Voluntary limb-load distribution in horses with acute and chronic laminitis.

OBJECTIVES: To compare limb-load distribution between horses with and without acute or chronic laminitis. ANIMALS: 10 horses with carbohydrate-induced acute laminitis, 20 horses with naturally occurring chronic laminitis, and 20 horses without foot abnormalities (controls). PROCEDURES: Limb-load distribution was determined, using a custom-designed system that allowed simultaneous quantification of the mean percentage of body weight voluntarily placed on each limb (ie, mean limb load) and the SD of the mean load over a 5-minute period (ie, load distribution profile [LDP]). Load distribution profile was used as an index of frequency of load redistribution. RESULTS: Mean loads on fore- and hind limbs in control horses were 58 and 42%, respectively, and loads were equally and normally distributed between left and right limbs. In addition, forelimb LDP was greater, compared with hind limbs, and was affected by head and neck movement. In comparison, limb-load distribution in horses with chronic laminitis was characterized by an increase in the preferential loading of a forelimb, a decrease in total forelimb load, and an increase in LDP that was correlated with severity of lameness. In horses with carbohydrate-induced acute laminitis, mean limb loads after onset of lameness were not different from those prior to lameness; however, LDP was significantly decreased after onset of lameness. CONCLUSION AND CLINICAL RELEVANCE: Quantification of limb-load distribution may be an applicable screening method for detecting acute laminitis, grading severity of lameness, and monitoring rehabilitation of horses with chronic laminitis.

Evaluation of hoof wall surface temperature as an index of digital vascular perfusion during the prodromal and acute phases of carbohydrate-induced laminitis in horses.

OBJECTIVE: To evaluate the use of hoof wall surface temperature (HWST) as an indirect indicator of digital perfusion and to describe HWST patterns during the prodromal and acute phases of carbohydrate-induced laminitis in horses. ANIMALS: 30 adult horses without foot abnormalities. PROCEDURES: Three experiments were performed. In the first, HWST was measured in 2 groups of horses acclimatized to hot (n = 6), or cold (6) environments and exposed to cold (15 C) ambient temperature. In the second experiment, HWST were measured in both forefeet of 6 horses before and after application of a tourniquet to 1 forefoot to induce vascular occlusion. In the third experiment, HWST were recorded in 12 horses before and during the prodromal and acute phases of carbohydrate-induced laminitis. RESULTS: Mean HWST of hot-acclimatized cold-challenged horses was significantly less than that of cold-acclimatized cold-challenged horses at all times. Transient episodes of high HWST were observed during prolonged cold-induced vasoconstriction. Hoof wall surface temperature significantly decreased during arterial occlusion and increased during reperfusion. Digital hypothermia was observed during the prodromal phase of carbohydrate-induced laminitis. CONCLUSIONS AND CLINICAL RELEVANCE: Determination of HWST is a valid technique to evaluate digital perfusion under appropriate controlled conditions in horses. Digital hypothermia detected during the prodromal phase of laminitis is consistent with decreased digital vascular perfusion or metabolic activity. If administered to horses during the prodromal phase, agents that enhance digital perfusion may prevent development of laminitis.

Effects of ground surface deformability, trimming, and shoeing on quasistatic hoof loading patterns in horses.

OBJECTIVE: To determine whether solar load distribution pattern on a solid nondeformable ground surface is the product of contact erosion and is the mirror image of load distribution on a deformable surface in horses. ANIMALS: 30 clinically normal horses. PROCEDURES: Solar load distribution was compared among 25 clinically normal horses during quasistatic loading on a solid nondeformable surface and on a highly deformable surface. Changes in solar load distribution patterns were evaluated in 5 previously pasture-maintained horses housed on a flat nondeformable surface. Changes in solar load distribution created by traditional trimming and shoeing were recorded. RESULTS: Unshod untrimmed horses had a 4-point (12/25, 48%) or a 3-point (13/25, 52%) wall load distribution pattern on a flat solid surface. Load distribution on a deformable ground surface was principally solar and located transversely across the central region of the foot. Ground surface contact areas on solid (24.2 +/- 8.62 cm2) and deformable (69.4 +/- 22.55 cm2) surfaces were significantly different. Maintaining unshod horses on a flat nondeformable surface resulted in a loss of the 3- and 4-point loading pattern and an increase in ground surface contact area (17.9 +/- 2.77 to 39.9 +/- 12.77 cm2). Trimming increased ground surface contact area (24.2 +/- 8.60 to 45.7 +/- 14.89 cm2). CONCLUSION AND CLINICAL RELEVANCE: In horses, the solar surface is the primary weight-loading surface, and deformability of ground surface may have a role in foot expansion during loading. Increased surface area induced by loading on deformable surfaces, trimming, and shoeing protects the foot.

