Of all the medical crises that can afflict a horse, laminitis surely is one of the most alarming. Horribly painful, and potentially devastating to his long-term soundness, the strange syndrome whereby the coffin bone inside the hoof begins to tear away from the laminae (the accordion-like soft tissues between the bone and the hoof wall) quite rightly strikes fear into the hearts of owners and trainers. Once the process has begun, it is often difficult to stop the cascade of metabolic events that can leave a horse's coffin bone many degrees out of position, sometimes even punching through the sole of the foot. For many horses, the grief doesn't end when the initial attack does. Instead, the "foundered" horse might face months, years, or a lifetime of painful feet, deformed hoof growth, and circulatory difficulties; what's worse, he'll forever be prone to further laminitic episodes.
Although science has identified many of the "triggers" of laminitis (gorging on grain, for example, or too much concussive pounding on hard roads), the real cause of the disease still is under intense investigation. Treatments, while many and varied, have a relatively shaky track record in terms of success (defined as the horse being able to return to his previous level of performance). What we do know is that expert farrier care will make a huge difference in terms of a foundered horse's comfort and eventual recovery. "There is a small window of opportunity early in the acute stage where we can intervene medically and prevent the damage to the laminae in many cases," says Steve O'Grady, DVM, MRCVS, whose practice, Northern Virginia Equine, emphasizes equine podiatry.
There is perhaps no other syndrome in the equine repertoire that requires veterinarian and farrier work so closely together, aiming toward a unified goal--to counteract, or at least minimize, the downward motion of the coffin bone (rotation or sinking) and help restore the horse's soundness.
When your horse first suffers a laminitis attack, whatever the cause--perhaps she gulped down too much sweet, spring grass, or maybe she retained the placenta after foaling and developed a raging infection--the important thing is to respond quickly. Early signs of laminitis, like early signs of colic, can be subtle and easily overlooked--a vague restlessness, a worried expression, shifting weight from one foot to another, a slight shortness of stride, and feet that feel warm to the touch. These symptoms quickly can escalate into a full-blown, rocked-back-on-the-heels, rooted-to-the-spot horse who's clearly in agony. By that time, much of the worst damage will have been done.
If you suspect a laminitis attack could be brewing, contact your veterinarian and farrier immediately. With judicious treatment, you might be able to head off the crisis and prevent it from occurring.
While you're waiting for your veterinarian to arrive, you can take action to alleviate your horse's discomfort. Stall rest is the first step, because if the sensitive laminae inside the hoof are in the process of separating and dying, movement can further tear the tissues. Deep bedding or sand footing, and soaking in cold water, can help relieve some of the laminitic pain.
Many veterinarians and farriers feel that quick action to support the frog (which lies below the coffin bone) can help minimize the amount of sinking and rotation of the coffin bone. You can fashion a temporary frog support with a couple of gauze bandages (or other soft material) secured with a self-adhesive bandage (such as Vetrap). This will suffice until your farrier arrives to install a Lily pad (a commercial frog support that can be fitted without removing the existing shoe). If you do give frog support, be careful that its dimensions stay within the borders of the frog. Pressure elsewhere on the sole of the foot might damage vulnerable arteries.
Laminitis specialist and farrier Ric Redden, DVM, feels there is some benefit to providing a laminitic horse with some heel elevation in the form of a 10- to 15-degree wedge, which can be made of wood with some sort of resilient material (indoor/outdoor carpeting, Styrofoam, or any of a number of plastic or rubber compounds) between the wedge and the sole. Such homemade wedges can be secured with a bandage around the pastern, and often afford quick pain relief. The idea is that the coffin bone alters its position because of the force exerted by the deep digital flexor tendon, which runs down the back of the cannon, under the navicular bone, and attaches to the coffin bone. Raising the heels relieves some of the pressure and pain that results from this tension, and might help minimize further damage to the separating laminae. Redden suggests applying the wedge to the most severely affected hoof first; thereafter, it should become easier to persuade the horse to lift the opposite foot.
Once your veterinarian arrives on the scene, the damage within the hoof should be assessed by doing a series of radiographs. In most instances, it's a good idea to pull the existing shoes, but the process can be painful for a horse suffering an acute laminitis attack. Pain-killing medications such as Bute and flunixin meglumine (Banamine) can be helpful. (In severe cases, your veterinarian might administer a temporary nerve block.) The shoes should be removed carefully, one nail at a time, to avoid placing further strain on the damaged laminae.
A complete set of X rays is an invaluable part of deciding what comes next for your laminitis victim. If only the laminae under the front wall of the hoof have separated, the coffin bone will tend to rotate downward. If they've pulled loose from the hoof wall all the way around, the coffin bone will "sink" toward the sole without changing its angle, sometimes moving as much as two centimeters. Coffin bones that have rotated only a couple of degrees are considered mild cases (although the rotation can continue to progress for days or weeks, depending on the amount of damage to the laminae), while those which have rotated in excess of 10 degrees usually are given a poorer prognosis.
