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Addressing the Foot: Clinical Assessment and Therapy for Laminar Instability in the Acute Case of Laminitis
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Clinical Assessment: The diagnostic approach should include a combination of digital palpation, lameness examination and radiography or other imaging modality. Palpation of the coronary band may provide initial information regarding distal displacement of the third phalanx (P3) with a furrow commonly occurring immediately proximal to the coronary band in those cases. The coronary band is also assessed for any cracking or hemorrhage. In most cases, an abaxial sesamoid nerve block will be needed on both forelimbs for thorough assessment of the solar surface, for radiographs, and importantly for the assessment of any hindlimb involvement. Lidocaine is the preferred local anesthetic due to its rapid onset and short duration of action, allowing time for digital examination and radiographs, but not an extended time of analgesia for the animal to further traumatize the laminae due to excessive ambulation.
Both lateral and D-P radiographs of affected limbs should be taken. It is important to place a marker at the center of the dorsal aspect of the coronary band (i.e. a BB, Fig. 1), and in the absence of digital radiography, to place some type of radiographic marker down the center of the dorsal hoof wall. To diagnose rotation, intersecting lines can be drawn parallel to the dorsal hoof wall and dorsal P3. For distal displacement, a line parallel to the ground should be drawn through the distal aspect of the BB (line a, Fig. 1). Measurement is then made from the proximal aspect of the P3 extensor process to that line (line b, Fig. 1). This measurement should be less than 10 mm in the digit without distal displacement of P3. The other measurement made is the distance between the dorsal hoof wall and dorsal P3 immediately distal to the extensor process (line c, fig. 1); this distance is normally 13-18mm in most breeds of horses, and up to 20 mm in larger breeds. Some radiologists prefer to make a similar measurement between the dorsal hoof wall and dorsal P3 at the dorsodistal tip of P3 (line d, Fig. 1), and compare that measurement to the more proximal one (line c) to again assess whether a rotational component exists to the displacement. The DP radiograph is assessed for any “gas lines” present in the medial and/or lateral quarter, and to assess for the rare instance in which P3 sinks unilaterally (medial or lateral). [...]
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