Sole prolapsed lamellae draining.

Acute laminitic onset to athletic recovery in a 12-year-old Arab mare


By Andrew Poynton, FWCF

This case is typical of many laminitic equines that suffer from laminitis. Whilst this study concentrates solely on the farriery treatment the mare was diagnosed with equine metabolic disease and is being treated for the condition. She was carrying some excess weight at the commencement of treatment but soon lost it. The approach to trimming and method of treatment are described, but radiographic interpretation and the cycle of events en-route to recovery are also addressed.

Imprint First and Plus shoes (low temperature mouldable shoes) Imprint Ultrafast Adhesive, refrigerant aerosol, Imprint Hoof Repair (synthetic horn substitute), surgical spirit, Keratex antibacterial wax putty.

Farriers hand tools, cordless drill 10 mm modified wood drill.

Sole prolapsed, lamellae draining.
Right fore sole view. 05/09/22 sole prolapsed, lamellae draining.

The mare was diagnosed with acute laminitis. Lateromedial radiographs were taken of the front feet only. The fore feet were filled in the palmar hoof with soft impression material and both feet padded and bandaged. The mare showed no signs of pain relief at this stage. This was videoed for reference. I was contacted and asked to attend the same day to provide farriery treatment. The assistance of a veterinary surgeon was requested due to the distressed state of the mare. Whilst waiting, I was able to lift a foot for a short time, so I proceeded to trim the hoof referencing radiographs (see ‘Hoof Trimming’) and fit the Imprint shoe (see shoe fitting, below). The mare remained calm and so the second foot was trimmed and the other shoe fitted.
Little trimming at this stage was necessary as the hooves were in moderate condition. The main objective was to swiftly apply a shoe that would support the frog without compression, as the frog and digital cushion are both compressible structures, so the material contacting the frog needed to arrest vertical displacement as much as possible.

Hoof Trimming
Taking reference from the new radiographs, standard (normal) hoof trimming relative to the position of P3 to achieve both dorso palmar (DP) and lateromedial (LM) balance was carried out. Any departure from this would be to bevel off the toe more than normal to shorten the point of breakover. The hind hooves were trimmed but no shoes were fitted.

P3 sinking
1. 06/07/22 Observations: Good phalangeal alignment. Groove visible at coronary border. Sole flattened but not particularly thin. Depth of laminal layer is abnormally thick, in a healthy foot this would be noticeably thinner than the hoof wall, this is an indicator of P3 sinking. There is marginal toe flaring.

Shoe Fitting
A shoe of the correct size was selected and fitted centrally to the foot. (For in-detail shoe fitting visit It is often advantageous to add a roll of softened Imprint Hoof Repair onto the frog mating side of the frog plate and then when being offered up to fit the shoe, this material is then moulded three dimensionally to the frog, creating a ‘frog cradle’ to maximise central contact to inhibit frog displacement. No direct load on the sole is made, whilst the toe of the shoe is well rolled to keep point of breakover shortened. The shoe can be set under the toe, similar as to fitting a hunter hind shoe, but bridging the sole. Also the shoe can be rounded more to one side to enhance foot balance and point of breakover if it is not central. So the sole is completely free of contact and accessible for monitoring and keeping clean and dry.

Immediate Result
Once the shoes were in place, the mare was turned around and walked into her stable. Another short video clip was taken, there was an immediate marked visible improvement in the mare’s mobility, enabling her to move around her box in less pain. No additional pain relief was administered at this point.

Subsequent Visits and Treatments
The mare was next treated six weeks later, she seemed to be holding her own. The procedure was repeated. Another four weeks elapsed – 10 weeks since commencement of treatment – the mare was in pain pointing her left fore.

New sole developing.
25/10/22 New sole developing, the hoof is harder and dryer albeit a small toe infection in laminae draining.
Sole has regenerated.
25/11/22 Sole has regenerated.

After removing the shoe and searching the foot, pus was released from the toe, along with partially congealed blood. The mare was able to bear weight on it and move about better. The foot was poulticed in the toe only and not on the sole, to keep it hard and dry.

The vet put the mare on a course of antibiotics. Ten days later the foot was reshod (the right was not shod at this time). At 12 weeks from commencement of treatment, the mare was able to walk out well, but sensitive when turned. The soles of both feet had been convex and crumbled away to reveal new soles, not fleshy but thin sole horn. Dry dressings were applied
to both following shoeing. The owner was concerned about the mare’s future.

Distal hoof wall still has a little way to grow out.
25/11/22 The distal hoof wall still has a little way to grow out.
Progressed to Imprint Plus shoe as the mare is now more mobile.
25/11/22 Progressed to Imprint Plus shoe as the mare is now more mobile. Notice toe and lateral branch bevelled to ease footfall and improve mediolateral balance.

At 18 weeks from the onset, the end of October, recovery of the hoof capsules was clearly evident but, ironically, the mare was still dogged with intermittent and significant pain due to localised foot infection. Soon after the left foot infection cleared up a similar occurrence happened to the right fore.
This is not uncommon with such cases. Towards the end of November, the front feet were X-rayed again revealing improved hoof integrity, with the bones high in the hoof although some recovery was still needed where there was still laminal separation at the distal 2 cm of the hoof. The feet were hard and dry.

On evaluation the mare was walked up and trotted, dancing and prancing, but not 100% level. When the shoes were removed there was signs of bleeding in the laminae at the toe. The feet tend to grow faster on the lateral side, so trimming and shoeing was carried out to counter this warping of the hooves.
In mid-December she was acutely lame in the left fore presenting as a foot infection, but frustratingly no pus was located. The foot was X-rayed and showed good hoof recovery, but still had small voids at the toe. The feet had grown out of balance, giving plenty to work on. The apparent infection grumbled on for a couple of weeks and then faded. The lameness seemed associated with the foot infections but not laminal instability. (She was last shod on 15 December 2022.)

