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Chronic laminitis forces every equine clinician into the same hard question: when comfort keeps slipping and radiographs keep worsening, what can truly change the mechanics of the foot and the horse’s day-to-day life? We sit down with Dr. Jim Orsini to talk about deep digital flexor (DDF) tenotomy, a procedure many people still treat as “last resort,” and why the data argue it may deserve earlier consideration in the right chronic rotational laminitis cases.

We dig into what the surgery is actually trying to accomplish: reducing the pull of the deep digital flexor tendon on the coffin bone (third phalanx) so the foot can realign to the ground surface. Jim walks us through the patient selection details that matter, including the rotation versus sinking distinction, and why great farriery is not optional. We also discuss the practical, clinic-friendly ways to judge success, from owner-observed comfort and stable pain-medication needs to radiographic progression like lysis, sole penetration, and hoof wall separation.

Then we get into the findings that made us pause, including the striking improvement signal at three to six months and the nuance around age, underlying causes like equine metabolic syndrome, and why chronic cases can be recognized late. We close with the real-world conversation every veterinarian has to have: cost, expectations, and the truth that chronic laminitis care is a long-term commitment, not a one-and-done fix.

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JAVMA article: https://doi.org/10.2460/javma.25.12.0839

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