Upon first presentation this horse’s right front foot was chronically foundered with minimal hoof growth below the dorsal coronary band. He was Obel Grade 3. He had been receiving hoof care from a well respected farrier through the podiatry program at a university equine hospital with minimal improvement. This horse’s underlying insulin resistance was controlled at this time, and despite the excellent level of care provided the foot was not improving. The owner was considering euthanasia and moved the horse to the Daisy Haven Farm Rehabilitation Center for one last attempt to improve the health of the foot.

Rusty - Laminitis Rusty - 16-year-old Arabian Gelding Right Front Foot at Initial Consultation Right Front Foot at Initial Consultation

Case Study #5 DDT/E and TEAM: Initial Consultation

Diet: Given this horse was a BCS of 4.5 with controlled insulin, his current diet was maintained
Diagnosis: Current medications were continued and his metabolic blood work remained stable
Trim: Hoof care protocol was implemented following hoof goals using glue/composite shoe to facilitate achieving goals with minimal success due to chronicity of hoof pathology
Exercise: Turnout in dry lot paddock 24/7
TEAM: As part of the new veterinarian/farrier team we were hoping new ideas and fresh eyes would make a positive change for this horse.

After implementation of the new plan, minimal improvement was observed. Phalangeal and Capsular Alignment were no better with the only improvement slightly better sole depth. A venogram was performed by the veterinarian showing lack of perfusion to the blood vessels at the coronary band and along the dorsal edge of P3 with capillary leakage. We were at an impasse due to lack of effectiveness of the derotation trim to create positive change. This horse couldn’t load his heels on his right front foot and also had minimal hoof growth below the dorsal coronary band despite aggressive interventions like hoof grooving below the impingement.

Right Front Foot at Initial Consultation

At this point in the horse’s rehabilitation it was clear that the previous farrier and veterinary team had been following similar protocols with equally poor results. After further research the current vet/farrier team recommended a deep digital flexor tenotomy to the owner with hopes of achieving the hoof balancing goals and facilitating growth below the dorsal coronary band.

Right Front Foot Venogram and Hoof Capsule Right Front Foot Venogram and Hoof Capsule

Deep digital flexor tenotomy has been viewed poorly as it is often performed as a last resort in salvage situations. However in this case the tenotomy facilitated the de-rotation trim and shoeing application designed to achieve the hoof goals outlined above. The hoof-pastern axis was greatly improved with better capsular and phalangeal alignment. Additionally the palmar P3 angle was able to be lowered to the ideal range of 3-8 degrees. Post-tenotomy new hoof wall was observed growing at the site of previous impingement at the dorsal coronary band. Repeat venogram 10 week posttenotomy showed significant improvement in the perfusion of the vascular structures.


The horse stayed at the rehabilitation center for an additional nine months post-tenotomy. DDT/E protocol was followed by the horse’s TEAM and the horse regained soundness with a stable hoof capsule showing healthy new growth through that time.

Right Front Foot nine months post-tenotomy showing improved hoof growth Right Front Foot nine months post-tenotomy showing improved hoof growth