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Wednesday November 22, 2017
12
Jul

Laminitis Simplified


Written by Sandy Loree
Category: Essays For Horse Owners
Hits: 5983

Laminitis has the reputation of being a devastating, diagnosis complicated disease. Over the years, drugs many people have dedicated immense time and effort studying laminitis, striving to find a cure. We are all aware of the symptoms of laminitis; the pain, the typical laminitis stance, sunken hairline, wavy growth rings, increased pulse, rotated coffin bone, dropped sole and extended white line. The cause of laminitis has been a mystery for some time. There seems to be several conditions laminitis is associated with: toxins, stress, flu, carbohydrate overload, fresh green grass, obesity and infections. There have been many treatments tried. Until now, an effective and dependable treatment method has not been found.

I have been managing founder cases by controlling the load share between the hoof wall and the sole since 1994. I am excited that the results of doing so have been excellent, consistent, repeatable, and dependable. By unloading the wall and laminae, the hoof is prevented from foundering and a foundered hoof can be repaired. Virtually every case experienced a high degree of improvement, with the end result of most cases approaching 75% to 100% of normal condition. The only limiting factors to the end result is the original genetic makeup of the hoof and permanent tissue damage as a result of the foundering process.

Controlling the load share between the wall and the sole, has given me a different view of this laminitis problem. To me, the problem is not as big nor as complicated as its reputation.

For the reader to appreciate my interpretation of laminitis and founder, more information is needed about the weight bearing systems within the hoof, about the principal of load share between the hoof wall and the sole, about the principle of tissue overload, and about how to unload the hoof wall.

WEIGHT BEARING ANATOMY

The weight bearing framework of the leg is the skeletal bones. They are aligned end to end down the leg and pastern. Position of the bones, locomotion and suspension are dictated and controlled by the ligaments and tendons. The weight bearing load is transferred down the leg from one bone to another through the articulating joints. The surfaces of those joints are in compression when bearing a load. The coffin bone is the end of the line. P3 is charged with the function of dissipating the load to the ground. Most of the load from the leg passes through P3.

The coffin bone has a unique design in that virtually all of its surfaces are involved with load transfer. The load enters P3 through the articulating joint surface from P2. The other surfaces are covered by tough horny tissue. The volar surface is protected by the sole callous while the dorsal surface is protected by the hoof wall. When the sole comes in contact with the ground, load is transferred directly from P3 to the ground. The sole and its corium are in compression. When the rim of the hoof wall contacts the ground, load is transferred from P3 via the laminae to the hoof wall and to the ground. The laminae is in tension.

So in fact, there are two weight bearing systems within the hoof. The principle of controlling the load share between the hoof wall and the sole refers to controlling the load share between these two weight bearing systems.

Trimming and shoeing techniques practiced today tend to minimize the load on the sole. I was taught at farrier school to minimize sole pressure. From my experiences as a farrier and horseman, I have learned that the sole of the hoof can be tender and easily bruised. There is a prevailing misconception that the sole cannot bear much load.

I believe, however, the sole is meant to carry a load or it would not be located on the bottom of the hoof. Based on over sixty cases I have applied sole support it has been proven to me that the sole is capable of carrying most or all the load from a given foot for an extended period of time. When put to use, the sole is stimulated to thicken and toughen and its load carrying capacity increases.

TISSUE OVERLOAD

When any given body tissue is asked or forced to endure a functional load greater than it is capable of supporting, that tissue will fail in the form of an injury.

There could be several scenarios contributing to this situation. First, the load could be simply larger and/or for a longer period of time than what that tissue is genetically designed to support. Second, the animal itself could be suffering a systemic condition that causes the various body tissues to be temporarily “sick”. An individual tissue thus may be too weak to carry a normal load. Third, the tissue may slowly deteriorate over time. When a horse is traveling, the tissues of the hoof are subjected to cycles of load on and load off with each stride. Under normal conditions, a certain number of tissue cells will be damaged and lost when the tissue is loaded or stressed. Cell loss is replaced through cell rejuvenation when the tissue is in a period of rest. There can be situations where the tissue’s ability to rejuvenate itself is slower than the rate of tissue damage. Factors that contribute to this scenario are: improper hoof care management, inadequate nutrition, extreme environmental conditions, lack of exercise to stimulate circulation, or an inferior circulatory system due to genetics or previous injury.

Regardless of the combination of scenarios for any given case, it can be said that the tissue is in an overload situation. If that overload situation continues, the tissue will fail. The body cannot heal an injured tissue if the injury process continues. If a tissue is being injured by an overload situation, the load must be removed to initiate the healing process. Once degeneration of a tissue is stopped, the body’s natural healing process can work its magic.

