FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
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.
Get Full Text
Publication Date: 2025-12-14 PubMed ID: 41392305PubMed Central: PMC12810431DOI: 10.1111/vsu.70068Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • 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.

References

This article includes 29 references
  1. Orsini JA, Parsons CS, Capewell L, Smith G. Prognostic indicators of poor outcome in horses with laminitis at a tertiary care hospital.. Can Vet J 2010;51(6):623‐628.
    pmc: PMC2871359pubmed: 20808574
  2. Patterson‐Kane JC, Karikoski NP, McGowan CM. Paradigm shifts in understanding equine laminitis.. Vet J 2018;231:33‐40.
    doi: 10.1016/j.tvjl.2017.11.011pubmed: 29429485google scholar: lookup
  3. Hood DM, Grosenbaugh DA, Slater MR. Vascular perfusion in horses with chronic laminitis.. Equine Vet J 1994;26(3):191‐196.
    doi: 10.1111/j.2042-3306.1994.tb04368.xpubmed: 8542837google scholar: lookup
  4. van Eps AW, Pollitt CC. Equine laminitis induced with oligofructose.. Equine Vet J 2010;38(3):203‐208.
    doi: 10.2746/042516406776866327pubmed: 16706272google scholar: lookup
  5. Wylie CE, Collins SN, Verheyen KLP, Newton JR. Risk factors for equine laminitis: A case‐control study conducted in veterinary‐registered horses and ponies in Great Britain between 2009 and 2011.. Vet J 2013;198(1):57‐69.
    doi: 10.1016/j.tvjl.2013.08.028pubmed: 24070987google scholar: lookup
  6. Horn R, Bamford NJ, Afonso T. Factors associated with survival, laminitis and insulin dysregulation in horses diagnosed with equine pituitary pars intermedia dysfunction.. Equine Vet J 2019;51(4):440‐445.
    doi: 10.1111/evj.13041pubmed: 30417404google scholar: lookup
  7. van Eps AW, Pollitt CC. Equine laminitis model: lamellar histopathology seven days after induction with oligofructose.. Equine Vet J 2009;41(8):735‐740.
    doi: 10.2746/042516409X444953pubmed: 20095219google scholar: lookup
  8. Gutierrez‐Nibeyro SD, McCoy AM, Selberg KT. Recent advances in conservative and surgical treatment options of common equine foot problems.. Vet J 2018;237:9‐15.
    doi: 10.1016/j.tvjl.2018.05.003pubmed: 30089549google scholar: lookup
  9. Hunt RJ. A retrospective evaluation of laminitis in horses.. Equine Vet J 1993;25(1):61‐64.
    doi: 10.1111/j.2042-3306.1993.tb02903.xpubmed: 8422888google scholar: lookup
  10. Eastman TG, Honnas CM, Hague BA, Moyer W, von der Rosen HD. Deep digital flexor tenotomy as a treatment for chronic laminitis in horses: 35 cases (1988‐1997).. J Am Vet Med Assoc 1999;214(4):517‐519.
    pubmed: 10029854
  11. Auer JA, Stick JA, Kummerle JM, Prange T. Equine Surgery.. 5th ed. Elsevier; 2019.
    doi: 10.1016/C2015-0-05672-6google scholar: lookup
  12. de Oliviera Dearo AC, Rosa VBB, Reichmann P, de Oliviera ML. Effects of two different deep digital flexor tenotomy techniques on distal articular angles of equine cadaver forelimbs.. Cienc Rural 2012;42(11):2005‐2010.
  13. Denoix JM. Functional anatomy of tendons and ligaments in the distal limbs (manus and pes).. Vet Clin North Am Equine Pract 1994;10(2):273‐321.
    pubmed: 7987720
  14. Cripps PJ, Eustace RA. Factors involved in the prognosis of equine laminitis in the UK.. Equine Vet J 1999;31(5):433‐442.
    doi: 10.1111/j.2042-3306.1999.tb03845.xpubmed: 10505961google scholar: lookup
  15. Steward ML. The use of the wooden shoe (Steward Clog) in Treating Laminitis.. Vet Clin North Am Equine Pract 2010;26(1):207‐214.
    doi: 10.1016/j.cveq.2009.12.002pubmed: 20381748google scholar: lookup
