Last Updated on March 29, 2022 by Allison Price
Laminitis and other conditions that could affect the feet of horses include navicular disease (puncture wounds), infections, keratomas, pedal osteitisis, keratomas, keratomas, laminitis.
Bone Cyst in Pedal Bone
Long-term lameness can be caused by a large cyst in the pedal bone (the dital phalanx). This may cause severe pain and unresponsiveness to anti-inflammatory medication. Cysts are most commonly diagnosed in young horses (between 1 and 3 years of age), but can also be found in older horses. This rare condition can be caused by trauma, or another developmental disorder. Your veterinarian may confirm the diagnosis by administering regional analgesia, x-rays, or computed tomography (CT) scans. Secondary fractures can occur when the pedal bone becomes weaker over time. Depending on the location of the cyst, surgery can be done either through the hoof wall or endoscopy (arthroscopy). Some horses can return to their performance level after surgery while others may be used for more strenuous activities such as breeding.
Corns and Bruised Sole
Bruising to the sole of your foot is usually caused by injury from stones, uneven ground, or another trauma. Poor shoeing, particularly in horses with flat feet and dropped soles can increase the chance of bruising. Bruising is usually located around the outer edge of the sole or near the toe. Depending on the severity of the bruising, it may be associated with lameness. The sole can appear normal, or it may feel reddening or swollen. Untreated, the area can become infected (subsolar abscess).
A corn bruise is a type that occurs in the sole at the buttress, which is the angle between the bar and the wall. It’s most common on the inner buttress’ forefeet. Corns can be caused by pressure on the sole from a shoe’s heel that has been left on too long or was not properly placed. Corns can also be caused by shoes that are too tight at the quarters, or too small.
You can have dry corns with mild inflammation or moist corns with severe inflammation and clear fluid oozing out. They may also release pus if they become infected. The sole of the feet may appear discolored, reddish or yellowish, and sometimes lameness can occur in the supporting leg. Pressure applied with hoof testers can cause pain or discomfort. A corn that is not treated promptly can lead to a pus-filled tract (the coronet) where the hoof’s horn meets the skin.
There are good chances of recovery. For simple bruises and dry corns, the first thing to do is to release pressure from the area. Pressure can be relieved by shortening the toes or wearing a suitable type of shoe (such a three-quarter-bar-bar shoe). To allow for continued drainage, a corn that has produced pus should be surgically drain and then bandaged. The wound may need to be cleaned by your veterinarian every one to two days. You should cover the sole until it is completely covered. The horse should also be kept in a clean, dry box stall. Horses with dropped soles may benefit from protective shoes that are wide-webbed and have a concave top.
Canker refers to an infection or overgrowth of the horn-producing tissues of the foot (epithelium). It affects the tough, flexible pad at the bottom of the sole (the “frog”) and the sole. It is often obvious that there is pus. It is not known what causes it. It is often thought that horses living in unsanitary or moist environments are at risk. However, it can also be found in well-cared for horses.
Canker can be found both in the front and back feet. It is usually found in the back of the frog, and can be seen as fronds or a cauliflower-like growth. The thick, foul-smelling fluid covers the affected tissues. It can spread to the sole or wall of the hoof. There is no tendency for it to heal.
The intensive treatment must be carried out. It is important to remove all affected tissue and loose horn. An antiseptic or antibiotic dressing should be applied every day. To allow healing to occur, it is important that the wound be kept clean and dry. This can take several weeks or even months. You should be watching closely for abnormal regrowth during the healing process. It must be treated immediately if it occurs.
Contracted heels are most common in the forefeets of light horses. This condition could be caused by poor shoeing, which draws in the quarters. This can prevent hoof expansion and proper frog pressure. Horses with dry hooves, excessive scraping of the wall, or trimming of the bars are more likely to develop contracted heels. This condition can also be caused by a hoof-immobilizing shoes, such as the one used to fracture the third phalanx (pedalbone).
The heel contracture causes the frog to be narrower and more shrunken. Bars may also become curved or nearly parallel when they are pressed together. Quarters and heels are constricted and pulled in. The hoofhorn is hard and dry. Heat may be felt around the quarters and heels. Horses that are ridden at high speeds may become lame and their stride lengths will be reduced.
