Tendons to be cut - Laminitus

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alpacalady

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Does anybody have any experience/information on the above. I have been given this as an option from the Laminitus Clinic as a last ditch attempt to save my 10 year old 12'2 pony who has had chronic lamintus on and off for 2 years she also has Cushings. My vet is not happy about carrying out this procedure and does not really agree with it but admits he has only had experience with one other horse but the Laminitus Clinic seem to carry it out as a matter of course at their clinic. Any advice/info greatly appreciated eg. cost/success rates/how long to recover. Many Thanks
 
Sorry I have no experience of this technique and not sure I have ever seen anyone on here discuss this
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I hope someone can give you some positive advice on this.

I do hope it is successful, if you decide to have this procedure carried out.
 
Hells bells! Is that real? I can understand what it would do, ie release the "pull" that the tendon asserts on the pedal bone that pulls it point-downward so it eventually protrudes through the sole. But cutting the tendon? How would the horse walk??? Wouldn't it just drag it's front feet along with every tortured step? The mechanism to "pick up" the feet would surely be destroyed? Wouldn't there be a huge risk that the horse would accidentally put it's whole weight on a wrongly put down foot at some point? I'll be very interested in the responses you get here alpacalady x
 
hi, there is no need to cut tendons, this practic is out of date and is jsed by people who are not up to speed on laminitis treatment, if you want help you can p m me
 
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hi, there is no need to cut tendons, this practic is out of date and is jsed by people who are not up to speed on laminitis treatment, if you want help you can p m me

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I would doubt that the Laminitis Clinic, the leading specialists in the country are not up to speed on laminitis treatment seeing as how they pioneer most of it.
 
Personally I would never consider such a procedure. Have you read the book Founder: Prevention and Cure the Natural Way. (http://www.amazon.co.uk/Founder-Pre...TF8&s=books&qid=1262270812&sr=8-2) It's easily the best book on laminitis around and I wish every horse owner would read it. The methods in this book really work - no tendon cutting or indeed any invasive methods needed. I don't really get the logic behind cutting the tendon anyway - it's the hoof capsule migrating upwards that causes the pedal bone to move position in the foot, not the tendon pulling it down. That just doesn't make any physiological sense!
 
It can be a useful technique to prevent reduce further rotation of the pedal bone and improve circulation to the foot and I wouldn't dismiss it if it is your pony's last chance. It is not as barbaric as it sounds and is done standing under sedation/local anaesthetic. It does not have a major effect on the pony's ability to walk etc as only the deep digital flexor tendon is severed.

Has your vet tried heel wedges (Redden Ultimate wedges are the type of thing, you can google them, but you can make similar things more cheaply using products avoilable in the UK)? I have found these to be very useful when applied properly and used in conjunction with a judicious reduction in heel height and over time this approach can help to reverse pedal bone rotation.

I am prepared to be shot down for recommending this, as no aspect of laminitis treatment is without controversy, but it is the approach taken by progressive podiatrists practicing in the States. In my experience is the one thing that may make a difference when all else has failed.
 
DDFT tenotomy (cutting the deep flexor tendon) is basically a last resort in severe cases, mainly because the pull of the DDFT is one of the things that makes the pedal bone rotate - this only happens in laminitis because the laminae are unstable in the first place.

I've never known a horse who's had it done, and we weren't told alot about it in our lectures (which probably indicates that its not used that often anymore), but the main points we were told is that success is variable, and they take alot of post-op care (heel extensions are needed for example). It is also possible to do tenotomy of the inferior check ligament, which is more successful than the DDFT, and basically works by allowing the DDFT to have more stretch/slack so it doesn't pull as much on the pedal bone.

I would imagine it wouldn't be a cheap procedure - it can be done under standing sedation but it's easier done under general anaesthetic, which would bump up the price a fair bit. If the laminitis clinic are recommending it I assume this really is a last resort for your pony, and I really feel for you having to make decisions like this.
 
If your pony has Cushings is she not in for a lifetime of pain from laminitis and almost starvation to control it? If she simply had laminitis then I would be urging you to go the barefoot route with total (every morsel that passes her lips) diet control. But the laminitic Cushings ponies that I have seen have all been terribly thin and I thought that laminitis was nigh on impossible to control when caused by Cushings and not by diet.