On 19 January 2023, I re-evaluated soundness and she was still intermittently cautious when turning. When trimming feet, a small pocket of pus was discovered in the medial heel quarter. There was plenty of hoof to trim, just part of the toe dorso-medially there was a deficit of horn. Before shoeing she was re-evaluated and to our delight moved well, so it was agreed that she would remain unshod and be monitored. To date she is doing well, behaving like a horse again.

Note abnormal thickness of the laminal layer
2. 15/08/22 before re-shoeing, again note abnormal thickness of the laminal layer and distal hoof wall deviation. A lesion in the sole is visible. Notice the frog cradle extend well forward of the centre of articulation and blends with the frog. The mare was comfortable at this stage.
Sole lesion and detaching distal hoof wall
3. 15/09/22 Sole lesion and detaching distal hoof wall is obvious whilst restorative proximal hoof growth in closer union was returning. It is at this stage that unsurprisingly the patient is likely to go through a delicate stage due to the partial sloughing of the hoof. This cannot be prevented but can be managed well to navigate a safe course to full recovery.
Six weeks growth before shoeing
4. 25/11/22 Six weeks growth before shoeing, at a glance may look similar to radiograph 2 but the main and significant difference is that the laminae are not inflamed and of less thickness than the hoof wall. Sole depth is good, regaining normal proportions.
Groove in the distal toe had been pared out to remove necrotic laminae.
5. Hoof trimmed before fitting the shoe. The groove in the distal toe had been pared out to remove necrotic laminae, congealed blood and pus from the recent toe infection. It was partially filled with an antibacterial putty as it was close to sensitive tissue.

The rational for writing this piece was not to show an exemplary case that recovered without a hitch in record time, rather, a case that was similar in many ways to other laminitics,
travelling through a sequence of predictable events, highs and lows, but treatable.
It is acknowledged that not all laminitics necessarily have to endure multiple foot infections and solear prolapse. That would depend on a number of factors, such as the size and weight of the patient, how soon restorative treatment is commenced and the overall management of the case. That said, once lamella breakdown has occurred within the hoof, that damaged structure has to grow out and, hopefully, the new horn growth proximal to it will have good vascular supply and given the right conditions will grow out as normal healthy hoof. It is worth repeating that there are recognisable events during the laminitic journey to recovery, see
At the initial acute onset, ‘the vascular crisis’ is well recognised and documented where vet, owner and farrier work together to arrest and reverse the destructive forces at play, ideally as soon as possible, as this is a ‘blue light’ situation; no comments like ‘give it time to stabilise’ will do. Valuable time can be lost if the essential bone column support is not in place. If the frog is resting on compressible material or in suspension, the patient is in a precarious state.

If treatment is initiated swiftly, damage to the lamella union is likely to be reduced, ideally before any detachment, rotation or sinking occurs. Once P3 detachment begins, then the farrier is in the situation of trying to catch up. Assuming that there is radiographic evidence of P3 rotation or sinking, support shoeing is initiated, the patient responds favourably, six weeks later it is treated in a similar manner, all seems well.
Another six weeks elapse but the patient becomes less mobile, awkward when turning, shifting weight, the feet are x-rayed again only to find that there has been further movement and detachment within the foot. As with this case, this was predictable, it is ‘the mechanical crisis’, the time in the process when the horn of the wall and sole begin to slough, a little like a finger nail that is clobbered with a hammer, there is an initial bleed, pain and bruising and then a month or two later the nail detaches. This analogy goes only so far, but hope fully makes the point. The finger and nail don’t have to support the weight of the creature above it or walk on it, the equine does!
All too often this stage is not understood and deemed a surprise, a downturn and failure of the treatment, euthanasia is discussed, and sometimes carried out. The magnitude will vary from case to case, but this pattern is something the author has witnessed over many years. If the farrier can leave a patient in a better place than on arrival with potential recovery, then there is every reason to persevere. As with this case the routine was repeated, with extra care directed at the juvenile sole.
Due to the continued support afforded to the feet, P3 decent was arrested whilst some sole and lower hoof wall detached. With as much fresh air to the new sole as possible, it hardened and thickened.
With this case, as the distal hoof wall had been depleted and the sole protruding, the rim of the Imprint shoe along with some Imprint Hoof Repair and adhesive was moulded into this void creating a synthetic lower hoof wall, providing improved hoof integrity, thereby enabling safe shoe fitting with sole clearance. The toe was rolled to eliminate upward force.
The reader will notice that the shoe fitted to the right fore foot is rolled at the toe and bevelled off all round the lateral branch. This is to achieve improved dorso-palmer balance (DP) which can be overlooked, to the detriment of the patient. Ideal foot balance on all planes is part of competent farriery, never more so when treating an unstable laminitic foot.

Although this 12-year-old mare had more than her share of foot infections, in little more than six months she was fly bucking around the ménage. With early intervention, skilled trimming and support shoeing of this type the farrier should expect a high degree of success when presented with similar cases. The materials used enable partial hoof restoration as and when needed, which can help maintain hoof integrity when the foot is at its most vulnerable state.
Being aware of the likely course of events and predicting what is likely to transpire with the owner and vet can help prepare everyone for what lies ahead and likely stay the course when the patients’ recovery appears to waiver. The sequence of radiographs realistically record the foot changes, but can easily be misinterpreted as a failing case. If the reader is faced with this response, take heart, present this article or even get in touch for a second opinion.

This article is from a case study which first appeared in Forge Magazine March 2023. © Andrew Poynton FWCF