Comparison of bending modulus and yield strength between outer stratum medium and stratum medium zona alba in equine hooves.

OBJECTIVE: To determine whether the bending modulus and yield strength of the outer stratum medium (SM) differed from those of the SM zona alba (SMZA) and to what degree they differed. In addition, a comparison was made among our values and values reported elsewhere. SAMPLE POPULATION: 10 normal equine feet. PROCEDURE: A 3-point bending technique was used to determine the bending modulus and yield strength of the outer SM and SMZA. Efforts were made to minimize biological and technical factors that could influence the bending modulus. RESULTS: Bending modulus of the outer SM was (mean +/- SD) 187.6 +/- 41.3 MPa, whereas mean value for the SMZA was 98.2 +/- 36.8 MPa. Mean yield strength was 19.4 +/- 2.6 MPa for the outer SM and 5.6 +/- 1.7 MPa for the SMZA. Values for bending modulus and yield strength differed significantly between the outer SM and SMZA. Significant differences were not detected when the outer SM was loaded in bending from the outer or inner surface. CONCLUSIONS AND CLINICAL RELEVANCE: Potentially, the SMZA could serve as a mechanical buffer zone between the rigid hoof wall and bone and laminar tissues. This buffer zone potentially assists the feet of horses in transmitting a load through the tissues and prevents the most susceptible tissues from becoming damaged. More consistency among tissue selection, preparation, and testing protocols must be attained before an accurate 3-dimensional finite-element model of an equine foot can be constructed.

Laminitis in the horse.

This article serves as an introduction to this issue on laminitis. As such, it contains the general perspectives and terminology that will be used in all subsequent articles. This article separates the clinical problem of laminitis into developmental, acute, subacute, and chronic phases and defines the criteria, duration, clinical goals, and implications of these phases. The basis for the significance of laminitis to the horse industry and the horseman is reviewed. Lastly, the organization of this issue is described.

The pathophysiology of developmental and acute laminitis.

This review implies that although we know more regarding the enigma of developmental and acute laminitis today than previously, there is still more to investigate. As these investigations are conducted and interpreted, new and more effective preventive and therapeutic regimens are likely to be developed, tested, and made available. As this occurs, the impact of laminitis should undoubtedly decrease. Unfortunately, due to the lack of clinical symptoms in the developmental phase and the shortness of the acute phase, it is also evident that the two sequelae of acute laminitis, subacute and chronic laminitis, are likely to continue to pose a major problem for some time.

Clinical presentation, diagnosis, and prognosis of chronic laminitis.

This article focuses on the initial assessment of the horse affected with chronic laminitis. Variations in the clinical presentation and primary considerations in making a differential diagnosis are included. The elements of a clinical history essential to sound, therapeutic management, and prognosis are summarized. The physical and radiographic assessment of the digital lesions and diagnostic approaches to the common systemic aspects of the disease are presented and discussed.

The digital pathologies of chronic laminitis.

This review indicates that the patient-to-patient uniqueness commonly seen in chronic laminitis represents the variable presence of the digital pathologies. Although some degree of mechanical failure is always present, the secondary metabolic and growth dysplasias, vascular pathologies, and sepsis may or may not be evident. The presence and severity of these pathologies appear to have a more significant impact on the prognosis of individual cases than does the displacement of the distal phalanx. It should be reiterated that it is often the combined presence of these individual pathologies that gives rise to the patient that is totally refractory to treatment. In the absence of these pathologies, many horses with significant displacement of the distal phalanx are not in pain and are not in need of treatment. It thus follows that a key to the improved rehabilitation of difficult patients is focusing research on the physiopathology and diagnosis of these nonmechanical problems.

The pathophysiology of chronic laminitis. Pain and anatomic pathology.