Are you certain you are not trying to keep her alive so that you don't have to face the upset of having her put to sleep? It sounds to me that she would be better off if you had her put down. I certainly would not put her through an operation just so that she can limp around a paddock for the rest of her life with her feet inadequately attached to her body and fighting the rest of Cushings syndrome to boot. Sometimes hardening our hearts is the fairest thing we can do for our horses.
 
I'd be interested to know which podiatrists are practising this in the US? Having just come back from training over there with the guy who pioneered barefoot and 25 years later is still at the forefront of hoof research I know that it's something he is fundamentally opposed to and he'd certainly not use the word progressive to describe any podiatrist who recommended it
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If your pony has Cushings is she not in for a lifetime of pain from laminitis and almost starvation to control it? If she simply had laminitis then I would be urging you to go the barefoot route with total (every morsel that passes her lips) diet control. But the laminitic Cushings ponies that I have seen have all been terribly thin and I thought that laminitis was nigh on impossible to control when caused by Cushings and not by diet.

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Really?
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Are you certain you are not trying to keep her alive so that you don't have to face the upset of having her put to sleep? It sounds to me that she would be better off if you had her put down. I certainly would not put her through an operation just so that she can limp around a paddock for the rest of her life with her feet inadequately attached to her body and fighting the rest of Cushings syndrome to boot. Sometimes hardening our hearts is the fairest thing we can do for our horses.

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and you've certainly got a hard heart
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I actually agree with Cptrayes - I'm opposed to life at any cost. And a procedure like this is not one I could ever consider.

Sorry OP.
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GedinskisGirl; I mean proper podiatrists i.e., vets or dual qualified vet-farriers; Redden, Floyd etc.

Euthanasia may well be the best option if this pony is at the end of the road, but I believe that when carried out appropriately, tenotomy of the DDF has a place in managing laminitics.
 
After having my horse pts last year though laminitis I really do feel for you. I dont know anything about the procedure mentioned, but would have thought the laminitis clinc know what they are talking about and should be able to advise you.

I know how hard it is to make that last decision and how you are looking at all possble avenues.
All I can say is take advice from your vet and farrier and from the laminitis clinic, but you will know in your heart of hearts whats best for you and your horse.
Good luck.
 
I also lost my horse two years ago with laminitis, I miss her every single day but I'm really glad I put her out of the ongoing misery of laminitis. Only you can make the decision but it sounds like your pony is pretty far gone, i'm sorry xx
 
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And you've certainly got a hard heart
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No, I haven't actually. It hurts like hell to do the right thing for a horse you love that's in trouble. Sometimes it's the only fair thing to do to take the pain yourself and take it away from your horse.

Believe me, it is much more painful to hardEN your heart, than to have a hard heart. That would be easy.

It broke my heart to have a four year old shot three years ago, but he was going blind and he was frightened. I could have sold him to some unsuspecting person but I took a heavy financial and huge emotional penalty to do the right thing for him. So think before you make judgements like that in future about people you don't know please.

I notice that you don't have any constructive suggestions for the OP about how she manage this horse? You posted simply to have a go at me.

OP I am assuming that your vet and you have been through pergolide and everything s/he can do to hold back the Cushings?

I really feel for you, but I think that you need to look him/her in the eye and ask one question, phrased EXACTLY this way:

"If this pony was yours, what would YOU do?"

and see what he says.
 
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GedinskisGirl; I mean proper podiatrists i.e., vets or dual qualified vet-farriers; Redden, Floyd etc.

Euthanasia may well be the best option if this pony is at the end of the road, but I believe that when carried out appropriately, tenotomy of the DDF has a place in managing laminitics.

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I guess we'll have to disagree on this one. I don't believe tenotomies have any place in managing laminitics. The science the procedure is based on is bogus and not the latest thinking at all - vets like Pollit are the guys at the forefront. Read his stuff if you really want to understand how the structures of the hoof work. Sadly most vets and farriers are the least well educated in this area as much of what is still taught has now been shown to be incorrect. These are not 'proper' podiatrists by any stretch of the imagination.

