Title (Diagnosis): 8.4.2. LAMINITIS AFTER A COLIC OPERATION
1. Author of texts and photographs: Václav Kubeček, CE-F
Place of work: Stables around Prague
2. Literary review: Horseshoeing, 42.6. Hoof laminitis, ISBN: 978-80-7490-052-5, Print Bat 2015
3. Patient data No. 8.4.3.
Breed: Friesian horse
Sex: Stallion
Age: 2 years
Color: Black
Work use: Stallion in preparation for licensing
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Problems complained of by the owner: Laminitis after colic surgery
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Duration of the problem: 10 months
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Stables: Box, paddock
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Feed : Hay
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Litter : Elephant grass
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Frequency of hoof treatment : 10-14 days after laminitic episode
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Shoeing type: After laminitic episode plaster, then a straight keg shoe with an M 15 hoof packing material
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Lameness, possible diagnosis: Unable to move
4. Anamnéza
5.1. Characteristics of changes:
After solving the colic problems in August 2018, there was an acute laminitic episode of the front limbs. The front hooves were plastered for 10 days and then shod by another farrier
5.2. Limbs conformation:
Slightly based wide stance of the forelegs with outward rotations and inward rotation of the phalanges.
5.3. Hoof shape and pathological changes:
Slightly club footed, right steeper, both overloaded on the inside. There is a noticeable ring in the horn of the hoof wall on both hooves.
5.4 .: Evaluation of the adjustment:
According to X-rays, the hooves had high heels, especially on the right front limb, where the axis of the phalanx was broken forward
5.5 .: Evaluation of previous shoeing:
Due to the shoeing on the straight two-clip shoe without breakover, in combination with the large palmar angle of the coffinbones, great pressure was exerted on the foot in the area of the tip of the coffin bones.
5.6 .: Examination results:
After shoeing the front hooves by another farrier, due to inappropriate shoeing and the continuing sinking of the coffin bones, extensive abscesses developed under the tips of coffin bones on both affected limbs. Examination by a veterinarian revealed increased pulsation of the digital arteries and temperature of the hooves. The stallion was unable to move and showed severe pain in the front limbs when standing.
Fig. 1 and 2: From the left - X-rays of the left and right front hoof revealed a poor position of the coffin bones and a broken forward HPA axes of in the hoof joints. Radiolucent areas under the hoof bones confirmed extensive abscesses and damage to the coffin bones of both limbs.
5. Case description
6.1. Chosen trim: The shoes were removed, the abscesses opened and disinfected. Both hooves were treated with plaster bandages for 14 days, which did not cover the dorsal part of the hoof surface, so that secretions could be removed from the abscesses and disinfected.
Fig. No. 3.-7: Plastered hooves
In plaster bandages the comfort of moving around the box improved, but the stallion had trouble coming to the place of shoeing on hard surface. After 14 days, the plaster bandages were removed. The abscesses were healed and the stallion could be re-shod again.
Fig. No. 8 - 11: From the left - Left and right front hoof, befpre treatment
Fig. No. 12. - 15 .: From the left - Before trimming the hooves, the tensile tolerance of the deep digital flexor tendon on both limbs was measured with a protractor to obtain information by how much the heels can be lowered. When trimming the hooves, the heels were shortened accordingly so as to reduce the palmar angles of the hoof bones as much as possible. In the dorsal part of the bearing edge, a long rocker was rasped on both hooves, extending almost below the tip of the coffin bone. Its purpose is to limit the pull of the deep digital flexor tendon as much as possible during the breakover phase.
Fig. No. 16 and 19 .: From the left - view of fitted and modified horseshoes
6.2. Shoe preparation:
Libero Equilibrium shoes with spider plates bars were chosen for shoeing. In the dorsal part, a rotating rocker bend was forged, which did not rest on the bearing edge of the hooves during burning. A small gap was kept here so that the thin sole was not burned or bruised.
6.3. Shoeing - 23.8.2018:
Fig. No. 20. - 23 .: From the left - View of the left and right hoof, always viewed from below and from the side, after shoeing. Before nailing the shoe, the space under the bar was filled with a Luwex Premium hoof packing, but so that it did not cover the dorsal part of the hoof. The shoes were nailed to the back holes for the shoes to limit the pressure of the shoes on the damaged sole in the dorsal part of the bearing edge. This created space for the treatment of a thin, abscess-damaged sole.
Fig. 24 .: Front view of the forelegs.
6.4. Veterinary measures
Betadine-soaked gauze was pressed into the gap between the shoe and the sole - see Fig. 25 - 30
Fig. 25. - 30 .: Disinfection of the sole surface
6.5. Principles of further care
Maintaining rest in the box, limiting the supply of energy by eliminating grain feed, high layer of shavings. Next shoeing according to the growth of the hooves to avoid double impact.
