Laminitis is a common but serious condition that involves separation of the laminae, which connect the coffin bone to the hoof wall.

A bout of laminitis can cause mild to severe pain in affected horses and result in lasting damage to the hooves. In extreme cases, the condition can result in permanent lameness and lead to the horse being euthanized.

With prompt treatment and appropriate rehabilitation, the majority of horses recover from laminitis and can return to light work within two to three months.

However, once a horse has experienced laminitis as a result of elevated insulin in metabolic syndrome or PPID, the chance of recurrence increases. Mares that have pregnancy-induced insulin resistance and laminitis may also experience it again on subsequent pregnancies.

Damage to the laminae and alterations in the circulatory mechanisms in the hooves leave the horse vulnerable to future attacks.

Careful management of your horse’s nutrition and health is critical to preventing laminitis from recurring. This article will discuss how to best support the recovery of a laminitic horse to help them return to soundness.

Laminitis Prognosis

The prognosis for horses with laminitis varies widely depending on the cause, the extent of damage to the laminae and the severity of pain experienced by the horse.

Horses with a mild case generally have a good prognosis and a high recovery rate. Treating laminitis promptly increases the chance of recovery for affected horses. Eliminating the cause and immediate attention to a realigning trim are critical to recovery.

Some horses are not able to recover completely if the laminae are severely compromised and the condition progresses to founder. Founder occurs when the coffin bone (also known as the pedal bone or the distal phalanx) has rotated and/or sunk within the hoof capsule.

However, if the cause is quickly and properly addressed and correct hoof care is maintained, even horses that have penetrated or sloughed their entire hooves have survived with a long period of intensive nursing.

 

Healthy vs. Laminitic Horse Hoof | Mad Barn USAIllustration:

 

While laminitis itself is not fatal, if the pain of the condition cannot be adequately managed, horse owners may make the decision to euthanize the animal.

In one review of veterinary case records for 216 horses and ponies with laminitis, 77% were able to return to soundness and resume their athletic careers.

Three percent of the animals did not regain athletic soundness but were kept as companions or breeding animals. 20% of the affected horses either died or were euthanized, with only a small number surviving for longer than 1 year. [16]

However, it should be noted that article was written before equine metabolic syndrome was well recognized and the role of insulin was known. Today, addressing hyperinsulinemia is a core component of laminitis recovery.

Laminitis Recovery Plan

Knowing what caused laminitis in your horse and how much weakening of laminar structures in the hooves has occurred is important when implementing a recovery plan for your horse.

Recovery from acute laminitis aims to achieve the following therapeutic targets:

  1. Resolving the underlying causes or predisposing factors that led to your horse’s laminitic episode.
  2. Addressing pain by resolving the cause and with medications as needed.
  3. Rehabilitating the hoof to support the coffin bone and reducing the weight bearing forces exerted on the laminae.
  4. Providing adequate rest and restricting the horse’s movement to prevent further injury and enable healing.
  5. Promoting blood flow to the hooves using vasodilatory medications or supplements that increase peripheral circulation.
  6. Enabling a gradual return to movement once the horse is no longer lame and can be maintained comfortably without pain medications.

Closely follow the advice provided by your veterinarian and work with an experienced farrier to increase the chances of a successful recovery.

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Addressing Underlying Causes

The first step to helping your horse recover from laminitis is to remove the influence of any predisposing factors that triggered the laminitic episode.

The most common cause of laminitis is high insulin (hyperinsulinemia) in equine metabolic syndrome or PPID – pituitary pars intermedia dysfunction, aka Cushing’s Disease. [2]

A familiar scenario is laminitis caused by spring pasture. It used to be thought that any horse could develop pasture-associated laminitis and that there was a component of hindgut disturbance from fermentation of fructan in the grass.

However, it has been well established that the only risk factor for laminitis at pasture is hyperinsulinemia. [1][2]

Laminitis can also occur due to high fever, illnesses or a retained placenta that causes sepsis. The condition may also occur from trauma or excessive weight-bearing forces on the hoof.

Other factors such as corticosteroid or cephalosporin drug use, exposure to black walnut shavings, Hoary alyssum ingestion, selenium toxicity, pregnancy-induced insulin resistance, severe colic and certain other hoof disorders can also contribute to the development of laminitis.

Work with your veterinarian to address underlying health problems or treat illnesses that contributed to laminitis, such as PPID or equine metabolic syndrome.

Rest Period

Horses recovering from laminitis require confinement to a stall or small area with deep bedding to restrict their movement and encourage them to lay down. Deep sand is best for conforming to the hoof while supporting the frog and sole. [17]

Laminitis weakens the connection of the laminae between the coffin bone and hoof. Your horse will need time with limited movement for these structures to heal and regain full strength.

