Rehabilitating Chronically Laminitic Feet

How veterinarians and farriers manage the chronically laminitic foot can often determine whether that horse can live a useful, relatively pain-free life. During the Sept. 17-18 Laminitis West Conference in Monterey, Calif., Bob Agne, DVM, an equine podiatrist at Rood & Riddle Equine Hospital in Lexington, Ky., discussed how the Rood & Riddle podiatry team approaches such cases.

Agne first assesses the foot, particularly noting whether the coffin bone is stable or unstable within the hoof. His treatment goals are to:

  • Address the underlying cause of the laminitis, if known;
  • Re-establish vascular perfusion (healthy blood flow) to the dorsal solar corium (the inner tissues from which the sole grows) to encourage sole growth;
  • Encourage healthy wall growth from the entire coronary band;
  • Protect and unload lesions; and
  • Treat any infections.

Agne recommended using radiographs to help farriers determine the proper trim for such horses. While many different types of shoes have been found to help achieve the therapeutic goals, Agne said the type of shoe isn't as important as finding the proper trim and establishing good therapeutic mechanics.

Hoof Cast

Applying a hoof cast is one way deal with chronic laminitis coupled with chronic toe cracks.

"It's good not to get married to one shoeing system," Agne said. "I can't tell you how many times I've had a horse go through three or four different types of shoes. It's just a matter of trying to find something that the horse likes and that encourages healthy hoof growth."

Generally, veterinarians and farriers will try to move the foot's base of support back towards the heels (to reduce load on the toe), raise the heels (to reduce the pull of the deep digital flexor tendon on the coffin bone), and ease the foot's breakover back toward the heels (also helping reduce load/torque on the toe). Support material can be used to help recruit the frog for partial weight bearing (thereby reducing weight on the wall).

For chronically laminitic horses that have toe cracks and/or poor-quality hoof wall, Agne has had success using hoof casts to stabilize the hoof capsule. After casting the foot, he adds the appropriate shoe. In these cases, he advises the horse owner to carefully monitor the heel bulbs just above the cast to be sure they don't get pinched or develop a lesion.

If a horse has severe rotation of the coffin bone, penetration or imminent penetration of the sole, and unrelenting pain that doesn't respond to therapeutic shoeing, Agne said a deep digital tendon tenotomy (cutting the deep digital flexor tendon that attaches on the bottom of the coffin bone) might be the only option to pursue with that horse. He will usually take a series of venograms (special radiographs, or X rays, that show the blood flow in the foot) to help him make that decision and to help monitor progress afterward.

"Case selection is really important," said Agne. "With a tenotomy, we're loading the back part of the foot." Horses that have a weak heel structure or show evidence of medial and/or lateral displacement of the coffin bone have a poorer prognosis than those that have robust heel structure and no evidence of coffin bone sinking.

Secondary complications of a tenotomy can include seromas (a tumor-like collection of serum in the tissues) in the sole or separated laminae, coronary band lesions as a result of coffin bone sinking, infections, flexor tendon contracture, and problems within the foot resulting from temporarily reduced stability of the coffin bone including navicular bone fractures and coffin joint subluxation (partial dislocation). Thus, following up with correct derotation shoeing to properly support the foot is critical, Agne said, as is close monitoring of the patient. 

About the Author

Tracy Gantz

Tracy Gantz is a freelance writer based in Southern California. She is the Southern California correspondent for The Blood-Horse and a regular contributor to Paint Horse Journal, Paint Racing News, and Appaloosa Journal.

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