Fig. 31. - 32 .: The rings in the horn of the hoof wall under the coronary band on the inner overloaded half of the hoof have not been solved yet.
6. Chosen measures
7. Development of changes
7.1. Effect of the 1st selected hoof adjustment
Immediately after hoof treatment and shoeing, the horse's movement on the hard surface improved by 80% - see Video # 1 (below)
7.2. Changes in the choice of horseshoes and shoeing - 2nd shoeing 24.10.2018
The second boost after 8 weeks was performed in a similar manner. The foot area in the dorsal parts of the hooves was examined in order to build a sufficient thickness of the foot under the tips of the hoof bones. The largest possible vault was created on the other parts of the foot surfaces (see Fig. 34. - 35.)
7.3. The effect of farrier measures
The most important farrier's measure is the correct balance of the hoof capsule in relation to the position of the coffin bone. All other farrier's measures must support the balance of the coffin bone.
A few days after shoeing, X-rays were taken and compared with images after shoeing by a previous farrier. A large positive change in the horse's movement was achieved by lowering the feet and thus aligning the axis of the bones and reducing the palmar angle of the coffin bones, by moving the breakover point under the tips of the coffin bones. Changes in the position of the coffin bones and improved hoof breakover reduced the pressure of the coffin bones on the dorsal surface of the hooves. This allowed the healing of abscesses and the growth of a new sole. The descent of the hoof bones was stopped by the spider plate bar and the active counter-pressure of the Luwex Premium hoof packing material.
Fig. 33 .: Comparison of the X-ray image of the left front hoof from 3.8.2019 with the image from 30.8.2019
Obr. 33.: Porovnání snímku RTG pravého předního kopyta ze dne 3.8.2019 se snímkem ze dne 30.8.2019
Fig. 36. and 37.: Front hooves when viewed from below after trim before shoeing. The heels were lowered to correct the position of the solar surface of the coffin bones relative to the supporting edge of the hoof.
Fig. 38. - 40: Seen from the front, there was a strong overloading of the inner parts of the hooves and thus an uneven growth of the new horn below the coronary band (see Fig. 38). Therefore, release hoof cuts were made at the site of constriction of the hoof wall with a ring (see Fig. 39. - 40.).
The dorsal wall was rasped parallel to the dorsal surface of the coffin bone. The same shoes were used for shoeing, and since the abscesses no longer needed to be treated, the entire foot area was filled with the Luwex Premium hoof packing material.
Fig. 41. - 42 .: Front hooves seen from below after the 2nd shoeing on 24.10.2018.
Fig. 43. - 44 .: Front hooves seen from the side after the 2nd shoeing on 24.10.2018.
Fig. 45. - 46 .: Front hooves seen from the side after the 2nd shoeing on October 24, 2018.
On December 4, 2018, 16 days before the next shoeing, X-rays were taken again. Despite the fact that the hooves were already 6 weeks after shoeing, the images showed an improvement in the thickness of the sole under the tips of the coffin bones, a reduction in the depth of descent and a reduction in palmar angles (see Figures 47 and 48).
Fig. 47. and 48.: X-rays on December 4, 2018
Fig. 49. - 50.: Left and right front hoof before shoeing seen from the front during the 3rd shoeing on December 20, 2018.
Fig. 51. - 52 .: Left and right front hoof after trim seen from below during the 3rd shoeing on 20.12.2018.
Fig. 53. - 54 .: Left and right front hoof seen from the front after the 3rd shoeing on December 20, 2018.
Fig. 55. - 56 .: Left and right front hoof seen from below after the 3rd shoeing on 20.12.2018.
Further treatment of hooves and shoeing was performed after 8 weeks, on 14.2.2019. The hooves grew by more than half its length. The release cuts balanced the growth of the new horn on both halves of the hooves. After aligning the dorsal wall, a stretched enlarged white line appears in the lower third. At the request of the owner, the stallion was not shod with spider plate and packing material, but on a two-clip front shoe Libero with a rocker, which was premature and very risky in terms of possible recurrence.
Fig. 57. - 58 .: Left and right front hoof viewed from the front after the 4th shoeing on 14.2.2019.
Fig. 59. - 60 .: Left and right front hoof viewed from the side after the 4th shoeing on 14.2.2019.
Fig. 61. - 62 .: Left and right front hoof viewed from below after the 4th shoeing on 14.2.2019.
8. Take home message
The treatment of laminitic hooves is a long-term matter requiring the active cooperation of a veterinarian, farrier and horse owner. The effect can take a long time and the treatment is often complicated by the impatience of the horse owner.
