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Equine Health Resource

Cold Therapy of Feet for Laminitis Prevention

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A horse may be at risk for developing laminitis due to many causes including colitis or other intestinal disease, grain overload, pleuropneumonia and retained placenta.

Cooling the lower limbs and feet (cryotherapy) in these at-risk horses may help prevent laminitis, but it must be performed prior to any visible signs of a problem.

Cold is thought to act by reducing enzymatic activity in the laminar tissue of the foot, thereby reducing some of the destructive processes that take place in laminitis. Cold has an anti-inflammatory effect, causes vasoconstriction (narrowing of blood vessels), provides pain relief, and lowers the metabolism of the tissues.

However, keeping a horse’s feet consistently cold is extremely labor-intensive. It requires immersing a horse’s feet in freezing water for a minimum of 72 hours or during and after a period of risk.

Current research suggests that adequate cooling of the equine foot requires constant cooling of both the hoof and the blood flowing into the hoof (the lower limb, at least as high as the level of the fetlock). The target temperature is quite cold, between 5-10 C (40-50 F), for at least 48 – 72 hours.

Standing a horse in an ice cold stream or the snow sounds good, but these settings are rarely practical.  A horse can stand in tubs of ice-water slush and the ice replaced (around the clock – day and night) as the bath warms, approximately every 1-2 hours. Ice filled rubber boots that enclose the hoof and lower limb are also used, but these too must be regularly replenished with ice to keep the temperature consistently low.

In my experience, current commercial systems (some of which keep the hoof and limb dry) are difficult to maintain and ineffective. Research has shown that many of these systems do not adequately enclose and immerse the hoof and limb and do not reach or maintain the necessary temperature required.

For now, immersion in an ice water slurry that is consistently replenished as the temperature rises appears to be the only reliable means of providing this treatment. Again, this is very labor intensive and may not be possible for some hospitals to achieve.

There has been debate as to whether cold therapy effectively slows laminitis once the signs of laminitis have started. Recent studies suggest that continued application of cold may be helpful in reducing progression of laminitis even after the onset of lameness.

Remember that none of these methods of providing cryotherapy are useful if the horse’s primary disease is not treated aggressively and effectively.

Consider Potential Side Effects & Complications

In my experience and according to research, there are surprisingly few side effects. Horses tolerate cold well.

Theoretical side effects include coagulation (more prone to blood clotting, which may reduce blood flow to the feet), edema or swelling of the lower limbs (due to standing in one place for days), alteration of mechanical properties including reduced tissue flexibility.

An area of skin can be frozen and damaged when cold is applied to that area for too long or too closely.

Consider Reasons Not To Use This Treatment

Cryotherapy should either be applied effectively and consistently or not at all.

Repeated cooling and warming of the limbs and hooves may actually be detrimental.

Is It working? Timeframe for effect

Several days of treatment may be necessary in horses at high risk of developing laminitis. The key to this treatment is starting it prior to the onset of signs.

If a horse that has undergone cold therapy ends up not developing laminitis, then the cold therapy may have been of benefit. Keep in mind that the most important part of preventing laminitis is effective treatment of the underlying disease. When an excellent job has been done in treating the horse generally, and ice has also been applied, there will always be the question of which factor(s) contributed to the fact that the horse never got laminitis.

Questions To Ask My Vet

  • If my horse is already showing signs of laminitis, should we use this treatment?
  • What is the best system to use to create the cold necessary?
  • Is your veterinary practice staffed and equipped to provide consistent cryotherapy for a 72 hour period?

Helpful terms & topics in HSVGWritten, Reviewed or Shared by Experts in Equine Health

Soft Ride
Soft Ride Boots - Ice Spa Boots
Equine Comfort Boots
WHY THE ICE SPA? As a leading manufacturer of equine comfort boots, Soft-Ride was asked to develop a portable, safe method to ice a horse’s legs for extended periods, such as the “72-Hour Uninterrupted Icing Protocol for Post-colic Surgery and Acute Laminitis,” as recommended by Dr. Andrew Van Epps of The University of Queensland and Dr. Jim Belknap of The Ohio State University. PRODUCT DESIGN PARAMETERS INCLUDE: • A supportive gel orthotic, as found in Soft-Ride Comfort Boots • A safe way to temporarily attach the device to the horse’s leg • A portable device that could be easily transported to shows and events • The ability to easily clean and disinfect the device so it could be used on multiple horses.
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Author: Doug Thal DVM Dipl. ABVP

RELATED REFERENCES

van Eps AW, Pollitt CC, Underwood C, et. al. Continuous digital hypothermia initiated after the onset of lameness prevents lamellar failure in the oligofructose laminitis model. Equine Vet J. 2014 Sep 46(5):623-30.Kullmann A, Holcombe SJ, Hurcombe SD, et al. Prophylactic digital cryotherapy is associated with decreased incidence of laminitis in horses diagnosed with colitis. Equine Vet J. 2014 46(5):554-59.van Eps AW, Orsini JA. A comparison of seven methods for continuous therapeutic cooling of the equine digit. Equine Vet J: 2014.

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