The fact that many vets and farriers and indeed the Laminitis Clinic still recommend some of the most barbaric procedures inflicted on horses - merrily slicing into hooves, exposing live tissue, without any scientific proof that these methods have any greater success than just letting the hoof heal itself.

The only way to cure laminitis is to remove the cause and then let nature/time repair the hoof structures. If the cause is diet then it's relatively easy. If it's cushings then obviously the issue is more complex and possibly insurmountable.
 
Yeah, as I said originally it's a contentious area. In lots of ways I agree with you; there are clinicians pushing salvage procedures too far; hoof capsule resection with transcortical pinning and casting just blows my mind and I'm fed of dorsal hoof wall resections in ponies done too agressively and too late when they should've been put down.

However I think that DDF tenotomies have a place in treating the chronically laminitic hoof in cases where welfare is not a pressing concern, and when done properly it can allow realignment of the digital column. I see laminitics that have such sensitive soles that the barefoot approach would not be appropriate, and I don't think the wait and see/give it time approach is fair in cases where changes to the hoof structure have occured.

I'm aware of Chris Politt's work and I feel I have quite a good understanding of hoof function thanks. There is no doubt he has contributed a huge amount to our understanding of the pathogenesis of the disease, but he is not a clinician and his research is minimally relevent to first line management of laminitics. Also, if you read his research he has more than his fair share of barbaric experiments.

I won't be as patronising as to point you in the direction of what I consider to be appropriate reading material: I suspect we are coming at this from different directions and I wouldn't be so presumptuous as to assume that you haven't read the books that I have read. Unfortunately there isn't a huge evidence base underpinning the way we treat laminitics so I do what has worked for me and do my best to keep up to date with what is working for others. I feel this approach results in a good success rate, but sadly it doesn't always go to plan.

I disagree about vets and farriers being least educated, although as in all fields there are the good and the bad. This is the same old point continually being made by hoof trimmers and EDTs on this forum. As a vet I think it is incredibly unprofessional to overtly criticise paraprofessionals, particularly in this very general way, but sadly the same courtesy is rarely returned.
 
Sadly my and many people I know have had very negative experiences with vets and farriers and their 'knowledge' of the inner workings of the hoof. And without exception they have been extremely disparaging of anyone who isn't one of them. Yet the man I've just trained with probably knows more about hooves than most people and increasingly more and more vets and farriers are coming over to his way of thinking. But many remain in the closet, too afraid to speak in public, afraid of being ostracised by their own colleagues. Such is the way when change beckons, sadly.

I'd be very interested in your theory as to what a tenotomy of the DDF tendon does to aid the positioning of the pedal bone in the hoof. I've read Eustace's thinking on the matter and found it riddled with errors and misunderstandings.

I realise as a vet that you want to do the best for your patients and you sound like a progressive vet, open to new ideas which is great. I still maintain that the best solution for laminitics is to remove the cause and let fourth dimensional changes do the healing. Of course correct (rather than corrective) trimming is also part of it but the hoof will always do it's best to heal itself, it's trying all the time. The more humans interfere with nature the longer it takes or the more things go awry. Of course it's human nature to want to fix things, to think we can do better than nature but it's been proven again and again that the more humans stay out of things the better for the planet in general.
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kizzywiz,
i note you,r doubts, and i wonder are they based on what you read, or experience.
i have worked on laminitic horses for the past 20 yrs, in the mid east ,u s a and uk. as a result, i know all the treatments that have been tried to treat rotation of the pedal bone.
rotation is not laminitis, but rather, the damage caused by it. the treatment of laminitis and cushings, must be done chemicaly, by drugs and restricted diet etc.
the damage to the hoof capsule must be done by mechanical methods, this is to transfer pressure from the pedal bone tip, and bring the bone into parallel with the sole, having done this, detached dorsal wall must be removed.
if you read deep into the laminitis trust methods, you will find that in the first instance, you are offered a vast selection of foods, frog supports , support systems, bar shoes etc. however if you search deeper, you will find that, removing the cause, reshaping the foot, and dorsal wall resection is what is done in bad cases. cutting of the d d f t to ease tension can be done easly with other methods, none of which involve surgery to a horse which is already in pain.
as well as all this, in a horse with cushings, the cause of laminitis can not be removed, so the methods i have mentioned must be used in order to destress the laminae, long term, we cant keep cutting the tendons
 
Finding it very interesting reading; I have a 11 year old laminitic sheltland ( not had an attack for 8 years)
His management is, out at night on a track system with two others, a very small amount of fresh grass is given each night ( I move around 4/5 electric fence posts) He is fed SS Lucie Stalks and Dengie Alfala pellets soaked with very watered down Kwikbeet, plus seaweed/linseed.