Generally, "sinkers" are considered the worst-case scenario, and any sufferer whose coffin bones have penetrated the sole has a long and painful path ahead of him. Once such horses were put down as a matter of course, but today it often is possible to treat such severe cases. Even those where the entire hoof capsule has sloughed off have been known to recover, with diligent, albeit expensive, care. It's important to realize, however, that recovery from virtually any case of laminitis should be considered in terms of months or years, not days or weeks. There are many approaches, but no shortcuts.
Once the initial laminitis crisis has passed (some 48 hours after the onset of lameness), you'll want to do everything you can to get your horse on the road to recovery. The approach your veterinarian and/or farrier might recommend can vary a great deal depending on the severity of the horse's condition, any pre-existing foot problems he might have had, and the practitioner's history of dealing with laminitic horses. Laminitis treatments are as individual as the patients they're designed to treat.
"The consensus is not to use shoes in the acute stage but to rely on different types of foot support," says O'Grady, "If one method is ineffective, change to another during the early stage. When do you shoe the horse? When the horse is comfortable, when the horse is off all or is just on minimal medication, and when there are no further radiographic changes for a reasonable amount of time. Emphasis should be placed on the use of radiographs as a guide to trimming and shoeing the laminitic horse."
If your horse's case is a mild one, careful and knowledgeable trimming might be all he needs to help realign the coffin bone in a straight line with the phalangeal (pastern) bones. Most farriers recommend lowering the heels and rasping the toe to reduce ground pressure and improve breakover. (It's important that your farrier ignore his instinct to pare the sole, however. After a laminitis attack, the sole will be perilously thin already, and the horse will need all the callus he can grow.) Farriers will want to avoid using therapeutic shoes at first, because the very act of shoeing, and the necessity of holding the horse's feet up for several minutes at a time while applying them, can be excruciating for a foundered animal, and can exacerbate further tearing of the laminae. If your horse can remain barefoot, you'll need to supply him with deep bedding in his stall for the duration of his confinement, and not rush him back into work the moment he appears sound again. Inside the foot, the healing still is progressing, and too much exercise too soon could trigger a relapse.
A significant number of laminitic horses do benefit from some sort of therapeutic shoe during recovery. The appliances at your farrier's disposal are staggering in their variety, but all have similar aims--to support the heels, relieve pressure at the toe (where the tip of the coffin bone might be pointing and creating pain and inflammation), and support the sole. One of the simplest is a normal shoe, applied backward on the foot. This arrangement allows some flex at the toe and helps support the horse's weight as he rocks it to the back of the foot.
There also are various arrangements of wide-web shoes (many farriers prefer to use aluminum, as it is lightweight and can be secured with very small nails), egg-bar shoes (which form an egg shape around the whole foot), and heart-bar shoes. The frog plate of the heart bar may need to be bent evenly upward so that it applies even pressure over the entire surface of the frog. In theory, this allows it to act like a spring, pushing up on the frog and pulling down on the hoof wall, thereby stabilizing the coffin bone. To avoid pressure necrosis, the heart bar should not extend beyond the point of the frog.
The heart bar shoe requires considerable skill both to make and to fit properly. Fitted incorrectly (usually too far forward), the heart bar can cause subsolar abcessation and crippling pain. In an attempt to address problems like this, farriers have developed variations on the theme, such as adjustable heart-bars, which can be adjusted without removing them from the horse's foot. A horse in recovery from laminitis might experience rapid and sometimes uneven hoof growth, so a shoe that can be "tweaked" every few days can help reduce the number of painful resets. (Some farriers have reported success with plastic glue-on shoes, which eliminate the need to pound nails.)
Most laminitic horses feel some relief when a section from the hoof wall at the toe is cut out before a shoe is applied. This leaves an open space between the hoof and the shoe at the toe. Generally, breakover can be eased when the toe of the shoe is rolled.
In most cases, a horse wearing therapeutic shoes will benefit from some kind of pad or sole packing, which is thought to take pressure off the hoof wall and support the coffin bone. Any number of materials have been used for sole packing, ranging from the traditional to the space-age--soft acrylics with names like Kwik Poly, Custom Support Foam, and Advance Cushion Support are popular with many farriers because they are manipulated easily and later "set" to a harder rubber-like consistency that will stay in the foot. Some farriers have reported success with thick pads packed with silicone rubber dental impression material. Whatever the material used, it is essential that absolutely no pressure is exerted on the sole beneath the descending tip of the pedal bone. In other words, only the back half of the sole can be recruited to help support the internal structures.
In severe cases, your veterinarian might recommend a hoof wall resection, or a technique called "grooving," both of which are designed to relieve the pressure of fluid buildup inside the hoof wall. Opinions are divided as to whether these approaches are beneficial, however, as they are fairly invasive and, in unskilled hands, potentially could open the inner structures of the foot to further infection.
There's considerable controversy over the practice of raising the heels, as opposed to lowering them. However, most farriers agree that improving the breakover of the foot can allow a farrier to use less heel elevation, which in turn means less risk of overloading the heels.
