Laminitis Emergency

Most of us know that when laminitis occurs, the hoof’s laminae — “fingers” of connective tissue that make up the white line and help hold the coffin bone in place — become intensely inflamed. If the damage is extensive, the attachments can become too weak to hold the coffin bone and it rotates out of position. It can even sink down closer to the sole.

The SoftRide boot.

We also know that laminitis is extremely painful for the horse and that it can have lasting effects. What many of us may not know is how to recognize laminits as quickly as possible and what to do for our horse if laminitis does set in.  You can download this entire article as a PDF here.

Stages of Laminitis

Early/prodromal stage. The horse isn’t yet lame. If you catch a horse at this stage of laminitis, the feet will feel abnormally cold. What’s going on is that the trigger for the laminitis – whatever it is (see sidebar) – is causing the vessels within the foot to spasm. In experimental models of laminitis, which were induced by carbohydrate overload or black-walnut toxicity, the severe decrease in blood flow lasts for a couple hours, followed by a return to near-normal temperatures.

You can download the above sidebar as a PDF here.

Acute stage. At this point, somewhere between eight to 24 hours after the laminitis trigger, the horse will be lame.

Those initial couple hours of reduced blood flow deprive the feet and hooves of sufficient oxygen and nutrients and cause cell damage. When the blood flow returns, the damaged tissues trigger an inflammatory reaction that again reduces blood flow to the foot. But this time, the extreme swelling and edema of the tissues literally crimp off small blood vessels, thus further reducing blood flow to vital tissues.

The inflammation again triggers increased blood flow to the foot — which now feels hot — with pulses in the digital arteries pounding. However, circulation to some areas, most notably the toe region, is still compromised, especially if the bone rotates and physically pinches off blood vessels. Of course, pain is a hallmark component of inflammation, which is why your horse doesn’t want to walk or bear weight on his feet during a laminitis episode.

Recovery. If the laminitis trigger is removed, inflammation normally subsides within 72 hours. Pockets of serum within the foot may make their way to the coronary band or sole to exit as abscesses over the next several months, causing a period of increased pain until they drain.

However, despite these extensive insults, horses with laminitis can return to soundness. Keep in mind, though, that simply having laminitis once now predisposes the horse to laminitis in the future since damaged lamina are known to not heal in a pristine manner.

First Aid

If you suspect your horse is developing laminitis, act immediately. The first hours are critical to reducing permanent damage and alleviating the intense pain your horse feels.

Remove the trigger. Anything that could be the suspected trigger for the episode should be removed and the veterinarian contacted immediately. The sooner you can reverse early circulatory problems or put the lid on inflammation, the better.

Cool the feet. Although cooling the feet has been criticized by some, medical research does prove that it is instrumental in helping to manage inflammation in the acute stage of laminitis. It should be instituted immediately if you suspect laminitis.

Ice water is an excellent way to cool the feet. Some horses require sedation in order to stand in an ice water bucket.

Here are a few tips for success:

1. Use a rubber feed bucket. It’s safer if the horse happens to move around in them and provides better traction standing in one.

2. Place the hoof in the empty bucket first. Slowly add ice around the foot, talking to the horse while you do it to keep him calm.

3. Slowly add water up to the level of the mid-pastern.

4. Stand with the horse (untied is safest).

5. Ice one foot at a time, unless you’re able to sedate the horse for the procedure.

6. Icing for at least 20 minutes is recommended. The longer you can ice, the better, if you are in the early stages of laminitis

Ice-water boots and ice wraps are also available from various manufacturers, and they work with varying degrees of success. For laminitis, though, we’d stick with real ice in a bucket. If you have no ability to ice the feet, at least run cold water directly from a hose over the feet for a minimum of 20 minutes to help slow inflammation.

Administer medications. Every case of laminitis is handled a bit differently to address specific issues of each horse. However, it is widely accepted that the use of non-steroidal anti-inflammatory drugs (NSAIDs) is a cornerstone of laminitis therapy. NSAIDs – such as bute, banamine and Previcox – each have varying degrees of success on a case-to-case basis. Your veterinarian will determine which is best for your horse.

Some veterinarians also add in acepromazine. Contrary to popular belief, acepromazine does nothing to mitigate pain. It actually changes the deformability of the red blood cell wall, which in theory will increase bloods chances of flowing through compressed arterioles (small blood vessels) in the lamina. Since blood brings nutrients and oxygen to tissues, its flow is literally vital.

