1 .

- Introduction:

The standard definition of abscess indicates that is a timely and localized accumulation of pus between two podal layers (dermis and
epidermis), produced as a body's response to severe tissue damage with or without an infectious process.

2 .- Causes of the appearance of an abscess:

As just discussed, hoof abscess appear for 2 reasons:

– There was a severe tissue damage. This dermal necrosis may have a source:

– Septic (The microorganisms can cause serious tissue damage when the animal is immunosuppressed, or when there is a lot of these
in the environment1. If this is not the case, we have to take in mind that the microorganisms, are usually opportunistic creatures
which take advantage of an existing tissue damage to proliferate).

– Traumatic (A strong impact on any part of the podal epidermis, a small pressure point on a thin sole that produces compression of
the solar dermis between the P3, the sole, and the external object, an injury that causes a discontinuity or fracture of the podal
epidermis, the introduction of an external body23, the presence of a horseshoe4 ... If the trauma is sufficiently large can cause what
is known as a sterile abscess or, which is the same, a non-infectious abscess).

– Toxic (The feet are the lower portion of the horse, and if we join other factors such as gravity, lack of constant movement, high
ambient temperatures, an inflammation of the podal dermis... we are going to be able to understand that fluids tend to accumulate
in them, and therefore the toxins that can be dissolved in them as well. These toxins can come directly from the diet or other factors
either directly or indirectly, gastrointestinal dysbiosis, insulin resistance, chemical applications as worming, antibiotics,
vaccines ...).

– There has been a tissue infection. As previously mentioned, the microorganisms that cause these infections are usually opportunistic and
take advantage of existing tissue damage. However, the origin of these microorganisms can be external (as by trauma or a fracture, the
podal dermis or corium is exposed to the environment or the foreign microorganisms are introduced to these tissues by a foreign body like
a nail, a splinter, a sharp stone, a problem of the white line ...) or internal (studies have shown that some of the gut microorganisms can
migrate into the bloodstream and reach the foot drop by gravity).

3 .- The mechanism for the appearance of an abscess:

Against any of these 2 situations, the body responds by activating the cascade of inflammation in the area. This cascade lead;
– Tumor and flushing of the area as well as presence of podal pulse (increase of the blood flow to the affected area)
– Pain (The nociceptive endings are activated to protect the area and prevent further traumatic injuries in the area)
– Heat (The temperature rises to accelerate the enzymatic reactions related to the healing process).

With the increased blood flow increases the influx of leukocytes to eliminate microorganisms in the area (primarily neutrophils) and
remove necrotic tissue (mostly macrophages), which will produce as a byproduct, the substance known as pus. The generation of pus
(keep in mind that it is a fluid substance), and the increased blood flow of the area, "causes" an expansion of the podal dermis or podal
corion5 which is rejected by the mere fact of being involved by a rigid structure (hoof or helmet). This fact leads to an increased
intracapsular pressure that triggers the following chain of events. This high intracapsular pressure activates the shunts arterio-venous or
AVA's, which are found throughout the podal corium, and diverts the arterial blood which passes from the artery to the vein without entering
the capillary network that supplies the dermis. This lessens the removal of toxins from the affected area, decreases the amount of nutrients
and leukocytes that reach the corium... and may increase the tissue necrosis and the severity of the injury.

This inflammatory process affects all coriums that make up the podal dermis and is known as supercoriatitis6, and as we have seen, the
abscesses are merely the byproduct (or symptom) of a supercoriatitis, mechanisms which are activated to a greater or lesser extent depending
the severity of the injury.

1 A horse whose feet are constantly in contact with urine and feces are exposed to an environment that weakens the protein structure of the
hoof capsule and in which there are a lot of highly pathogenic microorganisms that will take advantage of any opportunity to get into any
breach in the hoof where they will find the ideal environment to proliferate.
2 One possibility would be a hot nail, which occurs when the farrier introduces the nail near the podal dermis.
3 One of the most dangerous situations is the introduction of a sharp object (usually a pin) into the navicular bursa. When this happens the
organisms are introduced into the sac of fluid that makes up the bursa. The infection can move up the limb making treatment very
difficult and with a very bad prognosis (may lead to euthanasia of the animal).
4 The shoe drops about 70% of the blood supply of the hoof tissues, causing tissue necrosis by hypoxia. This means that in certain cases
(not common but can occur), when shoes are removed and the blood supply is restored, it "detected" tissue damage was "hidden" and
activate the inflammatory mechanism described in Section 3 of the article.
5 The union of all the coriums is named by Jaime Jackson, as supercorium.
6 Term coined by James Jackson to replace the word laminitis, since it only involves inflammation of a specific part of the dermis corium.
4 .- The self-healing mechanism or abscess auto-solution:

