Page 98 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.3 The foot 73

VetBooks.ir effective for pain control and may also be beneficial 1.120
as an anti-inflammatory agent early in the disease.
Flunixin meglumine may be effective in treating the
primary disease but is not as effective for analgesia
(0.25–1.0 mg/kg i/v q12 h). Additionally, aceproma-
zine (0.01–0.02 mg/kg i/v or i/m q6–8 h) and dimeth-
ylsulphoxide (0.1–0.2 g/kg i/v or via a nasogastric
tube q8–12 h) are frequently recommended, but data
to support their use is lacking. Other pharmacologi-
cal interventions that have been used include sys-
temic administration of pentoxifylline, isoxsuprine,
aspirin and heparin. Treatment with cryotherapy is
also beneficial in the acute stage of the disease and
it appears advisable to treat with cryotherapy for at 1.121
least 72 hours. The primary objectives of support-
ive therapy are to decrease the likelihood that the
distal phalanx will displace subsequent to lamellar
injury and to control limb oedema. This is achieved
by: strict stall rest; removing the shoes (although
this is somewhat controversial because removing
the shoes may involve some trauma to the lamel-
lae); bedding the stall with peat or sand; hoof boots
with closed cell foam inserts; packing the ground
surface of the feet between the walls, typically with
Styrofoam or silicone putty; and moving the break-
over back and elevating the heels. The latter can be
achieved simultaneously by applying a commercial 1.122
cuff and wedge pad combination (Modified Redden
Ultimates, Nanric Inc.). Limb oedema should be
controlled with stable bandages.

Chronic laminitis
The treatment of chronic laminitis is also a com-
bination of medical therapy and supportive care;
however, in contrast to acute laminitis, supportive
care in the form of corrective shoeing is the main-
stay. Therapeutic shoeing varies with the form of
displacement that has occurred. The treatment of
horses with capsular rotation of the distal phalanx,
(i.e. the damage primarily affects the dorsal part of Figs. 1.120–1.122 (1.120) Lateral radiograph
the foot) is the best documented. There have been showing rotation of the distal phalanx and perforation
many types of therapeutic shoes used in horses with of the sole. (1.121) Lateral radiograph of the same
chronic rotation, but there are some guidelines that case demonstrating placement of the wooden shoe in
should be applied regardless of shoe type chosen. relation to the position of the distal phalanx. (1.122)
Shoes should be positioned in relation to the distal Lateral radiograph of the same case demonstrating sole
phalanx, using radiographic control, with three spe- growth and significant realignment of the hoof wall
cific objectives (Figs. 1.120–1.122). The point of with the distal phalanx following a deep digital flexor
breakover is moved in a palmar direction to decrease tenotomy and 5 months treatment with a wooden shoe.