When a horse steps on a nail it is a true emergency. Not only can a puncture wound damage important parts of the hoof, but it provides a pathway for dangerous bacteria that can lead to terrible infections.

The lead photo for this blog was sent to me by a friend. Her horse came up lame at the end of a hunter pace. She immediately dismounted and checked his hoof, but no puncture wound was visible. After two more days, when the horse didn’t recover, she called the vet. The x-ray revealed that the nail had gone entirely into his hoof, with no part of it protruding. I will cut to the chase and let you know that her horse recovered and is sound again, but spent nearly a month at a veterinary clinic fighting a serious infection. His survival, at times, was touch and go.

What should you do when your horse steps on a nail?

If you discover your horse has stepped on a nail, your first thought may be to pull it out. Don’t. The first thing you should do is take photos of the area — especially if the nail is protruding from the hoof — and call your vet so they can recommend what to do next.

Because of the pressure placed on the nail by the weight of the horse and the density of the internal structures of the hoof, the nail can bend as it enters and take an unexpected angle. If your vet can come and x-ray the hoof, they have a much better idea of the entry wound and how far the nail traveled into the hoof. In the case of my friend’s horse, the x-ray revealed the nail and after blocking the hoof, the end of the nail protruded far enough that the vet was able to pull it out. What she found was an old, rusty horse shoe nail. Most likely it had come from a lost shoe buried in the mud.

As you can see from the cross section of the hoof, there are many vital structures in a horse’s hoof. My friend was extremely lucky that the nail didn’t physically damage any of the internal structures, but even though the wound was cleaned and soaked, and the horse started on antibiotics, the nail trapped a ton of bacteria and it created a serious infection.

She opted to move him to the clinic so they could care for the wound and continue with aggressive treatments. After several more days, the infection burst out the coronary band. At this point, the clinic turned to a more experimental treatment – transdermal carbon dioxide therapy, a treatment based on the benefits of bathing in carbon dioxide rich waters.

Transdermal Cabon Dioxide Therapy

The carbon dioxide treatment used by the vet is called RespiDox. According to the company website, it uses pharmaceutical CO2 to mix and vaporize with warm water into a therapeutic gas-mist which is enclosed around the therapy site in a sealed and safe environment. This sealed atmosphere maximizes the continuous transfer of gas into the tissue for the full twenty to twenty five minute therapy cycle.

Clinical research has shown positive effects of transcutaneous pharmaceutical carbon dioxide in the treatment of peripheral vascular disease, exercise endurance, skin grafts, wound healing, muscle disuse, tumorigenesis, bone fractures, and laminitis.

Transdermal pharmaceutical carbon dioxide dramatically increases tissue blood flow and oxygenation through a physiological process called the Bohr Effect. “Increases in tissue carbon dioxide directly activates the biologic cascade leading to angiogenesis. Angiogenesis is the natural process whereby new blood vessels are formed. New blood vessels are needed when the metabolic demand outstrips the delivery of oxygenated blood (e.g. during heavy exercise) and when tissue is stressed, or damaged, and therefore needs new blood vessels to heal and form fresh new tissue.“

Does it work? It certainly helped my friend’s horse who is sound and back in work.

Have you ever had to deal with a nail in your horse’s hoof?