Laminitis is a complex
disease syndrome often seen subsequent to a variety of primary
diseases. The prognosis ranges from good to grave and is
dependent on the degree of damage to the vital supporting
structures and mechanical stability of forces perpetuating
displacement of PIII. This syndrome demands the expertise of
professional farriers, as well as veterinarians as therapeutic
shoeing plays a major role in the successful treatment of the
majority of laminitic horses.
Treatment length can vary from a few weeks to years, requiring
commitment and dedication for seemingly endless maintenance
regimes. Establishing an effective protocol to treat laminitis
will improve the treatment regime and help farriers and
veterinarians gain good experience. Success rates vary from
horse to horse and are greatly influenced by the ability of
veterinarians and farriers to assess the damage, read the
particular needs and treat the syndrome with a progressive
attitude, built on knowledge of the subject and professional
Obtain a good history and carry out a thorough physical
examination to include radiographs on the first visit.
Laminitis often follows other primary disease maladies, such
as colitis, pneumonia, pleuritis, retained placenta, dystocia,
potomac fever, blister beetle ingestion, protracted diarrhea,
salmonella, selenium toxicity, fescue poisoning, injudicious
use of corticosteroids, stress, contra limb acute lameness and
others. Be alert to the hoof characteristics that vary from
normal, both grossly, as well as radiographically. Being
focused on details will help rule out other acute foot
problems that closely mimic the signs of laminitis.
A methodical, disciplined technique assures consistent, good
quality, pure lateral projection. Soft detail images reveal
anterior-posterior balance and the relationship of PIII to
horn and horn to load. These parameters must be clearly
demonstrable as they become an essential guideline for
pathological shoeing. Most professional farriers have become
quite proficient reading good quality, soft tissue detail
film, as it relates to their task of re-establishing a
meaningful equilibrium. Films taken before and after each
shoeing session tremendously increase the knowledge bank and
efficiency of farrier and veterinarian and consequently
improves the prognosis. Practice tips that have improved my
- Pure lateral, primary beam strikes the foot in a
horizontal plane, just above the ground surface.
- Zero film, subject distance.
- Opaque marker, detailing the face of the horn wall, as
well as ground surface.
- Positioning block, 3 x 5 x 7, with a wire running
through the long axis is compatible with most all x-ray
The distance from the face of PIII to the outer horn wall is
referred to as horn-lamellar space. Become familiar with
normal parameters. Most light breeds will measure 15 to 17
mm., heavy, older broodmares, stallions and most Standardbreds
will measure 20 to 22 mm. Base line views become most valuable
as they establish a starting point. The depth of sole and cup
directly beneath the apex of PIII is quite easy to monitor
with pure lateral films. Extensor process relationship to
coronary band varies from horse to horse and foot to foot.
Rely on the base line film to assess starting location.
CLASSIFY THE DAMAGE:
Rotation is significant with acute cases but is very
misleading with chronic cases due to abnormal horn growth.
Classify the damage before establishing protocol. A scale of 1
to 1000 offers a realistic classification system for all
laminitic cases. Classify each horse at onset based on
history, physical and radiographic examination. Design therapy
to reverse forces at play and meet the needs of the patient.
This system enables me to treat not only each case but each
foot as a separate entity and to better explain the
seriousness of the syndrome to my clients.
|0 - 250
||Initial clinical response can be very painful. Initial
treatment normally produces very favorable results.
Mechanical aids to reduce tendon pull are an adjunct to
therapy. No displacement - horse appears clinically normal
in a matter of days and has an uneventful recovery, (30 to
45 days minimum, up to six months). Most retain athletic
|250 - 500
||Five to eight degrees of rotation within the capsule
and/or less than 1 cm. sinking. Normally eight to nine
months full recovery. Most remain athletic but drop in
class or retire to slower sports. Therapeutic shoeing
|500 - 700
||Greater than eight degrees rotation. Greater than 1 cm
sinking. May require deep flexor tenotomy as an adjunct to
therapeutic shoeing. Recovery eight months to one year.
