Laminitis and Equine Digital Osteoarthritis
Laminitis Re-defined | Management & Prevention | Case Studies
KC La Pierre, founder of the Institute of Applied Equine Podiatry (IAEP) views laminitis (inflammation of the corium of the lamellae) as a symptom and not as a defined disease process. New AEP research and our understanding of true foot function is challenging what is conventionally viewed as chronic laminitis or chronic founder and is suggesting it should be redefined as equine digital Osteoarthritis (EDO). These horses have symptoms associated with the chronic phase of the conventionally viewed laminitis cascade such as diverging growth rings in the hoof wall, rise in the coronary band at the quarters and heels, a flatter or convex sole, etc.
Horses with EDO in all probability will experience soft tissue inflammation elsewhere in the body resulting in an altered gait and bilateral hind limb lameness and resulting loss of performance. Indeed, inflammation that persists in the chronic phase is now viewed in AEP as systemic inflammation affecting the whole horse.
Horses that have laminitis do not necessarily develop EDO and laminitis may resolve within hours or days without the owner noticing. If the inflammation progresses, the horse may founder which is a displacement of the hoof wall from the dermis of the internal arch apparatus of the foot. In extreme cases, usually when the underlying cause is not resolved, acute laminitis can result in oedema and ischemia with an acute loss of suspension of the internal foot resulting is detachment of the external hoof from the foot. This is termed sinker and has an extremely poor prognosis. However, horses with EDO may suffer chronic inflammation which can last indefinitely. As such, AEP is offering this alternative labelling and treatment of chronic laminitis as EDO as a description of chronic inflammation. This is important as the pathogenesis or cause of acute laminitis and chronic inflammation may differ in each individual horse.
Horses can suffer mild laminitis and recover often without the owner ever noticing and these horses may not develop chronic founder or EDO. However, horses with EDO can and often suffer frequent bouts of laminitis. In addition, recent histological studies have shown changes to the extra cellular matrix of the ungular cartilage in horses with EDO which is in direct proportion to the degree of conformational changes associated with chronic founder. In addition, the cellular changes observed are a recognisable feature of osteo arthritis. This could suggest these horses have a developmental disease associated with compromised immune function and could be described as auto-immune. This would suggest EDO can progress and create marked loss of conformation and performance of the cartilage in the foot. This affects the entire suspension of the foot within the hoof and haemodynamic response is affected. Horse with a grade 3 or 4 EDO are particularly at risk if they experience an episode of laminitis as any founder or further loss of suspension can be catastrophic and lead to sinker and ultimately loss of life.
When adopting physiological sequencing within AEP and the treatment of the equine digit, it is important to identify and appreciate if the horse is experiencing laminitis, sinker, founder or chronic founder (which is now defined in AEP as EDO). X-rays, spectrum of usability, gait analysis, blood and urine testing tests, hoof testing, application of physiological sequencing and case history can all be used to help diagnosis, treat and manage the horse with laminitis and/or EDO.
AEP’s view of laminitis and EDO is supported by the Haematogenous Laminitis Trigger Factor Theory (a theory introduced by Chris Pollitt, BVSc, PhD of Australia); in that blood borne triggers activate constituent enzyme systems that in turn attack individual connective tissue elements. The root cause in each theory is likely to be the same; however, AEP investigations are governed by physiological sequencing and how the resulting loss of elasticity affects dynamic equilibrium of function within the foot. APE does not prescribe to the lamella suspension theory and this is because of AEP’s understanding that the lamellae are not the primary structure responsible for the suspension of the coffin bone within the hoof capsule. In AEP, the coronary band and its relationship to the supporting structures is believed to be responsible for suspending the internal foot within the hoof capsule.
Some of the triggers of laminitis are believed to be; increase in blood protein levels, virus or other pathogens, lack of essential amino acids (resulting in excess protein in the blood stream), hormonal changes (during changes in nutrition, from stress, pain or during seasonal changes for instance), toxins from plants or other sources, chemicals (vaccines, steroids, wormers, agricultural sprays, preservatives and other harmful additives in horse food for example), long term fasting or neglect and abrupt changes in diet.
Changes in blood glucose can also play a major role in the development of laminitis and EDO. Conventional veterinary medicine cites decreasing local concentrations of glucose as a cause for lamellae separation, going as far as to acknowledge that other epithelia may be similarly weakened. Research also suggests that not all triggers associated with acute laminitis are associated with EDO, such as carbohydrate overload and trauma induced laminitis. Horses with EDO are at increased risk of laminitis. Wherever humanly possible, avoiding known and potential triggers should be the priority for these horses. Some EDO horses are so sensitive to changes that a properly conducted hoof trim may initiate a response similar to that which is experienced as trauma in the EDO horse and can trigger an inflammatory response with resulting pain and even lameness.
The treatment protocol for the horse with laminitis and/or EDO involves a team approach with the vet, owner and hoof care provider primarily. Correct veterinary intervention and appropriate mechanical support alongside careful management (with a holistic viewpoint) is crucial in a horse experiencing laminitis or EDO (or both). The treatment will depend on the diagnosis and will always involve reducing the inflammation and pain, providing mechanical support and facilitating stability to the caudal foot and prevent further deterioration in health and performance to the hoof.
