2. LAMINITIS Types of inflammation. Inflammations of the hoof. Dr. Tóth Péter. SZIU, Faculty of Veterinary Sciences, Large Animal Clinic

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1 Inflammations of the hoof Types of inflammation Dr. Tóth Péter SZIU, Faculty of Veterinary Sciences, Large Animal Clinic 1. Aseptic circumscribed (sole bruise) 2. Aseptic general - laminitis 3. Septic circumsribed superficial - Hoof abscess deep septic 4. Septic general = deep septic inflammation 1. Solar bruise Hoof wall anatomy Between the bars and quarters Fariers mistakes Flat hoof, underruned heels Clinical signs treatment: phenylbutazone, correct shoeing Basal cells (black arrow) and basal membran (white arrow) 2. LAMINITIS 1

2 Grain overload Causes of laminitis I. Other endotoxemic diseases retained placenta Colitis, Mechanical trauma of the pododerma (too much trimming, nonweight bearing lameness on the collateral limb etc.) Glucocorticoids, high oestrogen level Cushing s disease (pituitary pars intermedia dysfunction PPID ) Effect of grain overload I. wheat, (bread), corn, barley, oats Lash pasture The effect of indigestible starch Effect of grain overload II. Endotoxin shock: death, or further effect of mediators What happens at the level of lamellaes? Basal cells of sec. horny lamellaes are separating from the basal membrane catecholamins, prostagalandins, histamin, serotonin, TNF Result: tachycardy, tachypnoe, fever, sweting, dearrhoea, colic signs + hoof pain Virginiamycin (5g/kg feed) serous(?) corial inflammation(?) (inflammation, edema, DIC) compartment syndrome? lamelles) Vasodilatation in early stage (separating of dry Vasoconstriction does not cause laminitis Role of AV bridges Pathogenesis I. Pathogenesis II. What is inducing separation and lysis of the basal membran? Lokal hypoglykemie Lamellar Matrix Metalloproteinase activity (MMP-2, MMP 9) Cytokin (TNF-α, IL-1ß etc) activity The mechanism is not clear yet 2

3 I. Developmental phase (8-40 hours) II. Acute phase contact with factors untill onset of lameness Permanent elevated temperature of the effected hoof Shifting weight from one limb to the other Seldom (?) occur, that just the acute phase will be observed first!?! Onset of lameness Obel categories I-IV. 1. Stiff gait 2. Shifts weight to the hind legs 3. Opposite feet can not be lifted 4. Reluctant to moove Acut phase - clinical signs shifting weight from one limb to the other Hot hoofs (up to 24 hours 30 degree hoof temperature) Digital pulsation Sensitiveness of the dorsal hoof wall Lameness at turns MVA eliminates lameness Mores frequently on the front feet III. Chronic phase If displacement of the distal phalanx happens Degree of lameness highly correlates with degree of lamellar degeneration Chronic laminitis clinical signs 1. Changes at the coronary band Separation at the white line 3

4 Chronic laminitis clinical signs 2. Changes of the solar surface Most important observations on the X- ray in acute laminitis B 25-28%B = A A 1. Distance between dorsal hoof wall and dist.phal. 2. Radiolucent line in the hoof wall 3. Coronary band proc. ext. distance 4. Rotation of the dist. phalanx palm/plant 5. DP view: extensiveness of separation 4

5 Observations in chronic laminitis Osteolysis, osteomyelitis, remodelling of the apex, Fractures of margo solearis β -α α β Prognosis after radiological appearance A palmar rotation has less correlation with histopathological changes than degree of lameness!! Treatment I. 1. Treat primer diesease! 2. Decrease pull of DDFT (rockering the toe) 2. Eg. in endotoxaemy: infusion, paraffin 4x4 l / day Carbo activatus: 1-5g/ ttkg, AB, Flunixin, etc. 3. NSAID: Flunixin 0.25 mg 3X vagy 1.1 mg 2X Phenylbutazon 4.4 mg, majd 2.2 mg 2X Ketoprofen 2.2 mg /ttkg 2X 4. Vasoconstrictors (peracut acut stage): ice pacs, cold water 5. Improve lamellar perfusion: ACP, isxsuprin hydroclorid, heparin100 IU/kg IV. 4x 5

6 Treatment II. 6. DMSO 10% : 0.1-1g/ttkg 5% dextrose infusion 8 liter / hours slowly 7. eliminate grain from the diet 8. Walking exercise: is not advised from the very beginning 9. MMP inhibitors - are still in research stage Chronic laminitis Systemic hypertension has to be controlled (phenylbutazone low dosis, ACP decreased sodium intake biotin, methionine (10g/day, 5g/day from the 2. week) foot care, protection of the solar surface Re-establishment of physiological situation between the first phalanx and the hoof wall. Elevating the heels and providing mechanical stability of the hoof 12-18% elevation is advised Frog and sole support: Gips bandage, styrofoam sole pad secured with duct tape For min.14 days after acute symptoms had dissappeared Deep bedding orthopedic shoeing (frog support) Orthopedic correction of chronic laminitis Removal of the dorsal hoof wall with underlieing lamellar wedge Correction of the heels Frog support with special orthopedic shoes frog suport may not overreach insertion of the DDFT may be elevated with ~ 3 mm from shoe level rolling shoe 6

7 Prognosis 1. Favorable: if there is no rotation or sinking of the distal phal 2. Guarded: is rotation occurs 3. Bad: if sinking (and rotation) occurs Recidiva is often present even with a favorable outcome Tenotomy of the DDFT If no improvement despite treatment Preparation: orthopedic trimming and shoing Operation: in standing local anesthesia HVB In the prox. third of the cannon separated from lig.accessorium Postoperative regime: 4 weeks bandage, boxrest Prognosis: after one year often euthanasia is necessary 7