The effect of hoof angle variations on dorsal lamellar load in the equine hoof

Reasons for performing study: In the treatment of laminitis it is believed that reducing tension in the deep digital flexor tendon by raising the palmar angle of the hoof can reduce the load on the dorsal lamellae, allowing them to heal or prevent further damage. Objective: To determine the effect of alterations in hoof angle on the load in the dorsal laminar junction. Methods: Biomechanical finite element models of equine hooves were created with palmar angles of the distal phalanx varying from 0–15°. Tissue material relations accounting for anisotropy and the effect of moisture were used. Loading conditions simulating the stages in the stance where the vertical ground reaction force, midstance joint moment and breakover joint moment were maximal, were applied to the models. The loads were adjusted to account for the reduction in joint moment caused by increasing the palmar angle. Models were compared using the stored elastic energy, an indication of load, which was sampled in the dorsal laminar junction. Results: For all loading cases, increasing the palmar angle increased the stored elastic energy in the dorsal laminar junction. The stored elastic energy near the proximal laminar junction border for a palmar angle of 15° was between 1.3 and 3.8 times that for a palmar angle of 0°. Stored elastic energy at the distal laminar junction border was small in all cases. For the breakover case, stored elastic energy at the proximal border also increased with increasing palmar angle. Conclusions and potential relevance: The models in this study predict that raising the palmar angle increases the load on the dorsal laminar junction. Therefore, hoof care interventions that raise the palmar angle in order to reduce the dorsal lamellae load may not achieve this outcome. See also correspondence by Redden See also correspondence by Curtis     

Analysis of strain and stress in the equine hoof capsule using finite element methods: comparison with principal strains recorded in vivo

Finite-element (FE) methods have great potential in equine biomechanics in evaluating mechanical stresses and strains in tissues deep within the hoof. In this study, we critically assessed that potential by comparing results of FE analyses of capsular strain with in vivo data. Nine FE models were developed, corresponding to the shape of hooves for which in vivo principal strain data are available. Each model had the wall, laminar junction, sole and distal phalanx (PIII). In a first loading condition (LC1), force is distributed uniformly to the bearing surface of the wall to determine reaction forces and moment on PIII. These reaction forces were subsequently applied to PIII in loading condition 2 (LC2) to simulate loading via the skeleton. Magnitude of the force resultant was equivalent to the vertical force on the hoof at midstance. Principal compressive strains epsilon2 were calculated at the locations of 5 rosette gauges on the real hooves and are compared with the in vivo strains at midstance. FE strains were from 16 to 221% of comparable in vivo values, averaging 104%. All models in this, and reports by other workers, show predominance of stress and strain at the toe to a greater extent than in the real hoof. The primary conclusion is that FE modelling of strain in the hoof capsule or deeper tissues of individual horses should not be attempted without corroborating experimental data.     

An investigation of the relationships between angles and shapes of the hoof capsule and the distal phalanx

Reasons for performing study: There is little scientific evidence to support the premise that poor foot conformation predisposes to foot pain and lameness. Objectives: To determine relationships between external characteristics of the hoof capsule and angles of the distal phalanx; to determine variability in shape of the distal phalanx; and to investigate association between distal phalanx angles and the injury causing lameness. Materials and methods: Feet were documented photographically and radiographically. Linear and angle measurements were obtained for the hoof capsule and distal phalanx and compared statistically. Horses were categorised according to injury group, and angles and linear ratios were compared between groups. Results: There was modest correlation between hoof wall and heel angles and angles of the distal phalanx. There was variation in shape of the distal phalanx. There was no significant association between injury type and angles of the distal phalanx, although there was a trend for the angle of the dorsal aspect of the distal phalanx with the horizontal to be smaller in horses with injuries of the podotrochlear apparatus or deep digital flexor tendon compared with other groups. Conclusions: There are variations in shape of the distal phalanx largely due to differences in orientation of the concave solar border and the solar border to the horizontal. Variations in shape of the distal phalanx were not accurately correlated with external characteristics of the hoof capsule. There were weak associations between injury groups and angles of the distal phalanx. Clinical relevance: Further work is required to elucidate risk factors for foot‐related lameness.     

