By Dr. Jennifer Miller-Bailey

 

The word tenotomy tends to strike fear in the hearts of horse owners. That's likely because so many know of someone who's horse had a tenotomy that resulted in eventual euthanasia of the horse. Or it could be the idea that severing a major tendon in the limb of a horse couldn't be anything but disastrous and debilitating. We are here to set the record straight and put minds to ease.

First, while severing the deep digital flexor tendon in the limb of a horse is no inconsequential act, it is one the horse can easily recover from. Meaning, the tendon does heal/scar in and become functional in about a year's time. To horses of many disciplines, a proper mid-cannon deep digital flexor (DDFT) tenotomy doesn't even hold them back from performing, given the necessary convalescence and rehabilitation. It certainly doesn't keep them from a normal "horsey" life outside of competition. This is in stark contrast to their ability to recover from the damage left by laminitis. Debilitation caused by severe laminitis is infinitely more difficult to live with than a DDFT tenotomy. Bone and laminar damage from severe laminitis renders many horses struggling to get pasture sound, much less athletic again.

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What if we told you severing the deep flexor tendon could help your horse avoid this high level of damage and actually preserve the health of the foot? In one to two years’ time the horse could even be ridden. This possibility however hinges on the decision to perform the tenotomy BEFORE laminitis ravages the foot. This key point is why so many horse owners have associated poor outcomes with the procedure.

Traditionally tenotomy has been viewed and used by Veterinarians as a salvage, last ditch effort to address chronic laminitis. At this stage the permanent damage has occurred and cutting the tendon provides no ability to prevent damage. Once more, derotational shoeing is not employed at the time of tenotomy thereby further lowering the success of the surgery. If both these faults are addressed, timing and shoeing, the success rate is immensely improved.

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How do we decide when to perform the tenotomy? Using serial venograms at the first detectable sign of laminitis, allows us to detect that small window of opportunity in which to intervene with a tenotomy. Outside of this window we lose the advantages of such a procedure. Often the venographic findings that indicate a tenotomy occur well before any radiographic findings of laminitis occur. Relying on radiographs only to determine the course of action leaves one sitting at the station long after the train has left. The damage has occurred, a certain chain of events has been set in motion, and very little will help to deter the outcome. This is not to say however that performing a DDFT tenotomy along with derotational shoeing on a horse that has already suffered great damage is not useful. It just doesn’t give the long-term outcome that performing the tenotomy much earlier in the disease process does.

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Perhaps the procedure itself sounds complicated or risky. That is also a great misunderstanding. The procedure is done standing, many times on the farm, in about 10 minutes. There is a small incision made over the flexor tendons in the mid-cannon region that is easily sutured back together. Other than bandaging and removal of sutures in 2 weeks, there’s very little aftercare for the surgery site. Despite the simple nature of the surgery, it does need to be performed by a Veterinarian familiar with this particular technique and shoeing style. You may be familiar with the saying, “The Devil’s in the details.” The details are extremely important and often the success of the procedure hinges on the details.

 

Now that we have demystified the tenotomy, perhaps you may understand the enormous utility and benefit a DDFT tenotomy can afford a horse suffering from laminitis. Perhaps now the fear will dissipate and rational heads will prevail at that critical time in which the health, and often the life, of the horse is on the line. If you are interested in learning more about this procedure, laminitis, or anything related, please contact us. We are always happy to educate horse owners so that more horses get the benefit of proper treatment options.