It is difficult to predict the outcome of recovery. Advanced cases may take six to twelve months for recovery. To promote swelling and moisture, the most important aspects of treatment are to moisten the feet. You can do this by soaking your feet in water for 10-14 days, then corrective shoeing. Use hoof-moisturizing products containing oils or waxy substances with care. They can trap water in the hoof. Hoof expansion is promoted by slipper shoes that have no more than three nails per branch. Avoid quarter clips and the fourth nail on your shoe.
To help expand the heels, a veterinarian can thin the quarters and groove the walls parallel with the coronet. The procedure can be repeated as the quarters expand.
Fracture of the Navicular bone
The navicular bones are a small but important bone that is located behind the coffin joint in the foot. It can fracture due to trauma or a jarring injury. It could also fracture due to navicular diseases. The cause of the problem is not always clear. Fracture in the navicular bone, which is less common than the pedal bone, is more common in the forelimb. Although pain can vary, a hoof tester will usually be able to locate the exact location of fractures. Lameness can persist. The diagnosis can be confirmed by X-rays or regional analgesia.
The best treatment is to rest for a while and do some corrective trimming. However, the fracture rarely heals completely and the outlook is not good. The chances of recovery are improved by surgical repair with lag screws.
Fracture of the Pedal Bone
Pedal bone fractures, also known as fracture of the third or coffin bone, distal phalanx or os pedis, can occur either at high speed (for instance, during a race), or from kicks to a solid object (such a stall wall). A jarring injury can cause sudden lameness. If the fracture extends into the adjacent joint, the lameness can be severe. Fractures that are not confined to the joint but through the wing (flatside) of the pedal bones may cause less severe lameness. Fractures of the pedal bone are more common in the forelimb, but they can also occur in the hindlimb.
Horses that break their pedal bones immediately become lame. Pain can be caused by pressing the foot with hoof testers. Pain can also be caused by tapping the foot with a hammer or turning the horse so that it pivots on the injured leg. If the fracture extends beyond the joint, lameness can improve significantly after 48 hours of stall sleep.
Regional analgesia is used to confirm diagnosis. X-rays are also used to confirm the diagnosis. Because the fracture may only be a small area at this stage, x-ray confirmation can be difficult. For confirmation of the fracture and to determine its extent, it may be necessary to repeat the x-ray several weeks or days later. If xrays fail to confirm the existence of a fracture in the bone, scintigraphy (MRI) or magnetic resonance imaging may be required.
For fractures not involving the joint, conservative treatment is typically sufficient. Although the horse should be back to normal, x-rays will still show that there is a fracture. To limit the expansion and contraction of your heels, it is common to use a straight-bar shoe with a clip at each quarter. Young horses less than three years old usually recover from fractures in the joint. A 12-month rest period is recommended. For horses older than three years, the chances of recovery are less good. It is highly recommended that a bone screw be surgically inserted. Infection is a common problem. Infection can cause fractures that heal quickly, but it is important to remove the screw at another surgery in order to return the horse to full working condition. Some horses may also be able to have a part of their local nerve surgically removed.
Keratoma refers to a thickened, hardened area in the horn that is located between the pedal bone (or hoof wall) and the toe. It is not known what causes it. It usually develops at the level the coronary band, but it can be difficult to spot until the growth has advanced. The bulging can be seen in the coronary bands or the hoof wall above the keratoma depending on where it is located within the foot. The growth has moved the white line toward the center of horse’s sole by inspecting the forefoot. The pedal bone can be affected by the pressure of the mass. It is possible to remove the mass surgically.
Two types of laminae are found in the horse’s feet. The sensitive laminae attach to the pedal bone. The insensitive laminae is the tissue layer just below the hard exterior of a hoof. Laminitis can be described as “inflammation in the laminae” and refers to either acute (short-term) inflammation or chronic (long-term) inflammation. Laminitis may develop in one of the four feet (the forefeet), or all four feet. A single foot can have support limb laminitis. This is usually due to a bone injury or severe lameness in the opposite limb.
When cells on the insensitive or sensitive laminae fail attachment to the sensitive, it is called acute laminitis. Failure of laminar attachments can cause catastrophic displacement of the pedal bones because the laminae suspend it within the hoof. Displacement can be caused by the heavy horse weight and pull from the flexor tendon. The pedal bone may rotate, sink or tilt within the hoof. A hole could form in the sole of your foot if rotation continues.
