Surgical treatment of laminitis-is there a place for it?

Several surgical procedures have been recommended for the treatment of laminitis. These procedures are the following:

Inferior check desmotomy. The purpose is to relieve stress on the deep digital flexor tendon. The procedure is very effective for flexural limb deformity. The procedure is effective in releasing tension on the deep digital flexor tendon but may be too little to make a significant impact on laminitis (depending on the severity).

Deep digital flexor tenotomy. Deep digital flexor tenotomy is a surgical alternative that transects the deep digital flexor tendon in either the mid-cannon bone region or mid-pastern region. Transection removes one of the main forces responsible for rotation of the coffin bone in laminitis. In one retrospective study, Seventy-seven percent of the horses that had the operation were still alive after six months, and 60% survived at least two years. This was considered substantial considering the presurgical conditions of the horses.

Transfixation pin casts. This is an external fixation device that uses large pins placed within the metacarpus and sidebar, the apparatus incorporates the foot and transfixation pins. The procedure reduces weight on the hoof and reduces the strain on the deep flexor tendon. There are no studies looking at outcomes relative to laminitis but there are individual cases where it has been effective. There are long-term issues associated with the pin holes.

Lag screw fixation of hoof capsule to the coffin bone. Investigations have been underway to test the possibility of preventing coffin bone rotation in cases of acute laminitis by placing a single screw through the hoof wall and into the bone. After 48 to 72 hours or once the initial inflammation has subsided the screw can be removed. While effective and relatively non-painful in non-laminitic horses, the procedure has so far been disappointing in its initial results with laminitic horses.

Hoof wall resection. Performing a  resection is the removal of part or all of the hoof wall can relieve the pressure on the laminae and thereby allow the critical blood circulation to be restored. With meticulous aftercare, the foot’s underlying tissues can then repair. Twenty years ago is quite popular but has since lost popularity.