Do's & Don'ts for laminitis

Do's

Do treat laminitis with the same urgency as colic.
Do remove or treat the cause. Laminitis requires medical, shoeing and sometimes surgical treatments in combination.
Do palpate the coronary bands and provide frog support on your first visit.
Do provide the animal with a deep bed and let it lie down if it wants to.
Do provide frog support with either a roll of bandage, Lily pad, heart bar shoe or plastic heart bar shoe.
Do use ACP in combination with frog support. This will allow you to prescribe a lower dosage of NSAID. The toxic side effects of NSAID's are important particularly in ponies and sick or elderly horses.
Do provide frog support to high risk horses. Fracture or severe sepsis cases causing non-weight bearing lameness require support on the contra-lateral limb. It is tedious to say the least to spend hours in theatre on fracture or colic cases to have them founder 10 days later!
Do radiograph the feet with markers if the animal shows the same or an increased level of pain 3 days after the onset of laminitis.
Do consider the relative heights of the coronary band and extensor process on radiographs. This has more prognostic relevance than 'rotation' of the distal phalanx.
Do attend with the farrier if a dorsal wall resection is necessary. Although this should be a painless and bloodless procedure not requiring anaesthetic it does require veterinary supervision. Only a veterinary surgeon may perform surgery on horses.
Do consider the use of a securely fitted muzzle as a management aid in dieting ponies which can then be allowed exercise without the risk of overeating.
Do be wary of fitting heart bar shoes to animals receiving analgesic drugs, less sensitive feet cannot respond to excessive shoe pressure.
Do encourage clients to insure their horses with a reputable company against veterinary fees as hospitalisation of severe cases can be expensive.
Do consider early referral of unresponsive cases.


Don't's.
Don't use corticosteroids.
Don't force exercise the animal. Exercise was thought to be beneficial by increasing the blood flow to the foot. There is already a tremendous increase in the blood flow to the foot but there is little or no perfusion of the dermal laminae. No amount of exercise will improve this situation and may well mechanically tear the remaining laminae thereby worsening the founder.
Don't remove large amounts of heel from acute founder cases, (including chronic founder type 1 cases suffering a secondary acute founder attack). this increases the tension in the deep digital flexor tendon and may result in more 'rotation'. First test by placing a wedge (equivalent in height to the amount of heel to be removed) beneath the toe of the foot and raise the contra-lateral limb. If the animal is more uncomfortable of if a depression appears at the dorsal coronary band, leave the heel alone.
Don't remove the shoes (other than to fit heart bar shoes) if the animal has a flat or convex sole. It will be more uncomfortable having to stand on it's sole.
Don't fit any shoe other than a correctly fitted heart bar shoe to foundered horses. If the animal has foundered, the bone is loose within the hoof. The higher you raise it from the ground by means of non-support shoes, the farther the bone has to move downwards.
Don't fit any device that applies pressure to the sole of the foot, it is not designed as a weight bearing structure and will easily bruise and abscess.
Don't take non-weight bearing radiographs, they are of little diagnostic value.
Don't ask farriers to fit heart bar shoes without you having taken radiographs using markers. Good farriers will legitimately refuse to do so.
Don't forget to mark on the frog where you placed the drawing pin. If the farrier cannot appreciate where the pin was placed he is unable to fit the shoe.
Don't cut holes in the soles of laminitis or acute founder cases. This will result in granulating solar corium protruding through the hole which will be difficult to control. If there is sub-solar fluid present effect drainage by entering the foot through the dorsal wall at the level of the wall-sole junction. The horny sole is your biggest ally in treating laminitis and acute founder.
Don't ask the farrier to fit pads. You cannot evaluate the sole, the soles become wet due to trapped solar evaporation. Any solar pressure will further compromise the blood flow within the foot and cause pain.
Don't fight to fit shoes to horses in severe pain. There are effective glue-on alternatives available.
Don't provide repeat prescriptions of NSAID without re-visiting. An acute laminitis case that is in significant pain after 10 days probably requires a change in treatment or management.
Don't use nerve blocks to reduce the animal's pain. The animal will further mechanically damage compromised laminae by walking on painless feet. Nerve blocks may affect the neuronal control of digital arteriovenous anastomoses and potentiate digital ischaemia.
Don't hope that antibiotics will help either 'gravel' or post-founder abscesses. They won't. Only when drainage has been provided will the lameness improve.
Don't tell the owner to starve the animal, some people take you literally. Feed according to the animals bodily condition. Hay and bran is a poor diet for horses and ponies. If the animal needs to be dieted do so gradually using a combination of alfalfa chop, straw chop, soaked sugar beet and hay. Beware of rapidly dieting very fat or pregnant ponies, they may develop hyperlipaemia which is often more serious than the original laminitis.
Don't think that because the movement of the distal phalanx has resulted in solar prolapse that is the end of the horse's working life. It is the means by which prolapse has occurred i.e., the amount of distal displacement which is important.

References. 

Cripps, P.J. and Eustace, R.A. (1999).

Radiological measurements from the feet of normal horses, with relevance to Laminitis.

Equine Vet. J 31.5. 427-433.

Eustace R.A. (1992)

Explaining Laminitis and its Prevention

R.A. Eustace. Bristol.

Eustace & Cripps 1999

Factors involved in the prognosis of equine laminitis in the UK.

Equine Veterinary Journal, 31. 5. 433-443

Hood, D.M. (1984).

Studies on the pathogenesis of equine laminitis.

Ph D Thesis, Texas A & M University, College Station, Texas.

Kempson, S.A. (1990)

Ultrastructural observations on the response of equine hoof defects to dietary supplementation

Vet. Rec. 127. 494-498.

Stick J.A., Jann H.W., Scott E.A. and Robinson N.E. (1982).

Pedal bone rotation as a prognostic sign in laminitis of horses.

J. Am. Vet. Med Ass. 180. (3) 251-253.