Foot health: how vets can be better involved

I must be having fun, because time flies – each December seems to come around faster and faster, which is good, because I love mince pies, Santa Claus, our annual crib service with its real live donkey and everything else that comes with Christmas time.

Another thing that comes around each December, though, is the renewal of my Register of Mobility Scorer (RoMS) membership. For this, I need to pay a small subscription fee, but more unnervingly, submit myself for the annual calibration test. This consists of watching a series of short video clips of cows walking, and then trying to correctly score them 0 (sound) to 3 (severely lame).

This is all the more daunting because I am a RoMS trainer myself, so to fail would be especially awkward. Thankfully, this year, I passed again, and this means that I am RoMS accredited for another 12 months – phew. But I did not achieve 100%. Perhaps this demonstrates the usefulness of this annual recalibration exercise – however “expert” we might feel we are at spotting lame cows.

The RoMS initiative for mobility scorers is not perfect: unintentional or intentional bias may still creep in – especially when being asked to score a herd for a farm assurance scheme. However, being RoMS trained and accredited is a step in the right direction to get mobility scorers singing from the same song sheet as far as possible, and to help more people recognise the early signs of lameness as effectively as possible.

Healthy Feet Programme

Mobility scoring is an essential part of the Agriculture and Horticulture Development Board (AHDB) Healthy Feet Programme (HFP), which was first launched in 2011. It followed extensive research at the University of Bristol (the Healthy Feet Project) in how to successfully help farmers reduce their lameness.

The HFP is delivered by “mobility mentors”, who are specially trained in herd lameness control and advisory skills. Most mobility mentors are vets, and this is the gateway for farm vets to become better equipped to improve foot health. Mobility mentors must now also be accredited with the RoMS.

The HFP has been extensively “road-tested”, demonstrating that it works. Since its inception more than 10 years ago, AHDB-funded research has further enhanced our understanding of lameness reduction. Now entering its second phase, a refreshed HFP offers better tools, clearer materials and new mobility mentor training.

To find out more about training to become a mobility mentor, visit www.bcva.org.uk/cpd/mobility-mentor-training

Using EDPET

“EDPET” as a term certainly seems to be gaining currency. I hear farmers using the word nowadays, and not only in the context of foot health. It is an acronym for “early detection, prompt effective treatment”, and is one of the four HFP Success Factors (https://ahdb.org.uk/healthy-feet).

Each of five words in the acronym is equally important, and to miss one element means it will not work.

A detection system needs to be in place, which is easier said than done. For the vast majority of farms, this means mobility scoring. Technology may one day replace a human being and their eyes for this job; a few exciting developments exist here, but we are not quite there yet. The mobility scorer should be trained, and as aforementioned, accredited.

Mobility scoring is for two distinct purposes: measuring foot health at a herd level (including for farm assurance) and for EDPET. The former is best done by someone independent and a quarterly basis is probably sufficient for most herds. For EDPET, the scoring must be done more frequently, and that means a trained individual within the farm team is usually most appropriate for this. Typically, fortnightly is a good compromise between resources and early enough detection.

The evidence is that without a dedicated and regular early detection protocol, new cases are not treated promptly at all. Groenevelt et al (2014) found that when farmers were left to their own devices, new lame cases were either entirely missed or, if they were treated, it was after a delay of a mean 38 days. As might be expected, this significantly affected the success of treatment, the recovery time and the recurrence rate.

Improving treatments

The “effective treatment” part of EDPET should not be underestimated or assumed. I would say we are still learning what the most effective treatment actually looks like for the various different foot lesions of cattle.

Foot trimming – even by trained professionals and according to a recognised protocol – can be variable (Åkerström and Thelezhenko, 2022). Add in to the mix that most treatments are carried out on farm by personnel who have often received no or little training, and almost no accreditation of standards, and the picture becomes ever-more cloudy.

The principles of treatment of claw horn lesions are reasonably well established – to remove weight from the affected claw, using orthopaedic blocks if necessary – but the finer details are not always clear.

For infectious diseases of the skin – digital dermatitis being the most prevalent and epidemiologically important – debridement and treatment with a suitable and licensed biocide is the generally accepted method.

However, again, disagreement exists over the details, including whether to use bandages (and for the record, this author says “not”). Beyond these basic principles, further research continuously guides us towards more effective treatment options. Suffice to say, for example, we probably need to be using NSAIDs more readily in all early treatment instances (Kasiora et al, 2022; Wilson et al, 2022), whether that be for claw horn lesions or digital dermatitis.