A preliminary study into the correlation of stiffness of the laminar junction of the equine hoof with the length density of its secondary lamellae

Reason for performing study: The relationship between mechanical behaviour and microscopic structure of the laminar junction of equine hooves under testing conditions requires elucidation. Objectives: To determine mechanical parameters and 2D length density of profiles of secondary lamellae of the laminar junction in the dermal region and to assess possible correlations. Methods: Specimens (25 samples in total) of the laminar junction were taken from front, quarter and heel parts from 3 equine hooves and exposed to a uniaxial tensile test until rupture to obtain Young's moduli of elasticity, ultimate stress and strain. Neighbouring specimens to those used for the biomechanical experiment were processed histologically to assess the length density of laminar junction basement membrane using stereological grids. Results: The estimated median (interquartile range) length density of the laminar junction basement membrane was 0.024 (0.020–0.027)/µm. Young's modulus of elasticity was 0.15 (0.11–0.35) MPa in the small deformation region, and 7.58 (6.14–8.68) MPa in the linear region was. The ultimate stress was 1.67 (1.41–2.67) MPa, and the ultimate strain was 0.50 (0.38–0.70). The Young's modulus of elasticity in the region of small deformations has a moderate correlation with the length density of the laminar junction basement membrane. Conclusions: As with most soft biological tissues, the laminar junction has a nonlinear mechanical behaviour. Within the range of small deformations, which correspond to physiological loading of the laminar junction, a higher length density of the laminar junction basement membrane is correlated with a higher resistance of the laminar junction against high stresses transmitted from the distal phalanx to the hoof wall. Potential relevance: The condition of the laminar junction apparatus may be easily quantified as the length density of profiles of secondary dermal lamellae. This quantification provides a simple tool that could be used for comparing the proneness of the various parts of the laminar junction to initial stages of laminitis.     

Relationship of foot conformation and force applied to the navicular bone of sound horses at the trot

REASONS FOR PERFORMING STUDY: Collapsed heels conformation has been implicated as causing radical biomechanical alterations, predisposing horses to navicular disease. However, the correlation between hoof conformation and the forces exerted on the navicular bone has not been documented. HYPOTHESIS: The angle of the distal phalanx in relation to the ground is correlated to the degree of heel collapse and foot conformation is correlated to the compressive force exerted by the deep digital flexor tendon on the navicular bone. METHODS: Thirty-one shod Irish Draught-cross type horses in routine work and farriery care were trotted over a forceplate, with 3-dimensional (3D) motion analysis system. A lateromedial radiograph of the right fore foot was obtained for each horse, and various measurements taken. Correlation coefficients were determined between hoof conformation measurements and between each of these and the force parameters at the beginning (15%) of stance phase, the middle of stance (50%) and at the beginning of breakover (86% of stance phase). Significance was defined as P<0.05. RESULTS: The force exerted on the navicular bone was negatively correlated (P<0.05) to the angle of the distal phalanx to the ground and to the ratio between heel and toe height. This was attributed to a smaller extending moment at the distal interphalangeal joint. There was not a significant correlation between the angle of the distal phalanx and the degree of heel collapse, and heel collapse was not significantly correlated to any of the force parameters. CONCLUSIONS: Hoof conformation has a marked correlation to the forces applied to the equine foot. Heel collapse, as defined by the change in heel angle in relation to toe angle, appears to be an inaccurate parameter. The forces applied on the foot are well correlated to the changes in the ratio of heel to toe heights and the angles of the distal phalanx. POTENTIAL RELEVANCE: Assessment of hoof conformation should be judged based on these parameters, as they may have clinical significance, whereas parallelism of the heel and toe is of less importance.     

