It is wise to treat and shoe the laminitic and foundered horse with the principles, techniques and tools that will provide the highest chance of success.  These principles and
techniques should be based on the
understanding of the foot's biomechanics and circulatory system.

Unfortunately, out-dated treatment and unconventional or unorthodox shoeing techniques, which go against the above, are still being applied.  
Many of these treatments
actually worsen the founder condition and confronting these techniques can be frustrating for the educated professional.

Some equine professionals will tend to look at each laminitic and foundered horse individually, using different treatments, trimming and shoeing techniques.  Esco has
seen
much higher success rates by developing a more defined approach that works in a majority of laminitic and foundered horses; then, as needed, adapted to fit each
individual horse.

So What is Laminitis and Founder?
Laminitis is a reduction of blood flow to the laminae secondary to inflammation.  If the blood supply is interrupted for only a short time, little to no permanent damage results.  
The more severe and longer the reduction in blood supply, the greater the chances of irreversible damage.  Once the reduction of blood supply caused failure in the laminae
between the distal phalanx (coffin bone) and hoof capsule, the animal is considered
foundered.

Founder is a complicated systemic disease resulting from a triggering insult.  In order to provide the highest chances of success, the horse is best served through the
collaboration of a qualified veterinarian and farrier.

The veterinarian's role is to diagnosis the insult, if at all possible,and provide treatment for the triggering insult and any systemic problems.  They will also provide correctly
taken radiographs for the prognosis, treatment and monitoring of the horse.

The farrier's role is to provide mechanical and bone column support.  This is done by utilizing the most successful treatment approach, the positive pressure, rigid steel heart
bar shoe.

Laminitis and founder is a complex disease with significant animal, human and economic impacts.  The cases are often clinically challenging to manage.  The most
significant consequence of found is that it remains a potentially crippling performance limiting, life threatening disease.  Over the years, many people have proposed many
devices and methods that they claim are cure-alls.  No one device or method works 100% of the time,but some work with a higher percentage than others.  
Such a method
does not compromise the blood supply
to the already damaged laminae of the foot.  The heart bar shoe fits this protocol.

The goal of shoeing is to counteract the downward movement of the distal phalanx (coffin bone).  This can be done most effectively through the use of heart bar shoes.  Heart
bar shoes should be applied as soon as possible to help stabilize the bone column.  The stabilizing effect of support via the controlled pressure on the frog, helps arrest the
founder damage.  In nearly all cases, nailing on a correctly placed heart bar shoe onto horse in any stage of laminitis and founder
will provide immediate relief.

Use of Pain medication
Routine use of medications such as bute (phenylbutazone) or banamine to relieve pain is controversial and not recommended. Pain medication does not stop laminitis; it
only masks the symptoms
. While pain causes stress to both the horse and the owner, it is important to acknowledge that pain has an important function. It prevents a horse
with laminitis from moving around too much during a period when its feet are in jeopardy, causing more rotation of the coffin bone. The best position for a horse with laminitis
is lying down. Removing pain medication may be the best thing to encourage your horse to lay down.

Esco Buff is a recognized
leader in the field of laminitis and founder farrier treatment and is routinely consulted for horse's that are laminitic or foundered.  He typically shoes
between 90 to 140 new foundered horse cases per year.  

In a twelve year period (1991 to 2003), Esco has documented and shod over 625 new-foundered cases with a 98% survival rate.  Of these 82% returned to their original
state of soundness, 16% were unable to return to their original state of soundness and 2% were euthanized.  Esco has written several articles and books on the subject of
laminitis and founder.  His current book,
Founder - How to Take, Read and Interpret Radiographs for the Prognosis and Treatment of the Foundered Horse is "a clear,
concise and easy to use set of directions" (Rachel Shuster, DVM, New Jersey) that provides "the veterinarian and farrier with a specific methodology fore determining the
severity of the founder, and more importantly, a methodology for determining progress" (Bob Smith, CF, Owner of Pacific Coast Horseshoeing School, California).