WHAT IS LAMINITIS

Whenever I see “ITIS” behind the name of a tissue, I take it to mean something is wrong with that tissue. It is “sick”, weak or unhealthy. The term “Laminitis”, to me, means the laminae is sick, inflamed or injured. Historically, laminitis occurs when the horse experiences a rather large, serious systemic stress. This stress can be initiated by a number of situations such as: nutritional overdose, toxins, infections, flu, heat stress, etc. and the body chemistry is altered.

The question that occurs to me is: Why is the laminae targeted in these situations?

My theory is that no one tissue is singled out. The entire body is affected. The chemistry of all soft, sensitive tissues of the body is upset. Knowing how I feel when I have the “flu”, it is a safe bet that during these situations the horse aches all over. He hurts whether he moves or stands still.

So I ask again, why is the laminae affected the way it is, seemingly more so than other tissues?

The main reason is unique to the laminae. The laminae is in tension when it is bearing weight. The sick laminae is stretched and torn with no physical limitation to how far the hoof wall can be separated from P3. The other weight bearing tissues of the leg and hoof bear their load in compression and thus damage is minor. Another reason is because the laminae happens to be located at the end of the leg. Circulation to the extremities of the limbs is a challenge at the best of times, and that problem is magnified when the body’s chemistry is out of balance. Also, when the horse is generally feeling poorly, it will tend to stand in one place thus the circulation to the lower leg is further reduced due to the lack of stimulation from movement. A third reason is that the hoof wall and laminae are difficult to unload. The hoof is structured so the wall contacts the ground first thus the wall and laminae are loaded with each stride. Standard trimming and shoeing practices also tend to maximize the load on the wall. Pain is natures way to encourage an animal to unload and rest a certain tissue thus giving it a chance to heal. By its own nature, the horse avoids laying down when suffering pain or stress.

These cumulative reasons cause the laminae to be quickly placed in a severe overload situation with no natural way to be unloaded. Laminitis is not a complicated disease. It is merely a condition of tissue overload.

WHAT IS FOUNDER

“Founder” is what happens to the hoof if the laminae overload is not reversed quickly. The hoof wall becomes displaced from the coffin bone. This hoof wall displacement is caused entirely by the weight bearing forces as the hoof wall contacts the ground. The laminae is traumatically injured and torn in the process. All other laminitis symptoms are subsequent to this mechanical injury.

The horse experiences severe pain that can last for weeks or months. A sunken depression along the coronary band is relative to the hoof wall displacement. The displaced hoof wall gives the impression that the sole has dropped. Radiographs give the impression that P3 has rotated. Often the sole becomes bruised and inflamed around the outline of P3. This damaged sole can slough away, exposing the sensitive sole corium and the tip of P3. The unnatural displacement of the hoof wall, causes mechanical restriction of the blood circulation to key areas within the hoof. Serum fluids are released from the damaged laminae and sole cells. This serum usually cannot escape through the hoof wall or the sole callous, and thus collects in pockets under the wall or the sole. The pain level increases as the fluid pressure rises in these seroma pockets. These seroma pockets can abscess and fester for several weeks before breaking out somewhere, usually at the coronary band. The characteristic “buzzing” pulse may be present before hoof wall displacement or after, but it is associated with severe inflammation and trauma.

As these complications set in, the overload situation expands to include tissues other than the laminae. If the injury causing load is not removed, the laminae and various other tissues of the hoof continue to be injured. The situation is now worse than ever. The healing process is retarded or impossible. The situation appears hopeless.

CHAIN OF EVENTS OF LAMINITIS / FOUNDER

  1. The horse gets sick.
  2. The body tissues become sick and weak.
  3. The laminae’s unique situation causes it to be overloaded with no relief.
  4. Within a few hours of onslaught of the systemic stress, the weight bearing load forces the wall from P3, tearing the laminae.
  5. Hoof wall displacement continues until the load is shared when the sole contacts the ground.
  6. Associated complications set in. Inflammation and seroma pockets are serious factors.
  7. With luck and time the situation stabilizes to a chronic condition.
  8. Without some form of reversal of the overload situation, the condition will remain chronic.

PREVENT FOUNDER

To prevent the hoof from foundering, remove the load from the hoof wall and the laminae when the horse is experiencing a systemic condition that historically leads to laminitis. Do this early before the hoof founders. Do not wait until tomorrow. An hour delay can be too late. Treat the horse to eliminate the systemic condition. Keep the wall unloaded (3 to 8 weeks) until the horse is nursed back to health.

REPAIR FOUNDER

To repair a foundered hoof the intent is to bring it back to its normal condition. Remove the load from the hoof wall and laminae as early as possible to minimize the damage that must be repaired. Again, a delay of an hour can make a huge difference. During the acute stages, treatments to control inflammation and techniques to remove serum fluids are necessary. The horse’s health and environment must be carefully managed to enhance the rejuvenation process. Keep the hoof wall unloaded until a new length of wall has grown from the hairline to the ground (8 to 12 months).