Squamous cell carcinoma of the hoof wall in a stallion

Squamous cell carcinoma of the hoof wall, with resultant invasion of the right hind distal phalanx, was identified in a 15-year-old Thoroughbred stallion. The clinical features included a chronic grade 2/5 right hind limb lameness and a sessile dorsal hoof wall mass that was not sensitive to palpation. Radiography revealed a well-circumscribed circular lucency within the distal phalanx, beneath the clinically noticed hoof wall mass. These features were considered to be characteristic of a hoof wall keratoma. Surgical intervention was done 10 months later. The histologic diagnosis at the time of surgery was squamous cell carcinoma. Eight months after surgery, progressive tumor invasion of the distal phalanx resulted in a pathologic articular fracture. This case highlights the need for accurate histologic diagnosis of equine hoof wall masses to differentiate between benign and malignant conditions.     

Treatment of acute laminitis. Supportive therapy.

Over the last decade, both the farriery and veterinary professions have greatly increased their collective experience and understanding of the treatment of acute laminitis. Many horses that would have not been considered candidates for treatment 10 to 15 years ago are now saved, and some progress to successful careers as athletes. Unfortunately, the difficulties over prediction of the course of the disease persist, which continues to complicate treatment decisions. By its nature, supportive therapy is designed to make the horse more comfortable and limit further laminar injury by countering adverse biomechanical forces. Therefore, the success of treatment depends on the degree of instability between the distal phalanx and the hoof when treatment is started as well as the effectiveness of medical and supportive therapy.     

MAGNETIC RESONANCE IMAGING OF THE EQUINE DIGIT WITH CHRONIC LAMINITIS

Chronic laminitis is a severe disease affecting the equine digit. It was hypothesized that magnetic resonance (MR) imaging would improve visualization of structures within the foot and pathology associated with chronic laminitis. This study aimed to describe the MR imaging findings in chronic laminitis, compare different pulse sequences for visualization of pathology, and to compare MR imaging with standard radiography. Twenty (10 forelimb, 10 hindlimb) cadaver limbs from 10 horses clinically diagnosed with chronic laminitis (group L) and 10 limbs without laminitis (group N) were used. Lateromedial radiographs and sagittal and transverse MR images of the foot were obtained. Radiographs and MR images were evaluated for anatomic definition and evidence of pathology. Dorsal hoof wall thickness and angle of rotation and displacement distance of the distal phalanx were measured. Comparisons were made between group L and N, forelimb and hindlimb within each horse, and MR imaging and radiography. Features consistently noted with MR images in group L, but not detected using radiography, included laminar disruption, circumscribed areas of laminar gas, laminar fluid, and bone medullary fluid. Other findings seen only on MR images included increased size and number of vascular channels, alterations in the corium coronae, and distal interphalangeal joint distension. Magnetic resonance imaging allowed better definition of laminar gas lines and P3 surface irregularity observed on radiographs. Based on measurements, group L had a greater angle of rotation, distal displacement, and dorsal hoof wall thickness than group N; forelimb hoof wall thickness was greater than hindlimb; and distal displacement and hoof wall thickness measurements were smaller using MR imaging than radiography, but had a similar pattern. It is concluded that there are features of chronic laminitis consistently observed using MR imaging and that these may be additional to features observed radiographically.     

A gross and histopathological study of an ectopic white line development in equine laminitis

In horses with chronic laminitis, an abnormal horny structure called lamellar wedge, is generated between the hoof wall and the laminar epidermis. To be able to manage horses with chronic laminitis correctly, more information about the pathological state of this abnormal horn is required. The aim of this study was to collect and analyze objective morphological data about the abnormal horn in order to understand its morphology and development. In the study, the abnormal horn was grossly visible on the sagittal hoof section from approximately 20 days after the onset of disease. In the histological observations, the structural characteristics of this abnormal horn were similar to the white line tissue, suggesting it is an ectopic white line. Mean value of the cross-sectional area of the abnormal horn against the distal phalanx section area (A/D) was 0.29 cm(2) SD +/- 0.14 and it finally showed an eight-fold increase over the mean value of normal white line section area against the distal phalanx section area. In conclusion, a large amount of the ectopic white line is thought to be finally able to inhibit normal hoof wall growth, so that it should be resected at the optimum time when would be after one month from the onset of the disease.     