Laminitis is thought to be caused by three diseases: 1) bacteria and bacterial toxins that spread through blood (called endotoxemia and sepsis, respectively), 2) hormonal disorders such as the equine metabolic disorder and 3) pain in the limb opposite the body. Ingestion of excessive grain, excessive exercise, or repetitive trauma are the most common causes. Generalized infections, ingestions of heartwood shavings of black walnut, retained placenta following foal delivery, colitis, colic and treatment with corticosteroids or other medications are all possible causes. Horses that are obese and overweight are at higher risk. A flush of fresh grass tends to increase the incidence of acute laminitis.
Signs and Diagnosis
Acute, subacute, and chronic laminitis are all possible. Acute Laminitis is the initial few days of founder, before any displacement occurs. Subacute Laminitis refers to founder that lasts longer than three days and does not result in displacement of the pedal bones. Chronic Laminitis refers to horses suffering from pedal bone displacement.
Acute laminitis is characterized by a horse that is depressed, has no appetite and struggles to stand. Horses with acute laminitis resist exercise and try to lose weight. It will walk slowly, crouching and short stride if forced to. Once the foot is lifted, it must be lowered as fast as possible.
Heat is usually felt throughout the hoof, particularly near the coronary bands. Pressure can reveal tenderness in the feet and cause muscle trembling. At this stage, lameness can be moderate to severe. Rotation evidence can be seen on X-rays as early as the third or fourth day. Laminitis causes horses to have high vital signs such as elevated body temperature, heart rate and respiration. A blood-stained discharge can seep from the coronary band in severe cases where the prospects of recovery are not good.
Subacute cases may show any of the above symptoms, but in a less severe form. A mild change in stance may be seen, along with some reluctance or difficulty walking and increased sensitivity to the soles of the feet. Acute or subacute episodes of laminitis can occur at different times and may become a chronic condition.
Chronic laminitis can cause horses to be extremely lame, and they may spend a lot more time lying down. Chronic laminitis is characterized by changes to the hoof shape over time. These cases usually occur after one or more acute attacks. The hoof may develop irregular horn growths (laminitic rings), and the hoof may become narrower and elongated. The wall may be almost vertical at its top (nearer the coronary band) or horizontal at the bottom, (nearer the sole). The sole becomes thicker and begins to curve or flatten outward as the condition progresses. Standing, the horse constantly shifts its weight from one foot towards the other. The X-rays show rotation of the pedal bone and a very porous state. The bone’s top is forced down and presses against the sole. It may even poke through the sole in severe cases.
A medical history is required to diagnose laminitis. This includes any possible contributing factors such as excessive grain intake. A physical exam will examine the horse’s posture, hooves and refusal to move. Regional analgesia (local nerve blocks) might also be useful. To determine if the pedal bone has been displaced, X-rays may be necessary. A x-ray of the feet affected can identify mild cases without visible hoof defects.
Outlook and Treatment
Because pedal displacement can happen quickly, acute laminitis should be considered a medical emergency. Your veterinarian should be contacted immediately if you suspect laminitis.
To reduce inflammation and pain, your veterinarian may recommend nonsteroidal anti-inflammatory medication. Other pain relievers might also be required. Corticosteroids should not be administered. Acepromazine, a different drug, may increase blood flow to the laminae. Please follow the instructions for prescribing.
The treatment of the laminae by cooling the affected foot with ice water (called digital hyperthermia) can help protect them early in horses that are at high risk of developing septic leprosy. This therapy may be appropriate for your horse if it is recommended by your veterinarian.
Standard shoes should be removed for the first 2-3 weeks. Shoes place most stress on the hoof wall, and consequently the laminae. To reduce pressure on the front hoof, the soles and feet should be cushioned with a soft, flexible material that is flexible. Laminitic horses should not be shod in metal shoes until 3-4 weeks after the onset. The laminar structure might be stabilizing. Type of displacement will determine the type of shoe. Once shoeing is not an option, your veterinarian will recommend the appropriate type.
Chronic laminitis can be treated by restoring the rotation of the coffin bone. This involves corrective hoof trimming, shoeing with a suitable shoe (such as Steward clogs, egg-bar shoes, heart-bar shoes, natural balance shoes or heart-bar shoes), and ensuring that the rotation of the coffin bone is normal.