A significant factor in achieving recovery after laminitis is how horses are managed after lameness resolves. Dr. Andrew van Eps from the University of Pennsylvania’s School of Veterinary Medicine recommends stall rest (with limited hand-walking) for a period of one week for every day the horse was lame. [3]

However, prolonged stall confinement worsens the poor circulation that is part of laminitis pathology. This can be seen when horses that are on stall confinement improve in their comfort level after walking for a few minutes.

Horses with an appropriate realigning trim and protective boots and pads may be allowed access to a sand or dirt paddock as long as their pain is not being blocked by medications and there are no horses or dogs to chase them.

In most cases riding should not be resumed until the hoof has gone through a complete growth cycle and radiographs show good alignment.

Post-Laminitis Veterinary Assessment

Veterinary follow-up care is essential to track the progress of your horse’s recovery from laminitis.

Radiographs are valuable for monitoring the effects of laminitis inside the hooves. This type of imaging can detect bone remodelling, bone rotation, and damage to the laminar structures.

Because laminitis can result in changes to the hooves after weeks or months, it is helpful to take radiographs throughout the recovery process. Your veterinarian may recommend that radiographs be taken multiple times during the recovery process to ensure healing is complete.

Blood tests may be used to check for and monitor the treatment of endocrine diseases including equine metabolic syndrome (EMS) and Pituitary Pars Intermedia Dysfunction (PPID).

These conditions may involve high insulin and glucose levels, insulin resistance, and increased levels of adrenocorticotropic hormone (ACTH). Treating endocrine disease is critical for helping your horse recover from laminitis. [4][5]

General blood tests may be used to assess the health of the kidneys or gastrointestinal tract when horses are being treated with anti-inflammatory and analgesic medications. Some of these medications can cause side effects.

NSAID medications are not meant to be used for prolonged periods of time and carry significant risks. They are also not very helpful in most laminitis cases that involved elevated insulin as the root cause, not inflammation.

Return to Movement

When a horse should be encouraged to move depends on how well he has recovered from laminitis. You should have your veterinarian’s approval before allowing your horse to move beyond his recovery space.

After having laminitis, horses should only be permitted to move freely when they meet the following criteria:

  • The cause of laminitis has been identified and removed or treated.
  • The horse has not received pain-relief and or anti-inflammatory medications for at least 48 hours and is comfortable.
  • Radiographs do not show evidence of worsening of laminitis.
  • The hooves have been assessed by a veterinarian and farrier to determine that they are balanced correctly. The coffin bone is at a correct angle relative to the sole of the hoof. The horse doesn’t show any signs of discomfort when hoof testers are applied to the sole of the hoof.
  • The hooves are supported to maximize weight-bearing at the rear of the foot. The horse can move comfortably with a heel-first landing.

Eventually, riding under saddle can be resumed when healing is well-advanced, and the laminae are stable.

Turnout After Laminitis

Follow your veterinarian’s advice on when to turn your horse out following recovery from laminitis. Turnout in a small area, alone or with a quiet companion, is safe as long as the horse’s pain is not being blocked.

Horses that have had laminitis should not be turned out to exercise freely in a large area until the laminar attachment between the coffin bone and hoof wall is stable.

When choosing an appropriate turnout paddock for your horse, consider his metabolic health. A horse with elevated insulin levels or uncontrolled PPID is at risk for another attack of laminitis if given access to pasture.

Horses with metabolic conditions may require turnout in an area with little or no grass.

Resuming Exercise and Training

Follow the guidance of a veterinarian to ensure your horse is ready to resume exercise and training. A gradual return to work is typically recommended for horses that have recovered from laminitis.

In a study of 14 obese horses with laminitis, all recovered successfully and resumed their previous level of soundness while following specific diet management and exercise programs.

When veterinarians advised in-hand movement to resume, exercise was increased in five to ten-minute increments until horses were walking 30 to 45 minutes two to three times per day. [6]

Sand is an ideal footing to exercise a horse on after the laminae have healed. Soft footings provide support to the sole and frog and reduce the weight-bearing forces on the wall of the hooves. These footings also enable the horse to turn easily and be more comfortable in a standing position.

Avoid exercising your horse on hard surfaces as this can cause pain in hooves with weakened laminae.

After exercise always check that the lameness has not returned, and the horse is still moving comfortably. If your horse shows lameness following exercise, contact your veterinarian for advice.

Hoof Rehabilitation

Structural changes occur inside hooves affected by laminitis. If the laminae have lost the ability to suspend and support the coffin bone, the bone can sink into the hoof capsule causing pressure on the sole.

The goal of rehabilitating hooves affected by laminitis is to reduce the amount of weight exerted on the front part of the sole and relieve pain and stress on the laminae while healthy laminar connections regrow. Therapeutic trimming and shoeing can help to shift the forces of weight-bearing to the rear of the foot.