A Novel Approach to the Treatment and Prevention of Laminitis: Botulinum Toxin Type A for the Treatment of Laminitis

Laminitis is an inflammation of the lamina of hoofed animals. According to the United States Department of Agriculture (USDA), laminitis impacts approximately 2% of the horse population each year. Because of the severity of the inflammation and chronic pain, it is frequently necessary to euthanize these horses. Surviving horses may be left useless, with resultant economic and social impact on the industry. Current interventions for laminitis are based on supportive care and alteration of biomechanical forces on the digit. The transition from laminitis to laminar failure (founder) is believed to be caused by the “weight of the horse and the forces of locomotion driving the bone down into the hoof capsule.” We hypothesize that an important factor is the torsional forces placed on the distal phalanx (coffin bone) by the deep digital flexor muscle and tendon. The paralyzing effect of botulinum toxin will result in a decrease of these torsional forces and therefore will aid in the prevention or treatment of the sequelae of laminitis. Seven horses with varying degrees of laminitis were evaluated. Each underwent pretreatment and posttreatment radiographs as well as pretreatment and posttreatment Obel grading. Each horse received botulinum toxin type A injected into the belly of the deep digital flexor muscle. In all cases there was radiographic stabilization of pedal displacement from the dorsal hoof wall. Obel scores showed improvement of 1 to 2 grades during the time monitored.     

White line disease: A review (1998–2018)

White line disease (WLD) is a significant pathological condition that affects the equine hoof. White line disease continues to frustrate veterinarians and farriers due to the diversity regarding the aetiology, diagnosis and especially treatment. Furthermore, WLD lacks a definitive definition as the disease becomes apparent only when the hoof wall is compromised with an extensive separation, a hoof capsule distortion is present or when lameness exists. Clinical signs can range from a minor hoof wall separation to an extensive disruption of the external laminar bond resulting in displacement of the distal phalanx within the hoof capsule. There has been a myriad of treatments and topical preparations proposed for treating WLD, but most remain controversial with few having any scientific documentation or evidence of efficacy. This review of WLD is based on the sparse information available in the veterinary literature, the large number of WLD cases treated successfully in the authors’ combined practices using conventional farriery and the relevant questions that hopefully can be answered in the future.     

Morphological spectrum of primary epidermal laminae in the forehoof of Thoroughbred horses

Reasons for performing the study: Hoof health is a major concern of horse owners as well as the equine industry. However, many questions remain concerning regional variations of laminar junction and its potential to remodel. Hypothesis: To examine regional variations in the morphology of the laminar junction and thickness of the hoof wall in Thoroughbred horses. Methods: The forefeet of 25 Thoroughbred cadavers were examined. Each hoof was divided into 20 blocks through 4 proximodistal slices (below the coronary band, each 1 cm apart) and 5 circumferential positions (toe, medial and lateral quarters and heels). In each block, 25 central primary epidermal laminae (PEL) were considered. Orientation of each lamina in relation to the hoof wall (LO), degree of bending (IA) and the spaces between the adjacent laminae (LS) were measured. Thickness of the hoof wall and number of branched PEL were also measured. Data were analysed using a split‐block design in ANOVA. Results: There were significant differences between the 2 proximal and 2 distal slices in LO and IA data, but not in LS data. Circumferentially, toe blocks were different from heel and quarters blocks. Lateral and medial heels as well as the quarters were mostly different. The hoof wall was slightly thicker laterally than medially. There were more branched PEL on the lateral side of the left hooves and on the medial side of the right hooves. Conclusions: These data add to the circumstantial evidence supporting the hypothesis of adaptive remodelling in the laminar junction. Results of this study signify the capability of PEL to remodel in response to applied stress to the regions of the hoof. Potential relevance: A deeper understanding of the gross and cellular processes of laminar remodelling may well prove to be complementary to an understanding of their failure in laminitis.     

