Milly is a 20 year old Welsh pony. She used to be ridden in pony club activities by her owner’s daughter. But when she outgrew her, Milly was retired. She now lives out all year round in a paddock that she shares with a few sheep.
Milly’s owner Steph goes to see her every morning to check her. And, one morning, she noticed that Milly was reluctant to come over to her. When Steph got nearer, she noticed that Milly was leaning back on to her hindlimbs and didn’t want to walk. She decided to call the vet as she had never seen Milly do this before.
Milly’s problem
When the vet examined Milly, she found that her heart rate and breathing rate were higher than normal, there were increased digital pulses in the front limbs, and the hooves were warm. Milly was reluctant to pick up her feet. And on examination with hoof testers, the vet found that she was painful on the soles of both of her front feet. Milly was also overweight, with a body condition score of 5/5.
The signs that Milly was showing indicated that she was suffering from laminitis.
What is Laminitis?
Laminitis is a painful condition of the foot, where the sensitive laminae in the feet become inflamed. This results in movement of the bone inside the foot, the pedal bone. As the pedal bone rotates and moves, it causes severe pain to the horse. Horses show signs of pain by not being able to move and by having an increased heart rate and breathing rate. Horses with laminitis are also seen to be rocking back on the hindlimbs in an attempt to take the weight off their painful front feet.
Laminitis can be caused by a number of factors, such as damage to the foot or severe infection. But in Milly’s case, being overweight and overeating lush grass were probably the major factors in the cause. Being overweight not only puts more strain onto the feet but it also increases the amount of inflammation in the body couple this with increased sugar intake from lush grass and the sensitive laminae in the feet will have suffered from severe inflammation, leading to swelling and pain inside the feet.
Often laminitis is caused by an underlying condition, such as Cushing’s disease or Equine Metabolic Syndrome. And once the initial signs are under control, testing should be performed to ensure that these underlying diseases are controlled appropriately.
Diagnosis
Although a diagnosis is usually made based on clinical signs; taking radiographs of the feet is very useful to determine what the position of the pedal bones is. Often owners may be reluctant to have the feet x-rayed, as the cost can be £300-£400. But it can really help to determine prognosis and develop a treatment plan. On radiographs, a measurement can be made of the angle of rotation of the pedal bone in relation to the dorsal hoof wall, an assessment of pedal bone sinking can also be made.
Fortunately, Milly was insured, and the insurer covered the X-ray, vet and treatment bills, a great relief to everyone involved!
Treatment
In Milly’s case, the radiographs showed mild rotation, but no sinking of the pedal bone. Sinking of the pedal bone carries a less favourable prognosis and many horses don’t recover, even with intensive management of the condition.
Once intravenous pain relief was given, Milly was moved to a stable with a deep bedding to provide comfort for her feet. The vet advised strict box rest for Milly. And a diet of soaked hay with daily oral medications put into a small amount of low sugar food and a balancer.
Encouraging Milly to lose weight is important. It will help to make her more comfortable on her feet, speed up her recovery and prevent the recurrence of laminitis. Weight loss can be achieved by feeding 1.5% of Milly’s body weight in hay and then soaking it in water to remove the sugar. As there will be very little nutritional value in the hay, a balancer needs to be provided to ensure that Milly still receives essential vitamins and minerals. Using a small holed or double hay net can help to slow down the rate of eating, so that the hay lasts longer throughout the day.
Outcome
Following the administration of pain relief, Milly started to look a lot more comfortable. After two weeks of box rest and oral pain relief, the vet came back to check on her. The vet found that she was able to walk well, seemed comfortable and the digital pulses had reduced. A blood sample was taken for Cushing’s disease. And the vet had a discussion with Milly’s farrier about remedial farriery, based on the radiographs.
Over the following weeks, Milly was weaned off her pain medication and was allowed to start walking exercise. The blood sample showed that Milly did have Cushing’s disease. This is a disease that increases the level of cortisol in the body, contributing to laminitis. Having been diagnosed, Milly will now require medication at a cost of £1-£3 per day for the rest of her life. This is to help prevent further episodes of laminitis. Regular check-ups and blood samples will also be required to monitor the disease. Steph will also have to make sure that Milly is kept lean to prevent recurrence of laminitis. This will require restriction of grass eating by using a grazing muzzle, turning out onto a bare paddock, or by minimising the amount of time that Milly is allowed to graze for.
Laminitis is a preventable disease in most cases. But, once the horse has it, it can be very painful and take a long time to resolve. Although the environmental management may be relatively inexpensive, the diagnosis and treatment can be costly as seen with Milly. Insurance can be beneficial in these cases as it covers the cost of the more expensive diagnostics and treatment. This is especially useful if treatment is required for a long period of time.
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