Georgia Skelton 1, Elizabeth Acutt 1, Darko Stefanovski 1, Andrew van Eps 1
Background
Diagnosing acute laminitis in horses, particularly in its early stages, remains a clinical challenge. Traditional clinical signs and radiographic evidence often appear only after significant disease progression. Digital radiography has potential for improved early detection through quantitative assessment, but its diagnostic utility has not been fully established. This study aimed to evaluate the diagnostic accuracy of digital radiographic measurements for identifying acute laminitis and distinguishing it from non-laminitic lameness in horses.
Methods
A prospective, observational study was conducted involving 66 horses presenting with acute forelimb lameness. Horses were categorized as having acute laminitis (n=36) or non-laminitic lameness (n=30) based on clinical examination, history, and follow-up. Standardized lateromedial digital radiographs of the forefeet were obtained, and multiple linear and angular parameters were measured, including the founder distance (distance from the coronary band to the extensor process), sole depth, palmar angle, and distal phalanx-to-hoof wall distances. Statistical analyses were performed to compare groups and assess diagnostic performance.
Results
Significant differences in radiographic measurements were found between laminitic and non-laminitic horses. Founder distance, palmar angle, and the dorsal hoof wall-to-distal phalanx distance were notably greater in the laminitic group, whereas sole depth was reduced. Receiver operating characteristic (ROC) analysis showed that several parameters, particularly founder distance and palmar angle, had moderate to high diagnostic accuracy, with the founder distance providing the highest area under the curve (AUC = 0.88). Multivariate logistic regression confirmed these parameters as significant predictors of acute laminitis.
Limitations
The study’s limitations include a relatively small sample size and potential variability in hoof conformation and positioning during radiography, which may influence measurements. Additionally, cases were limited to those presenting to a referral hospital, which may introduce selection bias.
Conclusions
Digital radiographic measurements, particularly founder distance and palmar angle, offer valuable diagnostic support in differentiating acute laminitis from other causes of forelimb lameness. These findings support the integration of objective radiographic criteria into clinical assessments for earlier and more accurate diagnosis of laminitis in equine patients.
Radiographic measurements were performed on lateromedial (A) and dorsopalmar (B) projections. Dorsal lamellar lucent zone (LLZ) measurements were made between the inner hoof wall and the dorsal aspect of the distal phalanx (Pd) and dorsal hoof wall to Pd (DHW-Pd) measurements were made from the dorsal aspect of the outer hoof wall to the dorsal aspect of the Pd. The LLZ and DHW-Pd measurements were made approximately perpendicular to the dorsal extent of the Pd in proximal, middle, and distal locations on the LM projection. Other measurements on the LM projection were the sole lucent zone (sole LZ), sole depth (outer limit of the solar surface to the distal dorsal tip of Pd), extensor process to level of the coronary band (founder distance), palmar cortical length of Pd (PCL), as well as inner and outer hoof wall angles relative to the angle of the dorsal (parietal) surface of the Pd. On the dorsopalmar projection (B), lateral and medial outer hoof wall to Pd (LHW-Pd, MHW-Pd) and LLZ measurements were made at the junction of the parietal and solear aspect of the Pd, perpendicular to the medial and lateral hoof wall. The sole depth and sole LZ measurements were made medially and laterally at the same point, perpendicular to the ground surface.
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