There are two options: severing the deep digital tendon (tenotomy), and removing a portion of the separated hoof wall. In cases of chronic rotation, deep digital flexor tendotomy is performed. To stabilize the pedal bone following surgery, it is necessary to use heel wedges or another technique. Resections of the hoof wall are less common than they were in the past. Because of instability in the hoof, only a small amount of the hoof wall can be removed.
Despite prompt treatment, there is no hope of recovery. It is important to keep the horse safe until the recovery process is complete.
The navicular disease, also known as Navicular Disease, is a degenerative long-term condition that affects the navicular bones and bursa. It causes damage to the navicular bone and cartilage, as well as destruction of the bone’s surface, flexor tendon breakdown, and abnormal bone growth at the border of the bone. It is a complicated disease process that can lead to a variety of complications. It is the leading cause of forelimb paralysis in long-term athletic horses. It is virtually unknown in donkeys and ponies.
Although the exact cause of this disease is not known, it could be due to increased pressure in the navicular bone or its blood supply. This is a common disease in the older riding horses. It usually does not appear until around 8-10 years of age. Some breeds are more susceptible to Navicular Disease, such as Warmblood horses and Quarter horses and Thoroughbreds, while others, such as Arabians or Friesians, are less common. A jarring injury or trauma, along with poor shoeing and conformation in the lower limbs, could also contribute to this condition.
Navicular disease usually develops slowly and is often subtly fatal. Both the forefeet and hindfoot can be affected. The disease can cause lameness that may appear and disappear quickly. A shorter stride may cause the horse to stumble more often. A tight circle can cause a temporary worsening in lameness. Common complaints of shoulder lameness include soreness in the shoulders due to changes in gait and posture.
A thorough history and physical examination are required to diagnose the condition. You can treat the lameness in one limb with regional pain relief. It may also be apparent in the other limb. The navicular bone may be affected by degenerative changes. This could include abnormal bone growths and bone reshaping.
The condition can be treated in horses, but it cannot be cured. Rest is advised for severe lameness. To restore normal bone alignment and balance, foot care should include trimming and shoeing. Some horses may be able to live longer if they have good foot care. Corticosteroids may be injected into the bursa or coffin joint to relieve pain, but it is not curative.
The surgical removal of a portion of the palmardigital nerve (“denerving”) can provide pain relief and extend the horse’s usefulness, but it should not be considered curative. There are severe complications that can accompany surgical nerve removal, such as the formation of a painful tumor or rupture of a deep digital flexor tendon.
Although the outlook for recovery is not good, a well-planned treatment plan can help horses stay healthy. Some athletes may be able to temporarily return to competitive status. Most horses that are affected by treatment eventually stop responding to it after a few months or years.
When x-rays show that the coffin bone has lost its mineral content, pedal osteitis can be diagnosed. The cause of this bone loss is usually long-term pressure or repeated trauma. Multiple jarring injuries, persistent corns, laminitis and chronic bruised soles are all possible causes. Pedal osteosteitis is a common condition in performance horses. It is often associated with hard track work.
The bone loss is permanent so the presence of pedal osteosteitis on xrays does not necessarily indicate a problem. A thorough exam will be performed by your veterinarian. Lameness might not be apparent. You may notice a stuttering or shuffle action in front. There might also be discomfort in the hoof area. Tapping and pressure from hoof testers can reveal tenderness across the sole if there is inflammation. The source of the problem can be identified by local nerve blocks ( region analgesia). X-rays can help diagnose this condition and differentiate it from other similar conditions.
The treatment involves treating the underlying condition. The treatment may include long rest, anti-inflammatory medication, and careful footwear to alleviate sole pressure. Although the outlook for recovery is uncertain and dependent on the underlying condition of the horse, proper management can extend the life expectancy of many horses.
Puncture Wounds for the Foot
Puncture wounds are often caused by poor horse-shoeing techniques, but they can also occur when a horse steps onto a foreign object that penetrates the horse’s foot. Nail binding means that a nail was driven too close to the sensitive foot structures, causing extreme pain and lameness. Nail puncture refers to the piercing of the connective tissue layer beneath the skin’s outer layer.