To improve the quality of treatments and foot care on farm, the BCVA has joined forces with professional foot trimmers at the Cattle Hoof Care Standards Board (CHCSB) to create a Lantra-approved training programme for farmers and farm workers. This is an ambitious, but timely, initiative. BCVA’s view is that, alongside the need for more qualified hoof trimmers, dairy farms should ensure at least one person who is competent in the recognition and treatment of lameness is present on every farm.

The approach to trimming and treatment has changed in the past 20 years, so it is important that everyone treating a lame cow is using the latest evidence-based approach. The courses, which will be delivered by vets in conjunction with foot trimmers – both of whom have suitable training, qualifications and Lantra accreditation – will teach new skills and also refresh existing ones. Vets can learn more at www.bcva.org.uk/content/bcva-accredited-foot-health-trainer

Motivation

That foot health is important for dairy herds is a given. Lameness is the most costly of all endemic health disorders; it causes reputational damage and is a welfare problem.

Nationally, around one-in-three dairy cows is lame (score 2 or 3), and this is similar in other countries, too. As a vet who has been working in the dairy sector for many years, I say with confidence that if any farm vet wants to make a difference to their dairy clients’ success, or to the welfare of the cows cared for by the vet practice, they would do well to concentrate on foot health.

Working to improve foot health is professionally satisfying, too. The threads of foot health run through all aspects of a dairy farm enterprise. That includes nutrition (because thin cows go lame); stockperson skills; cow flow; time budgets; building design; fertility; transition cow management; teamwork; and breeding policy.

If a vet concentrates on improving foot health, they will inevitably be pulling on all of these threads and will simultaneously see improvements in multiple areas of health, production and sustainability on the farm. A planned and continued approach will be appreciated by the business owners – and you will never be short of work.

No reason exists why every vet working with dairy farms would not benefit from becoming a mobility mentor and an RoMS-accredited mobility scorer. Increasingly, these accomplishments are being recognised as foundation stones for the dairy practitioner, and are valued by practices here and abroad.

Teamwork

Anecdotally, vets have sometimes felt left out of the loop when it comes to foot health. This has probably coincided with an increase in the role of the professional trimmer.

Certainly, in my working lifetime, I have seen a large shift whereupon 25 years ago, it was usual for vets to be asked to treat lame cows during the routine farm visit and now it has become a rarity. More recent graduates can feel disenfranchised, and their only exposure to practical foot care is for radical surgery or digit amputation, when others have failed to effect a cure. The reality is that maintaining foot health is now more of a team effort. It is difficult for a farm vet to compete with a professional trimmer using equipment costing tens of thousands of pounds, and who does the job every hour of every working day.

However, no reason exists for vet practices not to get involved. An increasing number employ their own paraprofessional trimmer(s), which naturally fosters a more collaborative approach. Even without this, however, vets can (and should) be integral components of the foot health team, concentrating on strategy, monitoring and prevention, rather than the everyday physical task of trimming.

Cramer and Wynands (2022) described a project in Minnesota, US, which involved active collaboration of multiple advisors – vets, nutritionists and trimmers – through facilitated group meetings to improve foot health on their clients’ farms. Participants shared predominantly positive views towards the project, and voiced appreciation about the quality of discussions and opportunity to connect with other advisors. Challenges remained around farmer engagement and trust between different advisors, but this work is just one example of how dairy farms and their vets are adapting to a changing landscape around foot health and teamwork.

Almost inevitably, this brings us back to the HFP again, and the value of becoming a mobility mentor. The actual role of the mobility mentor is to show leadership in improving foot health and this usually involves building a foot health team, which might include the farmer, the trimmer, an RoMS mobility scorer and the farm workers.

The HFP provides the framework around which this teamwork can take place, and the mobility mentor training helps to develop the vet’s skills and confidence to do so.

Summary

Foot health on dairy farms is a vital element of the modern dairy vet’s work. The HFP is the established framework with which to undertake this work. Farm vets need to be trained to deliver this (mobility mentors) and the training is highly recommended.

In addition, mobility scoring by RoMS-accredited scorers is the predominant way of measuring and monitoring foot health in the UK. Mobility mentors must be RoMS-accredited scorers as part of their role, but other personnel, including paraprofessionals and “vet techs”, can become trained and subsequently RoMS accredited.

Foot health involves teamwork. Mobility mentors are the obvious people to take the lead and they are supported to do so. A new initiative for appropriately trained mobility mentor vets to lead on-farm training in practical hoof care has recently been announced by the BCVA.