• Home
    • What we do
    • About TLS
    • TLS Privacy Policy
    • Contact
    • Case Studies
  • Laminitis
    • Emergency Treatment
    • Chronic laminitis
    • Laminitis FAQ
  • EMS/ID
    • Management strategies for EMS/ID
    • EMS/ID FAQ
    • Rosie
  • Diet
    • Diet FAQ
  • PPID
    • PPID FAQ
    • Half Pint
    • Widget
  • Feet
    • Realigning Trim
    • Feet A-Z
    • Chronic laminitis
    • Understanding x-rays
    • Taking hoof photos
    • Feet FAQ & Articles
    • Feet gallery
    • Reading the foot
    • Dorsal rotation/long toes
    • High heels
    • Palmar Angle Calculator
    • Sorrel
    • Monroe
    • Cedar
  • News
  • Articles
  • A-Z
    • A
    • B
    • C
    • D
    • E
    • F
    • G
    • H
    • I
    • J K
    • L
    • M
    • N
    • O
    • P Q
    • R
    • S
    • T
    • U V W X Y Z
  • Case Studies
    • Danae
    • Half Pint
    • Herbie
    • Herbie diary
    • Herbie's TTouch diary
    • Izmir
    • Misty
    • Nero
    • Nutmeg
    • Nutmeg TLS rehab
    • Rosie
    • Sorrel
    • Tex
    • Widget
  • France
    • Articles en francais
  • Research
    • New Research/Research by Date
    • Research papers by subject
    • Research papers by author
    • Research news/comment
    • Research projects >
      • NSC in grass & hay
      • How much do horses eat?
      • Do fructans cause laminitis?
      • Turmeric/Curcumin
      • Insulin response to diet
    • Help with research
  • Help!
    • Join Friends of TLS
    • Donate
    • Appeals
    • Raise funds for TLS
    • In Loving Memory
    • Friends of TLS only
The Laminitis Site

Casareño's recovery

12/6/2014

5 Comments

 
9 x-rays taken over 6 months illustrate Casareño's laminitis story:
Casareño, a 16 year old Andalusian, developed laminitis in all four feet in May, five days after having a corticosteroid injection (6 mg Celestone - betamethasone) for a suspected pastern joint sprain.

03 June - x-rays showed a large palmar angle (not measured by the vet) of around 15 degrees.
The treating vet applied casts that raised the heels, further increasing the palmar angle and presumably the pressure on the tip of P3.
Picture
August 2014
24 June - reverse shoes and 5 degree heel wedges had been applied.  The palmar angle was around 23 degrees, dorsal rotation of 5.73 degrees was measured, and the hairline marker indicated considerable sinking.

TLS recommended the rehabilitation protocol published by Debra Taylor et al. (2014) - remove shoes, fully realign the feet, support with thick pads - and on 10 July the shoes and wedges were removed, but the feet were only trimmed to tidy up frogs and bars.  The vet declared that carrying out a realigning trim could be "a disaster" and that the long toes and high heels should not be corrected until more sole depth had developed (TLS disagreed!).  The frogs were infected with thrush, which is common when heels are too high.

17 July - x-rays showed slightly increased palmar and dorsal rotation, which would be expected with no recent trimming.  Personal correspondence from Debra Taylor backed the argument for commencing the realigning trim.  The vet admitted that the situation was very bad and that something must be done as soon as possible, and agreed that a barefoot trimmer could be instructed.  The owner feared that Casareño could be heading towards euthanasia.  

13 Aug - after two trims (apparently without reference to the TLS suggested trim), very little progress had been made with realignment, and an abscess was now evident in the sole beneath, and very close to, the tip of P3.  A third hoofcare professional was instructed, and guided by mark ups from TLS, realigning trimming finally got underway.

25 Aug - after just one trim the dorsal and palmar angles were reduced.  Casareño was finally off of NSAIDs and moving better.

15 Sept - after two further realigning trims the toe was looking much better, but the palmar angle was still too high.  Note the gas pocket indicating abscessing beneath the tip of P3, and the change in the hoof wall at the toe.  At this point Casareño had increased but not full comfort, due probably to a combination of the feet still not being fully realigned, the solar abscess on the right fore, and heel rubs from wearing boots in a sandy environment.

