Preventing Supporting Limb Laminitis (AAEP 2003)

"Laminitis in the contralateral (same end--fore or hind--opposite leg) limb is a well-recognized and potentially devastating sequela (result) in horses with complete fractures, sepsis involving a synovial structure, catastrophic breakdown injuries, and other conditions that cause unilateral non-weight-bearing lameness," said Ric Redden, DVM, founder of the International Equine Podiatry Center in Versailles, Ky., in a presentation on the topic during the 2003 American Association of Equine Practitioners' convention.

"The mechanism of contralateral limb (also called supporting limb) laminitis has not been well studied," he said, explaining that his observations point to a combination of the duration of excessive weight-bearing and the structural integrity of the foot. He theorizes that the heavy, unrelenting load on the supporting foot compromises blood flow, resulting in tissue starvation and death--there has to be loading and unloading of the foot to allow blood to move in and out of hoof structures.

"If a horse has been standing on one leg for several weeks and suddenly switches legs, it's not because he's gotten that much better," Redden warned.

His goals for supporting the foot include:

  1. Substantially decreasing tension in the deep digital flexor tendon; and
  2. Supporting the cup of the foot (i.e., providing arch support).

"These goals must be implemented as soon as possible after severe lameness develops," he stated. "Laminar damage in the supporting foot likely begins within a few hours of constant loading. This syndrome is well underway by the time the horse shows the first signs of discomfort."

Redden raises a horse's heels by 10° and moves breakover back until the horse's palmar angle (angle the coffin bone makes with the ground) is at least 20°. Moving breakover back this far allows the horse to "self-adjust his palmar angle to find the most comfortable position," he says. Filling the sole with an elastic polymer is the other part of the equation.

He also noted that radiographs are important to determine if the palmar angle has reached at least 20°. This shoeing should be maintained until the horse can bear full weight on the injured limb, he said.

Clinical Results

Out of 86 horses treated at Redden's clinic for severe unilateral laminitis (37), foot puncture wounds with sepsis (26), distal limb amputation (13), comminuted (shatter) fractures of the first phalanx (treated with cast; 6), completely ruptured superficial digital flexor tendon (3), or catastrophic rupture of the suspensory apparatus (1), only two (2.3%) developed supporting limb laminitis in a limb being managed in this fashion. One was an amputee, and one was the horse with suspensory apparatus rupture. Redden noted that the reported mortality rate in horses with contralateral limb laminitis is at least 50%.

"When it comes to laminitis, prevention--whatever it takes--is far more effective, and ultimately less expensive, than treatment," he stated.

About the Author

Christy M. West

Christy West has a BS in Equine Science from the University of Kentucky, and an MS in Agricultural Journalism from the University of Wisconsin-Madison.

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