The equine foot has a security "mechanism" to easily deal with these problem. The foot, will
attempt to remove the pressure caused by the presence of pus through the removal of it
abroad. As the hoof is a “rigid” structure, the mechanism will, taking as guides the parietal
sheet, facilitate and guide the ascent of pus until it reaches the softer part of the foot,
the coronary band. Ones there, the pressure produced by the abscess on the coronary band,
will be very high (and painful) because has to break this layer of tissue to facilitate the pus
exit to the outside, causing an immediate reduction of pressure (the pain is drastically
reduced once the pus has gone outside).

In this picture, we can see an abscess that has been allowed to complete the self-healing process

5 .- The symptoms that appear in a horse with a foot abscess:

The symptoms can vary depending on whether it is an acute or a chronic abscess. Thus, an acute abscess (usually begins in the solear or
parietal coriums), is characterized by;

– A very sharp pain (usually prevents the horse of bearing weight on that limb and gets to walk with small jumps 7)
– Generalized or localized sweating in the affected limb.
– Increasing of the temperature of the lower extremity and podal pulse presence.
– Fever (only in very serious cases of abscess)

In these 2 pictures, we can see the typical posture of a horse with an abscess

Instead, in a chronic abscess (usually begins in the solear corium) these symptoms may not appear and is more typical to observe:

– Tenderness over rough floors (songs of river)

– Loss of thickness and / or the concavity of the sole
– Presence of black and smelly material in the angle of the bars, in the same bars, in the tip of the toe...

In the left image we can see an extremely invasive treatment applied by Ian Mckinlay (American famous farrier who treats race horses). In this foot, has
been removed all the epidermal skin of the heels, bars and angle of the sole, due to the presence of a subsolar abscess in the area. The lack of structure
required the application of a glue-on horseshoe.

In the right image we can see a subsolar abscess with the typical appearance, drained after performing a big hole about 5mm in diameter at the height of
the white line.

7 The foot tends to remain high and only maintains contact with the floor through the tip of the toe.
6.- What don't have to be done when we deal with an abscess:

Many farriers and veterinarians8 tend to use tweezers to try to detect the location of the abscess and, once done, make a aggressive and
invasive technique which consists in making a hole 9 in the hoof capsule to reach the podal dermis and facilitate the exit of pus causing a
drastic and instantaneous decrease of the pressure and pain. This treatment comes with antibiotics, vaccines and stall confinement. We have
to take in mind that;

– The tweezers, are an imprecise and harming tool because the vet or the farrier, are going to apply different amount of pressure each
time that they squeezes, and they can apply as much pressure as they wish, being able to cause damage and lesions in the inner
structures.

– The abscesses aren't easy to spot and is quite common to have to make several holes or increase their size to get the pus comes out.

– The artificial man-made hole, opens a channel through the hoof capsule, in an
area not designed for that 10, weakening its structural integrity over a long period
of time (the time depends on the area where drilling has been conducted and the
size of this. Generally speaking, the defect, remains there for a period of several
months; normally between 2 and 6 months).

– The hole, forces out the pus before the internal tissues are prepared and mature 11.

– The presence of a hole which is communicating the environment with the internal
structures, increases the risk of an external infection and tetanic attack (hence the
veterinary protocol indicates that should be given to the horse, antibiotics and
one dose of antitetanic vaccine12, and both are forms of toxins that can lead in
other problems and increase the tissular damage).

– The stall confinement will reduce drastically the movement of the horse. This
movement is essential to obtain rhythmic pressure on the inner structures and help
the pus of the abscess to drain in its totality. In other words, the reduction of the
horse's movement, will difficult the pus drainage and will increase the risk of the
development of a chronic abscess.