Foreign objects can enter the sole of your foot and cause infection. Subsolar abscess is a pocket of pus and infection that can easily form. A puncture wound can cause severe lameness, especially if the foot is heavy. The degree of lameness could be comparable to that caused by a fracture. Horses may be able to stand and point at the affected foot. The affected foot may feel warmer to the touch and experience increased pain. The infection could progress to the heart, where it can swell or rupture. The fluid builds up in the fetlock and pastern areas, which can then swell and become fluidy. To diagnose, you will need to pull the shoe and apply hoof testers. Then, you’ll need to trim the area in question to find the foreign object or entry point.
Many times, puncture wounds near or in the frog can penetrate important structures within your foot, such as the coffin joint, the navicular Bursa, and the tendon sheath for the deep digital flexor tendon. This infection can be very serious and needs immediate treatment. X-rays are a good way to identify the affected structures.
Nail bind and nail piping require prompt treatment with disinfectants or poultices. Abscesses can be prevented by ensuring adequate wound drainage. If a pricked foot is diagnosed early, there is a good chance of recovery. The treatment time for an abscess below the sole of a foot may be extended. The outlook for recovery is not good if the infection has spread to the joints.
Every foreign object should be removed and found. The infected area must then be trimmed with a hoof knife for drainage. Your veterinarian may recommend that you flush the abscess every 1 to 2 day for multiple treatments. You should protect your foot by wearing a boot or rubber boot until the site heals completely. The wound will heal faster and more quickly if it is through the sole rather than the wall. Tetanus should be vaccinated for all horses that have puncture wounds. Regional analgesia is a temporary treatment for severe pain. If the infection is well-drained and localized, antibiotic treatment is not required. If the coronary band is damaged, however, antibiotics may be necessary. Emergency surgery is required for deep punctures of the foot that are involving the deep digital flexor tendon or navicular bones.
Fractured extensor process (Pyramidal Disease, Buttress Foot).
The extensor process of the pedal (coffin bone) bone is located in the front portion near the coronary bands. It can be fractured by trauma, osteochondrosis or improper bone formation. More often than the hindlimbs, the forelimbs are affected. Lameness may be caused by bone fragments from the fracture. Secondary arthritis can occur because the extensor process is near the coffin joint. Untreated fractures that are large can lead to an increase in the area of the toe above the coronet. This can create a “buttress foot”, or a pyramidal appearance to your foot.
An injection or mouth-to-mouth anti-inflammatory medication may prove beneficial. The surgery to remove the broken pieces was successful. A good prognosis is possible for small pieces that can be removed with an endoscope (arthroscopy).
Quittor refers to a chronic (chronic) inflammation in the cartilage of a pedal bone. It is characterised by the death of cartilage and one or several sinus tracts that extend from the diseased cartilage through skin. Although it is rare today, it was once common with draft horses.
Most cases of injury to the coronet/pastern causes infection in the deep tissues. This results in a pus-filled abscess. A crack in the hoof wall can also cause quittor. First, there is inflammation of the cartilage. Then comes the formation and drainage tracts. Lameness can occur during the inflammation stage.
Most cases of successful surgery to remove diseased cartilage and tissue are successful. Without surgery, drug treatment is most likely to fail. The cartilage will eventually die without drainage and treatment. Abscesses can recur, and then spread to deeper structures, causing long-term lameness. The chances of recovery are not good if there is severe damage to the distal phalangeal or coffin joint.
Sandcrack (Toe Crack, Quarter Crack, Heel Crack)
Cracks in the wall are found in sandcrack. They start at the coronet and run down to the hoof. The cracks are thought to be caused by excessive pressure on the hoof wall or the coronary band. It could also be caused by inappropriate shoeing, such as using a small or delayed resetting shoe.
Sandcrack is most evident when there is a crack in the coronet’s horn. Lameness can vary depending on the extent and site of the injury. Infections may cause lameness and bloody or pus-filled discharges.
Corrective shoeing is used to correct the weight distribution. Bar shoes are often recommended. The crack can then be cleaned by a veterinarian. An antiseptic can be used if the crack has become infected. A veterinarian can also use surgical wires, putty, screws and/or drains to stabilize the crack. The hoof is then wrapped until new horn formation becomes apparent.
Scratches (Greasy Heel).
Scratches (also known as greasy heel) is a chronic inflammation of the skin that causes the rear surface of your pastern and fetlock to enlarge and release fluid. Although it is often associated with poor stable hygiene and other factors, no cause has been identified. Draft horses and heavy horses are more susceptible than others. The hindlimbs are most commonly affected. Standardbreds are often affected by wet tracks in spring. Scratches have been linked to the common use of limestone at racetracks.