9 Oct - two trims guided by the previous x-rays brought the heels down, reducing the palmar angle further, but probably still not quite far enough.  Note how the frog apex, marked by a drawing pin (that should have had the pin shortened much further!), had migrated forwards - the true frog apex will always be behind the tip of P3.  Casareño was now being walked out in-hand.

01 Dec - the feet had remained stable but probably still needed a little more off the heels to bring the palmar angle down to between 3 and 5 degrees.  This should be guided by the live sole - which can be difficult to find on dry compacted feet that have had high heels for a long time.  Note that the black gas pocket indicating the abscess has grown out and healthy tissue appears to be supporting P3.  The true frog apex has been identified and the frog trimmed back, so the true apex can again be used to guide the trim.  Note the clear shape of the collateral grooves on the x-ray.  Note also the first radiographic signs of bone remodelling at the tip of P3 - we suspect this is due to the long-term high palmar angle and pressure on the tip of P3.    Casareño is now in regular in-hand work and being turned out, with his feet protected by boots and pads.
Sole photos of the right fore from July to November show the abscess and stretching forward of the frog.

In November Casareño's vet posted on owner Pat's Facebook page: "I'm super happy to see Casereño recovered. Now you're probably the person who knows most of laminitis in Spain and I must admit that you made me crazy with so many articles you've read ....hahaha!!
Was fortunate to have the help of people The Laminitis Site but especially with the professionalism of an expert as is the blacksmith Bryn Simmo ..... GRACIAS Pat!!!"

Raising the heel has unfortunately been advocated for laminitis cases for some time.  TLS can see no justification whatsoever for doing this - see Don't raise the heel!  Instead, in Care and Rehabilitation of the Equine Foot, p 351, Pete Ramey says "at the first signs of laminitis, restore P3 to a more natural ground plane, relieve pressure on the walls and pad the sole with foam rubber – vertical sinking and destructive pressure to the solar corium can be prevented”.  Pete also says, on p 350, "I believe that DDFT tension concerns have held back the veterinary and farrier world, preventing rotation reversal by leading people to stand P3 up on its tip and ultimately destroying the foot."  
Although Casareño's recovery from laminitis has been challenging and painful at times, he was lucky to have a vet and farrier who were open to different ideas, and owners who were totally committed to his recovery. The full story of Casareño's rehabilitation will follow soon.


The video below shows Casareño's progress from being crippled in July to jumping for joy in December:

References:
Taylor D, Sperandeo A, Schumacher J, Passler T, Wooldridge A, Bell R, Cooner A, Guidry L, Matz-Creel H, Ramey I, Ramey P
Clinical Outcome of 14 Obese, Laminitic Horses Managed with the Same Rehabilitation Protocol
Journal of Equine Veterinary Science Volume 34, Issue 4, Pages 556–564, April 2014
5 Comments
Ellen Hearne
12/8/2014 09:49:26 am

Thank you for posting this series of x-rays and photos. I am especially appreciative of the notations on the tip of the frog. This series will give me a lot more confidence to trim more effectively!

Reply
Trickle Netr link
5/20/2016 10:58:30 am

Fabulous website. Packed with so much info! May I add a link to my website? Cheers :)

Reply
Andrea
5/20/2016 07:28:00 pm

Hi Ellen
Yes, we'd love you to link to The Laminitis Site from your website.
We already have a link to yours on our Management Strategies for EMS page.

Reply
sydney radden
9/10/2016 01:40:26 am

love all your info on founder, i rescued a pony seven years ago and still struggeling with him and he s got cushions too had all the tests done but ANY INFO is helpful, thanx

Reply
The Laminitis Site link
9/20/2016 02:18:15 pm

Hi Sydney, thanks for your kind comments.

Have you looked through this article and links: http://www.thelaminitissite.org/articles/laminitis-ems-or-ppid-start-here?

