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

## TL;DR

This study examines the effectiveness of a surgical procedure combined with special shoeing in treating chronic laminitis in horses and ponies.

## Contribution

The study introduces a combined surgical and shoeing technique for managing chronic laminitis with low joint instability.

## Key findings

- Most horses and ponies showed improved lameness and survival rates up to 24 months.
- Target palmar angles were achieved in all cases with minimal joint subluxation.
- Outcomes were comparable to other tenotomy methods with better joint stability.

## Abstract

To describe outcomes following high‐metacarpal deep digital flexor tenotomy (DDFT) combined with Steward clog application in horses and ponies with refractory chronic laminitis.

Retrospective observational study.

Client‐owned horses and ponies (7 horses, 8 ponies) with severe refractory laminitis.

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.

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.

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.

This technique maintained DIPJ stability in 25/26 joints and achieved outcomes comparable to previously described tenotomy methods.