The potential pathologic manifestations of chronic laminitis are just as varied, and possibly more so, than the list of possible inciting agents of the disease itself. The extent to which rehabilitation and return to normal function can be attained, cannot always be accurately determined by physical examination. It should be remembered that significant physiologic and pathologic alterations occur in chronic laminitis; thus, even if radiographically the patient returns to a normal appearance, residual morphologic and structural defects are likely to remain.

The mechanisms and consequences of structural failure of the foot.

Many of the difficulties in managing the horse with chronic laminitis are associated with the foot's mechanical failure. The occurrence of digital collapse cannot be viewed in isolation as the primary therapeutic focus. The circulatory, metabolic, and growth pattern changes induced by the foot's mechanical collapse often serve as major limiting factors to successful rehabilitation. From the discussion above, it is obvious that a significant amount of research is needed to better understand the biomechanical pathologies of the failed foot.

Laminitis as a systemic disease.

This article presents the clinical pathology and the involvement of the cardiovascular, renal, endocrine, and immunologic systems in laminitis. The data available on these systems are presented with respect to the disease phase and severity. The nutritional and metabolic alterations realized in the chronically affected horse are also presented. In this discussion, the origins and clinical implications of these systemic findings are discussed.

Descriptive epidemiological study of equine laminitis.

A descriptive and matched case-control study of laminitis was conducted in 7 private practices and at the Texas Veterinary Medical Centre (TVMC) between May 1992 and July 1993. Out of 108 horses with laminitis, 19 acute (49%) and 20 chronic (51%) cases were seen in private practice and 16 acute (23%) and 53 (77%) cases at the TVMC. Gastrointestinal disease was the most common problem in 19/35 horses (54%), occurring just prior to the onset of acute laminitis in all hospitals. Among all horses in the study, most commonly used drugs were phenylbutazone (68%), acepromazine (34%), dimethyl sulphoxide (DMSO) (27%), antibiotics of various types (19%) and flunixin meglumine (19%). Acepromazine, DMSO and flunixin meglumine were used more commonly in acute cases of laminitis compared to chronic cases. In acutely affected horses, DMSO and flunixin meglumine were used significantly more often at the TVMC. In chronic cases, phenylbutazone and antibiotics were used more often in private practice. Shoeing and trimming were more commonly part of the treatment protocol for chronic cases. There were no significant associations between age, breed, sex or weight and the occurrence of acute laminitis. Horses with chronic laminitis were significantly older (P=0.04) and more females tended to be affected (P=0.08).

Vascular perfusion in horses with chronic laminitis.

Vascular perfusion casts were used to define and characterise the macroscopic perfusion defects present in the distal digit of 11 horses affected by chronic laminitis. Five clinically normal horses were used as controls. Based on clinical history and clinical status, horses with chronic laminitis were classified as being potentially treatable or clinically refractory. Eleven macroscopic vascular defects were noted in the casts from horses with laminitis. Four types of lesions were identified in the submural laminar circulation, 3 in the coronary bed and 4 were associated with the solar circulation. Multiple defects were present and a definite trend was noted for the perfusion defects to be worse in the casts of clinically refractory subjects than in those considered treatable. This information suggests that evaluation of circulatory status should add significantly to the ability to separate treatable from clinically refractory patients. Results also indicated that ventral displacement of the third phalanx (sinkers) and compression of the solar vasculature are more prevalent than is presently thought.

Keratin and associated proteins of the equine hoof wall.

In this study, we described water-insoluble proteins extracted from the germinative regions (stratum internum and coronary band epithelium) and the cornified outer surface (stratum medium) of the equine hoof wall. Two major types of polypeptides were identified: the intermediate filaments (IF) and the IF-associated proteins. The IF, including keratins, composed a major portion of this fraction, had electrophoretic mobilities on sodium dodecyl sulfate-polyacrylamide gel electrophoresis in the range of 40 to 80 kDa, and reacted with acidic or basic keratin-specific monoclonal antibodies. Differences in the composition of keratins between germinative layers and the stratum medium were seen. Another less well-characterized group of polypeptides associated with the IF also were extracted with the water-insoluble polypeptide fraction. These associated proteins had an apparent molecular weight between 10 and 30 kDa on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and contained a higher percentage of sulfur-containing amino acids than did the IF. Water-insoluble protein fractions compared favorably with those found in other less-specialized keratinizing tissue with respect to size, immunoreactivity with monoclonal antibody, and amino acid composition.

