, hoof care providers will have to sustainable over the long term. Approaching cases with a
leverage the capsules' structural integrity and physiology
against the bio-mechanical principles they are trying to
employ. Simple fundamentals of foot care can be contraindi-
The hoof capsules’ ability to
rehabilitate itself with professional
intervention can be significant C
when a Hoof Care Provider provides M
a shoeing package that is well Y
thought out and applied correctly.
CM
MY
CY
cated with the application of therapeutic concepts. Without CMY
addressing the primary issue of the capsules dysfunction first,
K
this approach to lameness management can yield poor
results for the horse long term.
In a positive context, the hoof capsules' ability to rehabili-
tate itself with professional intervention can be significant one-dimensional approach can ultimately lead to further
when a Hoof Care Provider provides a shoeing package that degeneration of the capsule and leave the horse with longer
is well thought out and applied correctly. In my opinion, I time frames of rehabilitation.
believe that is when the internal structures are still viable. Horseshoe manufacturers have flooded the market with
There seems to be a limit in terms of hoof capsule rehabilita- every option that hoof professionals could wish for. As
tion, where the capsule may have been mechanically competitive surfaces and training modalities have changed,
stressed beyond its physiological range and this can be so have the Hoof Care Providers' response to traction,
indicated when the hoof capsule is slow or doesn’t respond to break-over, support, and leverage (9). When it comes to
well-interpreted intervention. As equine health providers, we break-over or asymmetric shoes, the only question here is,
have to make a full evaluation of the hoof capsule to have “How much is appropriate, or how much is too much”?. Let’s
realistic expectations of the hoof capsules' ability to respond try and break this down into bite-sized pieces as therapeutic
favorably. foot care can be difficult to quantify because numerous
A case description that falls into this bracket could be factors need to be considered when applying any shoe.
Negative Palmar/Plantar Angle. Radiographically, these can Limb conformation, hoof type, and equine discipline,
t h e c l i n i c i a n february 2021 22coupled with the introduction of a specific lameness, are just I believe that Hoof Care Professionals and Veterinarians
a few of the considerations that Hoof Care Providers will hold two of the most valuable roles in the care and manage-
evaluate. Hopefully, all of these components can be man- ment of equine health. When these two parties work cohe-
aged within a single shoeing formula and they are considered sively together, the horse benefits exponentially.
complementary issues. Careful monitoring of unfavorable With that being said, all we have to do is pick up
changes to the lameness level and the hoof capsules re- the phone.
sponse may need to be navigated while the lameness is iden-
tified and treated. Yours, in equine health care,
When Hoof Care Providers approach a lameness case, it Stuart Muir Nzcef,Cjf ,DipWcf, Apf
is important that they use shoeing principles that meet the NEAEP Vice President
Resident Farrier, Rood and Riddle Equine Hospital
requirement of the horse, and the lameness level is managed
Lexington, Kentucky
appropriately. Soft tissue injuries are some of the most difficult
cases for Hoof Care Providers to create shoeing packages
for. This is can be attributed to contraindicated logic where
the shoeing plan may contradict some of the basic principles REFERENCES:
of Farriery (2). Again, we stare into the counterargument of 1. Dyson, S., Murray, R., Schramme, M. and Branch, M.
Newtons' 3rd Law, and Collateral Ligament injuries are a (2003), Magnetic resonance imaging of the equine foot:
good example of this. 15 horses. Equine Veterinary Journal, 35: 18-26.
One of the Hoof Care Providers' main targets, when they https://doi.org/10.2746/042516403775467531.
are trimming, is achieving medio-lateral balance (7), this is 2. Morrison,M.(2013).The Thoroughbred Racehorse
when the coffin bone is parallel to the ground surface. In Foot: Evaluation and Management of Common Problems.
theory, if we introduce an asymmetric shoe to a collateral Lexington, KY: Rood and Riddle Equine Hospital.
ligament strain or injury, basic medio-lateral balance princi- 3. Ramey,P.(2011).Care and Rehabilitation of the Equine
ples are challenged. This is due to the grounds interaction Foot, Georgia: Hoof Rehabilitation Publishing LLC.
with the shoes profile. The value of implementing asymmetric 4. Bowker,R.(2003).Contrasting Structural Morphologies
shoe shapes has to be considered against the subsequent of “Good” and “Bad” Footed Horses. East Lansing, MI:
change of the reorientation of force within the hoof capsule. Department of Pathology and Diagnostic Investigation,
Personally, I prefer to have a full understanding of the Michigan State University.
extent of each injury, and if progress is being made with the 5. Curtis,S.(2006).Corrective Farriery: a textbook of
therapies that are being applied during rehabilitation. In this remedial horseshoeing Volume Newmarket, Suffolk, UK:
context, if the pathology is showing signs of improvement, a R&W Communications.
reduction of the mechanical value of the shoeing package 6. Hickman,J and Humphrey,M.(1988).Hickmans
may need to be addressed also. Farriery: Second Edition. London, Great Britain:
Lameness rehabilitation can be multi-dimensional. J.A. Allen & Co. Ltd.
