Pedal bone rotation - and heel support?

[Shilasdair]

Hi all
Me again - with another question about laminitis.
In a case where the pedal bone has rotated, and perhaps sunk a little, what would be the advantage in providing 'heel support to increase the pedal bone angle'?
Surely we would want to increase toe support and reduce heel height to reduce pedal bone angle and realign the rotation (very gradually)?
All thoughts/discussion welcome.
I want to understand.

 

[Nari]

The only thing I can think of is if they hope to ease the strain on the ligament or tendon (sorry, I can never remember which it is) in the hope that will in turn ease the pull on the pedal bone - maybe mechanically viable but I think in practice it isn't going to work as any easing will soon stop and you'll be left with worse alignment and a bigger mess to sort out.

Who is suggesting this and did they explain their reasoning? I'd be very interested to know because like you I've always seen heels dropped to try and realign the hoof capsule to the bone, not the other way round.

 

[laura_nash]

I think the whole terminology around laminitic changes can pretty unhelpful really. By concentrating on how much the pedal bone has rotated or sunk it encourages this idea that the pedal bone location is the problem and people can somehow correct that / push it back up / stop it being pulled around or whatever.

It would make much more sense to talk about how much the hoof wall has detached, since thats were the actual problem is, and then it puts the focus where it has to be, on growing a new, strongly attached hoof wall.

Whilst the new hoof wall grows down its all about damage limitation to make the horse as comfortable as possible and avoid causing further injury by using the trim, pads or whatever to get everything as well supported and aligned as can be achieved. I can't see any way that raising the heel will help.

ETA: Looks like Nari is right and its some out-dated and disproved idea about reducing the tendon pull:

https://www.thelaminitissite.org/articles/dont-raise-the-heel

 

[shortstuff99]

My old mare had bad rotation in both front feet of about 15 degrees (cushings caused). For the first few months we were barefoot with frog supports and then padded. From there moved onto egg bar shoes, pads and then gel between the two. Then just egg bar shoes, the back to normal shoeing. The pedal bone rotation 'corrected' back to the normal positioning. Took a long while though.

 

[DizzyDoughnut]

My vet did this and wedged ponies heals up by cutting up those thick pad things and vet wrapping and duct taping them on.

I thought it was a bad idea seen as surely you want to try to bring the pedal bone back to alignment not make it worse. I rang my wonderful farrier who agreed with me so I took them off and he came out and put some kind of putty in his hoof instead then he just wore cavallo hoof boots with a gel insert after that when needed.

 

[tallyho!]

It very much depends what else is going on. However from your question if it is rotation and sinking then Laura Nash and Nari are right. The pedal bone and hoof wall grow down from the coronet attached rather like Velcro. It’s better to think of the hoof “detaching away” from the ground and so full hoof support particularly the sole and frog particularly the heel bulbs (if the horse any decent bulb to speak of and many shod horses do not) is most important to get the horses’ weight off the hoof wall, or periphery if you like, so the weight doesn’t force the hoof wall to “peel away” even more.

Raising the heels, therefore putting more pressure on the toe sounds like torture to me. Unless (although maybe not) of course the toe has been filed away as much as is comfortably possible. Even then it’s not sensible. Sole support, like a foam pad in a hoof boot would provide immediate relief, possibly even comfortable enough to walk on gently and I’ve witnessed this many times.

 

[Christmascinnamoncookie]

Dunno if you saw a pic of my horse’s hooves yesterday? The farrier thinks it’s the start of laminitis/pedal bone rotation, vet coming on Friday. He wore his Cavallo Simples today with inserts and the difference in his soles is quite bizarre!

I too would not be happy putting more pressure on the front of the feet. Seems counter intuitive. I’d actually be over the moon to get shoes back on him. He’s been so footsore since losing shoes constantly but the capsule is looking good so he may be able to hold a shoe. Egg bars were mentioned.

 

[Shilasdair]

I appreciate your replies - glad I'm not the only one who can't see why heel raising is a good plan- that's an interesting link, Laura.

