This is a report case of Laminitis that was complicated by the diagnosis of Pituitary Pars Intermedia Disfunction (PPID) and a subsequent seroma forming part way through the shoeing cycle. A complete diagnosis by the veterinary surgeon involving not only radiographs but also blood tests and management advice was critical in the early stages. When the complication of the seroma took place, the farrier and vet worked together as a team to come up with a solution for further treatment. An open minded approach was required with a modification of the application relative to the horse’s pathology resulting in a good outcome for the horse.
Signalment and history
Hamish is a 15 year old grey cob gelding that was diagnosed with Laminitis in summer 2020. The horse was blood tested for Pituitary Pars Intermedia Disfunction (PPID) and radiographs were performed prior to heart bar shoes being applied by the horse’s regular farrier. In early 2021, he began to deteriorate in terms of comfort and was brought in for box rest and await further diagnostics from the horse’s veterinary surgeon. Following a discussion with the horse’s regular farrier, the horse was referred to me by Severn Edge Veterinary Surgeons.
A new set of radiographs were performed and there was a noticeable rotation of the pedal bone, a substantial founder distance and compromised sole depth (Sherlock and Parks, 2013). Due to the excessive heel growth, the tip of the pedal bone was pitched into the sole (Fig. 1)
Fig. 1 A latero medial projection of the right front foot.
The horse was now on 3 sachets of Danilon pain relief every day and spending a lot of time lay down. A fresh set of blood tests were performed to see if the adrenocorticotropic hormone (ACTH) level had changed over the last few months, a normal reading would be 40 or less in the healthy horse (Donaldson et al. 2005). The reading for this case was 65 and due to the result, a course of Prascend was prescribed by the veterinarian to help bring the ACTH level down. Due to the discomfort of the horse, it was decided that nailing a shoe on would not be an option (Fig. 2).
Fig. 2 The radiograph superimposed on a photo of the right front foot.
Diagnosis and treatment plan
Corrective farriery involved removing the excessive heel and toe distortion with the trim whilst maintaining thickness of the compromised solear callous (Fig. 3). Lowering of the heels started at the widest part of the hoof and gradually increased to the point of heel. The toe was dorsal wall dressed only to create a wall alignment with the parietal surface of the pedal bone.
Fig. 3 Pre trim image of the hoof that helped to formulate the trimming plan.
Clogs and casts were chosen as the preferred application to help realign the internal structures (Steward, 2010). The heavily bevelled off design of the clog reduces leverage on the hoof when the horse is turning, the heel taper resisting the directional pull of the deep digital flexor tendon and the bevel at the toe setting the breakover further back under the hoof whilst maintaining hoof wall integrity.
Firstly, two pilot holes either side of the hoof wall were drilled using a 4mm wood drill bit positioned behind the widest part of the hoof, so the screwed on clog wouldn’t be rocked forwards onto the toe. Then, a layer of Artimud anti fungal clay was applied to the sole and frog to eliminate bacteria and keep the hoof healthy whilst the owner couldn’t access the hoof to clean out during the shoeing cycle. A soft setting two part impression material was applied to the rear half of the hoof only, so the toe would not be over loaded and create pressure with the ascending rotated pedal bone.
An EDSS Stewart clog was applied to the hoof by using 30mm screws through the pilot holes, one either side was attached first before placing the hoof on the ground to apply the other two screws. Drywall screws were chosen due to their slim shank and coarse thread for a safe and secure attachment. The advantage of this process is that an application can be made quickly on horses that struggle to bear weight on the contra lateral hoof. Once this was applied, additional impression material was placed over the screw heads and at the heel bulbs. This was to protect the heels and screw heads from any pressure of a cast being applied (Fig. 4).
Fig. 4 Clog applied with screws.
The hoof was then brought forwards onto a hoof stand and a 2” hoof cast applied around the circumference of the clog, wrapping around the base and being brought upwards to approximately 10mm below the coronary band. This will help to keep the clog in position and reduce tensile forces on the hoof wall by 40% (Hircock, 2014) (Fig. 5)
Fig. 5 The finished clog and cast application.
