After nearly 40 years of treating horses suffering from founder, laminitis, heel pain or navicular disease, I've made several critical observations in regard to the need for using anti-inflammatory drugs.
While many other veterinarians disagree with this approach, I've been able to fix laminitic horses when I can get to them before they are given bute or other pain-relieving drugs. If I get a heart bar shoe on one of these horses, the shoe serves as my method of pain control.
Here are three of my most important observations from working for nearly 5 decades with these problems:
- I have not lost a laminitic horse since the 1970s when I have been able to treat the horse before it was given phenylbutazone (bute) and or banamine.
- The vast majority of these laminitic horses were able to return to roping, barrel racing, cutting and other athletic functions.
- The treatment cost is usually low compared to treatments that include chemical pain relievers such as bute and banamine. In addition, I've seen a more positive outcome for the horse.
The problem I have with giving a horse bute or other anti-inflammatory pain relievers is that the drug kills the pain and allows the horse to continue to stand. This leads to P3 rotation, which in turn crushes the circumflex artery, cuts off the blood supply to P3 and results in the demineralization of the tip of the coffin bone.
Since graduating from the Colorado State University Veterinary School in 1962, I've devoted most of my years to the study and treatment of laminitis. I've had considerable success in saving the lives and relieving the pain associated with this devastating condition in hundreds of horses.
In treating this complex condition, a close veterinarian and farrier partnership is crucial. My goal here is to share what I've learned so everyone may further contribute to the health and well being of the horse.
While the causes of laminitis are many, the most common one is carbohydrate overload. An overweight and under-exercised horse is particularly at risk.
Laminitis usually represents a sign of an underlying disease process, which includes these diseases of, damage to or infections of the intestinal tract:
- Toxemia, following retained afterbirth.
- Stress and trauma, such as occur with dystocia.
- Deep necrotic wounds, resulting in septicemia.
- Pneumonia, which is severe and often may be necrotic.
- Drugs, especially high levels of steroids and reactions to different drugs.
- Mechanical laminitis, such as road founder, trimming and/or shoeing. This forces the horse to walk on the sole or allows the shoe to place extreme pressure on the sole.
In the early stages of laminitis, the affected horse often appears to be stiff. When rotation of the coffin bone begins, the horse will place his fore feet farther in front to help prevent rotation. Most of the weight is carried by the back feet, which are camped farther forward.
When owners call the veterinarian about a rear leg problem on an affected horse, an exam with hoof testers often shows sole pain at the front of the frog. A false positive may occur if the sole is thin or wet from standing in a wet pasture. A false negative may occur when the sole is thick or extremely dry.
Equine veterinarian George Platt is convinced that administering anti-inflammatory drugs to laminitic horses is a mistake. Instead, the Eagle, Colo., equine veterinarian relies on a properly applied heart bar shoes to reduce the pain of laminitis.
Radiographs are the logical place to begin, as the rotation of P3 is seldom the same in all four feet. While there may be a normal digital pulse in all four feet, a pounding pulse may result after rotation occurs.
I take lateral radiographs with a 3 1/2-inch block placed under each foot. The X-ray beam is aimed parallel to the ventral border of the third phalanx. While radiographs may be negative in the early stages of laminitis, other changes may be present such as pedal osteitis or other re-shaping of the bone.
One of the major problems is that it can often be difficult to find a farrier that can build or properly fit a heart bar shoe.Many farriers have never built one and many details must be addressed.
Treatment begins with radiographs, an accurate diagnosis and evaluation of the primary cause. I also like to take a complete blood count and serum analysis. But it pays to be logical.
As an example, if you're dealing with a mare with a new foal, and you ask about the placenta and no one has seen it, you've more than likely already diagnosed the problem.
I treat retained membranes using a gas sterilized stomach tube and flush the uterus with approximately 3 gallons of warm water. The uterus is filled and siphoned until the water is clean, which may take several days. This flushing treatment is also useful for getting these problem mares back in foal.
Check the feet for bruises, abscesses or blood in the white line. If blood appears in the white line, it has to have occurred within the past 4 weeks. While the blood is coming from torn lamina and indicates laminitis, it is not necessarily a case of founder.
Applying The Heart Bar
I use a heart bar shoe for pain relief as discussed in John Dollar's 1895 book, A Handbook Of Horseshoeing. He states, "If you use this shoe on draft horses pulling heavy loads over cobblestones, you will reduce the laminar disease." He was a smart man and ahead of his time.
The heart bar shoe doesn't work as well when bute, banamine or another drug has been administered to allow the horse to stand up and walk. I've found many chemical-treated horses will continue to rotate.
The heart bar shoe places pressure on the frog to prevent rotation and will push the third phalanx back toward its original position. A heart bar should be reset every 2 or 3 weeks.