Once the inflammation is reduced, a long-term treatment plan can be employed and as appropriate to the individual horse. Providing balance to the hoof capsule for health is crucial. During laminitis, in attempts to alleviate the pain often experienced in the caudal hoof wall; the horse shifts weight to the heels. However, the increased force on the hoof wall of the heels translates to excessive force on the coronet band and its foundation (the lateral cartilages). The change in haemodynamics resulting from the inflammation and change in gait alters pressure and growth of the hoof capsule and the hoof can quickly become imbalanced.
Regular and correct trim method is essential to break this vicious cycle in the foundered or EDO horse. AEP tools such as Solemate pads and/or Perfect Hoof Wear can also be adopted after application of the High-Performance Trim (or HPT) method, where applicable. These can be fashioned into an orthosis designed to provide support, relieve abnormal stress on the structures at the caudal aspect of the foot, sole and coronet band; whilst reducing discomfort, thus encouraging correct movement needed for correct growth. They also provide correct stimulus for growth and return of conformation of the structures of the entire foot which have become negatively affected by laminitis/EDO and underlying lack of homeostasis.
Prevention of laminitis and EDO is becoming more difficult if vets, farriers, trimmers, owners and carers remain ignorant to the root causes. The domestic horse is facing an increasingly toxic environment, with more and more agricultural spraying in the UK countryside. These chemicals and other agents are finding their way into so called ‘healthy’ horse food stuffs and supplements as well as drifting through the air (from airplanes dumping fuel and agro-chemical spraying activities for example) onto grazing lands from neighbouring farms and on hay and haylage. There is scientific evidence linking metabolic disease and exposure to certain agro-chemicals in mammals and I hypothesise that exposure to these, combined with changes to management practices and farriery trends is predisposing horses to laminitis and EDO.
In addition, the environment in which we keep domestic horses in the UK is often not meeting the nutritional needs of the horse. In addition, modern practices such as narrow gene pool breeding, chemical worming, vaccinations, mono cropping grass, use of inappropriate grass species and wrapping forage is changing the chemical and nutritional status of the horse. This changes the gut microbiome, leads to chemical imbalances and ultimately leads to a lack of homeostasis which can lead to imbalances in the system which manifests in an array of symptoms, syndromes and diseases, including but not limited to laminitis and EDO.
DAEP’s are skilled at assisting owners and carers in helping provide correct environmental stimulus for their horses through proper management. This can prevent disease in the first instance but also help manage diseased horses and even help return full health and performance. But only IF the horse is exposed to correct environmental stimulus AND the horse still has the innate ability to heal itself.
X-rays can assist with understanding the position of internal arch and the health of P3 and can assist with development of an effective prognosis and treatment protocol. They also help appreciate loss of health to the foot as a result of a chronic loss of suspension which often accompanies EDO. Due to physiological sequencing, and the classification of tissues in the foot within AEP (soft, dynamic and static), x-rays help the vet and DAEP in providing critical information required for opinion on prognosis. EDO and long-term loss of suspension can result in chronic changes to haemodynamic blood flow and resulting changes in bone density and conformational changes to the foundation tissues (in particular P3 and the navicular bones). Chronic inflammation and chronic loss of suspension can also create strain and inflammation at the insertion points of the foot’s ligaments and tendons and thus pain. X-rays can help identify these changes, in particular the DP 65-degree view observing the solar margin of P3. I strongly recommend clients discuss AEP opinion and findings with their veterinary surgeon to assist with diagnosis and treatment protocol.
Further research on laminitis and EDO is needed. For more information about EDO and foot function contact the Founder of the Institute of Applied Equine Podiatry; KC LA Pierre at 770 NE 145 Ave, Old Florida 32680, USA OR email KC at firstname.lastname@example.org. I strongly recommend vets, horse owners and equine health care professionals read the book Laminitis, Founder & Equine Digital Osteoarthritis by KC La Pierre: https://store.appliedequinepodiatry.org/laminitis-founder--equine-digital-osteoarthritis-p163.aspx
Holistic Equine: https://www.holisticequine.co.uk/
Holistic Reflections https://www.holisticreflections.co.uk/
Silver Lining Herbs: http://www.silverliningherbs.co.uk/index.php
Calm Healthy Horses UK: https://www.calmhealthyhorses.co.uk/
Calm Healthy Horses (Main NZ site): http://www.calmhealthyhorses.com/
Thunderbrook Equestrian https://thunderbrook.co.uk/
Institute of Applied Equine Podiatry: http://www.equinepodiatry.com/home.html
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La Pierre, K.C. Laminitis, Founder & Equine Digital Osteoarthritis. Naples, Florida: IAEP, Inc, 2018.
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Associations between endocrine disrupting chemicals and equine metabolic syndrome phenotypes
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Please contact us if you would like more information about AEP and laminitis. We provide AEP consultation and can liaise with your vet and current hoof care provider.
We also provide SCENAR therapy and a range of products (from March 2019) which may help in the management or recovery of a horse at risk of laminitis. These include:
Silver Lining Herbs - unique, high quality, affordable herbal range which we personally use and endorse for the whole 2 and 4 legged family including our dogs and cats too! These can help reduce inflammation initiated by disease causing pathogens
StreamZ magnet wraps - again, our horses, dogs and 2 legs use these at Yewcroft and help with reduction of inflammation and pain and also help maintain healthy homeostasis!
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Beccy Smith B.Sc.(Hons) EBW DAEP MIAEP