  16. D'Arpe L, Bernardini D. Digital Venography in Horses and Its Clinical Application in Europe. Vet Clin North Am Equine Pract 2010;26(2):339‐359.
    doi: 10.1016/j.cveq.2010.06.006pubmed: 20699179google scholar: lookup
  17. Rucker A. Equine Venography and Its Clinical Application in North America. Vet Clin North Am Equine Pract 2010;26(1):167‐177.
    doi: 10.1016/j.cveq.2009.12.008pubmed: 20381745google scholar: lookup
  18. Eustace RA, Caldwell MN. Treatment of solar prolapse using the heart bar shoe and dorsal hoof wall resection technique. Equine Vet J 1989;21(5):370‐372.
    doi: 10.1111/j.2042-3306.1989.tb02694.xpubmed: 2776725google scholar: lookup
  19. Ritmeester AM, Blevins WE, Ferguson DW, Adams SB. Digital perfusion, evaluated scintigraphically, and hoof wall growth in horses with chronic laminitis treated with egg bar‐heart bar shoeing and coronary grooving. Equine Vet J Suppl 1998;26:111‐118.
    doi: 10.1111/j.2042-3306.1998.tb05129.xpubmed: 9932101google scholar: lookup
  20. Morrison S. Long‐term Prognosis Using Deep Digital Flexor Tenotomy and Realignment Shoeing for Treatment of Chronic Laminitis. J Equine Vet Sci 2011;31(2):89‐96.
    doi: 10.1016/j.jevs.2010.12.008google scholar: lookup
  21. Zetterström SM, Boone LH, Farag R, Weimar WH, Caldwell FJ. Effect of single and double hemitenotomy on equine deep digital flexor tendon length and strength in experimental load challenges. Vet Surg 2022;51(7):1153‐1160.
    doi: 10.1111/vsu.13808pubmed: 35437771google scholar: lookup
  22. De Gasperi D, El Azzi MS, Martins JPN, Brounts SH. Ex vivo study shows novel, rapid, suture‐free tenotomy technique for the equine deep digital flexor tendon. Am J Vet Res 2024;85(2):1‐6.
    doi: 10.2460/ajvr.23.09.0215pubmed: 38109844google scholar: lookup
  23. O'Grady SE. Farriery for chronic laminitis. Vet Clin North Am Equine Pract 2010;26(2):407‐423.
    doi: 10.1016/j.cveq.2010.04.008pubmed: 20699184google scholar: lookup
  24. Karikoski NP, Patterson‐Kane JC, Singer ER, McFarlane D, McGowan CM. Lamellar pathology in horses with pituitary pars intermedia dysfunction. Equine Vet J 2016;48(4):472‐478.
    doi: 10.1111/evj.12450pubmed: 25869529google scholar: lookup
  25. Karikoski NP, Horn I, McGowan TW, McGowan CM. The prevalence of endocrinopathic laminitis among horses presented for laminitis at a first‐opinion/referral equine hospital. Domest Anim Endocrinol 2011;41(3):111‐117.
    doi: 10.1016/j.domaniend.2011.05.004pubmed: 21696910google scholar: lookup
  26. Asplin KE, Sillence MN, Pollitt CC, McGowan CM. Induction of laminitis by prolonged hyperinsulinaemia in clinically normal ponies. Vet J 2007;174(3):530‐535.
    doi: 10.1016/j.tvjl.2007.07.003pubmed: 17719811google scholar: lookup
  27. Frank N, Geor RJ, Bailey SR, Durham AE, Johnson PJ. Equine Metabolic Syndrome. J Vet Intern Med 2010;24(3):467‐475.
    doi: 10.1111/j.1939-1676.2010.0503.xpubmed: 20384947google scholar: lookup
  28. Miller C, Utter ML, Beech J. Evaluation of the Effects of Age and Pituitary Pars Intermedia Dysfunction on Corneal Sensitivity in Horses. Am J Vet Res 2013;74:1030‐1035.
    pubmed: 23802675
  29. Kirkwood NC, Hughes KJ, Stewart AJ. Pituitary Pars Intermedia Dysfunction (PPID) in Horses. Vet Sci 2022;9(10):556.
    doi: 10.3390/vetsci9100556pmc: PMC9611634pubmed: 36288169google scholar: lookup

Citations

This article has been cited 0 times.
Subscribe to our newsletter
Join 99,970 horse owners like you who receive our email updates on horse health and nutrition.