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Topic:Lameness
Lameness in horses is a condition characterized by an abnormal gait or stance due to pain or mechanical dysfunction affecting the limbs or spine. It is a common issue in equine practice and can result from a variety of causes, including injury, infection, or degenerative diseases. Lameness can affect a horse's performance and quality of life, making accurate diagnosis and management important for equine health. Diagnostic techniques often include physical examination, imaging, and gait analysis. This page aggregates peer-reviewed research studies and scholarly articles that explore the etiology, diagnostic methods, and management strategies for lameness in horses.
A historical perspective of laminitis. The causes of laminitis are many-often interrelated, sometimes direct opposites. The history of laminitis has been a search for the cause or causes of laminitis and for effective treatment. Going in and out of fashion, many treatments have lasted for centuries, some for millennia, but very few have been proven.
The lamellar wedge. In horses with chronic laminitis, an abnormal horn structure called the lamellar wedge develops within the lamellar region of the foot. This pathologic structure adversely affects normal foot function, and influences return to previous performance levels. Understanding the pathologic process that leads to the development of this structure is essential for correct supportive foot management of the horse with chronic laminitis. The ability to prevent or reduce the formation of the lamellar wedge may eventually lead to better outcomes in cases of laminitis.
The pharmacologic basis for the treatment of developmental and acute laminitis. The treatment of laminitis has been fraught with confusion and controversy for several decades, mainly because of a lack of understanding of the pathophysiology of the disease process. However, recent advances in laminitis research have greatly improved our understanding of the disease process. This article discusses the various treatment options for laminitis in the context of the findings of recent scientific investigations of laminitis pathophysiology.
The use of the wooden shoe (Steward Clog) in treating laminitis. This article describes the use of the wooden shoe in the treatment of chronic laminitis. The shoe, designed to provide a solid base and full roller motion, offers mechanical advantages and enables reduction and redistribution of forces within the hoof capsule.
Acute laminitis: medical and supportive therapy. Acute laminitis is a serious complication of many primary conditions in the horse. This article summarizes the most appropriate approach to management of the horse with acute laminitis, based on current information.
Chronic laminitis: strategic hoof wall resection. In the chronic-laminitic foot, severe soft-tissue compression and compromised circulation can result in osteitis and sepsis at the margin of the distal phalanx. Resultant inflammation and sepsis may cause the coronary corium to swell, drain, or separate from the hoof capsule, usually within 8 weeks of laminitis onset. Slow-onset cases of soft-tissue impingement can develop secondary to distal phalanx displacement due to lack of wall attachment. With either presentation, partial upper wall resection is required to reverse compression and vascular impingement by the hoof capsule. If the patholog...
Clinical presentation, diagnosis, and prognosis of chronic laminitis in North America. Chronic laminitis involves laminar morphologic changes resulting in digital collapse and can vary greatly in its clinical manifestation depending on duration, severity of lameness, and stability of the distal phalanx/hoof wall interface. Accurate assessment of the whole patient is mandatory and consideration must be given to signalment, occupation, and owner expectations, as well as history and etiology, which often predict the broad course of the disease. Diagnosis is made via physical examination with adjunctive serial radiographic evaluation and possibly venography. Eventual functionality o...
Therapeutic hypothermia (cryotherapy) to prevent and treat acute laminitis. Digital hypothermia successfully reduces the severity of experimentally induced laminitis. Continuous-distal limb cryotherapy may be a useful technique in clinical cases that are at risk of developing laminitis. This article examines the effects of hypothermia on tissue as well as the rationale, and suggested protocols for the usage of distal limb cryotherapy in the prevention and treatment of laminitis.
80 causes, predispositions, and pathways of laminitis. For most of history, the causes of laminitis have been based on observations. In the last 30 years or so, however, the number of theories has exploded, with only a few being confirmed by experiments. This article highlights these theories.
