Dr. Judith L. Mulholland

Shoes are a positive option, not a necessity in all cases. They combine well with sand as bedding. Most horses which have failed to improve begin to if the feet are protected or shod with supportive bar shoes.

• Since writing this section I avoid packing feet entirely. I get the best surface for the horse I can. I will cover the feet, protect the sole, Use compressible packing to medicate exposed sensitive sole and fit shoes etc., but I avoid any form of packing leading to sole pressure that the horse cannot get relief from and that includes commercial sole packs of any kind.
• A large sheet of H-grade polystyrene is really handy for standing the horse on while you are working.
• If the horse is able to be shod and will benefit from it, protect the sole of the weight-bearing foot during shoeing. Stand the horse on dense foam, which helps prevent sinking and tearing of the laminae at the toe and crushing of the circumflex artery (during the acute stage).
• Open-toe bar shoes, egg bar shoes and English bar shoes, and commercially made therapeutic bar shoes specific for laminitis are available. One advantage of the open-toe bar shoe, when correctly fitted, is that no pressure is applied to the wall at the toe. This means no pressure is transferred to the laminae, and none to the coronary band. For chronic cases and ponies I have found that this shoe gives an increased weight bearing surface area behind the widest part of the foot and relieves all pressure from the toe allowing for resection of the laminitic wedge.
• For acute cases, my first choice is a bar shoe that can form the basis of a hospital plate, so that the sole can be supported without excess pressure of any kind, frog pressure can be accurately increased and the soles are protected. Filling the whole sole with very soft foam soaked in Betadine is often enough. I do not like any form of firm setting hoof reconstruction products, not even the flexible ones. In my experience they lead to too much pressure.
• If the wall is very soft and weakened, the feet may collapse onto the shoe and the wall will distort. I have found that one of the best ways to deal with this is removing the shoes and making adjustments to maximise contact with the outer edge of any hardened laminae and solid wall, and to let the feet harden as much as possible. Often by this stage it is leading into Summer, and therefore I use the dry weather to my advantage and encourage the owners to keep the horses feet away from moisture. The harder and dryer they are, the better the weak laminae are at transferring force to the limb without collapsing.
• In chronic cases where the hoof has become distorted or if the sole is convex (normal is concave) there may be a lot of sole pressure and pain. Relieve this by removing excess built-up sole, and use foam to stand on, so the horse has less pain or is pain free before spending a lot of time working on one foot. The horse will be a lot easier to work with if you take the time to do this.
• Make sure the hind feet are comfortable as these are now the primary weight bearers.
• The sole is extremely sensitive to pressure from mud, stones and badly fitted shoes.
• Seating out the inner border of the shoe to prevent sole pressure is essential.
• Most cases require only front shoes if the horse is on a soft surface.
• The shoe must offer maximum posterior support (shoe length). Egg bar, straight bar, English bar shoes and set-under toe bar shoes or reverse shoes are all suitable. In effect, the shoe is modified to suit the individual. Freedom from sole pressure, ease of break-over (the toe is set under or bevelled or both) and posterior support are the key features.
• The hoof/pastern angle must be normal, not broken forward or broken back. A suitable surface will allow the horse to choose an adjusted angle if raising the heel increases comfort.
• The frog can help support body weight. Frog pressure can be achieved with padding, bar shoes, or padding combined with hospital plates, hoof construction materials etc. This method allows for easy adjustment if the horse shows signs of discomfort and immediate removal of pressure when no longer required.
• Frog pressure has some benefits on circulation to the toe. It activates the pathway (anastimose) from the dorsal digital artery to the circumflex digital artery near the heel, bringing blood around to the toe by an alternative route. This is very beneficial in keeping damaged tissues at the solar border supplied with fresh blood. However, excess pressure can be worse than none at all. Judge the response to alterations and decrease or remove the pressure if a negative response is produced. This is a key reason I prefer hospital plates which allow for as much adjustment as needed.
