Trail Emergency! A Nail in His Hoof

By Javier Donatelli, DVM

You’re out for a trail ride with friends on a beautiful, sunny spring day. One minute everything is fine, suddenly your horse comes up very lame, not wanting to put any weight on his hind foot, except occasionally resting his toe. Your riding partners don’t see anything obvious, so you hop off to investigate further. When you pick up your horse’s affected hoof, you are horrified to find a rusty nail sticking out of his sole.

While a hoof puncture can happen in the pasture or barn just as easily as on a trail, being away from the barn complicates the situation because it’s harder for your vet to reach your horse. Even if she can get to you, her ability to X-ray the hoof to see the track of the nail before it’s removed—the preferred diagnostic method—is compromised due to lack of electricity.

To handle this potential emergency, follow these steps:

1. First and most importantly, DON’T pull out the nail. Note exactly where it’s located, what angle it entered the sole and how deep it penetrated. If you have access to a camera (standard on most cell phones), take a photo of the bottom of his hoof showing the exact location of the embedded nail.
2. Call your veterinarian. Ideally, you want to wait for your vet to reach you so she can remove the nail herself, allowing her to discern whether or not it has damaged any critical structures, such as the navicular bone, a tendon or joint.
3. If your vet cannot reach you on the trail, you will need to pull out the nail before you can walk your horse home. Most nails can be easily pulled out by hand. As you remove it, again carefully note the angle of entry and how deep it penetrated the sole.
4. After removing the nail, but before putting your horse’s hoof on the ground, use the camera to take another photo while you hold the nail parallel to
   

   If you must remove a nail from your horse's hoof, use a camera to note where it was located.

   your horse’s sole with the tip pointing toward the location of penetration and indicating the depth with your fingers (see photo right).

5. If you have access to a wrap, such as a polo bandage, wrap it around your horse’s hoof and sole to keep the nail hole as clean as possible.
6. Lead your horse back to the barn on foot. Do not ride.

Once your vet arrives, here’s what to expect:

1. She will use a sharp hoof knife to dig around the nail hole to expose the track to the air. This helps decrease the chance your horse contracts tetanus, a neurological infection caused by deadly Clostridium tetani, anaerobic bacteria that live in the soil and may have contaminated the nail.
2. If your vet determines that the puncture is uncomplicated, that is, it did not puncture any critical structures, she will treat the injury like she would an abscess: She may soak the affected hoof in hot water and Epsom salts, apply an ointment, such as ichthammol, to draw out any infection and then wrap the hoof to keep it clean.
3. Finally, she will administer a wide-spectrum antibiotic to stave off infection as well as an anti-inflammatory to decrease pain and inflammation. She will also give your horse a tetanus booster.

Complications from a nail puncture can range from something as simple as abscess or as severe as a career-ending injury if it has pierced one of the sensitive structures in the hoof. If your vet determines that one of these structures has been affected, she will refer your horse to a veterinary hospital for immediate and aggressive treatment.

Javier Donatelli, DVM, of Poolesville, Maryland, runs a private equine veterinary practice, Javier Donatelli Equine Veterinarian LLC. He specializes in lameness, dentistry and general medicine. He has done extensive work for many local horse rescues, and he is an EPIC Business Member. Dr. Donatelli can be reached at javdonatelli@hotmail.com or by phone at (301) 330-5035 (office) or (240) 676-1990 (cell).