Your veterinarian may also use intravenous or topical DMSO as well, under the theory that it can help reduce tissue damage by binding and neutralizing harmful byproducts that the body produces during an inflammatory episode.

A word of advice: Make sure you give those NSAIDS exactly on schedule and at the exact dose the veterinarian orders. If you’re a few hours late and the medications run out, your horse may start an inflammatory cycle (complete with tissue damage and pain) all over again. Be consistent and accurate with your medication administration.

Take radiographs. Radiographs help determine if any rotation or sinking of the coffin bone has occurred. They should be repeated any time there is a worsening or if the horse fails to improve as expected.

These “X-rays” are so important that many farriers now request radiographs are taken each time the hoof is trimmed. Because the coffin bone can move between visits, radiographs give the farrier a fresh perspective on where and how to trim the hoof. The farrier’s goal is to optimize angles in the hoof to support healthy blood flow. If he or she does not have radiographs to guide them, then it’s a trim made in their st “estimation.” Unfortunately, for horses with laminitis, every millimeter counts, so the more precision, the better!

Call in an experienced farrier. Be sure he or she is willing to work with your own veterinarian over the long term.

Rest the horse. Although you may sometimes hear otherwise, an acutely laminitic horse should not be forced to walk. The pain is nature’s way of telling the horse not to stress the damaged feet. Forced walking can worsen damage.

If possible, immobilize the horse in a well-bedded stall or a small sand or peat moss paddock. Bedding allows your horse to take pressure off the rim of the foot (where the lamina are) and gives him the incentive to lay down and take the load off of the already stressed lamina.

Mechanical Care

The time-honored approach for treating the acutely laminitic horse is to pull the shoes, lower excess heel, back up the toes to establish a more parallel position between the coffin bone and the hoof wall and keep the horse on a deep, soft surface. This is a physiologically sound trim, however, when to begin this work on a laminitic horse must be determined by the veterinarian and farrier on a case-by-case basis.

Some horses cannot have their heel trimmed aggressively at first, others may need to stand in special boots such as Styrofoam pads or Soft-Ride boots (more below). The goal is to remove mechanical forces that may put tension on the damaged and weakened laminae and also redistribute the load to other parts of the hoof such as the sole and the frog.

Note: There are a mind-boggling number of trim methods being touted by this expert or that for regular trimming, laminitis and other hoof ailments. We advise you to stick with the basics and discuss your options in depth with your veterinarian and farrier. It’s best if all decisions are made through group communication, preferably with radiographs assisting the process. This is not the time to go messing around with a new trimming theory! Your goal is to ensure the stability of the coffin bone, maximize blood delivery to all tissues, and relieve your horse’s pain.

Your laminitic horse can be greatly helped through the use of Soft Ride boots,the ones with the purple/ turquoise inserts. They are hugely beneficial for the laminitic horse, and we find the company is responsive to the needs of the customer and the horse. 

Or, you can choose to fit the hoof with a layer of Styrofoam, which will help relieve pain and protect the hoof from further damage. You can get precut Styrofoam blocks in a kit of four that can be trimmed for precise fit (sizes 00 to 4). They can be purchased from Equine Digit Support System, Inc.

The EDSS styrofoam hoof pad.

Bottom Line

If you suspect laminitis, act immediately. It’s far better to be over cautious with laminitis than to dismiss initial symptoms and not call in your veterinarian. Once you’re past the acute phase, successful rehabilitation strives to shift the landing and weight bearing to the back of the foot, where it belongs. Good, regular farrier care, working directly with your veterinarian, is a critical element in your horse’s recovery.

Be prepared to see your farrier every four weeks, since laminitic hooves are dynamic. The bone can move and/or the hoof can grow in a bizarre fashion due to abnormal blood flow. It’s far easier for your horse to have more frequent visits from the farrier where he or she just rasps a bit “here and there” than to handle a full-blown eight-week farrier visit.

Many horses are rehabilitated successfully barefoot, while others require the help of specialized shoeing systems like heart bars or Equine Digital Support System (EDSS). The important thing to remember is that every laminitis case is different and what works for one horse might not work for another. Work closely with your veterinarian and farrier in order to achieve the best result.

Article by Contributing Veterinary Editor Grant Miller, DVM.

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