A singular case of traumatic total hoof capsule avulsion

Total, full thickness hoof wall avulsion is rare in horses. Sometimes complications such as fracture of the distal phalanx, osteomyelitis, septic arthritis and degenerative joint disease have been reported. Limiting motion at the affected site and hoof stabilisation are essential to obtain a good hoof regeneration. This case report reviews the clinical features including diagnostic techniques (radiographic examination and venography) of a Quarter Horse filly presented with a complete and full‐thickness traumatic hoof capsule avulsion complicated by an open fracture of the third phalanx. A transfixation casting technique was performed followed after one month by 2 short limb casts applied for 2 months each. Twenty‐four months after trauma the foot had completely regrown. The dorsal aspect of the hoof wall appears to be remarkably shorter compared to the heels. From a radiographic viewpoint, the lateral aspect of the left hind foot shows diffuse bone remodelling and a deformed distal phalanx.     

The pathogenesis and treatment of osteomyelitis and laminitis in a stallion after the prolonged topical application of formalin to the distal phalanx

A 12-year-old Quarterhorse stallion was presented with a severe lameness in the left forefoot. There was a 3 cm diameter cavity in the sole that extended to the solar surface of the distal phalanx. Radiographs revealed an osteomyelitis and a sequestrum which probably developed following the prolonged topical application of 10 percent formalin. The sequestrum was removed and the infected bone curetted under general anaesthesia. The horse was shod with heart bar shoes on both front feet 7 days after the surgery. Eight months later, radiographs showed marked rotation of the distal phalanx despite continual shoeing with heart bar shoes. Surgical resection of the dorsal wall of the hoof at the toe removed the pressure applied by the laminar wedge, and combined with the stabilising and supporting action of the heart bar shoe, permitted realignment of the distal phalanx approximately 30 degrees closer to the normal skeletal axis by 26 days post-operatively. This case highlights some of the recent developments in the treatment of laminitis and suggests that effective treatment is possible if the value of the animal warrants the time and investment.     

Retrospective analysis of distal limb conformation and lameness in mature horses after desmotomy of the accessory ligament of the deep digital flexor tendon for management of a flexural deformity

Mature horses that present with flexural deformity of the distal interphalangeal joint and lameness isolated to the foot may obtain long‐term benefits from desmotomy of the accessory ligament of the deep digital flexor tendon (ALDDFT). This retrospective analysis of medical records and radiographs included 13 horses, aged ≥2 years, presented for lameness isolated to the hoof region and diagnosed with flexural deformity of the distal interphalangeal joint. Radiographic angles of the hoof and distal interphalangeal joint and lameness scores were compared before and after desmotomy of the ALDDFT. Follow‐up data including the ability to perform the intended use were obtained at least one year after surgery. There was improvement in the angle between the dorsal aspect of the third phalanx and the weightbearing surface of the hoof, improved alignment between the dorsal hoof wall and dorsal aspect of the third phalanx, and improved alignment of the distal interphalangeal joint. Lameness was decreased in 9/13 horses and 10/13 horses were performing at their level of intended use. Evidence of improved hoof conformation and lameness following desmotomy of the ALDDFT in lame horses with flexural deformity of the distal interphalangeal joint would indicate this procedure should be considered in mature horses.     

An investigation of the shape of the hoof capsule in hindlimbs,its relationship with the orientation of the distal phalanx and comparison with forelimb hoof capsule conformation