Characterisation and distribution of epidermal growth factor receptors in equine hoof wall laminar tissue: comparison of normal horses and horses affected with chronic laminitis.

Epidermal growth factor (EGF) receptors were detected in plasma membrane preparations of equine hoof wall laminar tissue at concentrations comparable to that of equine liver. Scatchard analysis of the equilibrium binding data suggested the presence of two classes of EGF binding sites in most of the controls (plasma membranes from clinically normal horses); a high-affinity class and a more numerous low-affinity class. The dissociation constant of the low-affinity class of EGF-specific receptors (KD = 1 x 10(-9)M) is in reasonable agreement with other values established for the EGF receptor. The variability between individual estimates for the KD of the high-affinity receptor class precluded an accurate estimate for those sites. A possible explanation is discussed. The high-affinity binding sites were uniformly absent in plasma membranes prepared from horses affected by chronic laminitis. Autoradiographic analysis localised the EGF receptors primarily to the secondary epidermal laminae, with an apparent greater density over the proliferative basal keratinocytes. Little label was associated with the dermal or the keratinised primary epidermal laminae. Tissue from horses with chronic laminitis had EGF receptors located uniformly over the hyperplastic epidermal keratinocytes. These data suggest that an EGF-mediated response may be involved in the hyperproliferative response that is characteristic of chronic laminitis.

EGF receptor-binding activity in the urine of normal horses and horses affected by chronic laminitis.

A heterologous radioreceptor binding assay (RRA) has been developed capable of detecting nanogram amounts of epidermal growth factor (EGF) receptor-binding activity in equine urine. The binding parameters of [125I]mEGF (murine EGF) to EGF receptors on equine plasma membranes are in good agreement with values from other EGF-RRA systems. The dissociation constant estimated from equilibrium methods (KD = 4 X 10(-10) M) is in reasonable agreement with that determined from the rate constants (KD = 6 X 10(-10) M) and is in good agreement with values determined in other species. The assay is specific for equine EGF (eEGF) receptor-binding activity and capable of detecting less than 0.34 nM eEGF receptor-binding activity in urine. Equine EGF receptor-binding activity in equine urine form adult horses varied widely between samples (8.5 +/- 6.5 nM). This variability was somewhat reduced when values were adjusted for dilutional effects using urine creatinine as an indicator (3.6 +/- 2.0 nanomoles/g creatinine). No significant differences were demonstrated between the means of EGF binding activity concentrations in clinically normal horses and horses affected by chronic laminitis.

Equine laminitis: a potential model of Raynaud's phenomenon.

Raynaud's phenomenon (RP) and equine laminitis in the horse are medical enigmas. Clinical and scientific data were compared to evaluate the degree of similarity that exists between these two peripheral vascular diseases. Data indicate that certain pathologic and pharmacologic aspects seem to have common features. Some of the correlations maybe due simply to both diseases having ischemia of the distal digits as a pathologic component. The exact etiology of the ischemia is not known for either disease. The results of this study suggest the hypothesis that RP and laminitis are the same disease in different species. This hypothesis can be tested more efficiently when the pathophysiology of both conditions is better documented. It is possible that comparative studies will promote advances in the understanding of both RP and laminitis. The fact that equine laminitis can be experimentally induced is of potential value in such future studies.

Effect of weight loading on the coronary band interstitial fluid pressure in horses.

Interstitial fluid pressures, as a possible function of limb load, were measured at 2 sites within the digital coronary dermis of both cranial digits in 10 standing horses. Fluid pressure changes and digital load measurements were simultaneously detected and recorded by use of, respectively, modified wick-in-needle and force plate transducers coupled to a microcomputer. Mean pressures, recorded at limb loads between 50 and 80 kg, were 2.29 +/- 3.17 mm of Hg at the toe and 2.49 +/- 5.91 mm of Hg at the heel. Mean pressures, recorded between 150 and 180 kg, were 5.01 +/- 5.23 mm of Hg at the toe and 1.28 +/- 7.69 mm of Hg at the heel. These data indicate that, in the static limb, no statistically significant change in interstitial fluid pressure occurs at loads up to 180 kg.