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Hello and welcome. My name is Sammy L. Pittman, DVM and I am a veterinarian, farrier, and horsemen with a great interest in the field of equine podiatry. My wife and I own and operate Innovative Equine Podiatry and Veterinary Services in Collinsville TX. I offer a full line of horse veterinary care, however my passion lies within the health and well being of the hoof to better serve your equine companion. With so much lameness attributed to the lower limb many horses require an out of the box approach to achieve the success desired.
Give us a call and we will be glad to help you in any way we can. Thanks so much.
I will be discussing different Cases and thoughts from our world with the horse. Feel free to contact us via text or call at 918.235.1529 or send an email to iepvs11@gmail.com. Thank you for reading and enjoy

Wednesday, January 11, 2012

Update On Lobo the Laminitis Case.

 Previous Post on Lobo.  Click on the link to the left for the first post.  Lobo is responding very well to the Tenotomy performed back in July.  He continues to grow hoof wall at an even rate toe to heel and continues to add good dense sole.  I would not consider success if those are not occurring.  In evaluation of your laminitis treatment if you are still growing more heel than toe then you are not effectively addressing the mechanical problem. ie more tendon release is needed either with an increase in Palmar angle or likely a tenotomy.

I placed Lobo in Rocker rails as he began to have upright pasterns indicating the need for more mechanics (increase in PA), and due to the affects of the tenotomy which removes most of the load on the dorsal lamellar attachments and solar corium at the apex of the coffin bone but increases load through heels.  The only load is distributed through the bone column through the palmar (back) aspect of the hoof which over time will add some heel crush.  This is best addressed with the rocker or the buttress trim.

I (and Lobo) liked the increase in palmar angle but I was not fond of how he could rock back in soft footing.  This being due to the lengthening of the deep digital tendon post tenotomy.  I moved him into an aluminum buttress with a five degree rail, which accomplished my goal of a higher palmar angle and ability to remove all crushed heel and load to widest part of frog.  The buttress shoe trim involves creating a positive palmar angle by trimming from the toe back with the rasp tipped at a 5-8 degrees.  This is continued approxiametly the wings of the coffin bone ideally.  The heels are then taken at an angle parallel to the palmar angle to the widest part of the frog.  The  buttress wedge bar is made of 1/2 by 1 inch aluminum bent in to a U - shape to fit the width of the heels.  Forge a wedge shape to fit your trim. Grinding or hammering a recess in the bar for the frog will necessary in most cases.    I really like this approach for my post tenotomy cases when added mechanics are needed to maintain good digital alignment.  This will occur in more severe cases when vascular and bone damage occur secondary to laminitis insult that was either not appropriately addressed  in a timely fashion or so severe that any mechanics would not have changed things sucha as in severe sinker cases.  Lobo did not receive the needed tenotomy until 6 wks post laminitis and the initial insult was severe creating compromise at the circumflex. This is noted in the venogram obviously but also in the shape of the tip of the coffin bone.  You can see flipped up circumflex starting to remodel around the apex.
 Maintained in tenotomy rail then a four point trim.  This is when we noted a need for more mechanics noted by upright pasterns.
 Initially placed in Rocker Rail to increase PA and removed crushed heels.




Note the still compromised solar vascular supply with lack of papillae but nice remodelling of the circumflex artery.  






 This is the Left series which shows similar improvement as the right.    Good remodelling around the circumflex b ut poor solar and terminal papillae.  I feel that even with even toe to heel growth and good sole depth that unless solar papillae return with more healing and regeneration time then any chance of a performace career will be limited.

Points to remember:  Evaluation of the vascular supply is paramount to determine success of the device you are applying.  Success should not only be measured by comfort of the patient but I cannot claim success without even toe to heel growth and addition of 7-10mm of sole depth every 30 days.  If this is not happening one must rethink their approach.  Note we did not have a natural increase in Palmar angle we created is due to upright pasterns.  The upright pasterns can be secondary to continued low grade bone pain or even some heel pain.  Achieving better digital alignment allows load be directed through the middle of the foot in the direction that the first phalanx is pointing.

Lobo is now getting 4-6 hours of paddock turnout after five months of stall confinement with the first three in firm wraps over tenotomy site to prevent excessive scarring and a tenotomy rail shoe to prevent toe from flipping up or undue strain on tenotomy site in soft stall bedding.

Please comment, email (iepvs11@gmail.com) or call (9182351529) if you have any questions.

1 comment:

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