There is limited information documenting hind foot conformation. The objectives of the study were to describe the shape of the hoof capsule of hindlimbs from the lateral aspect in horses of variable breeds, and, within horses, to compare the conformation of the hoof capsule of forelimbs and hindlimbs and determine the orientation of the distal phalanx within the hoof capsule in hindlimbs. Lateral photographs of the fore and hind feet (n = 225) and lateromedial radiographs of the hind feet (n = 29) were obtained. Differences among breed and shoeing status groups were assessed using multivariable mixed-effects linear regression models. Angular parameters and ratios of linear measurements were compared between fore and hind feet; angular radiological variables and photographic parameters of the hind feet were compared. The mean dorsal hoof wall angle for hind feet (50.9°±3.7°) was smaller than forefeet (51.8°±3.9°) (P = 0.04). The mean heel angles for hind feet (36.4°±9.6°) were smaller than forefeet (40.1°±9.3°; P < 0.001). Dorsal hoof wall (P < 0.001) and heel (P = 0.002) angles were larger in unshod than shod feet. In the hind feet, the dorsal hoof wall was parallel to the dorsal aspect of the distal phalanx. The median angle of the distal phalanx to the horizontal (angle S) was 0.6° (interquartile range: −1.4, 2.3°). There was a positive relationship between angle S and the hoof wall angle (W); each 1° increase in angle S was associated with 0.6° increase in angle W (P < 0.001). Angle S was also positively associated with photographic heel angle; each degree increase in the angle S was associated with 1.8° increase in the heel angle (P < 0.001). It was concluded that the angle of the distal phalanx to the horizontal in hindlimbs is smaller than published values for forelimbs. The orientation of the distal phalanx in hindlimbs is correlated with external characteristics of the hoof capsule.     

The influence of temperature and age on the T1 relaxation time of the equine distal limb

The extent of fat suppression using short tau inversion recovery (STIR) imaging is variable between horses. Our aim was to determine if patient's age and/or hoof temperature have an influence on the T(1) relaxation time of bone marrow in the equine distal limb, thereby affecting the suppression of fat signal. Magnetic resonance imaging was conducted on standing horses and cadaver samples using a low-field magnet (0.27 T). The hoof temperature was measured at the lateral side of the coronary band. A modified inversion recovery fast spin-echo (IR-FSE) sequence was used to measure the signal intensity for a range of inversion times (TIs) at six different regions of interest (ROI): (1) distal aspect of the proximal phalanx, (2) proximal aspect of the middle phalanx, (3) distal aspect of the middle phalanx, (4) navicular bone, (5) proximal aspect of the distal phalanx, and (6) distal aspect of the distal phalanx. The T(1) of the bone marrow in the equine distal limb was calculated from the results and was found to increase by 3.13 ± 0.08 (SE) ms/°C. There was no significant effect of age (2-16 years) but the T(1) values measured from the limbs of young (< 1 year) animals were considerably longer (32.6 ± 1.7 (SE) ms). Similar effects of temperature and age were found for all measured ROIs but there were significant differences in the mean values of T(1) , ranging from +7.7 (distal aspect of the distal phalanx) to -13.2 ms (distal aspect of the proximal phalanx).     

Keratomas in horses: seven cases (1975-1986)

The diagnosis of keratoma in 7 horses and their treatment and outcome were evaluated. Horses were 2 to 20 years old, of various breeds, and were intact or castrated males. All were lame, and 6 horses had had previous injuries of the affected hoof that had not responded to prior treatments. Only 1 hoof was affected in each horse. Keratomas were beneath the hoof wall (6 horses) or sole (1 horse). Radiographically, a circular or semicircular defect with a discrete margin was present in the distal portion of the third phalanx in 3 horses. Grossly, keratomas were firm solitary masses (1.5 to 5 cm diameter); gray, tan, or yellow; and oval or conical. Keratomas were excised from beneath the hoof wall by removing a section of hoof wall (5 horses) or by undermining the wall beginning at its junction with the sole (1 horse). A keratoma beneath the sole in 1 horse was excised by excavating the sole to the level of the palmar surface of the third phalanx. Keratoma was verified microscopically by the presence of characteristic rings of squamous epithelial cells with abundant keratin. Purulent exudate and inflammatory infiltrate often were present concurrently, reflecting an associated localized infection. Aftercare included daily application of an antiseptic iodine solution and foot bandages, and shoeing with a treatment plate several weeks after surgery. Hoof and sole defects healed completely between 6 months and 1 year. By 1 year after surgery, 6 horses were sound, and keratoma had not recurred.     

A fresh look at white line disease

White line disease occurs secondary to a hoof wall separation. Clinical signs may vary from not being lame to severe lameness with rotation of the distal phalanx depending on the extent of the disease affecting the inner hoof wall. The author has found that removal of the hoof wall overlying the diseased area combined with the appropriate farriery is the most important aspect of therapy.