"New information about the etiologies and pathogenesis of laminitis and founder emerge over time.  Over time, numerous new preventative measure and treatment have also
appeared.  It is commonly felt that the more treatments there are for a disease process, the lower the probability of one treatment being more successful than another.  This
statement is quite applicable to laminitis and founder.  However, after being amazed at the various laminitis and foundered cases successfully treated with the application of
correctly placed heart bar shoes, I now believe that it is crucial to involve an experienced farrier at the onset of such cases.  I'm convinced of the higher probability of success
when using properly placed heart bar shoes in pre-acute, acute and chronic cases, along with identifying and treating any underlying causes" (Jennifer A. Reetz, DVM,
DACVIM).

Here are some other comments by veterinarians, farriers and horse owners.

"Esco is the man who saved my horse from being put down due to founder.  Heart bar shoes allowed my horse to be become sound again."  Clare Eisler, PA., ceisler@juno.
com

"Ten years ago my horse foundered.  Esco fitted my horse with heart bar shoes and for the first time in months my horse could walk without pain.  Two months later we were
riding once again."  Jeanne Phillips, NY, jphillips@phillipsllc.com

"It is my opinion that Esco Buff has real solutions to a complex problem."  The late, King A Lamadora (farrier), Daly City, CA.

"When my horse foundered, Esco spent an extraordinary amount of time with me, explaining exactly what was happening and what he was going to do.  After the application
of a correctly placed heart bar shoe, my horse was sound within a few days and now you would never know he ever foundered."  Doreen Kula, NY, aa_scout1@yahoo.com

"It is unbelievable - the difference the heart bars make.  I know, from personal experience with my horse.  The shoes took her from eyes filled with pain to relief and joy.  I can
never thank you enough!"  Glenda Burross, PA, glburross@dejazzd.com

"I've seen foundered horses treated with styrofoam, Stewart Clogs, sand stalls, deep bedding, anti-inflammatory meds., pain meds., and treated with nothing.  A rigid steel
heart bar shoe, correctly placed using properly taken radiographs, is the only way to ensure that founder is arrested and reversed."  Chris Richardson (farrier), NY,
qualityhoofcare@gmail.com

""If anyone has any doubt about the heartbar shoe, my horse's experience with sinkers on booth front feet with the coffin bone penetrating the soles, will convince them how
amazing they work in the recovery of my horse."  Heidi Wheaton, PA, heidiwheaton.com

"The goal is a successful return to the horse's state of useful soundness and comfort.   The heart bar shoe has been proven to have the greatest success."  Lidia Ivanovna
Sawortotnow (farrier), CA.

Recommended Resource Guide

Founder Data Collection and Analysis - How to Take, Read and Interpret Radiographs for the Prognosis and Treatment of the Foundered Horse
by Esco Buff, PhD, CF, Morris Publishing, Kearney, NE, 2005.

Laminitis and Founder - Prevention and Treatment for the Greatest Chance of Success    
by Doug Butler, PhD, CJF, FWCF and Frank Gravlee, DVM, MS, CNS, Life Data Labs, Inc, Cherokee, AL, 2007.

Equine Laminitis
by Christopher C Pollitt, BVSc, PhD, RIRDC Publications, Barton, Australia, 2001.

Factors Involved in the Prognosis of Equine Laminitis in the UK
by RA Eustace, BVSc, Cert EO, Cert EP, FRCVS and PJ Cripps, BVSc, Bsc, Msc, PhD, MRCVS, Equine Veterinary Journal, 31.5, 1999.

Radiological Measurements From the Feet of Normal Horses, With Relevance to Laminitis
by PJ Cripps, BVSc, Bsc, Msc, PhD, MRCVS and RA Eustace, BVSc, Cert EO, Cert EP, FRCVS, Equine Veterinary Journal, 31.5, 1999.

Explaining Laminitis and its Prevention
by Robert A Eustace, BVSc, Cert EO, Cert EP, FRCVS, JW Arrowsmith Ltd, Bristol, Great Britain, 1992.

Founder Data Collection and Analysis Form
by Esco Buff, PhD, CF, Webster, NY, 1990.

Proceeding of the 13th Annual AAEP Convention,
Burnery Chapman, CJF and George Platt, DVM, Dallas, TX, 1984.


"Raising the heels for laminitic horses increases the load in the dorsal laminar junction.  The results do not support the practice of raising the heels for laminitic horses."           
Ramsey GD et al.  The effect of hoof angle variations on dorsal lamellar load in the equine hoof. Equine Veterinary Journal 2011;45;536-542.

