If your horse is showing signs of acute laminitis, they require emergency veterinary attention and prompt treatment.
Laminitis affects the soft structures of the equine hoof, known as the laminae, and can cause significant pain and lameness.
An episode of laminitis can result in permanent damage to the internal structures of the hooves if left untreated.  Although the condition can be life-threatening, many horses recover with proper management.
At the first sign of a laminitis attack, there are steps you can take to slow the progression of laminar damage and improve your horse’s prognosis. This includes immediately calling your veterinarian, removing your horse from pasture and grains. In some cases, standing the horse in an ice water bath is helpful.
This article will discuss emergency steps to take if you think your horse is experiencing a flare-up of acute laminitis. Once the lamnitic emergency has been managed, follow these steps to support your horse’s recovery.
Laminitis Emergency Treatment Protocol
Laminitis should be treated promptly to minimize damage to the laminae.
Step 1) Assess Your Horse for Signs of Laminitis
Observe your horse’s ability to move. Determine if he is willing and able to move at the walk and turn his body. Don’t force the horse to move if he is not able to as this could cause additional damage to the laminae and increase pain.
Look for signs of pain. Horses with laminitis may be unwilling to stand on hard surfaces. They may also shift their weight frequently and lift their feet alternately. They are unwilling to lift their feet. A glazed facial expression, irritability, and unwillingness to be touched can be signs of pain. They may spend more time than normal lying down.
Check your horse’s digital pulse. An unusually strong pulse in your horse’s digital artery can be caused by obstruction to blood flow through the hoof and could potentially indicate the presence of laminitis. Use your fingers to check the pulse of the paired digital arteries which run over the sesamoid bones in the back of the fetlock and in the upper and mid pastern.
Step 2) Contact Your Veterinarian
Laminitis is a veterinary emergency that requires prompt treatment. A veterinarian can determine the extent of damage that has occurred in the hooves and what treatment is required.
A veterinarian will perform a medical assessment including a lameness exam to diagnose your horse and determine a treatment plan for laminitis. Be prepared to provide your veterinarian with your horse’s medical history and current diet.
Radiographs may need to be taken to detect if there have been any changes to the coffin bone. These images can also be very helpful for the farrier to determine how the horse should be trimmed to properly balance the foot and if therapeutic shoeing would be beneficial.
Step 3) Move Your Horse to a Small Area with Soft Bedding
Horses with laminitis should move as little as possible until they are assessed by a veterinarian. Until the extent of the damage to the laminae is known, restrict unnecessary movement to avoid causing further injury.
If your horse shows signs of laminitis while at pasture and is unable to move, it may be necessary to use a trailer to transport him from the field to the stable. Do not leave the horse on pasture under any circumstances.
If moving the horse from one area to another is necessary, try to stay on soft ground or create a path using a soft footing such as sand or sawdust. Materials such as rubber mats or carpets can also be used to make a pathway for the horse to walk on. If necessary, the veterinarian can use nerve blocks to allow the application of Styrofoam pads or boots with pads.
A stall or small area with soft bedding is ideal for your horse to stand on. Beddings such as shavings, sawdust, or soaked wood pellets are helpful for supporting the hooves and maximizing weight distribution.
Step 4) Administer Cold Water Therapy
Cryotherapy involves the controlled cooling of a horse’s hooves, preferably prior to or at the onset of lameness. This therapy can be administered using either ice water or commercial systems.
Experts recommend cooling the hoof wall to 5 to 10 degrees Celsius (41 to 50 Fahrenheit) for a period of 48 to 72 hours.  Cryotherapy is widely accepted as an effective therapy to prevent and treat laminitis related to a systemic inflammatory response.
Pasture-associated laminitis is related to insulin spikes in metabolic syndrome. Icing can help prevent it but only if started before the horse is lame. It has not been shown to be helpful after the fact and may be contraindicated.
Cryotherapy induces vasoconstriction, decreases inflammatory damage and decreases metabolic activity in the area. This reduces the activity of enzymes that break down the laminae. 
Step 4) Identify the Cause of Laminitis
Laminitis can occur due to a range of causes.  Determining the cause of laminitis in your horse is important as this will influence what type of treatment is necessary.
