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FROM THE HOOFCARE & LAMENESS ARCHIVES

Laminitis Therapy: Do's and Don'ts for Equine Practitioners

Robert A. Eustace founded the Laminitis Clinic at the veterinary college of the University of Bristol in England in 1988. He is the author of the new handbook Explaining Laminitis and its Prevention, and will present new findings on laminitis therapy at the Newmarket Lameness Seminar in Cambridge, England in August.

Referral cases of laminitis are brought to Dr. Eustace for evaluation, treatment or longterm therapy. Seeing a large number of laminitic horses has provided Dr. Eustace with data for general recommendations on acute or chronic founder therapy.

DO... Treat laminitis with the same urgency as colic.  

DO... Remove or treat the cause. Laminitis requires a combination of medical, shoeing and sometimes surgical treatments.

DO... Palpate the coronary bands of all feet and provide frog support on your first visit. Frog support may be in the form of a roll of bandage, Lily Pad, heart-bar shoe, or plastic heart-bar shoe.

DO... Provide the animal with a deep bed and allow it to lie down if it wants to.

DO... Use ACP ("ace" or acepromazine) in combination with frog support. This will allow you to prescribe a lower dosage of NSAID (nonsteroidal anti-inflammatory). The toxic side effects of NSAIDs are important, particularly to ponies and sick or elderly horses.

DO... Provide frog support to high-risk, non-laminitic horses. Fracture or severe sepsis cases that cause nonweightbearing lameness require support on the opposite limb. It is tedious (to say the least) to spend hours in surgery on fracture or colic cases to have them founder ten days later.

DO... Radiograph the feet with markers if the animals shows the same or an increased level of pain three days after the onset of laminitis.

DO... Consider the relative heights of the coronary band and extensor process on radiographs. These indicators provide more prognostic relevance than "rotation" of the distal phalanx.

DO... Attend with the farrier if a dorsal wall resection is necessary. Veterinary supervision is required, even though this should be a painless and bloodless procedure. Only a veterinary surgeon may perform surgery on a horse.  

DO... Consider the use of a securely fitting muzzle as a management aid in dieting ponies. With a muzzle, they may be allowed turnout exercise without the risk of overeating. 

DO... Be wary of fitting heart-bar shoes on animals receiving analgesic drugs, which may mask normal response to excessive shoe pressure.

DO... Encourage clients to insure their horses with a reputable company to cover veterinary fees, and hospitalization in severe cases.

DO... Consider early referral of unresponsive cases.  

DON'T... use corticosteroids.

DON'T... force exercise on a laminitic horse. Exercise was thought to be beneficial in that it would increase blood flow to the foot. However, there is already a tremendous increase in the blood flow to the foot, yet little or no perfusion of the dermal laminae. No amount of exercise will improve this situation. Exercise may well mechanically tear the remaining laminae, thereby worsening the founder condition.

DON'T... remove large amounts of heel from acute founder cases. This includes chronic founder Type 1 cases that are suffering a secondary acute attack of laminitis. Heel removal in the acute phase increases tension on the deep digital flexor tendon and may result in more "rotation". Test trimming parameters by placing a wedge that is equivalent to the amount of heel to be removed beneath the toe of the foot. Lift the opposite limb. If the animal is more uncomfortable or if a depression appears at the dorsal coronary band, leave the heel alone.

DON'T... remove the shoes if the animal has a flat or convex sole, unless it is to replace them with heart-bar shoes. The horse will be more uncomfortable if it has to stand on its sole.

DON'T... fit any shoe other than a correctly fitting heart-bar shoe on a foundered horse. If the animal has foundered, the distal phalanx is loose within the hoof capsule. The higher you raise the distal phalanx from the ground with nonsupporting shoes, the more distance the bone has to move downwards.

DON'T... fit any devise that applies pressure to the sole of the foot. The sole is not designed as a weightbearing structure and will easily bruise and abscess.

DON'T... take nonweightbearing radiographs. They are of little prognostic value.

DON'T... ask farriers to fit heart-bar shoes unless you can provide good radiographs taken with markers. Good farriers will legitimately refuse without proper radiographs.

DON'T... forget to mark on the frog where you placed the drawing pin. If the farrier cannot appreciate where the pin was placed, he or she is unable to fit the shoe.

DON'T... cut holes in the sole of laminitis or acute founder cases. This will result in granulating solar corium protruding through the hole, which will be difficult to control. If there is subsolar fluid present, provide drainage through the dorsal wall at the level of the wall-sole junction. The horny sole is your biggest ally in treating laminitis and acute founder.

DON'T... ask the farrier to fit pads. You cannot evaluate the sole, and the sole will become wet with trapped solar evaporation. Any sole pressure will further compromise the blood flow within the foot and cause pain.

DON'T... fight to nail shoes onto horses in severe pain. There are effective glueon alternatives available to you. (See Eustace shoe, Hoofcare and Lameness #914.)  

DON'T... repeat prescriptions of NSAIDs without revisiting the horse. An acute laminitis case that is in significant pain after ten days probably requires a change in treatment or management.

DON'T... use nerve blocks to reduce the horse's pain. Walking on painless feet may cause further mechanical damage to already-compromised laminae. Nerve blocks may affect the neuronal control of digital arteriovenous anastomoses and potentiate digital ischaemia.

DON'T... hope that antibiotics will help either "gravel" or post-founder abscesses. Only when drainage has been provided will the lameness improve.

DON'T... tell the owner the starve the animal. Some people would literally do that. Feed according to the animal's body condition. Hay and bran is a poor diet for animals. If the animal needs to be restricted, do so gradually, with a combination of alfalfa chop, straw chop, and hay. Use caution dieting very fat or pregnant ponies; they may develop hyperlipeimia, which is often more serious than the original laminitis.

DON'T... think that solar prolapse caused by movement of the distal phalanx means the end of a horse's working life. It is the means by which the prolapse has occurred (i.e., the amount of distal displacement) that is important.

Proper and timely application of frog support through the use of a heart-bar shoe facilitates the foot's stabilization following acute laminitis.

Palpation and radiographic monitoring of the coronary band and extensor process may be more relevant in prognosis than so-called "rotation" of the distal phalanx.
Caption for drawings on "Dos and Donts" article

Examine closely these schematic representations of sagittal sections of two equine digits. The upper drawing (a) shows reverse rotation of the hoof whereas the lower drawing (b) shows true rotation of the distal phalanx (P3) relative to the proximal phalanges. The degree of rotation as described by Stick et al (1982) is the same in both drawings.

This article originally appeared in Hoofcare & Lameness: The Journal of Equine Foot Science and is available for your personal use only. Re-publication is prohibited without the express written permission of Hoofcare & Lameness.

Detailed information on this and many other hoofcare topics can be found in Hoofcare & Lameness publisher Fran Jurga's award-winning guide to hoofcare, "Understanding the Equine Foot".  

For more information, or to order, click here

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