Re: Need help with path forward for severe rotation

Jessica Gunderson

I thought it might be easier to just provide part of a consultation I received, as I do not want to misrepresent anyone's feedback.

"Reviewing the radiographs dated April 21 I conclude. LF reveals slight displacement of the L zone, shallow sole plus cup approx. 10 to 12 mm total and 10-to-12-degree PA. RF HL zone remarkably distended at the distal measurement, less sole depth than the left same amount of cup
May 4 21 Both L zones had remarkable increase in the distal displacement of the L zone. The RF had much less sole and a 15-degree PA the LF sole depth was questionable doe to oblique image the PA was approx. 10 to 12 degrees
June 28th RF HL zone extremely large ratio with large gas line within the laminar wedge, subsolar sepsis thin sole no cup. Remarkable osteoporosis which suggests limited weight bearing.
LF Extremely large HL zone with chronic gas line, about the same amount of sole and noticeable new but minimum new growth at the coronary band and 20-degree PA.
July 6th Rf progressive signs of uncompensated laminitis, resorption of the apex, signs of solar sepsis and further distended hoof capsule distortion. An attempt was made to perform a venogram unfortunately technique difficulties resulted in extensive perivascular contrast injection.
Aug 5 RF Both feet had the heels trimmed to 10-to-12-degree capsule and put in my ultimate. Both coffin bones reveal extensive resorption of the apex. The mechanical benefits of the ultimate can optimize reperfusion at the onset or shortly after and help avoid the cumulative ill effects that invariably haunt the majority of significant bouts of acute laminitis. Applying the ultimate with this degree of vascular damage, the subsequent large PA and destructive soft tissue parameters has limited mechanical benefits as the PA prevents the load from shifting from apex to heel as designed. However, there is some level of mechanics even at this very late stage of the syndrome. Soft Rides are nothing more than cushion boots and have very limited if any mechanical benefits that can adequately reduce the tension on the DDFT as it continues to tear the bone away from its failed antagonist and the domino effect picks up speed. To have any hope of saving Khan’s life and reducing the painful response we must quickly eliminate the force of the DDFT and reposition the load zone of P3 to a zero PA with a minimum of 20 mm of heel mass. The derotation shoeing, decompression trim and shoe placement are technique sensitive as specific goals are to be obtained followed immediately by a DDF tenotomy. The bone damage is permeant as well as a fair amount of the vascular supply but there may be a reasonable chance to enhance healing. The prognosis is directly related to the speed and quality of reperfusion to vital growth centers and the bone. Complications are to be expected and at best a protracted treatment period of 8 to 12 months lies ahead. The bone sepsis will trigger abscesses and potential sequestrum that require immediate attention and continuous monitoring. The RF will be the toughest to deal with as it is the steeper profile foot of the two feet. I will mark the images as I would want them to appear following the trim shoe and tenotomy. I am glad to help walk the farrier and surgeon through my protocol using What’s App consultation if you decide to go forward."

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