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Home / Equine Research Bank / Vet Surg / High-metacarpal deep digital flexor tenotomy and Steward clo...
Veterinary surgery : VS2025; 55(1); 236-247; doi: 10.1111/vsu.70068

High-metacarpal deep digital flexor tenotomy and Steward clog shoeing for managing chronic refractory laminitis: A retrospective clinical study.

Abstract: To describe outcomes following high-metacarpal deep digital flexor tenotomy (DDFT) combined with Steward clog application in horses and ponies with refractory chronic laminitis. Methods: Retrospective observational study. Methods: Client-owned horses and ponies (7 horses, 8 ponies) with severe refractory laminitis. Methods: Medical records (2018-2019) were reviewed. All underwent standing high-metacarpal DDFT tenotomy proximal to the accessory ligament (AL-DDFT) junction, followed by customized Steward clogs application. Preoperative assessment included radiography and venography. Postoperative management involved nonsteroidal anti-inflammatory drugs (NSAIDs), controlled exercise, and serial monitoring of comfort, alignment, and survival up to 24 months. Results: Median follow-up was 24 months (range: 6-24 months). Six-month survival was 100% (7/7) in horses and 88% (7/8) in ponies. At 12 months, 43% (3/7) of horses and 88% (7/8) of ponies remained alive and improved to Obel grades 0-2. At 24 months, 43% (3/7) of horses and 50% (4/8) of ponies survived, one returning to light work. Obel grades at 24 months ranged from 0 to 2 (Obel 0: n = 3, Obel 1 = 3, Obel 2 = 1). A single distal interphalangeal joint (DIPJ) subluxation (4%, 1/26 limbs) resolved with corrective farriery. Target palmar angles (3°-10°) were achieved in all cases. The majority of non-survivors had endocrine-associated laminitis. Conclusions: High-metacarpal DDFT tenotomy, with preservation of the AL-DDFT, combined with Steward clog application provided effective P3 realignment and lameness improvement with low DIPJ subluxation incidence. Conclusions: This technique maintained DIPJ stability in 25/26 joints and achieved outcomes comparable to previously described tenotomy methods.
© 2025 The Author(s). Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.
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Publication Date: 2025-12-14 PubMed ID: 41392305PubMed Central: PMC12810431DOI: 10.1111/vsu.70068Google Scholar: Lookup
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  • Journal Article
  • Observational Study
  • Veterinary

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study evaluated the effectiveness of a surgical procedure called high-metacarpal deep digital flexor tenotomy (DDFT) combined with Steward clog shoeing in horses and ponies suffering from severe, chronic laminitis that was resistant to other treatments.
  • The researchers retrospectively analyzed clinical outcomes, including survival, lameness improvement, and joint stability, over a follow-up period of up to 24 months.

Introduction to the Problem

  • Laminitis: A painful and debilitating condition affecting the tissues (laminae) bonding the hoof wall to the pedal bone (P3) in horses and ponies.
  • Refractory chronic laminitis: Laminitis cases that do not respond to conventional medical and supportive treatments, often leading to severe lameness and poor prognosis.
  • The study addresses challenges in managing these difficult cases by combining a surgical and farriery approach to improve outcomes.

Methodology

  • Subjects: 15 client-owned equids (7 horses and 8 ponies) with severe refractory chronic laminitis treated between 2018 and 2019.
  • Intervention: Standing high-metacarpal deep digital flexor tenotomy (cutting the deep digital flexor tendon above the accessory ligament junction without damaging the accessory ligament) to reduce mechanical pull on the pedal bone.
  • Supportive Care: Customized Steward clogs applied postoperatively to correct and maintain the alignment of the pedal bone (P3) within the hoof capsule.
  • Assessments:
    • Preoperative radiography and venography to assess hoof and bone status.
    • Postoperative monitoring included pain and lameness grading (using Obel grades), alignment checking, and survival tracking for up to 24 months.
    • Use of NSAIDs and controlled exercise as part of rehabilitation.

Results

  • Survival Rates:
    • At 6 months: 100% survival in horses; 88% in ponies.
    • At 12 months: 43% of horses and 88% of ponies alive with improved laminitis scores (Obel grades 0-2, indicating minimal to mild lameness).
    • At 24 months: 43% of horses and 50% of ponies survived, with some animals returning to light work.
  • Lameness Improvement: By 24 months, survivors mostly showed low Obel grades (0 to 2), reflecting good clinical improvement.
  • Joint Stability and Bone Alignment:
    • Only one case (4%) of distal interphalangeal joint (DIPJ) subluxation was observed, which was corrected using farriery.
    • All cases achieved target palmar angles (3°-10°), indicating successful realignment of the pedal bone.
  • Endocrine Factors: Most non-survivors had laminitis linked to endocrine disorders, which may influence prognosis.

Conclusions and Clinical Implications

  • The high-metacarpal DDFT tenotomy procedure, when performed proximally to preserve the accessory ligament, combined with Steward clog shoeing, effectively realigns the pedal bone and improves lameness in chronic refractory laminitis cases.
  • This technique maintains stability in the distal interphalangeal joint in the vast majority of cases, lowering risks of joint subluxation compared to other tenotomy methods.
  • Outcomes in terms of survival and functional improvement are comparable to other surgical treatment options, making this a viable option for severe laminitis refractory to other management strategies.
  • The combination of surgical tendon release and corrective shoeing provides a comprehensive approach addressing both mechanical and anatomical issues in chronic laminitis.

Cite This Article

APA
Hargitaiova K, Maleas G. (2025). High-metacarpal deep digital flexor tenotomy and Steward clog shoeing for managing chronic refractory laminitis: A retrospective clinical study. Vet Surg, 55(1), 236-247. https://doi.org/10.1111/vsu.70068

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English
Volume: 55
Issue: 1
Pages: 236-247

Researcher Affiliations

Hargitaiova, Kristyna
  • College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Maleas, Grigorios
  • Equuria Orthopedics GbR, Emstek, Germany.

MeSH Terms

  • Animals
  • Horses
  • Retrospective Studies
  • Horse Diseases / surgery
  • Tenotomy / veterinary
  • Tenotomy / methods
  • Female
  • Male
  • Foot Diseases / veterinary
  • Foot Diseases / surgery
  • Hoof and Claw / surgery
  • Chronic Disease
  • Treatment Outcome
  • Inflammation / veterinary
  • Inflammation / surgery
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use

Conflict of Interest Statement

The authors declare no conflicts of interest related to this report.

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