Treatment using the heart bar shoe and dorsal hoof wall resection technique.
N=10, 20% or 2/10 euthanized., 10% or 1/10 lame at trot., 70% or 7/10 returned to their previous use at comparable levels of performance.
Eustace RA, Caldwell MN. Treatment of solar prolapse using the heart bar shoe and dorsal hoof wall resection technique. Equine Vet J. 1989 Sep;21(5):370-2.

Multiple heart bar types used.
N=140, 71% or 100/140 alive and sound., 29% or 40/140 dead or unrideable.
Eustace RA.  Explaining Laminitis and its Prevention.  RA Eustace, Bristol 1992:65.

Multiple heart bar types used.
N=211, 77% or 162/211 returned to athletic soundness., 3% or 7/211 did not regain full athletic function., 80% or 169/211 survived., 20% or 42/211 died or were euthanized.
Cripps PJ, Eustace RA.  Factors involved in the prognosis of laminitis in the UK.  Equine Vet Jour 1999;31(5):433-442.

Goetz and Comstock (1985) reported that in a group of 22 horses affected with varying severity and chronicity of laminitis, 46% became sound following the use of adjustable
heart bar shoes as a part of the treatment regime, 27% were improved by at least 2 Obel grades and 27% required euthanasia.

Eustace and Caldwell (1989) demonstrated that animals with degrees of distal phalanx rotation greater than the suggested threshold of 11.5 degrees can return to full athletic
function if they are treated using a heart bar shoe and the technique of dorsal wall resection.

It has been demonstrated that an alternative circulation coming from the dorsal artery at the rear of the distal phalanx that is activated when weight bearing is shifted from the
wall to the frog.  Pollitt, C. Equine Foot Studies, video,1992.

Isoxsuprine has been used for years before any testing was done, and the tests showed that it has no effect on the blood flow to the foot.
Ingle-Fehr JE, Baxter GM.  The effect of oral Isoxsuprene and pentoxyfyline on digital and laminar blood flow in healthy horses. Vet Surg 1999;28:154-60.

Nitroglycerin has been recently reported not only is ineffective in increasing digital blood flow, but it was not even absorbed into the digital circulation.  
Gihooly MH, Eades SC, Stokes AM, et al. Effects of topical nitroglycerine patches and ointment on digital venous plasma nitric oxide concentrations and digital blood flow in
healthy conscious horse.  Vet Surg 2005;34:604-9.

Acepromazine has been reported to effectively increase digital blood flow for a short time when administered intramuscularly.
Hunt RJ, Brandon CI, McCann.  Effects of acetylpromazine, xylazine, and vertical load on digital arterial blood flow in horses.  Am J Vet Res 1994;55:375-8.                                       
Leise BS, Fugler LA, Stokes AM, et al. Effects of intramuscular administration of acepromazine on palmar digital blood flow, palmar digital arterial pressure, transverse facial
arterial pressure, and packed cell volume in clinically healthy, conscious horses.  Vet Surg 2007;36:717-23.

Nonsteroidal Anti-inflammatory Drugs (NSAID’s) Phenylbutazone, flunixin meglumine.  There is some research suggesting that NSAID’s inhibit bone healing.  Whether
clinically important or not remains controversial.
Giannoudis PV, MacDonald DA, Matthew SJ, Smith RM, Furlong AJ, De Boer P. Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-
inflammatory drugs. J Bone Joint Surg Br. 2000 Jul;82(5):655-8.

Bute in high doses can also damage the gut and there is some research suggesting that it can cause blood vessels to become more leaky and can suppress the
metabolism of cartilage cells. Beluch,Bertone, Anderson and Rhode.  Amer J Vet Research 2001. 62:1916-1921.

The measurements of Angle of Rotation was shown to be unrelated to outcome, “in other words one may as well measure the length of the horse’s ears as a measure angle
of rotation if you want to predict outcome.”  Horse shod with some form of heart bar shoes.
Factors Involved in the Prognosis of Laminitis in the UK. Eustace RA and Cripps PJ.  Eq Vet Jour 1999;31(5):433-443.
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Laminitis and Founder Treatment