RECIPE FOR TREATMENT OF LAMINITIS

Commonly prescribed treatments for laminitis have been unreliable and often ineffective. One case will benefit from a certain treatment while another will not. Here is my recipe for treating laminitis. This recipe has not failed me yet. The key is to first unload the laminae and then provide for fluid drainage from within the hoof capsule. When the horse is suffering a systemic condition that could lead to laminitis, or if the horse is exhibiting symptoms of laminitis, action must be taken immediately. Do not wait to see how bad it will get. The horse owner, the veterinarian and the farrier must work together as a team toward the common goal of returning the horse to normal soundness with a healthy foot.

1. Initiate farrier care to unload the wall - NOW. This will minimize damage and suffering on acute cases. For chronic cases, the sooner you start, the sooner you get your horse back.
   • Have the farrier travel to the horse
   • Remove the shoes
   • Trim heels lower to position P3 level with ground
   • Trim the walls level with or shorter than the sole
   • Do not remove sole callous, bars or frog
   • Provide soft ground such as sand, saw dust, snow
   • Or apply a commercial sole support system that cushions and molds to the contours of the sole cavity

2. Initiate veterinary care to treat the systemic problem that triggered the laminitis.
   • Have the vet travel to the horse

3. Expect inflammation and build up of serum fluids under the hoof wall and sole callous. The pain level increases as the fluid pressure rises in these seroma pockets. Pro-active mechanical drainage via grooves cut through the hoof wall and poultice application are effective to minimize the pressure. Systemic anti-inflammatory therapy is also very beneficial.
   • Administer systemic anti-inflammatory agents
   • Rasp horizontal grooves through the hoof wall at the toe
   • Apply a poultice over these grooves
   • Monitor the situation closely
   • Make adjustments as required

   During this traumatic period, it is important to keep priorities in perspective. It was the weight bearing load on the wall which caused the initial injury to the laminae. That load must be minimized throughout the healing process or the laminae will continue to be overloaded and injured and the situation cannot be resolved. When the horse is suffering periods of pain relative to inflammation and serum pockets, do not give in to the temptation to abort unloading of the wall in favor of treating the more immediate symptom. It may, however, become necessary to temporarily remove the sole support system to initiate drainage. Areas of extreme tenderness or exposed sole corium can develop anywhere but will usually be at the toe area or around the apex of the frog. The sole support system can be modified to avoid pressure in these areas. This will make the horse more comfortable and allow for the application of medication on those spots.

4. Provide a healthy environment.
   • Deep soft bedding such as sand or saw dust to encourage laying down
   • Nutrition, shelter, social company
   • Free roaming exercise is important but avoid overdoing it
   • Lay the horse off work

5. Guard against sole overload.
   • Use a moderate level of sole support when possible
   • Use a quality support system to cushion and distribute the load
   • Keep the horse's body weight down
   • Provide soft, dry ground conditions
   • Monitor the situation and make adjustments as necessary

6. Maintain a reduced load on the wall until the new wall and laminae are grown (8 to 14 months). It should be noted that the displaced hoof wall, as such, cannot be reattached. Repair can only occur through the process of normal hoof wall growth. Once the wall is unloaded, the new wall generating from the coronary band becomes attached with healthy laminae as the growth progresses toward the ground.
   • Reset the sole support system at 4 to 5 week intervals

EXPECTED RESULTS

For pre-founder cases, while the horse is suffering a systemic condition that is known to trigger laminitis, if the hoof walls are unloaded early before the lameness symptoms appear, the feet will not founder and the horse will remain sound. The horse will still show signs of being sick relative to the systemic condition. It is advisable to keep the sole support system on the horse for three to eight weeks after the horse recovers to guarantee time for the laminae to return back to full health.

For chronic cases, the horse will usually experience an immediate improvement to its comfort level. The application of quality sole support to cushion and distribute the sole load provides pain relief from pressure points on the sole area. Unloading the wall relieves the strain on the injured laminae. These cases may occasionally experience some problems with sole inflammation but not to the same extent as acute cases. They will start off similar to the two to four month stage as described below.

