At the 2015 American Association of Equine Practitioners Annual Convention in December, Dr. Bryan Fraley of Fraley Equine Podiatry presented a talk on modifying hoof boots to address chronic laminitis. This presentation was a summary of an extensive paper provided in the AAEP Proceedings.

Fraley reminds that no application for laminitis will achieve success unless the practitioner addresses the underlying cause(s) of laminitis. Once that goal is accomplished, his solutions of modifying hoof boots by gluing on shoes may prove beneficial.

“The modification of boots is already quite relevant to clinical practice because they are easy to use, adaptable and comfortable,” says Fraley. “Comfort is often the barometer that owners use to measure success or failure.”

(Photo: Bryan Fraley) A variety of shoes can be glued to hoof boots to accomplish goals of addressing a chronic laminitic horse.  One simple modification Fraley has used is gluing an aluminum rail shoe onto a boot. He also uses polyurethane shoes or egg bars with boots. To accomplish this, he will place a boot in a vise and attach the shoe using methylmethacrylate (which bonds well to steel, aluminum, polyurethane and wood).

Fraley provided these pros to using modified hoof boots for chronic laminitis in his paper:

• Can provide comfortable and mechanically favorable treatment.
• Easy application without the need for advanced farrier skills.
• Changes can be made quickly.
• Can be applied with minimal trauma.
• Cost effective in relation to some glue-on applications.
• Can be applied to feet that can’t be nailed into or sustain a glue-on option.
• Provides easy access to entire digit.
• Expands your arsenal to help horses, as well as advise colleagues.

He lists these key elements for successful treatment of chronic laminitis with a modified boot:

• The boot must fit perfectly and be of solid construction.
• Use case appropriate sole support.
• Modify the boot to improve their mechanics. 
• Limit rubbing to maintain healthy skin and hoof while in the boots.

With a poor fitting boot that is too large, the foot tends to twist and turn, says Fraley. Furthermore, the dangers increase when a shoe is applied to the bottom of the foot. Fraley says to imagine a boot that turns 180 degrees around with a 10° wedged shoe attached to the boot’s bottom.

(Photo: Bryan Fraley) The image above shows a polyurethane shoe glued to a boot. Fraley reports that about 5 ounces of glue is required to secure most shoes. He says shredding 1 square inch of fiberglass cloth into every 2 ounces of glue aids in its strength. He will cover the lower portion of the boot with duct tape to prevent the glue from attaching to it for cosmetic reasons.  After the glue dries, you can rasp away minimally extra glue.

He adds that a sturdy boot is important as you are asking the device to expand beyond the duty it was designed for.

“The wedge places added strain to the boot’s toe, and many boots fail at the toe region over time,” he says. Fraley like to use ethylene vinyl acetate (EVA) to make pad inserts. He recommends purchasing these in bulk if the caseload necessitates.  He also uses orthopedic felt for horses that can handle firmer material. He also has found in his experiences that's some horses prefer the felt pad because it doesn’t place as much pressure to the medial and lateral sulci of the frog as other options may do.  He also uses carpet felt, silicones, urethanes and impression materials.

The most important think to remember, according to Fraley is that each material has its own durometer measurement. Familiarize yourself with the rating of a product before selecting it because a horse may not tolerate even slightly firmer material.

There are common pitfalls to avoid with using modified boots, according to Fraley:

• Because of the size and varieties, providing this option requires a larger inventory.
• They are higher maintenance for the horse owner. According to Fraley, you have to get the owner buy-in early on so that they will commit to being part of the plan.  He finds owners often prefer to “set it and forget it” approaches.
• Rubs, sores and dermatitis can occur with prolonged use. Human socks applied before putting on the boot can reduce these. Fraley will often dust these socks with baby powder to control moisture that can build up in the boot and adversely affect the hoof.