• Cover exposed sensitive tissues with sugardine swabs, treat as an open wound, combine with a hospital plate or bandaging and change regularly. House the horse in a clean, dry area.
• Fill space between sole and plates or pads with sugardine or some other form of soft, antiseptic dressing and foam.
• If there are signs of sub-solar fluid build up or infection in the wall on X-ray, or laminitis is severe, drainage should be established at the toe. Remove an inverted V-shape section of anterior wall (toe) to the level of the sensitive sole. In severe cases, the wall and sole will drain a large amount of serum immediately, giving relief. Treat as an open wound; use sugardine swabs and bandage.
• Do not remove sole during the first 30 - 40 days other than to relieve sole pressure. Exposed sensitive sole will form granulation tissue, requiring treatment to discourage it.
• The wall can be thinned across the toe (anterior wall) to just outside the insensitive laminae. This may relieve pressure over the laminae and distal phalanx. This is not a severe resection, does not bleed, and none of the sensitive structures are exposed. It is thought to allow more flexibility of the wall and allows for some swelling.
• Resection of the laminitic wedge can be performed when the horse’s condition has stabilised (6 weeks or longer). This does not expose the sensitive laminae or remove the wall at the coronary band over the toe and will still offer good regrowth without the risks associated with resection up to the coronary band.
• Should you raise the heels? I think the only way to answer that is to place a wedge under the heel of the dressed hoof and see what the animal does. If you do it to one foot and it begins to take more load on it, then go ahead. However, if you raise the heels and wedge the foot and fill the sole with filler and the horse is not better. You have made it worse. Raise the heel < 15° only when you can demonstrate a benefit. I have seen a few horses much worse after this has been done. I don’t do it. I encourage a mound and a soft surface and let the horse sort it out itself.
• If the horse is not better with farriery changes in less than 24 hours, reassess them carefully and make adjustments if necessary, small details matter at this stage.
• A 30 day shoeing schedule will make it easier to reduce distortion and keep the hooves in balance. Never go more than 6 weeks between farrier visits.
• Remove nails individually with nail pullers - this reduces pressure and damage to the hoof.
• If the horse was recovering well and the shoeing was successful, then a week or 2 later the client rings and says the horse/pony has gone lame again and they suspect a problem with the shoeing, be diligent in checking every detail of your work. The space for sole pressure may have filled with dirt causing pressure, the wall may be collapsing onto the shoe, un-shod patients may have worn all the wall away because they were running about and feeling good - then they get sole pressure and go foot sore. Some have gut pain and inappetance from the drug therapy used to treat the pain, which is then a cause of more laminitis or confused with foot pain. This is the time when horses may experience their next bout of laminitis because e.g., ‘the horse was going really good so we put her out in the paddock for a while’ or, ‘I didn’t think a few days without the supplements would make any difference’, or ‘I started to put her back on her old feed because she has lost so much weight’, or ‘I let my child ride it yesterday’, etc. You need to discuss the whole lifestyle, because laminitis relapses due to these types of issues are common.

Nailing:

In severe cases the reaction may be extreme, so veterinary assistance with nerve blocks and sedatives may be required. However older, well-educated horses usually allow you to shoe them the first time without much trouble.

Constantly picking up sore feet makes the horse resentful. If a horse is comfortable and recovering in its living area, leave it alone, you can still check the hoof temperature, pulse and coronary band etc., without picking up feet.

The opposite applies if there is a risk of sole pressure due to the bedding packing into the feet. In these cases, cleaning the sole out 2 - 3 times per day is the minimum.

At the second shoeing, the horse may expect it to hurt and therefore misbehave. Tapping vibration causes pain. As the laminitis improves, so should behaviour.

Use smaller, thinner nails. Avoid the toe area, and drive the minimum number of nails (4 - 6). Tap gently, with rhythm, and don’t try and tighten them right down. When nailed with care, many acutely laminitic horses do not react badly. Glue on shoes and hoof reconstruction compounds are options.