A surgical solution

At the veterinary clinic, Andreas Klohnen, DVM, took over Raye’s case. “I used Dr. Sobeck’s radiographs,” he says. “They had been taken only a few hours previously and were quiet clear, so there was no need to take them again.”

On the images, Klohnen noticed a dark shadow on the coffin bone, suggesting the nail tip was indeed touching and had damaged the bone. “It looked like it had been there for some time and a bit of infection had begun,” he says. A slight digital pulse and heat in the foot confirmed an infection in the early stages. The nail head was also near where the deep flexor tendon attaches to the bone, but there didn’t appear to be damage to that area.

“It was very interesting that this mare wasn’t lame,” says Klohnen. “Why wasn’t she when other horses would have been toe-touching, fracture-like lame? It’s an abscess-like sensation that causes the intense pain, so perhaps any fluid was somehow running through the tract out of the hoof and not building up. Or perhaps she’s just very stoic. She was a bit off, but not nearly as lame as I would have expected her to be.”

Raye was quickly prepped for surgery. With the mare unconscious and on the surgical table, Klohnen began to work. “Cutting into the hoof with a blade is extremely difficult,” he says. “So, after we scrubbed the hoof the best as we could, we used a cautery unit to actually just burn through the hoof sole and into the tissue. It’s cauterizing as it’s cutting, so it also limits the amount of bleeding.”

Klohnen left the nail in place and cut a large oval around it as he worked deeper into the hoof. “By leaving it in place, you can make sure you are going exactly along the route the nail took,” he says, “and that you go as deep as necessary. You are also cleaning and debriding the area as you go.” Once the entire tract had been widened, the nail fell free.

Because the nail had reached the coffin bone, Klohnen then used an instrument called a curette to scrape away at its surface. “We gently clean the bone until the surface is nice and white with no signs of injured or infected bone,” he says. He also visually confirmed that the flexor tendon had not been compromised or injured by the nail.

Once that was done, Klohnen flushed the tract repeatedly with sterile saline solution. “If the nail hadn’t reached the bone, we may have flushed the wound with Betadine,” he says. “But that is too harsh for bone, so we used large amounts of saline instead.” The clinicians then packed the cleaned wound with gauze soaked in a triple antibiotic solution and bandaged the entire hoof before bringing Raye out of anesthesia.

Nestrick watched the entire surgery

from an overhead viewing area. “My experience with small animals made me just knowledgeable enough to really worry,” she says. “But the practice owner came in and assured me she was fine. I was expecting her to be really lame when she recovered, but she wasn’t. She was walking around on that hoof like nothing had happened.”

Raye stayed at the clinic for the next 10 days, finishing a course of systemic antibiotics and receiving anti-inflammatory medications. The bandage on her hoof and the packing inside the wound were changed daily. “The wound needs to heal from the inside out,” explains Klohnen. “So we watch as the depths fill in with nice, pink granulation tissue. And we pack less and less in as needed.”

Once back home, Nestrick took over caring for Raye’s healing hoof, which was sometimes logistically challenging. But Raye never took a lame step. “It can take months for a hoof to heal completely,” explains Sobeck. “Even after the wound itself fills in, it has to shrink and dry and harden. Then it goes through primary cornification, where it turns into the type of tissue you find on the horse’s sole. Then it enters the final stage, where that tissue hardens. We will keep her with a pad under the shoe for a long time for all of that to happen.”

The promising outlook for Raye is a direct result from Nestrick’s remembering and heeding Sobeck’s warning to not remove nails found in hooves and to seek immediate veterinary attention.

“If she had pulled the nail and said, ‘Let’s just see what happens,’ things probably would have gone much differently,” says Klohnen. “I suspect that over the next 48 to 72 hours, the infection would have started raging and the mare would have become painfully lame. Then we would still have had to do all the same things in regard to surgery and aftercare, but it would have been much harder and much more expensive with less chance of a favorable outcome.”

In the end, Sobeck’s Facebook post about Raye’s hoof had nearly 250 comments and 20 shares with many of those who had said they’d pull the nail reversing their position when they learned more about the risks. “This is something I’m always going to be warning people about,” says Sobeck, “and obviously there are still people that need to hear it: Don’t pull the nail out. Call your veterinarian.”

The radiographs revealed a dark shadow on the coffin bone that suggested the nail tip was indeed touching and had damaged the bone.