High-metacarpal deep digital flexor tenotomy and Steward clog shoeing for managing chronic refractory laminitis: A retrospective clinical study.

Abstract

OBJECTIVE: To describe outcomes following high-metacarpal deep digital flexor tenotomy (DDFT) combined with Steward clog application in horses and ponies with refractory chronic laminitis. STUDY DESIGN: Retrospective observational study. ANIMALS: Client-owned horses and ponies (7 horses, 8 ponies) with severe refractory laminitis. METHODS: Medical records (2018-2019) were reviewed. All underwent standing high-metacarpal DDFT tenotomy proximal to the accessory ligament (AL-DDFT) junction, followed by customized Steward clogs application. Preoperative assessment included radiography and venography. Postoperative management involved nonsteroidal anti-inflammatory drugs (NSAIDs), controlled exercise, and serial monitoring of comfort, alignment, and survival up to 24 months. RESULTS: Median follow-up was 24 months (range: 6-24 months). Six-month survival was 100% (7/7) in horses and 88% (7/8) in ponies. At 12 months, 43% (3/7) of horses and 88% (7/8) of ponies remained alive and improved to Obel grades 0-2. At 24 months, 43% (3/7) of horses and 50% (4/8) of ponies survived, one returning to light work. Obel grades at 24 months ranged from 0 to 2 (Obel 0: n = 3, Obel 1 = 3, Obel 2 = 1). A single distal interphalangeal joint (DIPJ) subluxation (4%, 1/26 limbs) resolved with corrective farriery. Target palmar angles (3°-10°) were achieved in all cases. The majority of non-survivors had endocrine-associated laminitis. CONCLUSION: High-metacarpal DDFT tenotomy, with preservation of the AL-DDFT, combined with Steward clog application provided effective P3 realignment and lameness improvement with low DIPJ subluxation incidence. CLINICAL SIGNIFICANCE: This technique maintained DIPJ stability in 25/26 joints and achieved outcomes comparable to previously described tenotomy methods.