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Tuesday, August 9, 2011

"To cut or not to cut?"

The above radiograph belongs to an aged stallion that presented to PHD Veterinary services with non-weight bearing lameness of 3 week duration in the left front limb. Historically, there was evidence of "white line disease" that had resulted in a partial hoof-wall resection however the stallion's condition was worsening on a daily basis. Radiographic exam (top radiograph) revealed greater than 20 degrees of coffin bone rotation and zero sole depth. The tip of the coffin bone was essentially about to come through the bottom of the foot. The decision was made to surgically transect the deep digital flexor tendon (DDF) in an attempt to reduce the "pull" of the tendon on the coffin bone. This procedure can be very effective in saving the life of a laminitic horse and eventually returning the horse to pasture soundness. The procedure is easily performed in the standing horse with sedation and a local block. Follow-up care is critical and requires collaboration with a farrier that is well-versed in shoeing laminitic horses (especially after transecting the DDF tendon). If the horse is not shod appropriately, the benefit of the surgery will be zero. Special thanks to Adam Whitehead for working with us on this case and all the other successful DDF transections that he has collaborated with. 

Two months after surgery, the coffin bone was properly aligned with the pastern bone and there is a significant amount of foot growth (sole depth). Note the specialized shoe-type and placement which is critical for this procedure to be a success! The stallion has not only returned to pasture soundness but was active as a breeding stallion within 3-4 months after the surgery. I strongly recommend having radiographs taken of your laminitic horse to determine what is the best approach to managing the case. Making the decision to cut or not to cut the DDF tendon should be considered sooner than later!

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