Corrective shoes such as heart bar shoes may be used to cover the rear third of the hoof’s ground surface to increase the horse’s comfort. Impression materials such as synthetic filler or resin are also often used to support the back of the hoof.

Not all horses recovering from laminitis require shoes; some recover better when barefoot with appropriate boots and pads. Barefoot is advisable in the early stages for all horses because trimming at 2 to 3 week intervals is often needed.

While horses are recovering from laminitis and their hooves are growing out, regular trimming and/or shoeing by a knowledgeable hoof care professional facilitates optimal healing.

Post-Laminitis Feeding Plan

Diet plans for horses prone to laminitis should restrict the intake of hydrolyzable carbohydrates (HC). Consuming excess HC can increase the risk of laminitis by promoting high insulin.

HC are the fractions that are digested in the small intestine and contribute to the insulin response. This includes simple sugars (ESC) and starch. NSC, nonstructural carbohydrate, overestimates risk because it includes fructan. Fructan is not a sugar and not digestible in the small intestine and therefore does not contribute to the insulin response.

A 2022 study examining recovery from acute laminitis found that horses with higher blood glucose and insulin concentrations took longer to recover from this condition. [15]

Horses prone to laminitis should not be fed any type of cereal grains or sweetened feeds. Laminitic horses are also advised to avoid alfalfa hay, which worsens foot pain in some metabolic horses although the mechanism is not clear. Brans and balancers fed in pound or higher amounts are also usually not safe.

Forage

All horses – and especially those prone to laminitis – should be fed a diet primarily comprised of forage. Hay (or a hay substitute) with an HC content of less than 10% dry matter is considered ideal for laminitis-prone horses although some may need it even lower. [7]

Forage should be fed at a rate of approximately 1.5 – 2% of the horse’s body weight, depending on their current body condition, physiological status and activity level.

Mature hay is typically lower in HC content and digestible energy compared to less mature grass hay and legume hays such as alfalfa and clover. However, environmental factors during the growth and harvesting of hay also influence the HC content.

A forage analysis should be submitted for any hay that is used to feed horses with PPID and EMS. A hay analysis will help you determine the HC content of your horse’s forage to ensure that it is appropriate for a horse recovering from laminitis and to determine mineral imbalances or deficiencies.

Soaking hay for 30 to 60 minutes in advance of feeding can help to reduce the sugar content. The amount of sugars removed by soaking varies depending on the type of hay, water temperature, and soaking time.

Soaking hay that is high in HC may not remove enough of these components to make it safe to feed laminitis-prone horses. In addition, starch does not soak out and will still be present to stimulate an insulin response.

Pasture

Depending on the time of the year, the NSC content of some pasture can increase to 40% dry matter. [8] Some horses will require restricted or no access to pasture.

A slow introduction to pasture grazing may be suitable for some horses after they achieve a healthy weight and normal hormone levels.

However, metabolic syndrome is genetically determined and never goes away. The horse will always be at risk of excessive weight gain or laminitis if fed improperly. The safest pasture is one that has grown to full height and dropped its seed but some horses may not tolerate those pastures either.

Some horses may need to have their access to grass and or grazing time restricted on an ongoing basis. For horses that can safely consume limited amounts of pasture growth, a well-fitted grazing muzzle can be used to reduce the amount of grass they can ingest.

HC levels in pasture plants fluctuate according to multiple factors including the time of day, season, and environmental stressors. [7] HC is lowest in grasses late at night and through the early morning, so long as temperatures are above 4 degrees Celsius / 39 degrees Fahrenheit [9]. These are the safest times to graze your laminitic horse.

Owners should be cautious about turning out their horses at times when HC content is higher, including:

  • When night temperatures fall below 4 degrees Celsius / 39 degrees Fahrenheit. [9] Sugar is stored in plants rather than utilized for growth during cool nights.
  • In the spring before seed has dropped.
  • When plants are stressed during times of frost or drought.
  • When grasses are over-grazed and shorter than 4 inches in height.

Supplements

All horses, including those prone to laminitis, benefit from a high-quality vitamin and mineral supplement to avoid nutrient deficiencies that are common in the equine diet.

Mad Barn’s AminoTrace+ is a vitamin and mineral specifically formulated for horses with metabolic conditions. AminoTrace+ is a concentrated low-NSC formula with enhanced levels of nutrients targeted to insulin sensitivity, antioxidant support and hoof growth.

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  • Complete mineral balance
  • Supports metabolic health
  • Formulated for IR/Cushing's
  • Hoof growth

Magnesium and chromium are two nutrients that have been shown to support normal metabolic function and may reduced the risk of laminitis. Research also shows that short-chain fructo-oligosaccharides (a prebiotic) help to improve insulin sensitivity. [10][11][12]

Some horses benefit from additional dietary protein if consuming a low quality forage. Mad Barn’s Three Amigos contains, lysine, methionine, and threonine, the three most common limiting amino acids in the horse’s diet.

