Fig. 5. Example of a case where a modified ultimate wedge was selected and improved the venographic appearance from first exam (A) to second exam (B) 9 days later. Note better filling of the proximal sublamellar zone, less folding of the circumflex vessels, and better depth of corium under tip of the CB with better visualization of solar papillae under the tip of the CB.
DDFT. However, further palmar angle enhancement with additional wedging or the addition of a rockered ground surface may be needed when higher levels of derotation are required. Lowering the mechanics to a high-scale rockered wedge rail shoec would be appro- priate after a significant sole response (20 mm) has occurred. Gradual reduction in mechanics at each reset may be attempted as long as the response is appropriate (as described earlier). One must consider the structural integrity of the lamellar bond. The author does not feel the lamel-
lar bond is sufficient to accept full load until a com- plete hoof has regrown, and oftentimes, the goal is to maintain protective mechanics until that occurs. Follow-up venograms will show a return to a more normalized internal anatomy with less compression. On these normalized venograms, a normally ori- ented papilla, rounded coronary plexus, and less dorsoproximal folding of the circumflex network will be observed. If significant improvement does not occur and an increased sole depth is not achieved, then the next higher level of mechanical therapy to
Fig. 6. Example of building pillars to create a parallel line to wings of the CB. AAEP PROCEEDINGS Vol. 64 2018 385
