Laminitis is usually diagnosed based on the symptoms. The physical examination may show marked prominence of the digital arterial pulses and further evidence of pain, such as elevated heart rate and elevated respiratory rate. If the disease has been present for a considerable period of time, your veterinarian may notice abnormal growth of the hoof capsule, dropped sole, and a widened white line zone. Typical clinical signs (symptoms)
The diagnosis of laminitis is usually established by the following criteria:
Appropriate clinical setting (one might expect laminitis to arise during treatment of some diseases – such as diarrhea)
Painful reaction to hoof testers at toe. Application of pressure using "hoof testers" at the toe of the laminitic hoof will often (but not always) elicit a painful reaction. In some cases, an abscess develops in the affected lamellae and might drain out through the sole or drain through the coronary band.
Increased prominence of digital arterial pulses
Radiography, although laminitis may be present without ANY radiographic abnormalities. It is strongly recommended that a radiographic examination of the affected feet should be undertaken as soon as possible when laminitis is suspected. In some cases during the early stages of laminitis, there are no abnormalities evident on radiography.
However, radiography is advocated because it is typically important to:
Determine whether this new pain represents a new event or reactivation of a preceding laminitic attack (chronic laminitis)
Establish a baseline upon which the effects of treatment can be judged (is it getting better or worse or staying the same)
Help assess the prognosis – the more severe changes (based on radiography) tend to be associated with a poorer prognosis.
Assist in the direction of treatment strategies that include special trimming, farriery, and removal of the hoof wall at specific locations
It is not usually necessary to anesthetize the affected hoof in order to make the diagnosis. Obviation of pain may result in severe damage (new or further separation of the coffin bone from the lining of the hoof wall) and exacerbation of lameness if the horse is exercised excessively. Although it is severe, the pain actually "helps" to prevent the affected horse from causing further damage to compromised lamellae.
The most common reason that laminitic horses fail to make a good recovery is because the horse is allowed to self-exercise too soon; it is common for affected horses to be "turned out" sooner than 6-8 weeks following initiation of treatment. These horses have often been stall-confined for several weeks (during treatment). Much too soon, they are turned out and (in light of their recent confinement) allowed to run around. Neither the owner nor the horse has any appreciation for the fact that the lamellar attachments have not completely healed. Although the horse perceives that his feet are okay, the weakened attachments can all too easily be re-damaged – leading to a major "flare-up" and worsening of the underlying disease process.
The specific treatment should be determined by the veterinarian who has examined the horse based on his findings and results of radiography of the affected feet.
Treatment Treat the primary problem if it can be identified
Application of hot or cold (depends on stage)
Appropriate pain relief
Thickly bedded stall
Drugs aimed at improving the blood flow to the feet (such as nitric oxide donors, acepromazine, pentoxifylline)
Drugs used to reduce inflammation which can develop when blood supply is poor (DMSO)
Change the angle of the painful hoof
Use of frog support
Special trimming and farriery - chronic cases
Surgery (transect the DDF tendon)
Other than the pain relief and the antiinflammatory properties of non-steroidal anti-inflammatories, (bute, banamine, ketofen), no drug has been shown to affect the course of laminitis. Despite years of research, this disease continues to defy solutions, and that is likely due to the fact that it can either be too late by the time symptoms are present, or the underlying problem has not been fixed.
Special Points Most affected horses are prone to further bouts of laminitis.
Most affected horses do not re-achieve the same level of performance that they had prior to developing laminitis.
Horse owners often undertake treatment without fully appreciating the potential cost (based on length of time and cost of drugs) and labor needed to care for affected horses. Many of those horses show episodic improvement during treatment, but overall continue to deteriorate.
Most veterinarians would agree, that laminitis is one major cause of suffering in horses, and it is difficult to know when to give up. Certainly, if the horse does not respond to pain medication, is relatively immobile, doesn't eat, has side effects of pain medication, if there is serious rotation of the coffin bone, hoof wall destruction, or infection, euthanasia should be considered.
These horses are suffering with little hope of relief. Eventually they will go down, and not get up. Although euthanasia is an extremely difficult decision, the picture is perhaps clearer with laminitis that with other diseases. You might want to set-up criteria for "suffering" and "indications for euthanasia," which may sound a little morbid, but if you put it on paper, that means you've thought about it. Talk it over with your veterinarian. They will be impressed and glad to help you further.
The prognosis is unpredictable, and it may be (and should be recognized as such) grave in some severe cases. Few "recovered" (remissive) horses will be able to work at a high level of performance.