Post shoeing, the horse was much more comfortable and was kept on box rest for a month with a review to take place to see if the horse could begin in hand walking (Fig. 6). The horse had an ACTH level of 25 but was displaying many cushing’s disease symptoms so a stimulation test was performed and provided a result of 125. As a consequence, the owner increased the Prascend medication level along with reduced dosage of Danilon. The owner was also advised to feed hay that was no more than 1.5% of the horse’s bodyweight per day. The hay should be soaked for a minimum of one hour to reduce the non structural carbohydrate (NSC) levels to less than 5%.
Fig. 6 Post shoeing image of the clog and cast applied.
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The horse had showed initial improvement over the first 3 weeks and was getting round quite well before suddenly going extremely lame, I attended the horse with the veterinary surgeon for further assessment. The horse was reluctant to bear weight on the front right hoof, radiography revealed a gas pocket around the tip of the pedal bone and a seroma was considered the potential issue. The clog and cast was removed and a foot search discovered a large pocket of pus and blood around the area where the pedal bone had pitched into the sole. Once the pressure had been relieved, a wooden template of the base of the clog was created out of 12mm plywood. The toe was cut away in a half circle in relation to where the pocket of pus had formed. The application process of applying a clog was performed again but with the modification of the plastic base being removable for treatment. The 30mm screws provided attachment of the ply base to the hoof with the plastic clog removable with two 39mm screws. These screws were chosen as it did not exceed the thickness of the clog and plywood in length. When the cast was applied, the material around the toe and quarters on the solear surface was removed with a knife so the clog can be unscrewed and removed with the portion of cast at the heel locking the plastic clog in position when screws were reapplied. Both feet had the hospital clog application applied in case the left front required emergency access for similar treatment.
The owner was then able to remove the clog every day and treat the affected area with a sugar and iodine combination held in position with a thick gauze (Fig. 7). This process was repeated for another 5 weeks prior to a full reshoeing. The owner was also advised to supply the horse with a copper mineralised salt lick as anecdotal evidence from previous cases of infection have found a substantial reduction in reinfection if copper was supplemented in the diet.
Fig. 7 The process of treatment for a laminitic seroma using a hospital clog.
Prior to the second shoeing of this horse, a fresh set of radiographs (Fig. 8) were performed that revealed a reduction in the rotation of the pedal bone, increased solear depth and a reduced founder distance (Hunt, 1993).
Fig. 8 Latero medial radiograph prior to second shoeing.
The horse was now not on any pain relief and walking round quite comfortably. The area of seroma had also cleaned up very well and the sole had hardened up (Fig. 9). Due to the sole still recovering, it was decided that a reapplication of the same system would be beneficial for the next 6 weeks whilst the horse can begin hand walking and being turned out in a sand arena for small amounts of time initially and gradually increasing every week.
Fig. 9 The area of seroma drying out and hardening up from treatment with iodine and sugar.
This case was selected for a report as it highlights the complications that can take place with laminitis and that no two cases are the same. In particular, the horse’s environment and underlying health issues played a role in the pathogenesis of the condition. Horses with PPID are more prone to infections, therefore in order to have a successful outcome from a farriery perspective the underlying causes have to be tested and medicated appropriately.
I would like to acknowledge the assistance of Dr Beth Bromley MRCVS for the diagnostics and medication of this horse and for working as a team to make Hamish a comfortable horse.
Donaldson, M.T., McDonnell, S.M., Schanbacher, B.J., Lamb, S.V., McFarlane, D. & Beech, J. (2005) ‘Variation in Plasma Adrenocorticotropic Hormone Concentration and Dexamethasone Suppression Test Results with Season, Age, and Sex in Healthy Ponies and Horses’, Journal of Veterinary Intern Medicine, Vol. 19, pp 217-222.
Hircock, P. (2014) ‘A pilot study to evaluate a therapeutic shoeing system for laminitis using a Steward clog and a hoof cast’, BSc dissertation, Myerscough college.
Hunt, R.J. (1993) ‘A retrospective evaluation of laminitis in horses’ Equine Veterinary Journal, Vol.25, No.1, pp 61-64.
Sherlock, C. & Parks, A. (2013) ‘Radiographic and radiological assessment of lamintis’, Equine Veterinary Education, Vol. 25, No.10, pp 524-535.
Steward, M.L. (2010) ‘The use of the wooden shoe (Steward Clog) in treating laminitis’ The Veterinary Clinics of North America, Equine Practice, Vol 26, No.1, pp 207-214.