Win win opportunity of referral

Laminitis referral case study of a 10-year-old 15.3hh hunter cob (now aged 14).

Background
This horse first suffered an acute laminitic attack in June 2015. Being a hunter he had been on ‘holiday’ and had not seen the farrier for some time and was initially under veterinary treatment alone. This was not achieving the desired result. The veterinary prognosis was poor due to the radiographic and clinical condition of the patient. Andrew Poynton’s initial involvement was on 29 September 2015.

Visit 1
Materials: 6” Imprint First round front shoes, Imprint Hoof Repair, adhesive and freezer.

Report
As the horse was not responding to treatment the vet advised deep digital flexor tenotomy or euthanasia. The farrier John Stanley AWCF suggested seeking a second-opinion from referral farrier. An appointment was made when both farriers could attend. The perceived merit in this was that Andrew Poynton, having particular expertise and experience of such cases, may be able to offer sound objective advice.
On arrival, the horse was found to be in some discomfort in his stable. The sole had perforated on the right fore with some proud flesh. The left foot had come close too, but was not quite so bad. The horse was in an advanced stage of laminitis, the acute onset was approximately 14 weeks previously. Chronic changes were showing but there were also signs of recovery. Although the hoof wall and sole were in a state of significant detachment, there was a ring of new horn growth from heel to heel growing in the right direction, albeit no more than 10 mm. The owner had used some form of hoof boot, which had a frog support area that appeared to have helped the horse.The fact that he had such thick soles has also helped.

Solear lesion

Post shoe fitting and the quarter crack excavated prior to repair.

Post shoe fitting and the quarter crack excavated prior to repair.

Treatment
Trimming and shoe fitting were carried out, taking reference from radiographs of the front feet, which showed significant P3 detachment and hoof deviation. The hind hooves were trimmed; there were signs of bruising in the sole. There was a lot of hoof to trim, as with the front feet. The whole frog came away with a new one above it. Imprint First shoes were fitted with extra Imprint Hoof Repair on the frogplate to create a ‘frog cradle’ to support the weight of the horse and alleviate some tearing from the lamellae. The shoe was set under the toe, but off the sole to minimise leverage and create solear elevation.

Result
Post shoeing, the horse looked relatively comfortable, and was able to turn left and right. He had had excess amount of hoof and the beginnings of superficial quarter cracks on the lateral aspect of both front feet. We had the chat about revised diet and restricted exercise with the owner. Next visit, six weeks.

Visit 2: 11 November 2015. Interval: 6 weeks
Materials: 6” Imprint Sport fronts and accesssories.

Report
Surprisingly the horse was walking sound, with no sign of lameness. Sole had regenerated on both front feet just healing across the toe; the right fore was the most vulnerable. He was having restricted turnout. All appeared to be going well.

Treatment
Reshod the horse with Imprint Sport shoes in front and trimmed the hinds as previously carried out.

Shoe placement and support: The shoe was placed as close to central beneath P3 as could be achieved with the ‘frog cradle’ providing a three dimensional finite base to inhibit further rotation or sinking of the bone. The shoe was fitted so that the sole was elevated to alleviate direct loading and yet maintain essential access to the sole for treatment and ventilation; this is an important aspect when treating all laminitic cases. The point of breakover was set under the toe to shorten the lever arm.

Result
The patient’s condition had stabilised and was making good progress. The case was handed back to John Stanley to continue with the work. The owner was delighted – there was much work to do, but he was looking like a sound horse and the hoof was growing out healthily. A positive result was anticipated, provided infection did not complicate matters. The regular farrier, having attended and been fully aware of all that was carried out and confident of being able to continue the work, proceeded with no further issues. All further communication both from farrier and owner was to report good progress and that Murphy was full of ‘joie de vivre’!

Footnote
This case is an example of a good outcome when farriers and vets collaborate. In this case a pleasing outcome was achieved. What can be learned from this case? To begin with, as a substantial sized cob, the horse was a high risk regarding potentially becoming a laminitic casualty, and when larger horses succumb they are harder to treat than, say, a 13hh pony.

Farriery involvement from the onset would have been desirable and possibly speeded up the patient’s recovery. Having seen many similar cases recover from being in a similar condition it was concluded that if managed well this one too may rally. It was on this premise that a cautiously optimistic prognosis was offered.

The owner would have been pleased if he was able to recover to be ‘field sound’; the reality was that he went on to do as much as he had done prior to the laminitis.

How was the above achieved? Attention to detail. All hoof trimming was taken with reference to the deep anatomy, balancing the hoof to the actual bone alignment on all planes. Before treatment when the horse was asked to walk he toe flicked and the hoof landed heel first. It is impossible for a horse with a contracted DDFT to do this; in fact this is an indicator of excess heel.

‘Chase the bone’ is one of my mottos, that is: keep the phalangeal bones in true alignment and balance and you have the foundation of a sound procedure. The strength of the hoof capsule was not compromised even though it was partially detached, mechanical function could be achieved without sacrificing the toe of the hoof. Comfort and hoof integrity were and are high ideals.

Owner’s report to Andrew Poynton, August 2019

Four years on from serious laminitis, when a deep digital flexor tenotomy on Murphy would have left him unrideable, Murphy is back to his old self. At the time, the attending vet was sceptical of your methods, but after seeing what you were doing, went away with the greatest respect for your techniques.

Murphy was treated by you in September and November 2015, recommended by my regular farrier. After your treatment, my regular farrier took over and carried out your follow-up treatment instructions. Murphy was looking well and sound by mid November 2015 – five months after onset – he was led out in hand on soft/smooth ground for 20 minutes or so. In late November he was regularly led out with a stable mate for around 40 minutes. He stayed sound and looked to be getting back to his old self.

By June 2016, he remained sound, and was being gently ridden on soft going. From 2017 to date, Murphy has been taking part in hunt rides, etc. We are members of Endurance GB (EGB) and take part in their organised rides not more than 10 to 12 miles (because we get bored after that distance!) He is slim, fit, on a permanent diet as per your instructions/orders. Speedy beet has been a good find. Even my farrier has remarked on how well and fit he looks!

The vets were impressed and I think have taken note of your methods. Thank you for your advice and keeping Murphy on the go.

Anne Goodall, and Murphy

This case report first appeared in Forge November 2019 and can also be view or downloaded as a pdf from this page.