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The Laminitis Site

If the bone moves - move it back! (OK - technically restore it to its correct position!)

8/17/2012

3 Comments

 
I gave a talk to the Charente Horse Group today on EMS, PPID and foot rehabilitation.  It's always so useful to get an insight into other people's perception of laminitis, and today several people commented that they hadn't realised that P3 (the pedal/coffin bone) could be returned to its correct position - they thought that once rotation or sinking had happened, the horse was stuck with it.  I guess this comes from the fact that you can't actually move the bone - but what you can do  is restore it to its correct position by trimming the hoof to hug the bone again - which generally involves reducing the palmar angle pretty much immediately (lowering the heels) and setting up the walls so that they grow down from the coronet at the correct angle with tight laminar connections (bringing the toe back and bevelling to where the wall should be).   The ECIR group and Dr Eleanor Kellon have been advocating that "the proper trim is one where the hoof capsule correctly conforms to the bones within it" for many years, and have guided owners and equine professionals through hundreds of successful rehabilitations.  Most of Pete Ramey's excellent book "Care and Rehabilitation of the Equine Foot" is about trimming the hoof to P3 and the internal structures of the foot.  I guess I'd been lulled into a false sense of security, thinking that everyone knew that laminitis rehab, in the majority of cases, is not much more than correct trimming (and protection).

Do people really still think that rotation or sinking following laminitis is a death sentence?!  I know past research (which perhaps belongs in the past!) has claimed that an angle of rotation greater than 11.5 degrees, or 15 degrees, gives a poor prognosis.  Well yes, I'd agree if the poor horse is just left like that!  But I've seen horses with rotation of well over 20' make full recoveries and go back to their previous work, often with the rehab trimming being done by their owners, or a farrier who is following instructions by email!  They simply need a correct trim - the trim that realigns the hoof to the bone - and to then have that trim kept perfect while the new hoof grows (plus the cause of the laminitis must have been identified and removed/treated and correct management must be in place).

And sadly I'm well aware that many horses are not getting their feet correctly realigned following laminitis - that's one of the main reason owners seek help on the internet.  To quote Dr Kellon and the ECIR group again, "too many horses fail to recover from laminitis due to incorrect trimming."  But once they get that correct trim, they can and usually do recover.
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For more on realigning feet following laminitis, have a look at The Derotating Trim:
http://www.thelaminitissite.org/feet.html
or check out Sorrel's story:
http://www.thelaminitissite.org/sorrel.html 
3 Comments
Anita Scott
12/27/2014 07:26:16 am

I have a pony with cushings (on 3/4 tablet per day) and EMS. My vet and farrier say she has some pedal bone rotation but that nothing can be done to improve it, they say there is no point x raying as it cant be corrected, their only advice is to put heart bar shoes on but again they say this wont help the pony so i am not willing to do this. I have tried to no avail to find a trimmer to help us but the ones i have tried are all too busy, I feel the farrier is not helpful at all and dont really know what more I can do to help my pony,to trim her hooves correctly. Can you offer any advice? She seems happy enough, isnt ridden and canters round in the field so I dont think she is in much discomfort but I feel things could definitely be improved with the right help. Many thanks :)

Reply
The Laminitis Site
12/27/2014 10:32:05 am

Hi Anita

Pedal bone rotation can always be improved and usually fully corrected, particularly if the realignment is carried out soon after the rotation has taken place. See http://www.thelaminitissite.org/2/post/2014/01/faq-rehabilitating-the-feet-after-laminitis.html

X-rays must ALWAYS be taken after laminitis, particularly if rotation is suspected. There is currently no proven method of calculating whether rotation has taken place without taking x-rays, although Dr Debra Taylor has shown that measuring collateral groove depths can give a good idea of the palmar angle of the pedal bone - see http://www.thelaminitissite.org/2/post/2013/11/measuring-collateral-grooves.html. However, many vets and farriers appear to be unaware of this method.

Hooves can look relatively normal but have significant rotation - see Sorrel's case study - http://www.thelaminitissite.org/sorrel1.html

Heart bar shoes should only be fitted if x-rays have been taken - it is essential to have x-rays showing the position of the frog apex before considering fitting heart bar shoes. See http://www.imprintshoes.co.uk/hot_flash_laminitis_afj.htm - I'm not endorsing this article, but note the statement "A heart bar should never be applied without radiographs!”

The Laminitis Site does not (generally) advocate the use of shoes for laminitis rehab, and recommends the barefoot realigning trim carried out by Dr Debra Taylor, Pete Ramey etc in their paper published this year in which 100% of horses, some with severe rotation (30 degrees palmar or dorsal rotation) recovered and returned to their pre-laminitis level of comfort - http://www.j-evs.com/article/S0737-0806(13)00637-0/pdf. All vets and farriers should be aware of this research. See also http://www.hoofrehab.com/HoofRehabProtocol.html and http://www.thelaminitissite.org/realigning-trim.html.

Is her PPID being fully controlled on her current dose of Prascend? Have you had ACTH and insulin rested recently?

It sounds as if you may need to find a team of vet and farrier/trimmer who will work with you - often we find owners end up finding new professionals to get the care they need for their horses. See Nutmeg's story - 2 different vet practices this year said she should be PTS, she came to The Laminitis Site for rehab and is now doing well, and now has a new vet and farrier: http://www.thelaminitissite.org/nutmeg-tls-rehab.html. See also Casareño's case study http://www.thelaminitissite.org/articles/casarenos-recovery and the article that his owner has just written about the changes she had to make to her professional team for Casareño to recover: http://www.thelaminitissite.org/articles/laminitis-rehabilitation-the-owners-perspective

You might also be interested in a case we are trying to help at the moment - Misty has had years of neglect, her feet are damaged beyond repair, but we have still been able, in just 2 weeks, to considerably improve her comfort and she has gone from being about to be PTS to being quite happy to mooch around: http://www.thelaminitissite.org/misty.html

If you are on Facebook you might like to join our associated support group - you can ask any questions, post photos and x-rays of feet for comments, and you will get a lot of support from other owners who have been in exactly the same position - sadly your story is far from unusual. https://www.facebook.com/groups/475349259169277/

Andrea

Disclaimer - all comments are subject to the disclaimer found at the bottom of each page on www.thelaminitissite.org.

Reply
The Laminitis Site
12/27/2014 10:39:21 am

Sorry - that should say "Have you had ACTH and insulin tested recently?"!

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