In at 7am with a slice of hay, back out at 3pm. Never out on frosty grass

He is not overweight, but for the last three weeks has been footy on the hard ground ( running around still on the field)

Do I keep him in 24/7 until he is sound; not let him on grass again? or keep his routine as it is? I've heard a lot of conflicting advise on laminitics, some say movement, some say not.

He was stabled for 6 weeks eight years ago; Incidently it was the same time of year.

I feel so guilty
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all advise very much appreciated
 
Don't feel guilty, they are so tricky to manage. You sound like you are doing the very best you can for him

Have you changed his hay at all - some have far more sugar in than others. Do you soak it to get the sugar out?
 
Grass post frost (defrosted grass!) will have higher fructan levels than normal at this time of the year. I would stop feeding him grass altogether - dry lot him if you can. I'd also question the alfalfa but try removing the grass first and see if it makes a difference. Movement is still important though - but only so much as he is comfortable with.

Has he been wormed or had any other drugs in the last few weeks? Worming can tip them over the edge and even bute... fructans are added to bute to make it more palatable but of course more fructans are the last thing you want to give to an already laminitic horse.

Have you had his hay sampled? Most feed companies will do this for free - you may be surprised at the levels of sugar in your hay, especially if it's first cut or single species rye grass.
 
Coolrunnings... don't feel guilty

I keep my lami's on a track too...
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All I can tell you is what I would do if it were my laminitic and that is that he would be off the grass pronto if he got footy for whatever reason. Stabled until he was sound. Better in a few days than gettig lami.

Do you soak his hay?...is it the same hay he has been on before he got footy? Could he be bruised at all from the hard ground? Have you changed farrier?

If nothing has definitely changed to cause this and you think it is laminitis , then I would perhaps consider getting him tested for cushings too.
 
My doubts are based on what on my own experience & also the vast amount of reading & research that I carried out when my pony went down with laminitis some years ago. My farrier trained with Robert Eustace for 4 years & this knowledge was invaluable in helping Meg with her recovery & getting & keeping her sound. She had rotation in both front feet, but returned to full ridden work, competing successfully in dressage up to medium level, with a little low key jumping at home for fun on a surface. By careful trial & error we worked out a management system which worked for her & gave her a great quality of life for years. She has now been diagnosed with cushings which is a whole new ball game, but with the help & support of my wonderful vet & farrier we seem to be managing well so far. I was not being disrespectful of your knowledge, & I am not sure that I would subject my own pony to this procedure, I just meant to make the point that I was doubtful that the Laminitis Clinic would be up to speed on what was current, & surely they must have experienced success with the procedure in order to recomment it? Sometimes though I do think that their procedures are invasive, & personally I would be looking carefully at what would be achieved at the end in terms of quality of life before I were to proceed. I believe that all laminitics are different & require different regimes, my friend manages here laminitic in a totally different way to me, who is to say what is right or wrong if it keeps this dreadful disease at bay??
 
Thanks everyone for your replies;
Not been wormed, his feed is the same as its been for years, ony difference is he is getting seaweed/linseed added and I swapped the Lucie nuts for the Dengie ones as easier to get hold of. Farrier the same too!
As he has been fab for 8 years I thought I'd got his management sussed! Only thing I can think of is the grass, although he's not on frosty grass until at least 3pm when the sun has gone down.
Hay is old meadow hay, cut in June 2008 and more like straw, lol, they love it, they've been on the same hay since the summer.

Never thought about cushings as he's only 11, is that a myth they only get it when older? sorry I don't know the other symptoms.

He's stopping in for now
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will reasess in a couple of weeks.
Thanks again, feel much better
 
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