Only the most extreme measures offered hope for a high-strung mare whenwhen heroicheroic plagued by a series of devastating hoof problems—including laminitis. effortsefforts By Ric Redden, DVM, with Christine Barakat wentyyears ago when I first OCD had progressed and the nearby started taking on horses coffin joint had developed degenerative paypay offoff with hoof problems others joint disease. Awesome would never be Tthought hopeless, I knew sound for riding of any kind. At that little beyond the fact that point, Deb just wanted to make her a their owners were desperate for some- comfortable broodmare. one to at least try. From these horses— But neither shoeing nor medication those who recovered and those who had a lasting beneficial effect. Eventu- didn’t—I learned things that I’ve put to ally, the decision was made to cut the use in other cases. As a result, we can nerves serving that area of the hoof save horses today that 10 years ago and inject the coffin joint in an effort wouldn’t have had a chance. to reduce inflammation. The procedure This isn’t to say that I never recom- should have made Awesome instantly mend that a horse be put down. When sound, but it didn’t. That’s when Deb pain turns to suffering—which I de- called me to come to her Cre Run Farm fine as pain with no hope for relief— in Doswell, Virginia. I think euthanasia is called for. But I don’t arrive at that point quickly. In Complications arise fact, that’s how I came to treat an I examined Awesome and con- Arabian mare named Im Awesome Tu. firmed that her situation was precari- Bred for racing, she was “big—big ous and unfortunately typical. Her and beautiful,” recalls her owner diseased navicular and coffin bones Deborah Mihaloff. “And she grew like had demanded so much attention that a weed that first year.”As a 2-year-old, another problem seemed to have the black filly entered race training cropped up out of nowhere. and was successful on the track. Then But it had existed all along. New she developed a persistent soreness in X rays of the right hoof revealed her right front hoof and was sent to the extensive ringbone—arthritis of the University of Pennsylvania’s New lower pastern joint. The denerving Bolton Center for a diagnostic workup. procedure had eliminated the discom- M V X rays revealed osteochondrosis fort associated with the navicular and D , N E dissecans (OCD) in the right front nav- coffin bones, but the ringbone was D D E R icular bone. OCD is one of several de- even more painful. C I R , Y velopmental orthopedic diseases that Equally troubling was the possibili- S E T R occur when a horse grows more rapid- ty of mechanical laminitis developing U O C ly than bone can properly form carti- S in Awesome’s left foot. When a horse O T O lage. Rest and medication seemed to isn’t able to bear weight on one front H AN UNEXPECTED TURN: Bred to race, P D N control Awesome’s condition for a few limb, the other takes it on. This con- the Arabian mare Im Awesome Tu A S Y showed early promise on the track. A months, but eventually she was lame stant load—sustained over days and R X Then she began to develop a series F more than she was sound. weeks—diminishes the blood supply. O O H An evaluation revealed that the Eventually, the blood-starved tissues of serious hoof problems. 42 EQUUS 348 die and the horse develops laminitis. My immediate goal was to enable MAY 25, 2002 SEPTEMBER 4, 2002 SEPTEMBER 5, 2002 Awesome to comfortably bear weight on her right hoof to protect her left hoof until the pastern joints fused, controlling the pain of the ringbone. I outfitted her right hoof with a device I designed called a “modified ultimate.” It’s essentially a cuff around her hoof with a wedge and breakover properties that allowed her to raise the heel at will. This enabled her to bear weight on her foot without putting her heel down, which was especially painful for her. The mare walked comfortably while wearing the device, and I returned to Kentucky hopeful that her condition would improve. However, after just four months, FROM BAD: The telling changes of ring- TO WORSE: In less than four months, TO CATASTROPHIC: To complicate matters, the mare’s “good” left Awesome was dramatically lame in her bone appear in the short pastern bone the changes characteristic of the front hoof showed evidence of developing laminitis—a result of left front hoof, and I made the return of the right front hoof. The