The four main types of laminitis are:
- Endocrinopathic laminitis: Occurs in horses that have equine metabolic syndrome and or Pituitary Pars Intermedia Dysfunction (PPID).  High insulin levels have been shown to be the only risk factor for pasture-related laminitis. Endocrinopathic laminitis accounts for about 90% of all cases.
- Sepsis-associated laminitis: This is laminitis associated with a systemic inflammatory response. It occurs as a secondary effect of illness such as pneumonia, colic, colitis, or retained placenta.  A systemic inflammatory response is also behind laminitis from grain overload, experimental fructan overload and infections such as Lyme disease, Potomac Horse Fever and Strangles.
- Supporting limb laminitis (SLL): The least common type of laminitis, SLL occurs in horses with a serious non-weight-bearing lameness. In cases of SLL, laminitis develops in a supporting limb. 
- Toxic: Exposure to the following can induce laminitis:
Endocrinopathic laminitis is the most common form of this condition. It affects horses with metabolic disease involving high insulin levels including PPID or equine metabolic syndrome.
Laminitis may develop in horses with chronically elevated insulin levels once they reach a critical threshold. There is also smoldering damage being done to the laminae even if the horse does not appear to be lame.
HC is used to describe carbohydrates that will stimulate insulin secretion by the pancreas. This differs from non-structural carbohydrates (NSC) which describes carbohydrates found within plant cells and includes compounds such as fructans which do not stimulate insulin secretion.
In these cases, horses should be removed from pasture immediately and not fed grain or concentrates.
Horses with sepsis-related laminitis are typically very ill with conditions such as colitis (inflammation of the colon), enteritis (intestinal inflammation), intestinal obstructions, metritis (toxic uterine inflammation following a retained placenta), or pneumonia.
These horses require treatment of their underlying illness to stop the progression of laminitis.
Supporting limb laminitis
Horses unable to bear weight on a lame limb cannot shift their weight between their legs normally. These horses are at risk of developing supporting limb laminitis due to decreased blood flow to the lamellae. Management of horses with tendon or ligament injuries can prevent this condition.
Other types of laminitis
Laminitis can also be caused by corticosteroid administration. Corticosteroids reduce insulin sensitivity for up to two weeks. Horses with preexisting metabolic disease are most at risk. Cephalosporin antibiotics have been associated with laminitis although the mechanism is unknown. Ask your veterinarian if you should stop these medications during the acute phase of laminitis.
Although rare, traumatic laminitis can also result from excessive concussion to the hooves that causes tissue damage (sometimes known as road founder).
Sinking or founder, a drop of the coffin bone to closer to the ground, occurs with thin and flat soles that develop over time in horses kept in shoes or trimming with toes too long and heels underrun.
Step 5) Provide Medications
Under the guidance of a veterinarian, provide medications to help relieve your horse’s pain and combat inflammation.
Medications may also be required to treat any underlying causes of your horse’s laminitis.
Common anti-inflammatory medications used in the emergency treatment of laminitis include Phenylbutazone (bute), Firocoxid, Flunixin Meglumine, and Dimethyl sulfoxide (DMSO).
Endocrinopathic laminitis which is the cause in 90% of laminitis cases does not involve inflammation. Therefore, NSAIDs are of limited effectiveness but can help in the first few days by targeting inflammation associated with the clean-up process.
In some cases of acute laminitis, medications are administered to inhibit the destruction of laminar connections due enzymes known as matrix metalloproteinases (MMPs). Types of MMP inhibitors commonly used in the treatment of laminitis include Pentoxifylline and Doxycycline.
Horses suffering from laminitis are typically prescribed pain-relieving drugs such as Phenylbutazone, Gabapentin, or Tramadol. Morphine, Lidocaine, Ketamine, and Butorphanol may be used in the hospital setting.
Medications for Underlying Conditions
Metformin: Used to treat horses with severe insulin dysregulation, this drug prevents blood glucose and insulin levels from increasing after a meal. 
