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Instructions for Applying
Redden Modified Ultimates
The Redden Modified Ultimate is a therapeutic aid designed to significantly reduce deep flexor tension as the load of the horse is transferred to the laminae. Mechanical mode of action is due to significant heel elevation, self-adjusting digital breakover and arch support. The Modified Ultimate helps stabilize the position of PIII within the capsule at the onset of the syndrome. When applied properly, the load is shifted from the apex to the heel area. This relieves stress on the laminae and download on the sole corium.

Note: Once displacement (capsular rotation) has occurred, proper realignment (derotation) must precede application of this device. Pure lateral radiographs with soft tissue detail are essential for accurate assessment, and they offer optimum information for the veterinarian-farrier team.
Use Caution When Realigning PIII

Realigning PIII (derotation) is best accomplished by pushing the heel back from just behind the widest point of the foot to the widest point of the frog. Work to create a 0º palmar/plantar angle. When you have greater than five degrees and an HL of 15/18, the heel is not pushed back as described.
Don't use the Modified Ultimate if the
palmar angle is greater than 5 degrees
Know your sole depth. Feet that have existing long toes, underrun heels, crushed digital cushion and caudal rotation have compromised heel circulation prior to laminitis. Loading the caudal part of the foot further compromises the weak heels, and becomes counter productive. To overcome this complication, use more breakover on the bottom wedge to allow the foot to rock forward and increase palmar angle.

Radiographs taken at the onset help establish a starting point and are extremely helpful.
Application Methods

Cotton Bandage
Wrap a cotton bandage (34" L x 6" W) around the pastern. Mix Advance Cushion Support (ACS) and shape it into a pancake approximately 1/2" thick and 5" in diameter. Place it inside the Ultimate. Slide the Modified Ultimate on the foot and set it on the ground to spread the ACS evenly over the sole, frog and sulci. Pick the foot up quickly to prevent excess ACS from pushing out the back of the Ultimate. Hold the foot up, if possible, until the ACS is cured. This will offer maximum arch support. Tape the Ultimate to the pastern bandage using 4" Elasticon (1 roll per foot), making a very secure figure-eight attachment.
If you choose to glue the Modified Ultimate on for a more permanent attachment, the cuff should fit the trimmed foot. (Remove the cuff from the Ultimate, fit the cuff to the hoof, mark proper placement on the wedge and reattach the cuff with the screws.) Apply ASC as described above. Remove the Ultimate, check for excess ACS and trim a depression in the ACS where the circumflex vessel would be found. Apply Equilox to the felt-lined area of the cuff and reapply the Ultimate.

When using any adhesive, examine the foot closely for breaks in the sole/wall junction. Sealing anaerobes can cause serious abscesses!
Left: Cutting a depression in the Advance Cushion Support™.
Right: Applying Equilox to the felt-covered Modified Ultimate.