Support Strategies in Chronic Laminitis Cases

Support Strategies in Chronic Laminitis Cases

An effective support system for the compromised hoof involves identifying the areas of compromise and then designing a specific strategy that addresses all the needs of that foot.

Photo: The Horse Staff

When a horse owner sits down with his or her veterinarian to look at a radiograph of a horse's laminitis-plagued foot, the last thing that owner wants to see is rotation of the coffin bone in the hoof capsule. Fortunately, in these cases farriers and veterinarians can try to minimize structural damage to the hoof by designing support systems that aim to improve circulation and stimulate hoof growth. At the 6th International Equine Conference on Laminitis and Diseases of the Foot, held Oct. 28-31 in West Palm Beach, Fla., Scott Morrison, DVM, described his strategies for supporting and treating the feet of horses with low-grade, compensated (stable coffin bone) laminitis and uncompensated (unstable coffin bone) chronic laminitis.

"An effective support system for the compromised hoof involves identifying the areas of compromise and then designing a specific strategy that addresses all the needs of that foot," said Morrison, who heads Rood & Riddle Equine Hospital's podiatry unit, in Lexington, Ky.

To identify these areas of compromise, Morrison might perform a thorough physical exam--paying special attention to palpating the coronary band--and take venograms (a procedure for visualizing blood flow within the foot) and radiographs (X rays) of the foot. He then designs a shoeing strategy to achieve the following:

  • Alter the hoof angle appropriately;
  • Recruit the frog, sole, and bars into greater weight bearing;
  • Unload or reduce weight-bearing in a particular region of the hoof (generally, that which is most painful or affected by structural damage);
  • Ease resistance to movement;
  • Aid shock absorption; and
  • Increase hoof capsule rigidity.

Morrison bases his treatment approach on each case's level of severity.

Low-grade chronic, compensated case feet "often have toe cracks, not much hoof to nail shoes to, and (the outer hoof walls) are dish-shaped," Morrison explained. With these horses he applies glue-on or mild mechanical shoes (the more mechanical the shoe, the more it increases the palmar angle), typically with a small heel wedge and a breakover point straight down from the coronary band to reduce tension on the laminae. (The laminae connect the coffin bone to the hoof wall and are compromised in laminitis.) After just a few shoeings, Morrison noted that these horses' soles start to thicken, which is important for protection as well as for a weight bearing and support. His aim for horses in light use, such as broodmares, is to get them barefoot as soon as possible and continue to trim accordingly.

It's typical for horses with metabolic syndrome to exhibit compensated chronic laminitis, Morrison said, noting that cases in these animals are characterized by more severe hoof capsule distortion. Thus, these horses' feet require additional sole support and more mechanics (more of a heel wedge) in their shoes.

"I trim for balance and shoe for support to accommodate the deep digital flexor tendon (DDFT, which runs down the back of the horse's leg and attaches to the back of the coffin bone)," he explained. "I try to get the bottom or solar surface of the coffin bone more parallel to the ground, trim the heel, and then use a wedge to decrease tension on the DDFT and establish a more even weight distribution over the solar surface of P3 (the coffin bone)."

When the hoof begins growing normally from heel to toe, Morrison considers it balanced, and at this point the farrier can reduce the degree of heel wedge gradually, depending on hoof capsule growth and the horse's comfort level.

Morrison said he considers uncompensated cases the "train wreck" cases. In these horses he might perform a deep digital flexor tenotomy, transecting the tendon in the mid-cannon bone region to remove one of the main forces responsible for coffin bone rotation. He also "grooves," or carves a niche in, the coronary band wall to increase growth and decrease stress on the laminae. Success rates for these horses depend on coffin bone health and whether there is sinking in the quarters/heels, Morrison explained.

Regardless of a laminitis case's severity, Morrison said rehabilitation is aimed at altering the sole and coronary band's growth patterns. "The foot essentially rebalances itself with our mechanical help. It's a process," he explained. "Once the foot is 'balanced' (i.e., has even wall growth in the toe and heels, good sole depth, and normal coffin bone angle) the mechanics can be scaled down to various degrees depending on the integrity of the lamellar attachments. Since the coffin bone is the foundation upon which the hoof capsule is formed, a healthy bone is imperative for long-term success."

About the Author

Alexandra Beckstett, The Horse Managing Editor

Alexandra Beckstett, Managing Editor of The Horse and a native of Houston, Texas, is a lifelong horse owner who has shown successfully on the national hunter/jumper circuit and dabbled in hunter breeding. After graduating from Duke University, she joined Blood-Horse Publications as Assistant Editor of its book division, Eclipse Press, before joining The Horse.

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