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The Laminitis Site

Laminitis rehab - barefoot v shod

11/23/2020

3 Comments

 
DRAFT

What are the benefits and disadvantages of barefoot v shod for horses recovering from laminitis?

For laminitis rehab, TLS doesn't recommend shoes because:

feet usually need frequent trimming during realignment - heels can grow 10 mm in 3 weeks, and shouldn't be lowered by much more than 10 mm, so trims usually need to be no more than 2 weeks apart initially until the feet are fully realigned.
the walls are not fully connected to the bone (and therefore skeleton), so weightbearing on the walls should be minimized. This is particularly important when an area of separation can be seen on the x-rays, as nothing in front of the area of separation is stable and therefore shouldn't bear weight at all. - the horse needs support directly beneath the pedal bone.

if the sole is thin but there is palmar rotation, i.e. heels need to come down, the only way to do this is to trim the bottom of the foot in 2 planes, impossible with shoes, no problem with well padded boots.

nearly all the penetrations we've seen have been in horses wearing shoes with no sole support (I have to say with the exception of the penetration we're working on at the moment, but she had casts fitted around pads with a hole cut out beneath the tip of P3 in the pads, giving P3 a hole to fall down into, which is exactly what happened. We think the only reason only 1 foot penetrated was because the hole in the pad on the other foot was badly placed and not beneath the tip of P3).







We see a lot of horses fail to recover, or P3 penetrate the sole, when they are wearing heart bar shoes, either plastic or metal.
Some examples:

Horse&Hound Forum 2010
A 14 year old 16 hh mare had been suffering from laminitis for 10 weeks when she suddenly deteriorated and the pedal bone could be seen as a bulge in her sole.  X-rays were taken and confirmed severe rotation in both back feet with around 1 mm of sole covering the pedal bone.  Front feet were not affected.  Imprints were fitted and eased her discomfort, after which pain was only seen when she walked out of the stable.  On between 4 and 1 Bute a day, not tested for PPID (or insulin?). Mare described as always having sensitive/thin soles.  3 days after posting on a forum for help, the owner reported that the mare had been unable to put any weight on her worst foot, the bone had moved more and sunk and vet and farrier said there was no alternative but to PTS.

Lessons to learn:
X-rays should have been taken as soon as laminitis was suspected - ideally on the first day, and definitely within the first week - and the feet realigned and supported through the full solar surface.
Horses should not leave their area of confinement with wall to wall bedding until their feet are fully realigned, well supported through the full solar surface, and they are off of all pain relief.
Lifting a horse off of its soles will often reduce pain - but is also likely to leave the pedal bone unsupported, allowing actual solar penetration.
Shoes will load the walls - already disconnected from the bone - and not allow lowering of the heels but protection of sole depth in the front of the foot. 
The cause of the laminitis must be identified as soon as possible and removed/treated/managed.




Although very limited, research by Panagiotopoulou et al. at the RVC that looked at the effects of a steel shoe v no shoe on one TB gelding when walking over a platform, found that "in all cases, the shod horse showed higher concentration of stresses on the P3 than the unshod condition, with the caveat that none of these differences were statistically tested."
Panagiotopoulou O, Rankin JW, Gatesy SM, Hutchinson JR
A preliminary case study of the effect of shoe-wearing on the biomechanics of a horse’s foot
PeerJ. 2016;4:e2164. doi:10.7717/peerj.2164



3 Comments
Gemma
12/19/2020 03:21:14 pm

Good afternoon all, Im looking for some help on the best way to go with my mini shetland, Pumpkin. He's 13 and has recently been diagnosed with cushings. He has been suffering with bouts of laminitis for the last 4 months or so on and off - get him sound and then he goes footy again. I've been trying to manage this with regular trims and hoof boots with pads but having gone footy again this week I bit the bullet and got xrays done and vet has advised there's rotation in both fronts with the right worse and vet recommends heart bars (he's never been shod so am concerned about this and have also read your advice against shoeing which adds to my concern). At the same time, I think because of everything he's been going through, he's also just been diagnosed with mild asthma which i think is probably more like a bronchitis due to a low immune system and now has an inhaler. Weight not an issue currently, he has analysed meadow hay from forage plus, a quarter prascend per day and twice daily he has a handful of simple systems lucie fibre nuts with some micro. linseed, forage plus laminae balancer, quarter bute. In addition Ive been adding some Global Herbs airways plus and restore which Im looking to phase out and start trinity consultants l94. During conversation with the vet on the phone once he'd looked at the xrays was packing no other options suggested or discussed. When I spoke to the farrier (who had also discussed with the vet) he said the vet had advised heart bars. I will discuss this further with my vet but would be grateful for some advice as to whether I can get my pony sound with biweekly trims? Or is it that in some cases alternative methods (packing or heart bars) are necessary. Many thanks in advance, Gemma