HOW TO UNLOAD THE HOOF WALL

To unload the hoof wall, the load must be placed onto the sole of the hoof. This can be accomplished two different ways. The simplest method is to trim the hoof wall short so the sole callous, the bars and the frog contact the ground before the hoof wall. The horse must be turned out on soft forgiving dry ground conditions such as grass turf, sand, saw dust or snow. When favorable ground conditions are not available or when the sole callous is insufficient, the foot can be fitted with a commercial sole support system to cushion and artificially extend the sole to or beyond the rim of the hoof wall.

For those who are leery of using sole support, it should be noted here that when the hoof founders, with no intervention, the wall is displaced until the sole comes in sufficient contact with the ground to take a portion of the load from the wall. However, P3 is then caused to be tipped toward the ground during weight bearing. This results in bruises and holes in the sole, eventual deformities to the tip of P3, and possible damage to the circumflex artery. If the load ends up being born through the sole anyway, then it makes sense to manage the load on the sole to avoid these typical symptoms of sole overload. Care must be taken to distribute and cushion the load over the entire area of the sole cavity, taking advantage of as much surface area as possible and avoid pressure points.

RECIPE FOR TREATMENT OF LAMINITIS

Here is my recipe for treating laminitis. This recipe has not failed me yet. The key is to 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.

  • 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.
    • 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 good commercially available sole-support system.
  • Initiate veterinary care to treat the systemic problem that triggered the laminitis.
    • Expect and manage 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. During these traumatic times, 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 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 application of medication.
    • Administer anti-inflammatory agents.
    • Rasp horizontal grooves in the hoof wall at the toe.
    • Apply a poultice over the grooves.
    • Monitor the situation closely.
    • Make adjustments as required.
  • 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.
    • .
    • 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.
  • 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.
  • Maintain a reduced load on the wall until the new wall and laminae are grown (8 to 12 months).
  • Reset the sole support system at 4 to 5 week interval.

WHAT TO EXPECT DURING THE TREATMENT PROCESS

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 from the 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.

First Two To Ten Weeks Of Treatment:

The horse’s soundness will gradually improve as the injured laminae heals and the associated inflammation subsides. However, it is to be expected that the horse will experience periods of severe pain until the inflammation is in control. These sore periods may come and go and can last for a few days or two to three weeks. The horse may improve nicely for some time, traveling at a careful walk. Then it can become so sore that it is reluctant to stand and may spend much of its time lying down. The horse must be provided with deep, soft bedding to make it comfortable. With gentle encouragement, the horse probably will allow the feet to be handled while lying down. It is a stressful time for the horse but with good management, the condition will stabilize and the horse will be back on its feet.

Two To Four Months Of Treatment:

Inflammation is not an issue any more. The horse will be happy, bright and will spend much time on its feet and will travel at a careful walk. The growth ring indicating when treatment started will be about one inch down from the hair line. The new hoof wall profile above that ring will be parallel with the coffin bone. There is a risk during this period that the horse begins to feel so good it may over exercise causing injury to the newly rejuvenated laminae and inflammation of the sole. The horse must be allowed free roaming exercise but kept quiet and content.

Six Months Of Treatment:

The horse spends most of its time on its feet. It travels at a normal walk and will occasionally trot or lope. The reference growth ring is one and a half inches from the hairline. The new hoof wall is smooth without the typical wavy growth rings associated with laminitis.

Eight Months Of Treatment:

The reference growth ring is two to two and one half inches from the hairline. The new hoof wall profile is parallel with the coffin bone. The horse generally travels sound.

Ten To Fourteen Months:

The reference growth ring has reached the ground. The white line will be close to normal width. The horse should be sound with a normal looking foot.

SUMMARY

Laminitis is simply a condition of tissue overload. The overload situation may be initiated by a number of causes, but it is the weight bearing forces, as the hoof wall contacts the ground, that do the damage. The laminae and other tissues are injured as the hoof wall is lifted away from the coffin bone. Laminitis is simple to manage if it is treated as an overload condition and the weight bearing load on the laminae is removed early. By unloading the wall and laminae, most complications associated with laminitis are minimized or non-existent. Inflammation and serum fluids within the hoof capsule are the biggest challenge but are now controllable. When we consider that this is similar to a human loosing a thumb nail, a displaced hoof wall should not be a permanent disability nor a death sentence. The hoof structure will rejuvenate. The horse can live and return to active performance.

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 wall growth progresses toward the ground. The rejuvenation takes ten to fourteen months to complete.

The subject of this presentation is Laminitis, but it is important to note that other ailments involving the hoof wall or laminae can be effectively managed by unloading the hoof wall. Hoof wall cracks, flares, dished profile, extended white line, and crushed heels are all symptoms of tissue overload. These problems also go away with a lesser load on the hoof wall and laminae. A reduced load on the wall can enable horses with thin, weak hoof walls to enjoy a productive performance life. A sole support system can be effective to manage cases involving loss of hoof wall such as white line disease or injury. If you unload it, it will heal.

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