SGLT2 inhibitors: Drugs in this class, such as canagliflozin, work by blocking reabsorption of glucose in the kidneys. They are extremely effective but expensive and reserved for horses that do not respond to diet, pergolide if needed, and metformin. 
Levothyroxine: This synthetic form of thyroid hormone is beneficial in horses that are resistant to weight loss.
Step 6) Surgical Intervention
In severe cases of laminitis that have progressed to founder, tenotomy of the deep flexor tendon may be used to reduce the pulling forces exerted by the DDFT on the coffin bone.
A tenotomy may enable the coffin bone to return to a normal position in the hoof capsule.
Step 7) Consult a Farrier for Therapeutic Hoof Care
An experienced farrier can provide corrective trimming and shoeing to assist in the treatment of laminitis by preventing further stress on the laminae.
Horses with laminitis benefit from trimming and shoeing strategies that shift the forces of weight-bearing to the rear of affected hooves. The body weight should be distributed over hoof structures including the frog, heels, bars, and sole.
Trimming and shoeing techniques help to reduce the damaging leverage forces on the toe region of the hoof and reduce the point of break-over. They also aim to restore a healthy angle of the coffin bone relative to the hoof capsule.
EVA foam, styrofoam, and various types of impression materials are commonly applied to the bottom of the hooves to help treat laminitis. The goal of these materials is to relieve pressure on the laminae to prevent further damage and reduce pain.
Hoof boots can facilitate healing after laminitis. Available in a range of sizes, hoof boots provide cushioning to the sole of the hoof and are often used in combination with padded inserts.
Some horses benefit from being shod with heart bar shoes. Therapeutic components such as pads and wedges may be used in addition to shoes. Barefoot trimming is beneficial for most horses recovering from laminitis, and is used with boots and pads until the horse is comfortable without them.
Laminitic horses require farrier care more frequently than horses with healthy hooves. Farrier care should be provided every four weeks for horses recovering from laminitis.
Step 8) Feed an Appropriate Recovery Diet
Once a horse has experienced an episode of laminitis for any reason, the risk for future episodes increases.  Feeding a proper diet is essential for helping horses recover from this condition and, in the case of endocrinopathic laminitis, to prevent future attacks.
After a flare-up of acute laminitis, horses with EMS or PPID should be fed a forage-based diet containing less than 10 percent HC (starch and Ethanol Soluble Carbohydrates (ESCs) including glucose, fructose, and sucrose). Hay can be soaked to reduce the sugar content. A forage-based diet is advisable during the recovery from other types of laminitis as well.
Hay should be fed at the rate of between 1.5 and 2% of the horse’s body weight. Never feed less than 1.5% of the horse’s body weight without supervision from a veterinarian.
Avoid feeding grains, sweetened feeds, and sugary treats. These foods are typically high in HC and increase the risk of laminitis recurrence in horses with metabolic conditions.
Access to pasture should be avoided while metabolic horses are recovering from laminitis.  Turn your horse out in a dry lot or with a sealed grazing muzzle to ensure they are not consuming any sugar-rich grass.
Ensure that your horse’s diet is balanced and there are no deficiencies in nutrients required for hoof growth. Some of the most important nutrients for hoof health include amino acids, biotin, and trace minerals including copper and zinc.
Mad Barn’s AminoTrace+ vitamin and mineral supplement is specifically designed for horses at risk of laminitis. AminoTrace+ provides balanced levels of key nutrients for hoof health and metabolic function.
Assess Recovery Progress
Horses affected by acute or chronic laminitis require follow-up veterinary and farrier checks to assess how well their hooves are healing.
Although horses can appear sound quickly after an acute episode of laminitis, they should be confined to allow their hooves time to heal. Follow veterinarian recommendations regarding when it is safe to turn your horse out and if or when exercise, training and riding can resume.
Your veterinarian may take radiographs throughout the recovery process to evaluate changes in the internal structures of the hooves. Radiographs are also valuable for your farrier to determine the best trimming and shoeing strategy.
Veterinary care appointments are important for monitoring endocrine function in horses with metabolic disease.
If you have questions about your feeding program for your horse after emergency treatment of laminitis, submit their information online for a free evaluation by our equine nutritionists.
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