Equine venography and its clinical application in North America. The digital venogram uses contrast radiography to evaluate the soft tissues and vasculature of the foot, thus identifying pathology attributable to laminitis. Pathology can be detected before changes appear on plain-film radiographs. When used in conjunction with clinical and radiographic findings, information gained from a venographic study informs and directs treatment. Serial venograms assess the response to treatment and help determine prognosis early in the course of therapy. If the venographic contrast pattern does not improve, either the treatment needs to be altered, or the damage is s...
Microbial events in the hindgut during carbohydrate-induced equine laminitis. Equine laminitis is the most serious foot disease of the horse, often resulting in death or euthanasia. Laminitis has long been recognized as an affliction of horses, as has the association of this condition with the ingestion of carbohydrates. Research into the pathophysiology of this condition has been facilitated by the development of reliable models for experimentally inducing laminitis, and DNA-based techniques for profiling complex microbiomes have dramatically increased the knowledge of the microbiology of this disease. Recent studies have provided substantial evidence showing equine hi...
The anatomy and physiology of the suspensory apparatus of the distal phalanx. The equine hoof capsule protects the softer, more sensitive, structures within. Failure of the connection between hoof and bone (suspensory apparatus of the distal phalanx or SADP) results in the crippling lameness of laminitis. Active basal cell proliferation occurs principally in tubular hoof and proximal and distal lamellae. The remaining lamellae are virtually non-proliferative and the hoof wall moves past the stationary distal phalanx, by controlled activation and inhibition of constituent proteases. The lamellar corium derives most of its blood supply from the branches of the terminal ar...
Home care for horses with chronic laminitis. Home care for horses with chronic laminitis has been discussed rarely in the veterinary literature even though, at any given time, most of us have at least 1 chronic laminitis case in our care that is being managed at home by the owner. Almost all of our knowledge on this aspect of laminitis treatment has been gleaned through experience, by individually working through the medical, ethical, financial, and emotional challenges these cases can present. Much has already been presented on the medical management of the laminitic horse and on strategies for trimming and shoeing the laminitic foot. T...
Progression of venographic changes after experimentally induced laminitis. Venography (retrograde venous angiography) is a relatively simple and practical method for vascular assessment of the digits in the standing horse. The technique is a useful adjunct to routine radiography. The clinical use of the laminitis venogram has resulted in a more comprehensive understanding of the collateral pathology associated with distal phalanx displacement and abnormal hoof growth. The effectiveness of therapeutic procedures such as hoof wall resection, coronary band grooving, deep digital flexor tenotomy, and therapeutic shoeing can be assessed by serial venography. This article ...
Overview of current laminitis research. All cases of laminitis are characterized by failure of the attachment of the epidermal cells of the epidermal laminae to the underlying basement membrane of the dermal laminae despite the diversity of diseases that underlie the syndrome. The preponderance of evidence supports roles for inflammation, metabolic derangement, endothelial and venous dysfunction, and matrix degradation as causes of laminitis. Inflammation, oxidant stress, and matrix degradation may be factors common to each of these mechanisms that lead to the laminar damage of laminitis. The understanding of the pathophysiology and...
Laminitis treatment: a personal memoir. The author has completed 40 years as a veterinarian treating horses with laminitis. The article is a recollection of his experiences with laminitis and the various treatment methods he came across while trying to treat the disease.
Analgesic efficacy of intra-articular morphine in experimentally induced radiocarpal synovitis in horses. To compare the analgesic effect of intra-articular (IA) and intravenous (IV) morphine in horses with experimentally induced synovitis. Methods: Eight adult horses. Methods: Randomized, observer blinded, double dummy trial with sequential crossover design. Methods: Radiocarpal synovitis was induced by IA injection of lipopolysaccharide on two occasions separated by a 3-week washout period. In one study period horses received treatment IA; morphine IA (0.05 mg kg(-1)) plus saline IV and in the other study period they received treatment IV; saline IA plus morphine IV (0.05 mg kg(-1)). Lameness an...