Low maintenance, pasture sound animals and a few can be
used for pleasure riding.
||Salvage: 2 cm. sinking, excessive rotation and maximum
solar compression, many with penetration. Timely
decompression, derotation, therapeutic shoes and bilateral
deep flexor tenotomies often move them to lower scale.
Those that remain in this category following initial
treatment have a grave prognosis at best end up chronic
cripples. This class requires practitioners and farriers
with good experience with complicated laminitic cases.
Expectations and goals should be discussed with all
parties concerned at the onset and updated periodically.
This is a devastating syndrome for the horse, as well as
owner. Being compassionate makes a profound statement.
Acute laminitis should be considered an emergency because the
window of maximum response closes rapidly. Sound mechanical
therapy applied in a timely fashion can be very effective
against secondary compressive damage seen subsequent to
displacement of PIII. Preventing and or minimizing
displacement in the face of this syndrome can alter the course
of the disease.
Treat the whole animal, address primary problems when known.
Use anti-inflammatories with discretion. Phenybutazone remains
the drug of choice. Many others have good to excellent
anti-inflammatory properties and can be useful. Nitroglycerin
creams and patches have been advocated recently and may have
potential. Caution; use with discretion and be judicious.
Teach proper use and handling of these products as they have
precautions and contra indications.
Apply emergency aid designed to significantly reduce deep
flexor pull, Modified Ultimates, Advance Equinea. The clinical
response will aid in assessing soft tissue damage. Before
applying any therapeutic device become familiar with the
specific conformation characteristics of each foot. Learn to
read positioning of PIII within the capsule with the aid of
radiographs as well as without.
Three basic principles are very effective against deep flexor
pull as it opposes diseased laminae:
- Raising the heel 10 to 18 degrees significantly reduces
pull on the tendon.
- Placing breakover directly beneath the apex of PIII, (phalangeal
point of rotation), eliminates opposing lever arm and
significantly reduces lamellar stress and sub solar
- Utilizing sole, frog, bars and sulci as uniformly loaded
Success with mechanics lies in applying a device that meets
the specific needs of each foot. Years of experience are
required of veterinarians and farriers to properly read feet.
A common error is to lump all feet and all cases in a basic
category. This philosophy fails to produce favorable results
the majority of the time. Very basic guidelines to help load
the heel and unload the apex and laminae:
- When rotation is present the hoof capsule must be
trimmed in a fashion that re-aligns PIII with the natural
load surface, otherwise the apex of PIII continues to
compress sole corium, further compromising circulation. Trim
the heel parallel to the freshly trimmed frog starting at a
point just behind the apex of the frog. Rasp the heel down
at the base until good, sound horn tubules are evident at
the widest point of the frog. Use discretion as over
trimming can produce harmful results. The horn capsule
forward of the apex of the frog will not make contact with
the shoe, therefore we are shoeing to the heel, not the toe.
All nails must go behind the widest point of the hoof in
order to secure the shoe to the heel. Re-alignment normally
increases deep flexor pull depending on severity of
displacement, hoof angle, heel angle and breakover
placement. Raising the heel once properly derotated
increases load to the heel area and reduces tendon pull
influencing sole corium and lamellar perfusion. Leave all
the sole and foot mass possible as it is natural protection
and desperately needed.
- Design the shoe so breakover is 3/4 of an inch forward
of the true apex of the frog. Note; many times the frog will
lay on top of the sole giving false impression of the true
location. Trim the toe at a 45 degree angle with the ground
surface to avoid breakover contact. Stay well forward of the
- Resilient custom fit arch support offers a broad
spectrum, evenly distributed support surface that reduces
load on the diseased laminae, Advance Cushion Supportb .
