Monitoring signs of laminitis

A new scoring method has been shown to be useful for monitoring the progress of cases of endocrinopathic-laminitis. Endocrinopathic-laminitis or hyperinsulinaemia-associated laminitis (HAL) is a common form of the condition, typically encountered in overweight animals.
Being able to grade the severity of the signs is useful, both for assessing the response to treatment in clinical situations, but also for assessing potential new treatments when they become available.
 
The 4-point Obel scale has been used for many years to describe the severity of laminitic signs. (See below). It was devised for use with severe cases caused by sepsis or starch overload, and may not be as well suited to cases of HAL, which often show a more gradual onset. 
 

A new method was developed by Meier and colleagues (See below), which examines five key clinical signs: weight shifting, response to lifting a foot, gait at the walk and turning in a circle, and palpation of the digital pulse.

 

The value of this new method was investigated in a randomised controlled field study involving eighty horses and ponies with naturally occurring HAL, seen at 16 veterinary practices in Germany.

Independent veterinarians assessed the severity of laminitis using both the traditional Obel method and the Meier method. Assessments were made on the day of diagnosis then 4, 9, 14, 25 and 42 days later. Pain medications were withheld for 24 h before clinical examination in all cases.

 

The researchers found that the time taken for the laminitis to improve varied between individuals, and was difficult to monitor accurately using the Obel method. The Meier method could identify more subtle changes. They noted that there was considerable variation in the rate of improvement of individual clinical signs. For example, lameness when turning in a circle persisted longer than signs of weight shifting and reluctance to allow the front leg to be lifted.

 

A full, open access, report of the work is published in the journal BMC Veterinary Research. The authors conclude that the Meier method provides a reliable and consistent method for monitoring the clinical status of horses with HAL.

 

They suggest that the pattern of improvement described in their study should provide a useful benchmark against which individual cases and new treatments can be assessed.

 

 

Table 1 The Obel method of laminitis diagnosis and severity grading (Obel, 1948)

Laminitis grade	Grade description
Normal	Horse appears sound
Obel grade 1	At rest, the horse shifts its weight between the forelimbs; the horse is sound at the walk, but the gait is stilted at the trot in a straight line and on turning
Obel grade 2	The gait is stilted at the walk and the horse turns with great difficulty, but one forelimb can be lifted
Obel grade 3	The horse is reluctant to walk and one forelimb can only be lifted with great difficulty
Obel grade 4	The horse will only move if forced to

 

 Table 2 The ‘modified Obel’ or ‘Meier’ method of laminitis diagnosis and severity scoring

Order of examination	Criteria	Description	Points	Given Points
Stage 1
Examine horse standing	Weight shifting	No weight shifting	0
		Weight shifting – including shifting weight between all feet;	2
		Abnormal time spent lying down; placing forelimbs in front of body
Gently lift each foot up and put back down straight away	Forelimb lift	Prompt and willingly maintained (each forelimb)	0
		Reluctant and maintained with difficulty (each forelimb)	1
		Unable to lift foot/resists attempts to lift foot (each forelimb)	2
Stage 2
Conduct on hard surface Walk horse approx. 30 m side-on to examiner	Gait at walk	Normal gait	0
		Mild - short, stilted gait - still moves willingly	1
		Moderate - short, stilted gait - reluctant/difficult to walk	2
		Severe difficulty walking or unable to walk*	6
		*do not force horse to walk; skip gait at circle and continue with digital pulse
Turn on a short lead clockwise and anti-clockwise	Gait at circle	Normal circling	0
		Mild head rise, difficulty when turning, still moves willingly	1
		Moderate, sharp head rise, reluctance/difficulty turning	2
		Severe difficulty turning, slow and clearly painful	3
Stage 3
All feet must be square on ground	Forelimb digital pulse	Normal - able to palpate, normal magnitude but not bounding	0
		Increased magnitude or bounding digital pulse (each forelimb)	2
			Total Score

 

 Both tables from: The application of a new laminitis scoring method to model the rate and pattern of improvement from equine endocrinopathic laminitis in a clinical setting ( http://creativecommons.org/licenses/by/4.0/)

For more details, see:

 

The application of a new laminitis scoring method to model the rate and pattern of improvement from equine endocrinopathic laminitis in a clinical setting. 

Meier, A., McGree, J., Klee, R. et al. (2021)

BMC Vet Res 17, 16 

https://doi.org/10.1186/s12917-020-02715-7