Horses that require additional calories to maintain weight typically benefit from receiving oil high in omega-3 fatty acids. Mad Barn’s w-3 oil is high in DHA, an omega-3 fatty acid known to reduce inflammation and improve insulin sensitivity. [13][14]

Jiaogulan is a Chinese herb with a potent ability to stimulate the production of nitric oxide inside blood vessels. [18] This counteracts the high endothelin-1 production to support normal circulation in the hooves. Jiaogulan also supports the normal homeostatic regulation of inflammation. [19]

Acetyl-l-carnitine is a naturally occurring metabolite of L-carnitine. It has neuroprotective effects, including in various models of neuropathic pain. [20] Neuropathic changes have been found in chronic laminitis which suggests acetyl-l-carnitine could help reduce the neuropathic pain of laminitis. [21]

Summary

In many cases of laminitis, horses can have a full recovery within six to eight weeks. However, every horse’s recovery time will depend on the extent of damage to the laminae in the hooves and how quickly healing occurs.

You can support your horse’s recovery by working with a veterinarian to address underlying health concerns and following their recommendations. A farrier can help you rehabilitate your horse’s hooves with corrective shoeing or trimming.

A qualified equine nutritionist can help you formulate an individualized feeding plan to support your horse’s recovery from laminitis and reduce the risk of recurrence. Submit your horse’s information online for a free consultation with our team of nutritionists.

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References

  1. Coleman, M.C. et al. Case-control study of risk factors for pasture-and endocrinopathy-associated laminitis in North American horses. J Am Vet Med Assoc. 2018. View Summary
  2. Menzies-Gow, N.J. et al. Prospective cohort study evaluating risk factors for the development of pasture-associated laminitis in the United Kingdom. Equine Vet J. 2017.
  3. Lesté-Lasserre, C. Life After Laminitis. The Horse. 2022.
  4. Johnson, PJ et al. Laminitis and the equine metabolic syndrome. Vet Clin North Am Equine Pract. 2010. View Summary
  5. Walsh DM. Field treatment and management of endocrinopathic laminitis in horses and ponies. Vet Clin North Am Equine Pract. 2010. View Summary
  6. Taylor D, et al. Clinical Outcome of 14 Obese, Laminitic Horses Managed with the Same Rehabilitation Protocol. J Equine Vet Sci. 2014.
  7. Watts, KA. Forage and pasture management for laminitic horses. Clin Tech Equine Pract. 2004.
  8. Longland, AC. et al. Pasture Nonstructural Carbohydrates and Equine Laminitis. J Nutr. 2006. View Summary
  9. Getty, JM. Testing Your Horse Pasture for Peace of Mind. Equimed. 2017.
  10. Vervuert, I. et al. Effects of chromium yeast supplementation on postprandial glycaemic and insulinaemic responses in insulin-resistant ponies and horses. Pferdeheilkunde. 2010.
  11. Respondek, F. et al. Dietary supplementation with short-chain fructo-oligosaccharides improves insulin sensitivity in obese horses. J Anim Sci. 2011.
  12. Winter, JC. et al. Oral supplementation of magnesium aspartate hydrochloride in horses with equine metabolic syndrome. Pferdeheilkunde. 2016.
  13. Hess, T. et al. Effects of n-3 Fatty Acid Supplementation on Insulin Sensitivity in Horses. J Equine Vet Sci. 2013.
  14. Elzinga, SE et al. Effects of Docosahexaenoic Acid–Rich Microalgae Supplementation on Metabolic and Inflammatory Parameters in Horses With Equine Metabolic Syndrome. J Equine Vet Sci. 2019.View Summary
  15. Sillence, M et al. Demographic, morphologic, hormonal and metabolic factors associated with the rate of improvement from equine hyperinsulinaemia-associated laminitis. Vet Clin North Am Equine Pract. 2010. View Summary
  16. Cripps, PJ. et al. Factors involved in the prognosis of equine laminitis in the UK Equine Vet J. 1999. View Summary
  17. van Eps, AW. Acute Laminitis: Medical and Supportive Therapy. Vet Clin Equine Pract. 2010.
  18. Tanner, M.A. et al. The direct release of nitric oxide by gypenosides derived from the herb Gynostemma pentaphyllum. Nitric Oxide. 1999.
  19. Aktan, F. et al. Gypenosides derived from Gynostemma pentaphyllum suppress NO synthesis in murine macrophages by inhibiting iNOS enzymatic activity and attenuating NF-kappaB-mediated iNOS protein expression. Nitric Oxide. 2003.
  20. Sarzi-Puttini, P. et al. Acetyl-L-carnitine in chronic pain: A narrative review. Pharmacol Res. 2021.
  21. Jones, E. et al. Neuropathic changes in equine laminitis pain. Pain. 2007. View Summary