Acute Laminitis – the horse industries worst nightmare
Off the back of my recent presentation ‘Diagnosis and Management of Acute Laminitis’ at the Australian and New Zealand College of Veterinary Scientists (ANZCVS) on the Gold Coast, I decided to summarise the presentation into 7 key points. The article is aimed at veterinarians, farriers and horse enthusiasts.
As we know, laminitis, particularly if it progresses into the chronic form can be debilitating, career limiting and life threatening. Laminitis is the inflammation and subsequent instability of the lamellar attachment. The lamellar attachment suspends the pedal bone within the hoof capsule.
Your horse has just developed acute laminitis – its time to call the veterinarian and farrier to make a plan. Below are 7 ways to help manage an acute episode of laminitis
1. Understand the different causes of laminitis and eliminate the risk factors
There are many different causes of laminitis, however they can be categorised as;
- Sepsis associated- i.e. horse with diarrhoea, pneumonia, retained placenta. Any conditions with a septic focus. These conditions require diagnosis and medical management by a veterinary team. In some cases, the horses will need to be admitted to hospital. It is important to control the underlying septic focus as quickly as possible
- Hormone associated- i.e. horse with Equine Metabolic Syndrome (EMS) or Pars Pituitary Intermedia Dysfunction (PPID). Accounts for approximately 90% of all laminitis cases. Again, these conditions require diagnosis and medical management by a veterinary team. Both EMS and PPID can be managed with a range of drugs. Not only that, it is important to engage a nutritionist to create a dietary plan for this horses. Also, supplementing with a hoof supplement such as Ranvet’s Hoof Food can be advantageous in growing new hoof wall
- Excess mechanical forces- i.e. horse with support limb laminitis or ‘road founder’
2. Understand the different phases of laminitis
There are 3 phases of laminitis;
- Developmental phase – horse has been exposed to risk factors that cause laminitis however isn’t showing clinical signs
- Acute phase – horse is showing typical signs of laminitis
- Chronic phase – occurs 72 hours after acute phase is recognised. Can progress to stabilise or become unstable
3. Quickly identify clinical signs of acute laminitis
- Reluctant to walk
- Lame on the turn at the walk, particularly on a hard surface
- Reluctant to lift limbs
- Increased in frequency of weight shifting
- Increased intensity of digital pulse to 1 or more limbs
4. Confine the horse to a stall with deep bedding
This will encourage the horse to lay down if required. It also reduces excess mechanical forces on the hoof wall and lamellar attachment. The bedding could be fine wood shavings or sand. Later on in the rehabilitation of the case, controlled exercise can be discussed, however in the initial 72 hours it is important to confine the horse
5. Administer anti-inflammatory medication
Again, this will require the advice of your veterinary team. Non-steroidal anti-inflammatories such as phenylbutazone can help reduce the inflammatory cascade and improve the comfort level of the horse. The dose and length of treatment should be discussed carefully with your veterinarian as the drug can have adverse side effects
6. Apply cryotherapy
Cryotherapy, or applying ice to the lower limb of the horse can reduce the inflammatory cascade. This has been shown to be effective in the developmental stage of laminitis and to a lesser extent in the acute phase. To apply ice to the lower limb of the horse, there are commercially available canvas boots or used 5L intravenous fluid bags can be taped around the foot. It is important however that the icing is continuous. This requires a large stockpile of ice, particularly in an Australian summer.
7. Obtain baseline x-rays and make a plan for supporting the hoof
After an acute episode of laminitis, it is important to obtain baseline foot x-rays. If the horse doesn’t have a history of chronic laminitis, it is unlikely you will see many changes on x-ray. These x-rays serve as a great way to make initial measurements of;
- Hoof wall width- known as the Hoof-Lamellar Zone
- Vertical depth- from the solar surface of the pedal bone to the block or shoe surface at the tip and wing of the pedal bone
- Coronary band to extensor process- also known as ‘Founder Distance’
Over time, if the laminitic episode progresses, these measurements will start to change. The changes in measurements may only be 1mm at a time. This is very significant in the early stages. This indicates to us that the horse is in an unstable form of laminitis and more of an aggressive approach is required.
The baseline x-rays also help us to determine the conformation of each individual foot, what protection the horse currently has under its pedal bone and if the horse has any pre-existing evidence of laminitis.
Foot conformation and how it determines our management plan
Now we know how are internal structures of the foot are positioned within the hoof capsule, we can decide on what orthotic we can use. Different foot conformations require forms of support.
An upright foot requires load shifted to the heels, away from the toe. This along with reducing the strain on the deep digital flexor tendon are key to ensuring the horse doesn’t progress further. This can be achieved by using a wedged heel cuff such as the NANRIC Ultimate.
However, in a flat foot with under-run heels, we need to shift load away from the heels. This can be achieved by loading the frog. An Ultimate wedged heel cuff or wedged heel/full rocker heartbar can be used. Dental impression material needs to be applied over the frog, so that the heels are not touching the shoe.
Another, fully customisable solution is FormaHoof. FormaHoof provides the entire hoof capsule with support, including the frog. It can be rasped to improve break-over and the heel height can be altered by changing the orientation of the mould. For more information visit my blog post on my trip to the Middle-East or the FormaHoof website.
Ensure you engage both your farrier and veterinarian as soon as possible after you notice an episode of laminitis. The sooner we can identify the cause of the laminitic episode and start to make a management plan, the more successful the rehabilitation phase will be.