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Researcher: The treatment of chronic laminitis is always difficult, so prevention is the key.

Published by Stephanie L. Church, Editor-in-Chief | February 5, 2020 | 2019 NEAEP seminar, hoof care, hoof problems, lameness, laminitis (founder)

"My horse has laminitis. What should I do?" Even though we may know the basic principles-cooling the feet, providing support, and resolving pain-asking a veterinarian who studies painful hoof disease for the latest advice on how to manage cases may be It helps. As researchers learn more about laminitis, the recommendations will indeed change.

Andrew van Eps, BVSc, PhD, MACVSc, Dipl. ACVIM is an associate professor of equine musculoskeletal research at the New Bolton Center in Kennett Square at the Penn Vet School of Veterinary Medicine at the University of Pennsylvania. He and his colleagues focused on laminitis in Penn Vet's van Eps laboratory, trying to understand why it occurs in different clinical situations. In the process, they discovered or confirmed the effectiveness of mechanical methods to help acute and chronic lamination horses.

Van Eps reviewed these approaches for veterinarians and horseshoes at the 11th Northeast Equine Practitioners Association (NEAEP) Annual Symposium held in Saratoga Springs, New York from September 25-28, 2019.

Laminitis occurs when the interlocking lamina of the coffin bone suspended in the hoof sac is damaged or inflamed. In severe cases, the lamina is pulled apart and the coffin rotates downward or sinks. Various conditions, from sepsis (blood infection) and endocrine problems to excessive weight bearing on the limbs, can cause laminitis. (Learn more about why and how it happens here.) Many horses with acute or chronic diseases will suffer tremendously enough for a veterinarian to choose to euthanize them.

With laminar inflammation and failure, it is necessary to unload the hoof wall and reduce the lever arm of the foot. Think of the bones of the limbs and hooves as levers; if the toes are very long, then as the foot breaks during exercise, the load on it will increase, which is painful for animals suffering from laminar inflammation. Van Eps has a variety of ways to support horses and tries to reduce the lever arm.

He admits that the sand in the barn is difficult to manage; it is heavy and difficult to keep dry, and must be kept dry to be used in these situations (it will harden if it gets wet/dirty). Some horses don't like to lie in the sand, so he recommends placing the sand where the horse is most likely to stand, and then spread it on the rest of the stable. Despite the inconvenience, "I don't think you can beat it in an acute case."

In fact, he said, standing on the sand and soaking in ice water are the two things that are most helpful for severe acute laminitis.

van Eps said that there are not many new mechanical methods to manage severe cases of acute laminitis, but he referred to an in vitro (laboratory) study in which researchers evaluated how trimming the hoof wall affects the laminar tissue damage in the limbs of a corpse . When they thinned the hoof wall by 25%, it turned into a more deformable hoof that suffered less laminar damage when loaded. "I don't encourage people to do this right now," he said, noting that increasing the water content of the feet is another way to make the feet more deformable, "but it's definitely worth thinking about."

Van Eps believes that chronic cases caused by underlying endocrine diseases (PPID or EMS) are "our nemesis" because the symptoms may be very mild, easily ignored by the veterinarian, and these cases may be difficult to treat. "Look for the (hoof growth) ring on the heel that is farther away than on the toes," he said.

He encouraged veterinarians to use X-rays as a screening tool to look for slight changes, including the measured increase in the thickness of the back wall of the hoof and the remodeling of the back surface of the coffin, which may indicate subtle early laminar changes. "I think we might need to do a better job interpreting minor signs," he said.

He explained that with the development of laminitis, a layered wedge will form between the coffin bone and the hoof wall, which is largely irreversible. "This wedge-shaped tissue is related to the stretching and mechanical failure of the lamellar tissue, which usually suspends the bones in the hoof sac," he said. "The bottom of the coffin and the soles underneath are not designed to bear the load of the horse.

"Once we lose the levitation function that flakes usually provide, this is where we are oppressed, and we get...pain," he said, as well as damage to the blood vessels in the area. In severe cases, the coffin bone may penetrate the sole, which further complicates management.

Van Eps said that the pain of acute laminitis mainly comes from the inflamed flakes, but he believes that much of the pain in chronic cases comes from the only compression under the tip of the coffin bone. "However, the pain of chronic laminitis is multifactorial, and it also involves a factor of neuropathic pain," he said, which means that changes in the limbs and spinal nerves actually lead to increased perception of pain.

"In most cases, our ability to control pain will determine the outcome," he said.

He said that identifying and accurately monitoring horse pain can be difficult, although behavioral responses may be the best method.

He reviewed the methods used to assess pain in Laminitic horses:

Horses will eat till the end," he said. "They will eat for comfort; this is not an indicator of happiness.

He said that some people see a horse eating and think that the horse is not painful, but this assumption is wrong.

"The horse will eat till the end," he said. "They will eat for comfort; this is not an indicator of happiness."

Van Eps advocates continuous monitoring of multiple pain parameters-checking horses regularly and continuously recording findings on paper to track progress. "I think you should always challenge yourself (your pain control methods) how to work," he said. "The only way to do this is to take objective measures.

For laminated horses, van Eps uses several general pain control methods:

In other words, by completely eliminating the pain, especially in cases of acute laminitis, we risk further harm to the foot tissue of the horse, especially if the horse is not properly restrained.

 "I am interested in improving regional techniques for analgesia in horses, especially when one limb is worse than the other, or they need some supplementary analgesia based on systemic medication," he said.

Examples of regional methods include:

Van Eps has found significant bone pathology (injury) in many cases of chronic laminitis that are resistant to analgesic treatment.

"This has some similarities with bone pain caused by human cancer, including bone loss and intractable pain," he said, "and complex local pain syndromes (injury or dysfunction of the peripheral and central nervous system, often Seen in a person). Injured limbs) where they will also lose their bones... and have severe pain. In these cases, it’s interesting that bisphosphonates are the most pain-controlling Effective means.

"So, I do think it might be worth—in cases where traditional methods cannot control pain and there is a lot of evidence of bone loss—consider trying bisphosphonates," he added.

To help laminitis horses be more comfortable, van Eps:

Finally, van Eps said that good communication between the veterinarian and the farrier is really helpful when dealing with acute and chronic laminitis cases.

"In general, it is important to realize that the treatment of chronic laminitis is always very difficult and will never be'cured'," he said. "So prevention is the key. Potential endocrine diseases (PPID and EMS) Screening tests, early diagnosis of laminitis (detecting early changes on X-rays), and proper management before laminitis progresses are the keys to successfully defeating this disease."

Stephanie L. Church, editor in chief, received a bachelor's degree in journalism and equestrian studies from Averett College in Danville, Virginia. As a Pony Club and 4-H graduate, her background is in triathlon, and she is training her recently retired thoroughbred horse racing to pursue a career in this subject. She also enjoys traveling, photography, biking and cooking in her free time.

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