High-metacarpal deep digital flexor tenotomy and Steward clog shoeing for managing chronic refractory laminitis: A retrospective clinical study.
Authors: Hargitaiova Kristyna, Maleas Grigorios
Journal: Veterinary surgery : VS
Summary
# Editorial Summary When medical management fails in chronic laminitis cases, surgical intervention combined with appropriate farriery may offer a pathway to soundness. Hargitaiova and Maleas evaluated high-metacarpal deep digital flexor tenotomy (performed proximal to the accessory ligament) paired with customized Steward clog application in 15 severely affected horses and ponies, reviewing medical records and follow-up data spanning 6–24 months post-operatively. By 24 months, 43% of horses and 50% of ponies survived with improved comfort (Obel grades 0–2), and one animal returned to light ridden work; notably, only one distal interphalangeal joint subluxation occurred across 26 limbs treated, with all cases achieving target palmar angles of 3–10°. The technique proved particularly successful in mechanically laminitic cases, though endocrine-associated laminitis showed poorer long-term survival, suggesting that underlying disease aetiology significantly influences prognosis even after surgical correction. For practitioners managing refractory cases, this approach offers meaningful hope for pain reduction and functional improvement, though realistic discussion with owners about variable outcomes—particularly where endocrine disease is the driving factor—remains essential.
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Practical Takeaways
- •High-metacarpal DDFT tenotomy combined with Steward clogs is a viable surgical option for severe refractory laminitis cases, particularly in ponies, with low complication rates and acceptable short-term survival
- •Preservation of the accessory ligament of the DDFT during tenotomy maintains distal interphalangeal joint stability while achieving effective P3 realignment
- •Patient selection is critical—horses with endocrine-associated laminitis had poorer long-term outcomes, suggesting underlying metabolic control is essential for success beyond the first 6 months
Key Findings
- •Six-month survival was 100% in horses (7/7) and 88% in ponies (7/8) following high-metacarpal DDFT tenotomy with Steward clog application
- •At 24 months, 43% of horses (3/7) and 50% of ponies (4/8) survived with Obel grades improved to 0–2, with one horse returning to light work
- •Target palmar angles of 3°–10° were achieved in all 26 limbs with only 1 case (4%) of DIPJ subluxation that resolved with corrective farriery
- •Endocrine-associated laminitis was the primary cause of non-survival, suggesting aetiological factors significantly influence long-term prognosis