Managing the lame cow – moving beyond the cure

Delivering workshops that aim to enhance farmer understanding of the bovine hoof is a key part of my job, and I have recently been lucky enough to facilitate a range of farmer meetings across the country – all with the aim of tackling lameness, and implementing the early detection and prompt effective treatment principle.

This principle is a key component of the Agriculture and Horticulture Development Board (AHDB) Healthy Feet Programme, which aims to help farmers reduce lameness levels in their herd.

During these meetings, the producers present really challenged me with questions around the process of applying orthopaedic blocks to treat claw horn lesions (CHL) and it has become apparent some knowledge gaps still exist.

The enquiries have most commonly been focused on what to do if the cow has lesions on both claws, how to create a substantial height difference between the two claws, and finally, how to keep the cow as comfortable as we can while it is in a state of recovery.

 The last point raised several thoughts in my head around how, historically, most of the research has focused on a particular end result for the cow – that is, “cure” or “not cure” – and not so much on the process of curing. We have seen a massive advancement in the treatment options available for CHL and digital dermatitis (DD) in the past 10 years, ranging from improved hoof trimming technique, to an increased range of orthopaedic blocks and including the evidence base around ketoprofen usage.

Each of these tools can give benefit to the cow if we can implement them properly. This implementation requires a degree of judgement by those delivering the treatment and requires training and experience.

Hoof trimming technique

Advances in our understanding of hoof trimming technique are encouraging a much more holistic approach to the investigation of lameness.

The proactive use of hoof testers diminishes the requirement of horn to be removed to search for lesions, meaning the functionality of the hoof can be preserved (Pedersen and Wilson, 2021). Hoof testers are an essential piece of kit for anyone who trims cows’ hooves. They should be used to not only investigate lameness, but also to check claw health before an orthopaedic block is applied.

By not taking “search cuts” when trimming and preserving functional horn, we are ensuring the hoof can work to its optimum during the healing process, whether that be on the healthy or diseased claw.

Implementing the deeper, wider model has been shown across several studies to be of benefit to the housed cow, with studies identifying a reduction in sole ulceration (SU) and white line disease when it is implemented (Stoddard, 2018; Sadiq et al, 2021). However, this technique also presents a benefit in the identification of lameness causing lesions at their earliest stages.

As we remove horn from the typical sole ulcer site, we are removing old horn and working our way closer to the newest deposition of horn the cow has laid down. This allows us to identify very early-stage sole bruising (SB) with an aim to treat if the animal is sensitive to hoof testers.

Identifying this stage of disease, and treating it proactively, is primarily a much more positive approach for the cow, with no open CHL present and less pain associated with potential treatment routes, but it is also a more positive experience for the individual treating the lame animal. The treatment of SB requires much less delicate knife work than, say, removing loose horn around an SU, and so, the likelihood of error derived from the individual treating the animal is low. This is also a much quicker process for the operator to carry out than the trimming of horn around open CHLs.

Orthopaedic block application

Many orthopaedic blocks and adhesive glues are now commercially available to us, each presenting an approach to CHLs that allows us to optimise not only the cure rate, but also the comfort of the cow while it is under treatment.

Making decisions around which block to apply can present challenges, but fundamentally, the condition affecting the claw, the site of the CHL and the environment the cow is managed in all need to be considered. More severe lesions take a longer time to heal, and so will require longer-lasting blocks (such as plastic/rubber blocks).

Lesions affecting the toe require a larger height difference to elevate them from the ground relative to lesions at the typical ulcer site.

If the animal is housed on sand cubicles, or in a high wear environment, then a more durable block may present benefit. If both claws have a challenge present, then using softer blocks may be preferable.

All these factors tie together to allow us to optimise block longevity and cow comfort for each individual case; we can also manipulate these factors by altering the application technique.

Block placement is critical to ensuring the cow will return to normal mobility as quickly as possible (cows can walk soundly if blocks are selected and placed appropriately). Pitching the block so its axial aspect is creating a larger height difference than its abaxial aspect will ensure that an optimum height difference is created (this can be achieved by grinding down the axial aspect of the block face).

Placing the block sufficiently far enough back on the healthy claw is also important in ensuring the cow will walk stably on the block (especially for toe lesions). When placing the block, also make sure that glue coverage is adequate to form a stable adhesive surface.

However, a common pitfall when applying block is leaving ridges of glue between the block and the heel of the healthy claw – this presents a potential challenge to the claw and can create sub-optimal mobility immediately, if not lameness.

Adhesives for use with orthopaedic blocks have also been changing rapidly over the past 10 years, with most commercial trimmers now working with two-part epoxy based resins, which set more quickly, and are mixed more evenly and efficiently.

 Some of these glues will have a degree of flex to them, offering a more forgiving surface for the cow to walk on. Furthermore, some blocking systems promote block retention through completely covering the toe of the cow with adhesive, giving a larger surface area for the block to be attached to.

It is important to remember that modern blocks and adhesives are designed to ensure the block stays on for as long as it needs to, and so re-checking these animals to remove the block (if required) is essential.

NSAIDs

Despite robust, positive evidence, the uptake of ketoprofen has been relatively slow in the UK.

The evidence base for ketoprofen usage informs us that its proactive usage (particularly in heifers) improves cure rates, reduces the risk of future lameness and reduces the risk of cull (Wilson et al, 2022). However, another factor that should be heavily considered is the welfare impact of proactive ketoprofen usage.

Evidence exists to demonstrate that animals receiving ketoprofen as part of a lameness treatment protocol experience less pain than those treated with just a therapeutic trim and an orthopaedic block (Whay et al, 2005; Sadiq et al, 2022).

Indeed, the cure rate achieved by Thomas et al (2015) identified that those animals receiving a trim and ketoprofen as a lameness treatment had a higher cure rate than those receiving a trim and an orthopaedic block, highlighting its importance in mitigating the effects of CHLs. We also have evidence to support its usage in the treatment of DD, with animals receiving ketoprofen at treatment having an improved cure rate and also giving more milk if treated when freshly calved (Kasiora et al, 2022).

We need to move away from just simply providing external management of CHLs and DD through the use of therapeutic trimming, orthopaedic block application, or application of topical agents for DD. To optimise cow welfare and comfort, we need to also provide alleviation from the intrinsic inflammatory nature of CHLs and tackle both the disease process and the pain associated with it.

Summary

Lameness treatments, and our evidence base around them, have developed in a rapid fashion in recent years, and will continue to do so.

By undergoing training to be an AHDB mobility mentor, I became acutely aware of the rate of change in the “lameness world”, which makes it an exciting environment to work in.

We must endeavour to utilise as many tools as possible to not only cure the lame cow, but to improve its welfare immediately post-treatment. Ketoprofen is now a key part of this protocol and can help to target not only the inflammation associated with the disease process, but also any pain. Vets, farmers and foot trimmers must work together to create a positive welfare outcome for the dairy cow – not just establish a cure.