A technique for laser-facilitated equine pastern arthrodesis using parallel screws inserted in lag fashion. To report a technique for laser-facilitated, minimally invasive proximal interphalangeal joint (PIJ) arthrodesis in horses. Methods: Case series. Methods: Horses (n=6); 5 thoracic and 2 pelvic limb PIJ. Methods: PIJ osteoarthritis (OA) diagnosis was confirmed by radiography. A diode laser was used to apply 2000 J of energy to the joint followed by insertion of 3 parallel 5.5 mm screws in lag fashion through stab incisions to achieve PIJ arthrodesis. After anesthetic recovery, limbs were maintained in bandages (n=2) or bandage casts (5) for 3 weeks. Horses were allowed exercise or turnout by 3 ...
Long-term outcome after arthroscopic debridement of distal phalanx extensor process fragmentation in 13 horses. To report long-term outcome after arthroscopic removal of fragmentation of the extensor process of the distal phalanx in horses. Methods: Case series. Methods: Adult horses (n=13). Methods: Medical records (2003-2004) of horses that had arthroscopic debridement of fragmentation of the extensor process of the distal phalanx were reviewed. Inclusion criteria included: lameness localized to the foot, fragmentation of the extensor process of the distal phalanx debrided arthroscopically, and a follow-up period of > or = 4 years. Results: Of the 13 horses, lameness was resolved in 11 (85%) initia...
Modified tenoscopic method for carpal flexor retinaculum release in a horse. To report the use of a proximolateral endoscopic portal with a distolateral instrument portal for carpal retinaculum release in a horse clinically affected with carpal canal syndrome. Methods: Clinical report. Methods: A 4-year-old Thoroughbred female. Methods: Carpal canal syndrome secondary to traumatic suppurative tenosynovitis was treated by accessory carpal bone debridement and carpal retinaculum release using a tenoscopic approach to the carpal flexor synovial sheath through a proximolateral endoscope portal and a distolateral instrument portal. Results: Resolution of carpal sheath effus...
Effects of domperidone on digital laminar microvascular blood flow in clinically normal adult horses. To determine effects of domperidone and acepromazine maleate on microvascular blood flow in digital laminae of clinically normal adult horses. Methods: 8 clinically normal adult horses (4 mares and 4 geldings). Methods: In a 4-period crossover study, domperidone was administered PO at 1.1 mg/ kg and 5.5 mg/kg and IV at 0.2 mg/kg; acepromazine was administered IV at 0.04 mg/kg. The washout period between treatments was 1 week. A 3-minute measurement of laminar microvascular blood flow (LMBF) was obtained with laser Doppler flowmetry. Baseline measurements were obtained at -2, -1, and 0 hours pr...
Clinical, magnetic resonance, and sonographic imaging findings in horses with proximal plantar metatarsal pain. Sonography is commonly used for diagnosis of desmopathy of the proximal part of the suspensory ligament in horses. However, magnetic resonance (MR) imaging has been stated to be superior for detecting disease and localizing lesions. In this retrospective study of 39 horses or 46 hind limbs with lameness due to proximal plantar metatarsal pain, the clinical and diagnostic findings are discussed and sonography and MR imaging compared for examination of the proximal part of the suspensory ligament. With MR imaging interpreted as the clinical gold standard, desmopathy of the proximal part of the s...
Equine laminitis: induced by 48 h hyperinsulinaemia in Standardbred horses. Hyperinsulinaemia is known to induce laminitis experimentally in healthy ponies with no history of the condition. Horses are more insulin sensitive than ponies and whether prolonged hyperinsulinaemia and euglycaemia would have a similar laminitogenic effect requires study. Objective: To determine if laminitis results when the prolonged euglycaemic hyperinsulinaemic clamp technique (p-EHC) is applied to clinically normal Standardbred horses, and to monitor hoof wall temperature seeking an association between vascular activity and laminitis development. Methods: Eight young, clinically normal St...
