Welcome again, This is a case of acute laminitis that we were called to look at late on the evening of May 29, 2011. History of colic episodes the previous couple of days but now not wanting to stand and when does stand has typical laminitis stance. Upon examination normal foot conformation no ridges but large bounding pulses noted in all four feet. Placed in Nanric modified ultimates which raise the palmar angle 18-20 degrees and Lobo immediately began to show signs of comfort with licking of lips, less distress and standing up squarely on fronts. He was still reluctant to move in a normal fashion. Baseline radiographs are taken on this evening and have soft tissue parameters within normal range. This is where many hoof care professionals are confused as no signs of bone displacement or rotation has occurred, but it is still very important to support this foot mechanincally with wedging to unload effects of the deep digital flexor tendon as the vascular compromise has likely began. The idea that if there is no rotation it is no laminitis/founder does not hold true. This will also show how important radiographs on day 1 of exam are so valuable when compared to the next visit 5 days later. A baseline venogram was not performed as finances where limited at this point.
The venogram is performed in the modified ultimate which unloads the flexor tendon by 60 percent. This also serves as a means to evaluate a certain therapeutic package. If your plan is to restore healthy blood supply then you should be able to prove that the package is going to do that via the venogram. This venogram suggest that the modified ultimate will not be enough to restore proper blood supply and that further mechanical release via deep digital flexor tenotomy would likely improve the situation as the sharp border of the coffin bone is cutting through the sensitive solar corium and its vital blood supply. Several methods to prevent the bone from displacing are practiced but few have been confirmed and followed with serial venograms and radiographs to prove that they are unloading the circumflex artery. The heart bar shoe is a positive force applied to the frog in order to antagonize the displacement of the coffin bone, but think about the tissue between the rigid heart bar and the coffin bone. The solar corium with its blood supply that makes the horny sole that we can see and touch. Obviously it has helped many cases but I think a further study as to it's affects on foot perfusion in a laminitis scenerio via serial venograms and radiographs is warranted. Below is the radiographs and venograms from the second visit 5 days later. I will also post a normal venogram for comparison.
|NORMAL VENOGRAM FOR COMPARISON TO LOBO'S|
|POST TENOTOMY RADIOGRAPH|
|TENOTOMY RAIL SHOE, POST TENOTOMY RADIOGRAPH|
Lobo has went from laying down 90 percent of the time to standing 90 percent of the time. Attitude and appetite have greatly improved. The plan is to recheck venogram and lateral radiographs in 2-3 weeks after tenotomy. I will gladly post those so we can all learn from this case. With the amount of bone remodeling that has already occurred to the fragile thin rim of coffin bone it is less likely we will have as good of a response as we would have if derotational shoeing and tenotomy where performed in the important window of opportunity at the second visit. However, I do expect a great improvement in the hoof growth and patient comfort. The amount of bone resorption will be what prevents Lobo from returning to a previous level of perfomance. We will have to wait and see.
I would like to thank my Lovely wife for helping and enduring the many crippled horses I drag to home to try to fix and learn from. It is vital to my education to have cases like this. I would also like to thank Brendan Frost for donating a Sunday afternoon to help me shoe Lobo.
Stay tuned for more exciting podiatry cases!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!