- Strict stall rest throughout the recovery period reduces
unwarranted stress on the healing laminae. Note; recovery
period is dependent on damage. Cases with significant
rotation and/or sinking must re-establish lamellar integrity
or relatively normal horn growth pattern and a dense sole to
reach optimum recovery, six months to one year is a normal
UNFAVORABLE TREATMENT RESPONSE:
When faced with an unfavorable response take lateral
radiographs with the shoes on. Routinely taking films
following every therapeutic shoeing and focusing on small
details improves the end result. Check for proper derotation,
mass of heel, sole impingement, progressive displacement
(rotation, sinking and lamellar thickening). Keeping in mind
the normal, evaluate the coronary band and look for
sensitivity, discoloration, moisture and abscessation. Take
dorsal-ventral views, look for pathological solar fractures. A
venogram of the digit is a helpful aid for determining
circulatory damage1 & 2. Classic sinkers have a stark loss of
contrast throughout the laminae, sub solar area and within the
semilunar canal. Subsequent venograms can aid in assessing
progress with cases showing marginal loss of contrast on the
initial examination. When faced with a poor or slow response
following proper derotation and shoeing, consider deep flexor
tenotomy as an adjunct to therapy. Deep flexor tenotomy should
be considered a viable means of treating complicated
laminitis. Proper derotation, shoeing and timely surgery can
offer penetrated laminitic cases full recovery.
Therapeutic shoeing is indicated for laminitic cases that
develop five degrees of rotation or greater and all with
sinking of any degree. Progress in the field of pathological
shoeing has accelerated over the past ten years due to
combined efforts of farriers, veterinarians and research.
Currently I prefer to fabricate a four point rail shoe,
similar to the shoe by Gene Ovnicek3 . I have modified the
concept to increase toe protection and applied a sole to
ground resilient arch support. There are many ways to make
this shoe. Farriers need to know the basic principles of
construction and application.
- Breakover is at the widest point of the foot, just in
front of the apex of the frog.
- Rails reduce tendon pull and enhance medial-lateral
- Arch support offers broad spectrum support to the sole,
frog and bars.
Properly placing the shoe on a derotated laminitic foot with
adequate mass of heel can offer a more consistent measure of
successfully treating laminitis. The shoe has offered a
favorable response for sinkers and cases with penetration.
This shoe and technique enhances the effects of deep flexor
Ninety-four horses were shod with four point rail shoes with
Advance Cushion Support.
- 75 had greater than ten degrees rotation.
- 38 had greater than 1 centimeter of sinking.
- 40 penetrated the sole.
- 38 treated with deep flexor tenotomy.
- Twenty-four returned to previous status.
- Of these twenty-four there were seven broodmares, one
stallion, one Arab show horse, one Quarter Horse, one Paso
Fino, five Walking Horses, one Saddlebred, one Morgan, one
Show Hunter, two riding horses, three were penetrated; one
Paso Fino, one Walking Horse and one Thoroughbred broodmare.
- Thirty-one returned to pasture soundness.
- Sixteen were penetrated, three Saddlebreds, one Arab,
four Thoroughbreds, two Quarter Horses, one Standardbred,
four Walking Horses and one Morgan.
- Nineteen were euthanized.
- Nine sinkers with penetration, one penetration and nine
chronic cases with extensive osteomyelitis.
- Thirteen could not be located for follow-up.
1. R. F. Redden, D.V.M. The Use of Venograms As A
Diagnostic Tool. Bluegrass Laminitis Symposium,
1993. International Equine Podiatry Center,
P.O. Box 507, Versailles, Kentucky 40383.
2. Chris Pollitt, DVM. Personal communication.
University of Queensland, Saint Lucia, Queensland
3. Gene Ovnicek. 525 Half Moon Road, Columbia
Falls, Montana 59912.
a. Modified Ultimates. Advance Equine, P.O. Box 54,
Versailles, Kentucky 40383
b. Advance Cushion Support. Advance Equine,
P.O. Box 54, Versailles, Kentucky 40383