Repeatability of subjective evaluation of lameness in horses. Previous studies have suggested that agreement between equine veterinarians subjectively evaluating lameness in horses is low. These studies were limited to small numbers of horses, evaluating movement on the treadmill or to evaluating previously-recorded videotape. Objective: To estimate agreement between equine practitioners performing lameness evaluations in horses in the live, over ground setting. Methods: 131 mature horses were evaluated for lameness by 2-5 clinicians (mean 3.2) with a weighted-average of 18.7 years of experience. Clinicians graded each limb using the AAEP lameness scale ...
Mastocytoma in the common carpal sheath of the digital flexor tendons of a horse. A 13-year-old Morgan gelding was examined for right forelimb lameness and tenosynovitis of the right common carpal sheath of the digital flexor tendons. The horse had moderate right forelimb lameness at the trot and marked effusion of the right common carpal sheath of the digital flexor tendons. Ultrasonographic examination revealed a soft tissue mass within the proximal pouch of the affected tendon sheath, located adjacent to the distal physis of the radius. Cytology and culture of the fluid revealed a sterile, eosinophilic tenosynovitis. Tenoscopic exploration confirmed the presence of a cap...
Standing magnetic resonance imaging detection of bone marrow oedema-type signal pattern associated with subcarpal pain in 8 racehorses: a prospective study. The proximal metacarpal region is a common site of origin of lameness in the performance horse. A number of disease entities are recognised as causes of proximal metacarpal lameness but a definitive diagnosis is often elusive. Magnetic resonance imaging (MRI) is hypothesised to offer advantages over traditional imaging modalities in the investigation of proximal metacarpal pain. Objective: To describe clinical and imaging features of cases of lameness in racehorses arising from the proximal metacarpal region in which standing MRI identified 'bone marrow oedema-type' (BMO-type) signal patterns....
Accuracy of ultrasound-guided injections of thoracolumbar articular process joints in horses: a cadaveric study. Arthrosis of the articular process joints (APJs) in the caudal thoracolumbar region of horses may cause back pain and subsequent reduced performance or lameness. Ultrasound-guided injections of the APJs of the equine back have been described only briefly in the literature. Objective: To evaluate factors affecting the accuracy of intra-articular injections of the APJs in the caudal thoracolumbar region. Methods: One-hundred-and-fifty-four injections with blue dye were performed on APJs including the T14-L6 region in 12 horses subjected to euthanasia for reasons unrelated to back problems. The b...
Concurrent or sequential development of medial meniscal and subchondral cystic lesions within the medial femorotibial joint in horses (1996-2006). Summary Reasons for performing study: Medial meniscal injuries and subchondral cystic lesions (SCL) are known to occur independently within the medial femorotibial (MFT) joint in horses. However, there are no reports of a potential clinical relationship between these 2 types of lesions. Objective: To: 1) document the concurrent presence or sequential development of medial meniscal and SCL of the medial femoral condyle within the MFT joint; and 2) determine the prognosis with both types of lesions. Methods: Retrospective case series of horses with both a medial meniscal and SCL of the medial fe...
Evaluation of the possible role of prostaglandin F(2 alpha) in laminitis induced in horses by nasogastric administration of black walnut heartwood extract. To provide insights into the role of prostaglandin F(2 alpha) (PGF(2 alpha)) in the developmental stages of laminitis induced in horses by ingestion of black walnut heartwood extract (BWHE). Methods: 10 adult mixed-breed horses. Methods: Horses were separated into 2 groups and were euthanatized at 12 hours after placebo (water) administration (control horses) or after BWHE administration and development of Obel grade 1 laminitis. Blood samples were obtained to determine plasma PGF(2 alpha) concentrations hourly for the first 4 hours and subsequently every 2 hours after substance administration...
Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint. Part 2: treatment and outcome. There are currently few long-term follow-up data relating to recovery from injury of a collateral ligament (CL) of the distal interphalangeal (DIP) joint and limited information about the effect of associated osseous injury on prognosis. Objective: To describe long-term follow-up results for horses with CL injury, with and without associated osseous injury; and to determine the effect of extracorporeal shock wave therapy (ECSWT) or radial pressure wave therapy (RPWT) on outcome. Objective: Prognosis for return to performance for horses with CL-related osseous injury would be worse than for hor...