So how about this plan;
1. Keep on a low sugar diet (she has EMS)
2. Support the feet 24/7 with EVA pads in Easycloud boots
3. Get the farrier to look at the X-rays and trim the toe back, the walls at the heel down a little.
4. Don't bute (she is lame but not lying down more than normal, is happy to lift her fronts, rest a hind etc so I don't think she needs it).
5. Reduce her steroids as much as I dare (not much - she tends to die).
6. Wait.

Anything I've missed?

 

[tallyho!]

The thing about eggbars... well in theory they sound great; takes pressure off toes, supports heels therefore the pedal bone. In reality they just leave a great hole in the middle for the bone to keep “falling through” and pulling the tendons even more. Eventually you end up with a collection of complications around the navicular. Even if you pad it, there’s still a cavity inside that shoe. You have to think about getting the whole foot supported by the ground then the hoof heals much quicker from the top down (Providing you’ve eliminated sugar completely)... the Velcro that’s already separated will not knit back together.

 

[tallyho!]

I appreciate your replies - glad I'm not the only one who can't see why heel raising is a good plan- that's an interesting link, Laura.

So how about this plan;
1. Keep on a low sugar diet (she has EMS)
2. Support the feet 24/7 with EVA pads in Easycloud boots
3. Get the farrier to look at the X-rays and trim the toe back, the walls at the heel down a little.
4. Don't bute (she is lame but not lying down more than normal, is happy to lift her fronts, rest a hind etc so I don't think she needs it).
5. Reduce her steroids as much as I dare (not much - she tends to die).
6. Wait.

Anything I've missed?

i was given some brilliant advice early on with my case... support the immune system however you think best... removing sugar is already a detox in itself but something like global herbs restore or L94 from trinity was such a help for us.

 

[Shilasdair]

i was given some brilliant advice early on with my case... support the immune system however you think best... removing sugar is already a detox in itself but something like global herbs restore or L94 from trinity was such a help for us.

That's great for other horses - but I spend my life suppressing this one's immune system with Prednisolone.

 

[tallyho!]

Poor gal.. poor you such a worry ?

 

[shortstuff99]

Was the EMS the cause of the lami? Is there a possibility of cushings?

 

[Shilasdair]

Yes, she has EMS and I think it probably was the cause (and some high sugar hay, in retrospect, coupled with a cold snap), and no, she doesn't have Cushings.

 

[Christmascinnamoncookie]

The thing about eggbars... well in theory they sound great; takes pressure off toes, supports heels therefore the pedal bone. In reality they just leave a great hole in the middle for the bone to keep “falling through” and pulling the tendons even more. Eventually you end up with a collection of complications around the navicular. Even if you pad it, there’s still a cavity inside that shoe. You have to think about getting the whole foot supported by the ground then the hoof heals much quicker from the top down (Providing you’ve eliminated sugar completely)... the Velcro that’s already separated will not knit back together.

So what, no shoes?

 

[shortstuff99]

Yes, she has EMS and I think it probably was the cause (and some high sugar hay, in retrospect, coupled with a cold snap), and no, she doesn't have Cushings.

That means the steroids won't be as much of an issue then.

 

[shortstuff99]

So what, no shoes?

I guess it depends on how you want to go, the egg bars worked really well for my mare but it might not be suitable for others.

 

[PSD]

Imprints made mine more comfortable but the hoof wall separation was too bad for any correction to be made and her soles were bulging in the end. I had her pts before her pedal bone penetrated, it wasn’t far off doing so. Laminitis is an absolute mine field and what works for one doesn’t work for another. My girl was 16&18 degrees in each foot before she was pts

 

[tallyho!]

So what, no shoes?

Ideally yes. This avoids peripheral loading as that’s where it is weakest in laminitis. Imprints are actually great too. A solution to get the whole foot supported and just as effective are boots and pads until you’ve got a new hoof capsule; which will take a good 4-6 months and you can tell if you’re getting a tight regrowth from the coronet; then when you put shoes back on, you’re shoeing to a good foot and not nailing close to torn laminae.

