Managing the Laminitic Horse or Pony
Acute laminitis must be treated as a veterinary emergency - your prompt actions in the first few hours can make a significant difference to the prognosis and future life of your pony
In this section I'll focus on my barefoot approach to managing acute and chronic laminitis - we don't use shoes so I am completely unqualified to comment on the use of heartbar shoes, wedge shoes or other shoeing approaches.
Management of laminitis is a group effort involving the veterinary surgeon, the owner, the trimmer and yard staff. There is a spectrum of laminitis from vague symptoms through to the full blown acute laminitis episode. Where along that spectrum do we start making lifestyle and dietary changes? It is all about your perception of risk, and how comfortable you are carrying that risk.
My own feelings are that the time to begin making lifestyle and diet changes is when any symptoms that could point to laminitis are first noticed. Prompt action when the symptoms begin to appear in the earliest stages can head of a major episode completely. The harsh reality of most laminitis events is that it is always easier to see the symptoms looking back on the events building up to an episode, than it is to see it coming when at the time these signs are appearing in a fragmented way and the question "I wonder if something is wrong?" starts to form in the back of your mind!
Management in the Acute Stage
The truth is probably that there is no universally effective treatment for acute laminitis, but there are some approaches that are found to work better than others. The Management of the laminitic pony in the period during and immediatelly after acute laminitis is focused on:
Preventing or limiting pedal bone rotation -whether radiographs have confirmed that rotation has occurred or not
Relieving the pony's pain
Improving blood flow in the feet
Addressing the underlying cause of the laminitis
By the time the laminitis symptoms are seen, degeneration of the sensitive laminae has already happened. It is well known that the onset of cellular injury within the lamellae occurs during the developmental stage of laminitis and precedes the onset of pain and lameness. Cellular damage may have been underway for a period of time before the horse, owner, and vet are aware that laminitis has happened.
In the initial few days the pony will find movement very painful and should be kept in a restricted area - stall or small pen, with a deep straw or shavings bed. Plenty of gentle reassurance and comfort should be given, becuase they will feel pretty miserable and probably fearful too.
Feeding
The pony should certainly have no further access to grass, and should be placed on the diet recommended in this web site. No cereals and nothing containing mollasses or sugar should be given at all.
Sharing the load
Dr. Robert Bowker states that the weight of the horse was never intended to hang from the laminae. The hoof walls, soles,bars and frogs are supposed to work in unison to support the horse. Trimming and shoeing practices that force the hoof walls to bear all of the force of impact create more constant stress than the laminae were ever intended to withstand. Add to this the constant stress of landing from jumps, or toe first landings throughout life caused by weak, underdeveloped frogs and digital cushions - the result is a gradual downward movement of the pedal bone (P3) (relative to the coronary band) over time. Dr Bowker states that this is remarkably common, but seldom recognized until the horse finally becomes lame.
There is no practical means to counteract the vertical load of the horse’s weight that is placed on its feet. The horse weighs what it weighs, and the mass of the horse can only be slightly altered, and no method of so-called foot support will alter the vertical load. 500Kg is 500Kg that has to place a vertical loading through ground contact. If the horse is shod or if the horse stands on a hard surface, all of that weight bearing is concentrated around the perimeter of the hoof onto the compromised laminae.
In acute laminitis, I personally feel it is appropriate to remove the shoes if possible and place the pony on a deformable surface so that the sole, bars, and frog in the back section of the foot become load sharing with the hoof wall.
I prefer this approach to using frog support because the anatomy of the horse's foot means that the horny frog and the digital cushion above it are deformable and compressible under pressure. When pressure is applied to the frog it quickly deforms, is compressed, and the support for the pedal bone is reduced. The frog can be irreversibly damaged by this focused pressure and in some horses it will cause increased pain and lameness (Stephen E. O’Grady, BVSc, MRCVS). It is perhaps better to use the whole solar surface, bars, frog, heel bulbs, walls to support the horse and reduce the mechanical stresses on the laminae. it is probably most beneficial to place the horses on a conformable surface such as sand initially.
Left: This shows the effect of peripheral loading caused by a horseshoe or when the horse is standing on a hard surface. Note that there is no support fo rthe frog, and the weight of the horse is being carried on the very structures that are breaking down.
Right: This shows the load being shared with structures on the ground surface of the foot when the horse can sand on a deformable surface such as shavings, sand or mud.
Trimming and Booting
With my laminitic ponies I took the approach that little and often was best - to avoid massive changes in the balance of the hoof - so I worked the toe shorter and reduced the dorsal wall over a period of time - I was fortunate in that neither were tremendously long to begin with.
Use padded hoof boots (such as EasyBoots and Comfort Pads) if there is any discomfort or if the ground is rough and uneven. Running around in rough ground or gravel on a thinned sole is dangerous and uncomfortable for the pony. The pony needs to build a thick callused sole before he does that! Pressure to a thin sole can cause bruising and can even restrict blood supply to the sole by restricting flow through and from the circumflex artery that follows the perimeter of the pedal bone. This can "starve" the sole and actually reduce the sole's ability to thicken and callus. Keep the horse on forgiving ground at first, and/or use the foam insoles in boots to avoid this pitfall.
It is not fair to a horse to allow it to get fretful or worried about being sore on rough ground, using the boots now can save hesitancy problems developing later.
The long term trimming goal is to try to move P3 position higher in the hoof capsule. My vet has remarked that if he tried to perform a coffin joint block on my horses he would be going in 2-3cm too low for it to work! P3 is in a naturally high position in the hoof capsule, resting on a nice thick sole!
Your trimmer can advise you on the best trim for your horse - perhaps lowering the heels, working the toe back, reducing wall height - the trim will depend on the shape of the feet and the condition of the feet to start with, and the amount of discomfort the pony is in.