Over time, the foot of a foundered horse will come to show the effects of the trauma it has suffered, developing a concave profile, "fever" wrinkles, and a tipped-up toe that resembles a kind of tragic elf slipper. Maintaining something resembling normal hoof conformation requires frequent visits from your farrier, and regular sets of radiographs that will demonstrate the progress of healing and help guide your farrier's rasp. Many veterinarians recommend taking a new set of X rays every five to 10 days after the onset of laminitis. This eventually will provide you with a complete storyline of the disease's progress.
Coming Back To Soundness
If there's a conclusion to be drawn about laminitis, it's that there are at least as many ways of dealing with it as there are ways of a horse developing the disease. No one method currently appears as a stand-out, and making a prognosis as to the horse's recovery still is extremely individual. Your best bet is to find a veterinarian and a farrier whom you trust, and follow their advice explicitly. This approach will be your best chance for achieving eventual soundness with your horse. It is important to remember that most laminitis damage is done before symptoms appear. If your horse gets in a situation that could cause laminitis, call your veterinarian immediately.
A tip: Not all veterinarians and farriers are experienced or comfortable dealing with laminitis. Don't be afraid to ask questions like, "Do you have good experience with complicated laminitis cases? How many do you see in a year? What kind of success rate have you had?" It might be worth asking for a referral to a laminitis specialist.
A Radical Departure
Quite opposed to the "traditional" approach to laminitis, with its emphasis on high-tech appliances, is the school of thought championed by German veterinarian Hiltrud Strasser. She claims to have had astonishing success with seemingly hopeless chronic laminitis cases simply by pulling their shoes, putting them on 24-hour turnout (the better to encourage pedal circulation), and performing frequent trims (two to three times a week) to lower the heels and encourage a foot that more closely resembles those of wild horses. Hoofcare specialist Sabine Kells, of Qualicum Beach, British Columbia, trained with Strasser, acted as translator for Strasser’s book, A Lifetime of Soundness, and now teaches the techniques to owners of laminitic horses.
Kells admits, "It’s 100% opposed to traditional methods of treatment, but I’ve seen so many hoof problems—not just laminitis, but quarter cracks, navicular, you name it—alleviated just by more closely mimicking the horse’s natural lifestyle. I generally don’t see horses until the owners have tried everything else. By that time, they may have been wearing heart-bar shoes for two years, and their hooves are so deformed that the hairline at the coronet is higher at the heels than at the toes!
"Healing takes circulation," Kells notes, "and if a horse is on stall rest, his circulation is not being stimulated. The horse may not be sound when you first put him on turn-out, but his motion will gradually improve, as will his attitude. Owners can get very concerned, because further rotation often happens when you first remove the shoes. But in my experience, it usually corrects, by itself, within six months of 24-hour turn-out. Movement is key to good hoof growth; that’s just natural to a horse."
The low heels are crucial to Strasser’s approach, Kells adds. Lowering the heels allows the resumption of a more natural slope to the hairline at the coronet, and the restoration of the bottom of the coffin bone to a ground-parallel position. The frequent trimming is necessary because as the normal hoof mechanism is restored to a foundered foot, new horn will grow rapidly and sometimes unevenly. The amount of horn removed by a single Strasser trim is much less than your farrier would remove in an average trim.
In some horses in which all else has failed, Strasser said the technique (which also emphasizes avoiding anti-inflammatory drugs and vasodilators) has been beneficial. "Usually you see improvement fairly quickly, though the horses who started off not looking particularly bad may get worse before they get better," Kells says. "But it’s not a quick fix. It may be a two-year rehabilitation in all, and during that time, the horse will occasionally be in pain; his feet will abscess; he’ll go through all the normal inflammation that is a part of the healing process." She acknowledges that sticking with the program under these circumstances requires a leap of faith from the owner, but that if laminitic horses are "given a natural lifestyle," they might recover.
Applying shoes to a laminitic horse is, in Kells’ opinion, a mistake, because shoes are inflexible and will limit the foot’s natural expansion and contraction (which is tied to circulation). Appliances like heart-bar shoes are considered, under the Strasser regime, useful in reducing discomfort, but rarely afford any real healing.
For more information on the Strasser approach, check their Web site at http://members.screenz.com/gretchenfathauer.
For more information on laminitis and shoeing, see Steve O'Grady's web site at www.equipodiatry.com. For a specific article on shoeing the laminitic horse, see his article at http://www.equipodiatry.com/lamishoe.htm
About the Author
Karen Briggs is the author of six books, including the recently updated Understanding Equine Nutrition as well as Understanding The Pony, both published by Eclipse Press. She's written a few thousand articles on subjects ranging from guttural pouch infections to how to compost your manure. She is also a Canadian certified riding coach, an equine nutritionist, and works in media relations for the harness racing industry. She lives with her band of off-the-track Thoroughbreds on a farm near Guelph, Ontario, and dabbles in eventing.