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Prognostic indicators of poor outcome studied at US referral hospital

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01 November 2010, at 12:00am

DR James Orsini, director of the Laminitis Institute at the University of Pennsylvania, describes laminitis as a very frustrating disease from a number of standpoints, including management.

“The pain and debility are often so severe that euthanasia is often considered, but this decision is not easy because of our lack of data and uncertainties about which horses are more or less likely to recover,” he says.

To try to take the guesswork out of predicting which horses are less likely to recover from laminitis, Dr Orsini and colleagues reviewed the medical records from 247 horses treated for laminitis that were euthanased or died.

These records were compared to the records of 344 horses treated for laminitis that survived and were discharged from the University of Pennsylvania’s Hospital for Large Animals between 1986 and 2003.

One of the most important findings of this study was that as the grade of lameness increased (using the Obel grading scheme from I-IV, where IV is extremely lame and reluctant to walk), the chance of a poor outcome also increased.

Horses with an Obel grade II lameness were three times more likely to die or be euthanased than horses with grade I lameness.

Horses with grade III and IV were 9.6 and 20 times more likely to have a poor outcome than the odds of a similar horse deemed grade I. The use of glue-on shoes significantly reduced the risk of death in horses with laminitis.

The results of this study were published under the title “Prognostic indicators of poor outcome in horses with laminitis at a tertiary care hospital” in the June 2010 edition of the Canadian Veterinary Journal.

The full-length article is available for free through PubMed Central.

  • The protective influence of glue-on shoes is interesting as farriers and veterinarians using this technology consider it a means to atraumatically support the laminitic foot,” says Dr James Orsini, the director of the Laminitis Institute at the University of Pennsylvania.

“Glue-on shoes allow the farrier and clinician to adjust the angle of the shoe relative to the weight-bearing surface of the hoof and the orientation of P3 (the coffin bone) relative to the rest of the digit and to the ground surface.

This relieves compression on the solar corium and tension on the dorsal laminar corium and likely also improves blood flow to these compromised areas.

“Glue-on shoe technology also allows one to create a larger weight- bearing surface which improves the biomechanics of the foot by reducing the concentration of load in the toe region,” he says.