Fig. 13. A, Pre-shoeing radiographs showing a ground rocker surface of the modified ultimate; and B, fully rockered 6-degree rail shoe for maintenance until the hoof capsule has regrown.
very important and helps validate the therapy used. However, at any given time, if a lack of progress is noted, then repeat venograms and radiographs can be compared with previous images. If a re- gression or a lack of response is identified, then a higher level of mechanical support is needed. For example, if this case failed to quickly add sole depth and venograms exhibited a lack of improve- ment with regards to circumflex displacement, measurable vascular depth of the tip of the CB, return of visible solar papillae while wearing the modified ultimate, then a deep flexor tenotomy would be considered. A lack of response while wearing high-end mechanical therapy is an indi- cation for deep flexor tenotomy in the author’s
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practice. A recovery is noted and a small degree of wedge is ground away to a lower palmar angle to allow more adjustability. As long as good com- fort continues, as has occurred in this case, then continued reduction is performed. However, the author will not completely remove mechanical therapy that reduces load and resistance in the DDFT and, subsequently, the dorsal lamellar bond and solar corium under the dorsal aspect of the CB until a full hoof capsule has regrown. At that point, an increase in exercise with mostly walking is a recommended. A slow and gradual increase in workload every 1–2 weeks is suggested. This has been an effective effort to test the lamellar bond and its structural integrity.
