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Friday, February 7, 2014

Foundered Horse with Inadequate Shoeing!

A 10 year-old Arabian cross gelding presented for shifting foot lameness and pounding digital pulses. There was no history of laminitis/founder. The horse was not willing to walk on concrete and was a grade 3/5 lame in both front feet on soft ground. Physical exam noted a prominent fat pad over the tail head and the development of a cresty neck! A radiographic exam was performed on both front feet to determine the severity of the gelding's condition.

Figure 1
Figures 1-3 correspond to the lateral projection of the right front limb. There is a clear explanation for the shifting leg lameness and pounding digital pulses. In Figure 2, the yellow dotted lines correspond to the dorsal hoof wall and the dorsal border of the coffin bone. In a normal horse, these two lines are parallel. However, in the case of laminitis/founder with coffin bone rotation the yellow lines are NOT parallel. The small blue triangles labelled A and B correspond to the angles of the yellow lines with the horizon (red line). In this horse, angle A does NOT equal angle B. These findings confirm the diagnosis of laminitis with coffin bone rotation. The difference between angle A and B corresponds to the degrees of coffin bone rotation and in this case that number was 10-12 degrees. The left front limb was similar.

Figure 2
In addition, the gelding's cranial to caudal balance is extremely poor. The yellow line in Figure 3 corresponds to the "center of rotation" and in a normal horse should divide the foot evenly in half. As such, there should be equal amount of ground contact (red lines) in front of the yellow line (cranial) and behind the yellow line (caudal). In this horse, the amount of ground contact behind the yellow line is nearly zero compared to that in front of the yellow line. This is due in part to the extremely long "toe" and the shoe placement. The extremely long toe and cranial shoe placement adds significant leverage on the toe which will aggravate the laminitis and increase the horse's level of pain!. Initial management of this case involved removing the shoes and significantly reducing the length of the toe. In addition, a blood sample was tested for insulin resistance and the horse was confirmed to be suffering from insulin resistance secondary to metabolic syndrome. The gelding was treated with the appropriate diet, stall confinement, pain medication, and medical management for insulin resistance. Stay tuned for follow-up.....

Figure 3

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