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Articles & Information
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. 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 Back to the articles table of contents Write to H&L: PO Box 6600, Gloucester, MA 01930. Tel 978 281 3222; fax 978 283 8775. Email webinquiry@hoofcare.com. Internet http://www.hoofcare.com. © 1998
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