Laminitis, updated emergency treatment

 

An Updated Approach to Farriery for the Emergency Treatment

and On-going Maintenance of the Laminitic Equine Patient

Treating laminitis and founder takes time, expertise and sufficient finance to maintain the equine patient until recovery is complete.

All case of laminitis should receive expert veterinary care and it is prudent to seek early veterinary support.

The length of treatment is governed by;-

1/The severity of the case

2/Early treatment utilizing correctly fitted deformable treatment solutions - Styrofoam - Equisoft or Stable Support hoof support systems

3/Veterinary treatments

4/Environment

"There are people who know the cost of everything but the value of nothing"

When treating Laminitis and Founder value for money is important and with so many treatments on offer it is difficult to discern which treatment is not only the most successful but also represents good value for money.

This study was taken from a selection of twenty five similar cases of laminitis. All twenty five cases received uniform veterinary treatment from the onset of laminitis.

5 cases treated using steel heart bar shoes. These five horses were kept in box confinement with in deep bedding prior to and following shoeing.

10 cases treated using plastic heart bar shoes, ("Eustace shoes") or Imprint shoes. These horses were kept in box confinement in deep bedding prior to and following shoeing.

5 cases treated using (Styrofoam – Equisoft – Stable Support Systems) and when appropriate, shod using the Equine Digit Support System. These horses all had access to limited free movement prior to and following shoeing.

5 cases treated using the Stable Support System both had access to limited free movement and when appropriate shod using the EDSS/Dr Steward Clogs.

All twenty five horses recovered and returned to their pre-disease work programs but there was a clearly defined financial cost relevant to the treatments given.

The costs of each case included the vets and farriers fees and any long term veterinary care, medication or specialist farriery. At this point I came to a crossroads regarding treatment. To my surprise! Despite, the initial start-up cost the Equine Digit Support System and EDSS Dr Steward Clogs were the cheapest option and the most successful treatment to return horses back to pre-disease soundness and in some cases actually elevated them to a higher level of soundness not previously experienced.

Financial considerations

; The start-up costs for steel heart bar shoes were the lowest, followed by EDSS/Dr Steward Clogs. EDSS was in the mid-price range and plastic adjustable heart bars had the highest start-up cost.

The shoeing periods for both types of heart bars was three - four weeks. The shoeing period for EDSS or Clogs is six - eight weeks. Each time the horse was presented for shoeing radiographs were taken prior to trimming to assist the trimming and shoe placement also to monitor progress. Radiographs were taken following trimming to confirm optimum trimming had taken place.

The horses wearing steel heart bars wore these for the lifetime of this project and beyond. (Until out of touch)

The horses shod in plastic heart bars, wore these until they were changed to steel heart bars. It was expected that these horses would normally wear steel heart bar shoes for life.

The horses wearing heart bar shoes were maintained under veterinary care for a minimum of one year.

The horses in this part of the project were shod using EDSS and Clogs and were shod for an average of three times, then initially maintained in Performance Leverage Reduction shoes. Once the equine patient had returned to a reasonable level of work, the equine patient was placed into "Centre Fit" shoes and returned to the owner’s regular farrier.

These horses were maintained in Natural Balance shoes charged at regular shoeing fees.

Conclusions;

Treating horses with bar shoes creates some "dependant pathology" thus making these horses dependant on their continued use, to remain sound.

Both types of heart bar shoes required long term veterinary and farriery input.

The plastic heart bars have a high start-up cost thus making their use very expensive and ineffective in returning the equine patient to pre-disease soundness without on-going expensive farriery in an effort to maintain a low level of soundness.

Although steel heart bars have a relatively inexpensive start-up, when veterinary fees, the additional cost of lifetime maintenance of bar shoes and the side effects of their use, makes this an ineffective and expensive option.

The Equine Digit Support System and the Dr EDSS/Dr Steward Clogs followed by continued maintenance in Centre Fit shoes yielded the best chance to recover to pre-disease soundness and is the cheapest option at the lowest on-going cost.

The EDSS adjustable shoeing system stands out as the premier choice for the treatment of equine Laminitis.

The Dr Steward/EDSS Clog is now chosen over other methods for the treatment of Equine Metabolic Syndrome – Equine Cushing Disease.

Designing a high yield, financially viable treatment regime

Box rest;

box rest may be a necessary evil at the start of treatment, or until the equine patient has become more clinically stable. However, box/stall confinement can be destructive to the recovery process. To confine a horse to box rest is like confining a human to bed rest in solitary confinement. Horses are social animals and when confined in this manor, often suffer depression without the contact with other horses. This depression can lead to horses giving up the will to survive and recovery is often slower. I have been involved in many cases that have failed to improve whilst on box rest but when moved from box confinement into a small confined outside area, approximately 20 to 30 meters square, have started to improve daily and have returned to pre disease soundness. I now see box confinement as a retrograde step in a long term treatment program. Horses will often only recover to the level of box rest.