 

[Red-1]

I would call Simon at Trinity Consultants about the L94. As I understand it, it doesn't exactly boost the immune system, it helps the liver. It has made a huge difference to mine when I have fed it.

 

[Goldenstar]

I can only say that my one really run in with Lami was with an older mare .
she suffered a terrible stress induced Lami .
The onset was sudden and her pain terrible .
It was a bank holiday my vet arrived rang the farrier and he drove on a bank holiday from Scotland .
She had a series of X-rays which had to be driven to the vets surgery to be developed ( this is a fair while ago )
She was shod in heart bars xrayed again then they got taken off and they where xrayed again that time they had them how where they wanted them .
You could see the horses relief in the heart bars she just relaxed .
She made a full recovery .

 

[Regandal]

My 17.2 gelding had laminitis, he had dental putty pads taped on for a month followed by eva pads in RX therapy boots for 6 months. Vet was insistent that we had to avoid peripheral loading.

 

[Shilasdair]

Thanks for the interesting responses - it's been educational reading them.

I showed my farrier the X-rays and the vet advice, and let him do his thing - I'm sure he has a better idea than I do.

 

[sbloom]

Not read all the responses so I'm sure it's been covered but afaik should be full sole/frog support, to support the tip of P3, raising the heels would be contraindicated and would be for relieving the DDFT but mostly for correcting negative palmar angles which are super common, especially in hinds.

The thing about eggbars... well in theory they sound great; takes pressure off toes, supports heels therefore the pedal bone. In reality they just leave a great hole in the middle for the bone to keep “falling through” and pulling the tendons even more. Eventually you end up with a collection of complications around the navicular. Even if you pad it, there’s still a cavity inside that shoe. You have to think about getting the whole foot supported by the ground then the hoof heals much quicker from the top down (Providing you’ve eliminated sugar completely)... the Velcro that’s already separated will not knit back together.

Absolutely, some brilliant illustrations from Progressive Equine Services on Facebook on this.

 

[tallyho!]

I can only say that my one really run in with Lami was with an older mare .
she suffered a terrible stress induced Lami .
The onset was sudden and her pain terrible .
It was a bank holiday my vet arrived rang the farrier and he drove on a bank holiday from Scotland .
She had a series of X-rays which had to be driven to the vets surgery to be developed ( this is a fair while ago )
She was shod in heart bars xrayed again then they got taken off and they where xrayed again that time they had them how where they wanted them .
You could see the horses relief in the heart bars she just relaxed .
She made a full recovery .

That is good to read. I wish my story turned out that way. It did in the end after having to try a good few options.

 

[tallyho!]

Thanks for the interesting responses - it's been educational reading them.

I showed my farrier the X-rays and the vet advice, and let him do his thing - I'm sure he has a better idea than I do.

As owners, we would like to think that was the case. Fingers crossed everything goes well. I hate laminitis.

 

[Shilasdair]

As owners, we would like to think that was the case. Fingers crossed everything goes well. I hate laminitis.

I appreciate the crossed fingers, Tallyho and others.

Time for an update, I think.

Horse continues to make a good recovery and is certainly happy and comfortable without any painkillers (I deduce this from the dramatic 'airs above the ground' she performed when being led in hand today ). I will keep her on the low-sugar diet, and need to keep the hoof boots on her to try to encourage sole growth with reduced wear. I may now start to reduce the pads from the EVA ones to firmer ones.

Thanks for the good wishes/helpful advice.

 

[Shilasdair]

Further update on my mare.
She has made a remarkable improvement according to her vet - and despite some pedal bone rotation, is now growing some lovely new feet.
She is sound and happy, although the plan is to keep booting her to stop her new sole growth from wearing away (abrasive fine sand paddocks).
So if you have a laminitic horse, even with EMS and pedal bone rotation/sinking, there is hope.
I'm pretty happy about this.