Managing equine lameness may require many professionals 7. Principles of Horse Shoeing. P3. Dr Doug Butler,
to come together to achieve a positive outcome. Ideally, all Jacob Butler.
the parties involved, can all meet at the same time to discuss 8. Duckett,D.(2008).The External Reference Points
the case. Being specific about the horses' progress, regard- of the Equine Hoof. The American Association of Equine
less of the injury, can only help expedite and reduce the Practitioners, 54th Annual Convention. San Diego, California:
timeframe when dealing with many common lameness Presentation.
anomalies. As professionals, as we progress into understand- 9. McClinchey, HL .Thomason, JJ. Runciman, RJ. (2004).
ing more about the technical aspects of rehabilitating equine Grip and Slippage of the Horses Hoof on Solid Substrates
athletes, inter-professional communication would ideally be measured ex Vivo. Ontario, Canada: Department of
as important as diagnostic imaging and foot care intervention. Biomedical Sciences University of Guelph.
t h e c l i n i c i a n february 2021 24Regenerative
therapy,
reimagined.
Easy to use Orthobiologics
at your fingertips
Learn more at hilltopbio.comBUILDING PARTNERSHIPS
Veterinarians Dealing with
Dissatisfied Clients
Compassionate listening and appropriate boundaries
are the key elements to successful management of client dissatisfaction.
By Amy L. Grice, VMD, MBA
Reprinted with permission of EquiManagement; sign up for our monthly newsletters at EquiManagement.com.
IF YOU ARE IN THE VETERINARY ers who get their issues successfully resolved tell about four
to six people about their experience.
PROFESSION for any length of time, sooner or later
In his book “Understanding Customers,” Ruby New-
you will encounter a client who is dissatisfied. This disgruntle-
ell-Legner stated that it takes 12 positive experiences to make
ment might be with lack of results after a treatment, the cost
up for one unresolved negative experience. Clearly, it is
of services, an interaction with your office staff, or with just
important to make a sincere effort to mitigate the complaints
about anything related to your practice. There are well-
of unhappy clients.
established methods for easing clients’ irritation, and most
The first step in resolving dissatisfaction is to know that
of them require taking a step back from the situation so you
it exists! According to a study by First Financial Training
can think clearly.
Services, 96% of unhappy customers don’t complain,
Clients can get rude or angry for many reasons, and
91% simply leave and never come back, and 5% suffer in
while some are justified, others are not. How you respond
resentful silence.
can make the difference between a client who feels satisfied
Consider polling your clients with a short survey about
with the resolution and one who vows never to use your
their satisfaction with your practice, utilizing a simple online
practice again and to tell all his or her friends about the bad
platform such as Survey Monkey. Examples of surveys can be
experience.
found on the AAEP Touch website.
Unfortunately, according to the White House Office of
Angry clients make their dissatisfaction easy to detect!
Consumer Affairs, a dissatisfied customer will tell between
That’s one positive thing about it. Another is that you might
nine to 15 people about his or her experience, and 13% of
discover some things about your practice’s performance that
customers will tell more than 20 people! In contrast, custom-
t h e c l i n i c i a n february 2021 26PHOTO CREDIT: ISTOCK
Compassionate
listening and
appropriate
boundaries are
key elements
to successful
management
of client
dissatisfaction.
you might never have known about otherwise. Because up to 90% of communication occurs
Adopt an attitude of openness about nonverbally, pay close attention to your body
learning where your practice’s performance is language! Maintain eye contact and a relaxed
failing to meet your clients’ expectations. It is posture, keeping your arms uncrossed. Actively
essential to be a good listener and make sure sympathize with the emotions the individual
your frustrated client feels heard. You must might have expressed. If an apology is in order,
remain calm and control your own emotions. If a express it with sincerity. If it is appropriate,
client starts yelling or being otherwise rude, there verbalize that you would never want your clients
is absolutely nothing to be gained by responding to feel the way this person feels. Respecting the
in a similar manner. However, setting boundaries client’s perspective goes a long way toward
is important. Utilize the phrase “I want to listen smoothing things over. Share your perspective
and try to resolve this issue, but you may not only after hearing the complaints of the client.
speak to my staff (or me) like that.” Compassionate listening and appropriate
An angry or dissatisfied client wants to be boundaries are the key elements to successful
heard and vent his or her emotions. By listening management of client dissatisfaction.
patiently, you can often defuse a situation, as
long as that person feels acknowledged. After EquiManagement offers free quarterly magazines,
the client has finished explaining his or her angst, online content, enewsletters, podcasts and more.
reflect back what you’ve heard and ask any Check out the Disease Du Jour podcast on equine
health issues.
clarifying questions.
t h e c l i n i c i a n february 2021 27FEBRUARY 2021 VOLUME 11, NUMBER 2
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