Stability;

Styrofoam – Equisoft – Stable Support Systems offers a cheap, reliable and efficient treatment for acute laminitis. Providing the horses feet have been supported using one of the above correctly fitted support systems it is usual for the horse to have become more ambulatory. This movement and support has been shown to be vital to the repair and recovery process. During this time it is usually possible to reduce the drug input yet, still maintain stability.

Why the Equine Digit Support System or EDSS/Dr Steward Clogs?

In my experience, with the absence of anything else, heart bar shoes were a good shoe of their time however, there are problems associated with heart bar shoes and their reliance on the frog alone, as a support mechanism. The very regular shoeing required in the maintenance of heart bar shoes, not only increases the cost but also interferes with recovery process when compared against EDSS or Dr Steward/EDSS Clogs. Armed with new, up to date and scientifically proven information we must move on and utilize a system that addresses the biomechanical needs of the foot for weight-bearing, circulation, physiology and pain response.

Ability to adjust the shoes;

To improve the soundness of the equine patient following shoeing, both EDSS and Dr Steward/EDSS Clogs can be adjusted. These adjustments can be done without the need to remove the shoes and at any time throughout the shoeing period. This removes the unnecessary and over regular re-shoeing interrupting the healing process.

Addresses natural weight-bearing:

The digit is supported by using only the rear two thirds of the foot through correct hoof preparation and shoe placement. Uniform support throughout the bars, rear sole and frog is achieved by the impression material, which is similar to the way earth packs into the foot of the unshod horse

Improves circulation and physiology:

De-rotation of the distal phalanx behind the tip of the frog reduces pressure on the solar circulation. The design of the pad/shoe unit decreases the direct pressure on the solar circulation. Impression Material molds to all areas of the rear of the foot. I feel this uniform loading and unloading improves circulation, by allowing the (digital cushion/lateral cartilage) system to function as nature intended it to. This is accomplished without local ischemia and pressure necrosis, which often plagues systems which rely on frog support alone. Adjustable heel heights and frog inserts support only during weight-bearing and release when a foot is unloaded. This mimics the frog contact with the ground during the weight-bearing phase of the normal foot.

Allowance for pain response of the digit;

Shoe placement such, that Breakover of the digit is directly below the distal border of the distal phalanx, thus decreasing the lever arm at the point of break-over. Wedge rails elevate the heels to provide relief of static tension on the deep digital flexor tendon during weight-bearing and allows for easier lateral movement. Adjustments using different sizes of wedge rails and frog inserts for heel height and frog pressure. This can be done without removing the shoe. The design of the shoe/pad unit pulls the pad away from the anterior sole, eliminating contact with painful areas of the sole, especially under the distal border of the distal phalanx.

Acknowledgments;

"New Hope for Soundness" - 1997: United States. Wild Horse Publishing

Natural Balance Trimming & Shoeing" Chapter 9; Adams’ Lameness in Horses – Fifth Edition: 2002 Lippincott Williams & Wilkins

"Natural Balance Trimming & Shoeing: Its theory and application" Chapter 5; The Veterinary Clinics of North America – Equine Practices, Podiatry : 2003 W.B. Saunders: 353-37

Curtis S: Corrective Farriery; a textbook of remedial horseshoeing volume 1: United Kingdom. Newmarket Farrier Consultancy: 2002

Colles CM: The relationship of frog pressure to heel expansion. Equine vet. J. 1989; 21:13-16

Bowker RM, Breuer AM, Vex KB, et al. Sensory receptors in the equine foot. Am. J. Vet. Res. 1993; 54: 1840-1844.

Page BT. Breakover of the hoof and its effects on structures and forces within the foot. Proceedings, Am Assoc Eq Prtnrs 1999; 45: 148-150

Page BT, Hagen TL: Breakover of the hoof and its effects on structures and forces within the foot. J. Eq. Vet. Sci. 2002; 22-6: 258-263

Bowker RM, et al: Functional anatomy of the cartilage of the distal phalanx and digital cushion in the equine foot and a hemodynamic flow hypothesis of energy dissipation. Am. J. Vet. Res. 1998; 59-8

Ovnicek G, Erfle J, and Peters D. Wild horse hoof patterns offer a formula for preventing and treating lameness. Proceedings, Am Assn Eq Prtnrs 1995; 41: 258-260

OUR NEWS

The Farriery Practice would like to thank everyone who attended our clients evening held in March. The evening was based on lower limb anatomy of the horse. It was a great success, filling the forge at Bridge House Equestrian Centre.

Read more...  

ABOUT TFP

Founded in 1990 by Mark Spriggs, Dave Nicholls and Mike Williams The Farriery Practice has grown into a successful Partnership of six Farriers who all strive to provide the best in service and knowledge.

Read more...  

FARRIERY PHOTOS

Click here to view images of our team, scenes from our latest events and our practice services in action

CONTACT US

To get in contact with The Farriery Practice, or to find out where we are based, please click here to view our contact and address details