In our experience, when a horse continues to struggle with laminitis, either the cause hasn't been correctly identified and management/treatment put in place, and/or the feet haven't been fully realigned and well supported. If a horse continues to suffer from PPID which leads to laminitis because its hormone levels aren't being fully controlled, then no matter what you do to the feet, the horse is likely to continue to struggle, and similarly even if you get hormone levels fully controlled and sugar/starch levels in the diet really low, if rotation remains uncorrected and/or thin soles are not well protected, then a horse is likely to remain unsound and uncomfortable.

If you'd like us to look at his history to see if we can suggest any area where you might be able to make improvements, you are welcome to email details to info@thelaminitissite.org.

Reply

Your comment will be posted after it is approved.


Leave a Reply.

    Articles

    ​Laminitis, EMS or PPID - start here​
    ​Who said "stop the carrots"?
    ​Pituitary stress hormones
    ​Should pergolide be increased for the seasonal rise?
    ​
    Are you using illegal supplements?
    ​Body Condition Scoring
    ​
    Pituitary Pars Intermedia Dysfunction
    Equine Metabolic Syndrome and insulin dysregulation
    TTouch for laminitics 1
    Laminitis and the Feet

    La fourbure et le pied
    Laminitis, EMS and PPID
    Testing Insulin
    Cold Weather 
    Laminitis Rehabilitation – The Owner's Perspective
    Casareño's recovery
    P3 - the pedal/coffin bone/third phalanx
    Vit C and PPID

    Vetcare Webinars Andy Durham 2013
    Movement - good or bad?
    Pulsatility of ACTH
    Starting pergolide/Prascend
    ​
    Managing horses with PPID - Marian Little & Dianne McFarlane
    Is it PPID or is it EMS? 
    FAQ: Rehabilitating the feet after laminitis
    Diet for weight loss
    Please report adverse reactions to Prascend
    Splitting Prascend tablets
    Measuring Collateral Grooves
    General Laminitis Quiz
    Body Condition Scoring Video
    Video comparing PPID symptoms and normal aging
    McFarlane 2011 Equine PPID
    Pharmacokinetics of Pergolide Mesylate in Horses - Rendle et al. 2013.
    EVA foam pads

    Rehabilitating the Laminitic Foot - Scott Morrison DVM
    Anaemia and Iron Supplements
    Early symptoms of PPID.
    Don't raise the heel!
    The Laminitis Site is now a charitable company!
    Izmir returns to work after laminitis in all 4 feet.
    Trimming the laminitic horse.
    A balanced foot.
    The circumflex artery and solar corium necrosis.
    What do you know about PPID?
    Laminitis myths.
    Frosty grass = high sugar!
    There are no magic potions!
    Is injected pergolide more effective than oral?
    ​
    Risk Factors for Equine Metabolic Syndrome - Dr Nichol Schultz
    Fly free Homey pony.
    Sorrel's doing great!
    Celebrating Homer's results!
    The Horse.com Ask the vet live: PPID.
    If the bone moves - move it back!
    Always get a diagnosis!
    Horses with laminitis need pampering!
    Autumn is the best time to 
    test for PPID.

    Archives

    March 2019
    February 2019
    November 2016
    August 2016
    February 2016
    January 2016
    July 2015
    June 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    October 2014
    September 2014
    June 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013
    December 2012
    October 2012
    September 2012
    August 2012
    July 2012
    June 2012
    September 2011

    RSS Feed

Laminitis/EMS/PPID? Start here
Need help/support? Join FoTLS
Donate to help laminitic horses
Disclaimer: The information, suggestions and links (hereafter referred to as “information”) contained in this website are provided for information purposes only and should not be relied upon nor replace professional veterinary advice.  Information is non-veterinary, is based as far as possible on current research, does not constitute advice or diagnosis, and should be discussed in full with all relevant vets and hoofcare or other professionals.  No responsibility is taken for the accuracy or suitability of information contained in this website, and no liability accepted for damages of any kind arising from use, reference to or reliance on any information contained in this website.  If you suspect your horse has laminitis or is ill, please consult your vet. 
The Laminitis Site is a charitable company registered in England & Wales No. 8530292, recognized by HMRC as a charity for Gift Aid.  
Please consider making a donation to support the work of The Laminitis Site.
For more information and membership of the TLS support/discussion group, join Friends of The Laminitis Site.
The Laminitis Site's Privacy Policy.