If the pastern’s “feather” is hidden, scuffs may not be noticed. Itchy, sensitive and swelling are common in the initial stages. Later, however, the skin thickens and loses any shorter hairs that remain upright. The skin’s surface is soft and the grayish-colored discharge has a rotten smell. Small masses of tissue, known as granulomas, may develop if the condition is not treated. Although lameness is not always present, it could be serious if the inflamed tissue beneath the skin becomes infected. The skin in the affected areas will thicken and become harder as the condition progresses.
A persistent and aggressive approach is often successful. The treatment involves removing the hair, washing with warm water and soap to clean any soft discharge, drying and then applying an astringent. A veterinarian can remove granulomas if they appear. Deep infections require whole-body antibiotics as well as vaccination against Tetanus.
White Line Disease (Seedy Toe Hollow Wall)
White line disease, also known as seedy toe, is characterized by the separation of the hoof walls. It is likely that abnormal foot shape or trimming causes the separation (e.g., long toes, overrun heels, etc.). It can occur at the heel, quarters or toes. Similar to laminitis, dislocation of the pedal bone may occur. Although the outer surface of a wall appears sound, a cavity can be found between the hoof wall & the laminae on the solar surface. This cavity can be infected by microorganisms. Tapping on the outer wall of the toe creates a hollow sound that covers the affected area. Although rare, lameness can occur when there is an infection, abscess or displacement of the pedal bones.
A physical exam and x-rays are used to diagnose the condition. Corrective trimming is essential to correct abnormal stresses in the hoof wall. The hoof wall that has separated will most likely be removed. A topical antiseptic may be recommended by your veterinarian. Corrective footwear (e.g. a heart-bar or egg-bar shoe) can be very helpful to give support to the rest of the foot and relieve stress.
Sheared heels can cause a serious imbalance in the foot by uneven heels. The problem is often accompanied by hoof cracks, deep cracks in the heels (bulbs), and an infection of thrush. Sheared heels can be caused by abnormal pressure placed on one side or the foot. This is usually due to abnormal confirmation of the leg and foot. It is possible to have navicular disease at the same moment.
Corrective trimming and shoeing may help restore balance and alignment of the feet. It is recommended to use a full-bar shoe with a diagonal reinforcement bar to support the heel and affected quarter. Multiple shoe resets will be necessary to make any improvement. If corrective measures are applied consistently until new hoof growth occurs, there is a good chance of recovery in simple cases.
Sidebone refers to the hardening or calcification of the cartilage in the coffin (pedal), bone. It is most common in horses with heavy forefeets who work on hard surfaces. It is also common in jumpers and hunters, but it is uncommon in racing Thoroughbreds. The most common cause is repeated jarring injuries to your feet. Sidebone can also be caused by improper shoe fitting that restricts normal movement of the quarters. Direct trauma can also cause sidebone.
Lameness is rarely caused by sidebone. Lameness is more common in those with a narrower or contracted foot. Sidebone problems such as navicular diseases or diabetes can also lead to lameness. Walking the horse down a slope or a shorter stride can increase the pain.
Although nerve blocks and examination can be used to diagnose sidebone, x-rays may be required for confirmation. Corrective shoeing can be used to correct lameness and protect the foot from injury. The wall may be expanded by grooving your hooves.
Thrush is a condition that causes frog degeneration and secondary bacterial infections. Some blame poor hygiene and poor management, but it’s more likely that poor conformation or trimming the feet and lack of exercise are to blame. When the horse’s weight pushes down on the hoof and other structures, exercise may be able to clean it out. Horses with sheared heels can also get thrush (see above). Thrush is more common on the hind feet. The affected area may have a thick, blackish discharge and a distinctive foul odor. It is possible that tissue near the borders of the frog could be dead. These symptoms alone can be used to diagnose the problem.
Dry, clean material should be used underfoot. The hoof should also be cleaned, including any softened horn. After removing the diseased tissue, an astringent lotion can be used to aid in recovery. The affected horses should be placed on a regular exercise program in a dry area. The frog may recover by wearing a bar shoe once the disease is over. Thrush can be caused by moist environments. With the right changes in footwear and exercise, recovery is possible.