Over a time period of 6 weeks, tenotomy is thought to allow P3 to realign with the ground surface. Critics claim that this technique is unsuccessful and invasive, with advocates making counter-arguments that it is often used in cases which are too far advanced for treatment to help. Tenotomy does risk subluxation of the distal interphalangeal joint (coffin joint), which may be avoided with the use of heel extensions on the shoe. Horses may return to work after the surgery. This treatment is often recommended for severe cases of laminitis, and requires proper trimming and shoeing to be successful. Botulinum toxin infusionAs an alternative to the deep digital flexor tenotomy, Clostridium botulinum type A toxin has been infused into the body of the deep digital flexor muscle. This theoretically allows for the same derotation as a tenotomy, but without the potential for scarring or contracture associated with that procedure. A recent study used this technique in seven laminitic horses. Significant improvement was seen in six of the horses, with moderate improvement in the seventh. Complications
Complications to laminitis include recurrent hoof abscesses, which are sometimes secondary to pedal osteitis, seromas, and fractures to the solar margin of the coffin bone. Informal use of the word "founder"
Informally, particularly in the United States, "founder" has come to mean any chronic changes in the structure of the foot that can be linked to laminitis. In some texts, the term is even used synonymously with laminitis, though such usage is technically incorrect.
Prior to injection, a tourniquet is placed around the fetlock to help keep the contrast material within the foot during radiography. Diffusion of contrast may make some areas appear hypoperfused, falsely increasing the apparent severity of the laminitic episode. After injection of the contrast material, films are taken within 45 seconds to avoid artifact caused by diffusion. Evaluation of blood supply to several areas of the foot allows the practitioner to distinguish mild, moderate, and severe compromise of the hoof, chronic laminitis, and sinking. Other diagnostics
Other imaging tools have been used to show mechanical deviations in laminitis cases include computed tomography, as well as MRI, which also provides some physiologic information. Nuclear scintigraphy may also be useful in certain situations. Ultrasonography has been explored as a way to quantify changes in bloodflow to the foot. Prognosis
The sooner the diagnosis is made, the faster the treatment and the recovery process can begin. Rapid diagnosis of laminitis is often difficult, since the general problem often starts somewhere else in the horses body. With modern therapies, most laminitics will be able to bear a rider or completely recover, if treated quickly, and if the laminitis was not severe or complicated (e.g. by equine metabolic syndrome or Cushings disease). Even in these cases, a clinical cure can often be achieved. Endotoxic laminitis (e.g. after foaling) tends to be more difficult to treat. Successful treatment requires a competent farrier and veterinarian, and success is not guaranteed.