condition arthritic condition had progressed having to bear a disproportionate amount of weight. A venogram trip to Virginia. It didn’t take much for became evident after the coffin and significantly. Awesome was lame and of the hoof revealed large areas at the front that were devoid of me to determine that the worst had navicular bones were treated. suffering extreme pain. functioning blood vessels. happened: She had developed lamini- tis in her “good” hoof. vidual’s breed, age and occupation. In Ill-suited for a sling within seconds the tissue turned To temporarily replace the hoof contrast, the venogram of Awesome’s I had planned to begin work on from a whitish color to bright pink, wall, I cut a thick piece of felt, soaked No hoof to stand on left hoof showed large areas at the Awesome as soon as she arrived, but then bled freely once the vessels it in Betadine, laid it over the laminae Big—very big—and I took a series of X rays, looking for front and along the palmar surface she was very high-strung. We needed were decompressed. That was an and taped it in place. Then I cast the the telltale swelling between the coffin (below the bone) that were devoid to put her in a sling, but she was so indication that the circulation had leg, using the pins I had placed in the beautiful, the bone and hoof wall that indicates fail- of functioning vessels. Deprived of wired that even sedation wouldn’t returned, and it made me very hopeful. cannon bone as support. Essentially, blackArabian filly ure of the laminae. There was a slight blood, the laminae in those areas help. Over the next two days, however, If I don’t see that within 30 seconds the lower leg was floating in the cast entered race swelling, but from the radiographs would soon fail. she seemed to acclimate to the sling. I of taking a hoof off, things usually with no weight put on the hoof. Awe- alone, it didn’t look that bad. I knew I I knew from looking at the veno- felt she would tolerate it well enough don’t end well. some was immediately comfortable. training as a had to do a venogram—a technique I gram that we had only a few days to for the procedure. 2-year-old and developed for horses in 1992—to pro- save her. She was experiencing mas- With the mare completely suspend- A DRAMATIC PROPOSAL duce an image of the circulation within sive vascular shutdown. The laminar ed, I anesthetized her lower leg and experienced the hoof. Then I’d know for sure what tissue was swelling within the rigid placed two surgical pins at the lower success on was going on. hoof capsule. Unable to expand, it was end of her cannon bone. They extended I placed a tourniquet around the like a tourniquet, cutting off circula- beyond the skin and with the addition the track. fetlock to cut off all blood to the hoof. tion and causing further damage. of a cast would eventually take on the Next I injected dye into the vein at the The gravity of the situation required entire load of the left leg. Using a pastern. The dye filled all the function- an immediate and extraordinary solu- Dremel tool, I then cut around the ing veins, arteries and capillaries of tion. I proposed shipping Awesome to lower edge of the wall of the left hoof, the hoof. I took six radiographs of the my clinic in Kentucky so I could totally separating it from the sole beneath hoof in 45 seconds—the dye disperses remove the hoof wall to restore circula- it. Because the laminae were so rapidly from the vessels. tion to the laminar tissues. damaged, it was an easy job. Once In a healthy horse, the images re- After a bit of thought-provoking dis- the sole/wall junction was separated, veal an extensive network of blood ves- cussion, Deb agreed. Outfitted with a I carefully peeled the entire hoof wall TWO-STEP PLAN: Together with a cast, surgical pins placed through Awesome’s left sels. Though quite similar from horse cast to keep weight off her left foot, the from the foot. front cannon bone (left) bore the entire load of the leg. Then the hoof wall (right) was to horse, these networks have unique mare made the journey to Kentucky, I gently massaged the exposed removed to restore circulation to the laminae. characteristics depending on an indi- nearly beating me home. laminae to restore blood flow, and 44 E QUUS 348 september 2006 september 2006 EQUUS 348 45 and even buck in the round pen we was causing the tendons attached to it keep her in.” I was a bit worried about to contract.