Never place the heart bar on a hard frog. While you want to trim away enough frog to make it soft, it may not be possible when the frog is hard and dry. In these cases, I place Equi-Pak on the heart bar to make sure there's something soft between the frog and shoe.
Accurate placement of the heart bar is crucial and it should be located toward the rear 60% of the frog. Protecting the back part of the frog is much more important than the anterior portion.
I can't offer a simple rule of thumb regarding the amount of needed frog pressure. Some thick and heavy frogs don't require a lot of pressure while thin and narrow frogs require more.
Use your thumbs and two fingers to determine the correct amount of needed pressure. Modify the heart bar shoe so it has contact with the frog and be prepared to reset the shoe in 2 or 3 weeks.
With moderate rotation, I'll apply the heart bar and resection the anterior hoof wall starting ½ to ¾ inches below the coronary band. This is necessary when the heel is growing faster than the toe. It occurs when P3 rotation allows the front hoof wall to jam the coronet and reduce the blood supply. Be sure the heart bar shoe is properly placed before doing a resection since the hoof walls can spread to the sides and create a severe sinking of P3.
The farriers I work with understand that the first, second and third phalanges must be aligned in a straight line. One of the major problems is that it can often be difficult to find a farrier that can build or properly fit a heart bar shoe.
Avoid raising the heel or toe. I use gauze pads or tape a piece of carpet to the frog for support until a farrier arrives. I want the heart bar shoe put on as soon as possible.
Place the heart bar shoe first on the most painful foot so there is more support when you pick up the opposite foot. When it is time for a reset, pull the shoe and reset it on the worst foot before removing the other shoes.
Examine the radiographs prior to shoeing. A long toe can often represent a poor trimming and shoeing job. Measure ¾- to ½-inch in front of P3 and cut the toe off at that point. A long toe often represents a poor breakover point.
A rolled toe is sometimes a good thing. Never nail a heart bar on a foot that has been nerve blocked, as the horse must feel pressure to avoid having you provide too much pressure.
Watch Blood Supply
There is a good blood supply entering the inside of the P3 and the two arteries join inside the bone to form the terminal arch and branch out to more areas. The circumflex artery goes to the tip of P3 and runs outside the bone and under the bone. As the bone rotates downward, the artery is squeezed between the sole and the third phalanx.
When a blood clot forms in the circumflex artery, the blood can back up and you can lose the whole bone. When a laminitic horse is walking, the pressure on this artery is intensified and the artery can actually be lost.
Once this artery is lost, so is the tip of P3. This often results in a blood-born infection, which increases the pain. With little blood supply, these horses spend most of their time lying down. Yet the blood supply isn't reduced with the use of a heart bar shoe.
The first abscesses to occur are usually formed anterior to the frog and the sole begins to bulge. All abscesses that form toward the hoof wall should be opened or they will break out at the coronary band.
With abscesses, I sometimes remove the entire hoof wall and pack it with sugardine. When I resection the hoof wall, I continue removing the hoof wall if it isn't attached to the underlying tissue. In some cases, this means removing the entire hoof wall and frog when the abscess is under the frog. I use disposable diapers and sugardine to control the infection.
The plus side of removing the hoof wall is that no rotation occurs. The new hoof usually grows back within 5 months because little pressure is placed on the coronary arteries.
What About Other Shoes, Devices?
My experience indicates that egg bar shoes have no stabilizing effect on P3. A reverse wedge pad places more tension on the deep flexor tendon and leads to more rotation. Hoof casts often compress the venus plexus of the sole.
Since these devices only offer support when standing or walking on one foot, the support is not continual. Raising the heel to take stress off the deep flexor tendon places the phalanges out of their proper alignment.
Sinker, Heel Pain, Founder, Navicular Disease
Navicular disease is often noted with pain in the middle of the frog. Once hoof testers indicate pain in the frog, apply a heart bar shoe posterior to the pain. Since the frog plate may only be 1- to 1 ½-inches long, make sure you align the phalanges in a straight line. I've had success using a short heart bar shoe.
When X-rays show P3 has begun to rotate, that's when founder is most apparent. The front feet are typically worse as they carry more weight than the back feet.
I've seen numerous founder cases where the horse is stiff gaited, sore shouldered or stone bruised. Many are wearing pads and are on bute or another chemical pain reliever. Yet I don't think a horse can founder on all four legs without bute.
I get quite a few calls about sinker. I've found it won't normally occur without the administration of bute, as the horse will normally lie down. My advice with sinker is to avoid using chemical pain relievers.
A club foot doesn't normally cause laminitis, but can if the heels are cut too low. This can cause extra strain to the deep flexor tendon.