This picture shows an abscess closely related to a fracture of the podal epidermis, which has been drained manually. This foot will need about 8
months to recover the structural integrity of the hoof capsule (Image from the article Farmilo, David).

6 .- Recommended treatment:

We have to know, that providing the correct environment (naturalizating it) and facilitating the movement of the horse, the abscess will
resolve with itself in a few days without creating any risk of infection and or debilitating the hoof wall. To achieve that, we have to
implement the measures recommended by the care practitioner podiatrist. (this treatment is valid as long as the cause of the abscess has not
been a sharp foreign body. In these cases we must apply a strict protocol as it can commitment to reach the animal's life even if it infects the
navicular bursa and subtract importance).

7 .- Prevention:

The best way to prevent abscesses is to naturalize the environment, doing the following things:
– Keep the horse's feet in a clean and dry environment.
– Permit the horse movement 24 hours a day.
– Permit the horse to live with other horses.
– Base your horse's diet in quality hay forages
– Permit the horse to go barefoot and maintain frequent foot revisions by a certified member of the AANHCP
– Minimize external toxics (worming, antibiotics, vaccines ...)

8 I want to make clear that making a hole to drain an abscess has to be done only by the veterinarian, not by the farrier. That's because the
ablation of the hoof capsule is seen for the veterinary medicine as a surgical procedure.
9 Making a hole in the hoof capsule is contraindicated for the reasons stated at this point, but its effects are even worse when they are large
(more than 2mm in diameter) or when they are made with inadequate instruments (curettes and / or equipment not sanitized).
10 The self-healing mechanism is designed to drain the abscess through the appearance of a crack in the coronary band and / or bulbs. So the
foot is able to maintain the structural integrity of the hoof capsule.
11 All healing process is ongoing and requires a certain time. Speeding up the events before the tissues are prepared, simply causes tissue
stress and has more drawbacks than advantages.
12 Keep in mind that both antibiotics and vaccines are external toxics that can cause physiological imbalances in the bodies on which are applied. This does
not mean that they cannot be applied, what means is that they must be applied only when is strictly necessary. If we don't make any hole in the hoof to
drain the abscess, the vaccines are not going to be necessaries and the antibiotics will be only necessaries for the big and important abscesses.
Abstract:

When there's an injury and, therefore, a tissue necrosis in the corium (due to trauma, pressure absorption by an inoperable hoof mechanism,
infiltration of microorganisms, poisoning, lack of foot care and occurrence of cracks, fractures of the epidermis...) appears an inflammation
of the supercorium (supercoriatitis) that allows the immune system to send more white cells in large amounts to clean up damaged tissue
and / or fight against opportunistic organisms (from external or internal sources). This process has as a byproduct the pus.

When the lesion is small, the swelling is small and the chorion is able to absorb the pus produced, but when the lesion is large, a ball of pus
and gas compresses the nearest corium, poducing the necrosis of it, increasing the initial injury and producing much pain. The abscess,
which is held between the dermis and epidermis, usually migrate within the equine foot looking for a weak point where go outside. This
weakness is in the healthy hooves the coronary band13.

If the abscess was not caused by a foreign body that has penetrated into the equine foot and could affect the navicular bursa, the only thing
we have to do is naturalize the environment and let the abscess do its course (the horse will be a few more days in pain but the recovery
process will faster) and follow the indications of the care practitioner podiatrist.

References:

1.- Carelse, Michele; Natural help for hoof abscesses

2.- Broomhall, Natalie (MA, DVM ); Post-Hoof Abscess Treatment
3.- Danvers Child, CF, RJF; Hoof Abscess
4.- Farmilo, David (Accredited Master Farrier); The Hoof Abscess
5.- Frosty Franklin (DVM); Hoof abscesses
6.- Harris, John (DVM); Hoof Wall Ablation by Using a Cast Cutter (1997)
7.- Kc La pierre; Hoof Abscesses (formation program)
8.- Pollit; Fluorescence in situ hybridization analysis of hindgut bacteria associated with the development of equine laminitis (2007).
9.- Posnikoff, Janice (DVM ): Horse Hoof Abscess

13 When the foot is not healthy or the trims are very aggressive and weaken any part of the hoof, an abscess can find more feasible to go outside at that
point and avoid using the coronary band.