Medical Approaches
- Dorsal hoof wall resection
A dorsal hoof wall resection may help in certain conditions after consultation with an experienced veterinarian and farrier team. If decreased bloodflow distal to the coronary plexus is seen on a venogram, or when a laminar wedge forms between P3 and the hoof wall, preventing the proper re-attachment (interdigitation) of the laminae, this procedure may be beneficial. When the coffin bone is pulled away from the hoofwall, the remaining laminae will tear. This may lead to abscesses within the hoof capsule that can be severe and very painful, as well as a mass of disorganized tissue called a laminar (or lamellar) wedge.
- Deep Digital flexor tenotomy
Because the rotation of P3 is exacerbated by continued pull on the deep digital flexor tendon, one approach to therapy has been to cut this tendon, either in the cannon region or in the pastern region. While this technique has been criticized as being unsuccessful and invasive, its advocates claim that it is too often used in cases which are too far advanced. Advocates claim that by cutting the tendon at the right time, mechanical de-rotation of P3 is possible, which can allow time for the new laminar attachments to form.
- Botulinum toxin infusion
As an alternative to the deep digital flexor tenotomy, Botulinum type A toxin has been infused into the body of the deep digital flexor muscle. This theoretically allows for the same de-rotation as the tenotomy procedure, but without the potential for scarring or contracture associated with that procedure. A recent study used this technique in seven laminitic horses. There was significant improvement in six of the horses, and moderate improvement in the seventh.
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