Reply
The Laminitis Site
12/19/2020 04:21:47 pm

Hi Gemma

If Pumpkin has laminitis and PPID then he has insulin dysregulation (ID), and he should have his baseline insulin levels monitored after he has been eating his usual hay to see how significant his ID is and to monitor improvement
PPID alone doesn’t cause laminitis, it is PPID with ID that causes laminitis, and a horse with PPID and ID should be managed as a horse with EMS, plus pergolide to treat the PPID. Pergolide can be given as Prascend or as the molasses-flavoured Bova pergolide paste, which can be much simpler for ponies as it comes in 0.2 mg increments, rather than the 0.5 mg increments of Prascend. Prascend tablets should not be split into less than the scored 0.5 mg halves without a pill splitter.
Are you confident in his PPID diagnosis? Is he showing clinical signs of PPID, as well as presumably raised ACTH? Have you eliminated other reasons for increased ACTH – see http://www.thelaminitissite.org/ppid-faq/does-a-high-acth-result-mean-my-horse-has-ppid.
Equine asthma can be a sign of PPID. Do check with your vet that his asthma medication won’t affect his ACTH results when you have him retested, as some drugs e.g. Ventipulmin have been shown to increase ACTH.

X-rays should always be taken at the first signs of laminitis, as it is often changes in the feet that are causing the pain seen as laminitis, so it’s good that you’ve got x-rays now. We really need to see the x-rays to be able to help – Friends of The Laminitis Site can post x-rays and foot photos for assessment and trim mark ups (join here, a £10 donation is payable for membership: http://www.thelaminitissite.org/join-friends-of-tls.html).

In our experience it is extremely rare that shoes would be better than correct barefoot trimming with boots and thick soft pads for laminitis rehabilitation, and this is backed by Debra Taylor’s 2014 research in which 100% of horses with laminitis, several with significant dorsal and palmar rotation, sinking and near solar penetration, recovered to their pre-laminitis level of soundness – see https://www.sciencedirect.com/science/article/pii/S0737080613006370.

We do however see quite a few horses fail to recover when heart bar shoes are fitted, as heart bar shoes generally leave the tip of the pedal bone unsupported, and if the laminae are significantly damaged/separated, under the weight of the horse the pedal bone can sink down into the hoof capsule and even penetrate the sole, particularly if the toe is long and/or weightbearing not minimized on the toe.
See http://www.thelaminitissite.org/feet-faq--articles/solar-penetration for how to prevent this.

It is important to correct rotation – that is dorsal AND palmar – as quickly as possible, to reduce the risk of further damage and to encourage the new hoof capsule to grow correctly. See http://www.thelaminitissite.org/realigning-trim.html.

Our recommended diet is based on Spillers Lite + Lean balancer, which we often feed with Dengie HiFi Molasses Free, salt and micronised linseed. This diet will generally provide everything needed and keep sugar/starch levels below 10%. See http://www.thelaminitissite.org/diet.html.

Be very careful when giving in-feed supplements. Any supplement that claims to prevent or treat an illness/disease must have a marketing authorisation number, otherwise they are illegal. In-feed supplements can be sold in the UK without proof that they do what they claim or are safe, and should be backed by published research to prove that they are safe and do what the product claims. If a supplement contains an active ingredient, there could be side effects and contra-indications with prescribed medicines, and your vet should be kept informed of what you are giving.

In conclusion, barefoot rehab with frequent realigning trims and boots and thick soft pads should help most horses recover from laminitis. Take x-rays as often as you can afford (ideally every month or at least every 2) until his feet are fully realigned. Monitor insulin to assess laminitis risk - remember ACTH has no relationship with laminitis risk. Spend money on x-rays rather than supplements, and check with your vet before giving any supplements that could have an active ingredient/claim to help prevent or treat any illness.

Reply
Gemma
12/20/2020 02:37:06 pm

Many thanks for coming back to me so quickly with all that info. I’m going to speak with my vet tomorrow to go through the options then do the same with my farrier and take it from there. The ID test is certainly something I need to look into with the vet also as well as obtaining the X-rays (will do as you suggest and become a foftls to get further help).

Currently I’m inclined to keep him on the soft bed with regular trims until he’s stable enough to put boots with pads on and let out (I’ve been using Cavallo’s with easycare comfort pads but may review other options as perhaps these haven’t been helping him and a better pair might be better during the rehab).

Lots for me to work out but am very grateful for the guidance you’ve given me so far.

Thank you,
Gemma

Reply



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    ​Healthy v laminitic foot
    ​Deep digital flexor tenotomy following laminitis​
    ​
    ​Laminitis rehab - barefoot v shod
    Hoof sloughing
    ​
    The realigning trim - the front of the foot​
    ​Sole support v frog support
    Robert Bowker Hoof Anatomy videos
    Can feet recover fully after laminitis?
    What do healthy feet look like?
    Solar penetration​
    ​Trimming overgrown feet- Aladdin's slippers
    ​
    Are rubber mats better than concrete beneath bedding?

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