For acute cases, with the horse displaying lameness symptoms and/or when the hoof wall has been displaced relative coffin bone, immediately upon unloading the wall, the horse will experience considerable relief of pain associated with the strained or traumatized laminae. The horse will now stand square on its feet rather than rocking back on its heels and will be much more willing and able to walk and give a foot to the farrier .

 

One to three weeks: The horse will still suffer intense pain until the inflammation (serum fluid pressure) is controlled. Daily changing of poultice dressings are required. During this stage the horse will spend much of its time lying down. This is a natural method of unloading the entire hoof and should be encouraged. Provide deep soft bedding. When there is no fluid pressure, the horse should rest comfortably without the appearance of stress.

Three to six weeks: Inflammation is under control. The poultice and bute treatments can be discontinued. The horse will spend more time on its feet, traveling at a careful walk. The horse will be happy to be alive with a good appetite. Provide a large pen and encourage exercise by placing food separate from water so the horse is required to go get it. Exercise will stimulate circulation which is essential to enhance the healing process.

Two to four months: There now is approximately one inch (1") of new wall growth from the coronary band which is closely connected to the coffin bone with healthy laminae. The horse may walk almost normal but is noticeably careful. There is a possibility of recurring problems with inflammation (serum fluid pressure).

Three to six months: One and one half inches (1 1/2") of stable new wall growth. The horse is comfortable. It walks freely and sometimes trots and lopes. There is a risk that the horse may feel so good that it will run around and tear the laminae again. Excessive traveling may cause the sole to be overloaded, resulting in sole bruises and inflammation. Keep the horse content with a quiet pen mate.

Eight months: Two inches (2") of new wall growth. The horse is quite sound. It is tempting, at this time, to relax the treatment and to overwork the feet. Do not quit now!

Twelve to Fourteen months: Complete new hoof wall grown out to the ground. The horse is sound with a normal healthy hoof structure. The horse can resume normal performance. The feet can be managed with normal trimming or shoeing. With some chronic cases, complete rejuvenation is limited due to the existence of permanent damage to the laminae and/or the blood supply to the laminae or coronary band. However, those feet can still become quite stable and can be managed with a lesser degree of sole support on a continuous basis.

OWNER'S RESPONSIBILITY?

• Manage the horse and its environment to prevent laminitis.
• First aid: unload the hoof wall immediately.
• Initiate action early when laminitis is a possibility:
  • Farrier care to unload the hoof wall
  • Vet care to treat the systemic condition

• Provide a healthy healing environment:
  • Soft ground
  • Free but unforced exercise
  • Good nutrition
  • Minimize the horse's body weight

• Regular daily observations.
• Be assertive to get emergency care from farrier and vet as necessary.
• Replace dressings as required.
• Arrange for the farrier at four to five week intervals.
• Have patience, stick to the program, do not give up.

FARRIER'S RESPONSIBILITY?

• Respond with a sense of ergency. Travel to the horse.
• Unload the hoof wall using the simplest methods and systems suited for the situation.
• Provide for fluid drainage:
  • Expose the laminae
  • Poultice

• Recommend vet care for the systemic condition.
• Trim or reset the support system regularly and often (4-5 weeks) without fail.
• Drop by to check on the horse often.
• Be assertive to intervene when necessary.

VETERINARIAN'S RESPONSIBILITY

• Respond with a sense of ergency. Travel to the horse.
• First aid: unload the hoof wall.
• Prescribe farrier care for long term unloading of the hoof wall.
• Treat to control and eliminate the systemic condition.
• Prescribe therapy for control of inflammation.
• Make frequent checks in early stages.
• Be assertive to intervene when necessary.

SUMMARY

Recommended methods for treating laminitis have not changed much over the last thirty to fifty years. The industry is still recommending the same methods and the results are sorely limited.

Using the methods described in this presentation, it is possible to fix a foundered horse. The period of intense pain is minimized and the horse will return to normal soundness.

If you unload it, it will heal.

Copyright � 2011 5sequine