Understanding Laminitis: Treatment for a Laminitic Horse

Laminitis in horses is one of the most feared conditions in the equine world — and with good reason. This painful, potentially life-threatening disease affects the sensitive laminae within the hoof, and if not recognised and treated promptly, it can cause permanent structural damage, chronic lameness, or even necessitate euthanasia. The British Horse Society estimates that around 1 in 10 horses and ponies in the UK is affected by laminitis every year. Understanding the causes, recognising the early signs of laminitis, and knowing how to manage a laminitic horse can make the difference between a full recovery and lasting harm.

What Is Laminitis?

Laminitis is inflammation and damage to the laminae — the interlocking, leaf-like structures that bond the hoof wall to the pedal bone (also called the coffin bone or distal phalanx). These laminae bear the horse’s entire weight, so when they become inflamed or weakened, the connection between the hoof wall and the bone can fail.

In severe cases, the pedal bone may rotate downwards or sink within the hoof capsule — a condition known as founder. This is an emergency and can result in the bone penetrating through the sole of the hoof.

Laminitis can affect any horse, pony, or donkey, but certain types are at significantly higher risk. Native ponies, Shetland ponies, cobs, and other good doers are particularly susceptible, as are horses with underlying metabolic conditions.

What Causes Laminitis in Horses?

Laminitis is not a single disease but rather the end result of several different triggers. Understanding these causes is essential for prevention.

Endocrine (Hormonal) Causes

The majority of laminitis cases in the UK are now attributed to hormonal disorders. The two main conditions are:

• Equine Metabolic Syndrome (EMS) — characterised by insulin dysregulation, regional adiposity (fat deposits on the crest, behind the shoulder, and around the tailhead), and a predisposition to laminitis. Horses with EMS have abnormally high insulin levels, which directly damage the laminae.
• Pituitary Pars Intermedia Dysfunction (PPID) — commonly known as Cushing’s disease. Most often seen in horses over 15 years of age, PPID causes hormonal imbalances that increase laminitis risk. Classic signs include a long, curly coat that fails to shed, muscle wastage, lethargy, and increased drinking and urination.

The British Horse Society puts it at up to 90% of laminitis cases being linked to an underlying hormonal disorder. That figure traces back to a Finnish teaching-hospital series of 36 laminitis cases, of which 89% showed evidence of an endocrinopathy (Karikoski et al., Domestic Animal Endocrinology 2011;41(3):111-7). It is a small hospital series from another country rather than an audit of British practice, so read it as a measure of how dominant endocrine causes are, not as a precise UK statistic.

Dietary Overload

Consuming excessive amounts of rapidly fermentable carbohydrates — whether from lush grass, grain, or concentrated feed — can trigger laminitis through a cascade of events in the hindgut. The carbohydrates overwhelm the small intestine’s capacity to absorb them and pass into the caecum and large colon, where they ferment rapidly. This kills beneficial bacteria, releases endotoxins into the bloodstream, and compromises blood flow to the laminae.

Common dietary triggers include:

• A horse breaking into the feed room and gorging on grain or mix
• Sudden access to rich spring or autumn grass
• Excessive amounts of cereal-based hard feed
• Fruit windfalls (apples, pears) in the field

Supporting Limb Laminitis

When a horse bears excessive weight on one limb due to a severe injury in the opposite leg, the overloaded limb can develop laminitis. This is because continuous, unrelieved weight-bearing reduces blood flow to the laminae. Supporting limb laminitis is most commonly seen after fractures or severe infections that prevent the horse from using one leg normally.

Sepsis-Related Laminitis

Systemic infections and toxic conditions can trigger laminitis by releasing inflammatory mediators into the bloodstream. Common causes include:

• Retained placenta — if a mare has not passed the placenta within three hours of foaling, endotoxaemia and laminitis are serious risks
• Severe colic — particularly cases involving gut compromise or requiring surgery
• Pneumonia and other severe systemic infections
• Colitis — severe diarrhoea from any cause

Mechanical Overload

Excessive work on hard ground, particularly in unshod horses or those with poor hoof conformation, can cause mechanical damage to the laminae. This is sometimes called “road founder” and is seen most commonly in horses worked extensively on tarmac or compacted surfaces.

Signs and Symptoms of Laminitis

Early recognition of laminitis signs in horses is crucial — the sooner treatment begins, the better the outcome. Signs vary depending on whether the condition is acute (sudden onset) or chronic (long-standing).

Acute Laminitis Signs

• Reluctance to walk — the horse may be unwilling to move, particularly on hard or uneven ground
• The “laminitic stance” — the horse rocks its weight back onto the heels, often leaning backwards with the front feet stretched out in front. This characteristic posture relieves pressure on the painful toe area
• Increased digital pulse — a bounding pulse felt at the back of the pastern, over the digital arteries. In a healthy horse, this pulse is barely palpable; in a laminitic horse, it throbs strongly
• Heat in the hooves — the affected feet feel noticeably warmer than normal
• Shifting weight — the horse constantly shifts from foot to foot trying to find relief
• Lying down more than usual — to take weight off painful feet
• Shortened stride — a pottery, stilted gait, particularly noticeable on turns
• Pain response to hoof testers — a vet or farrier pressing hoof testers across the sole will elicit a pain response, typically most marked at the toe

Chronic Laminitis Signs

• Divergent hoof rings — growth rings on the hoof wall that are wider at the heel than the toe, indicating abnormal hoof growth
• Dished hoof wall – the front of the hoof develops a concave (dished) shape as the pedal bone rotates
• Flat or dropped sole — in severe cases, the sole becomes convex (dropped) as the pedal bone pushes downwards
• White line widening — visible stretching of the white line at the toe
• Recurrent abscesses — particularly at the toe
• Long-term lameness — variable but often worst on hard ground and tight turns

How Laminitis Is Diagnosed

A veterinary diagnosis of laminitis typically involves:

1. Clinical examination — assessing gait, stance, digital pulses, hoof temperature, and response to hoof testers
2. Radiographs (X-rays) — lateral views of the feet to assess pedal bone position. X-rays reveal whether the bone has rotated (measured as the angle between the bone and hoof wall) or sunk (measured as the distance between the bone and the coronary band). These measurements guide treatment and provide a baseline for monitoring
3. Blood tests — to check for underlying EMS or PPID. Key tests include resting insulin, ACTH (for PPID), and glucose. An oral sugar test or thyrotropin-releasing hormone (TRH) stimulation test may be used for borderline cases

Grading the severity helps guide treatment decisions. The Obel grading system is commonly used:

• Grade 1 — subtle lameness, shifting weight, shortened stride at trot
• Grade 2 – moves willingly at walk and trot but with a shortened, stabbing stride; a foot can still be lifted without difficulty
• Grade 3 — reluctant to move; resists attempts to lift feet
• Grade 4 — refuses to move; may be recumbent

Treatment for Laminitis in Horses

Laminitis treatment in horses requires swift veterinary attention and a multi-pronged approach targeting pain, the underlying cause, and hoof support.

Immediate First Aid

If you suspect laminitis:

1. Call your vet immediately — laminitis is an emergency
2. Move the horse to a stable with a deep, supportive bed (shavings or sand are ideal as they mould to the foot). If the horse is very reluctant to walk, do not force it — wait for veterinary advice
3. Remove all hard feed and restrict grazing – offer soaked hay only, and ask your vet how much to feed. Soaking leaches sugar but it does not make hay reliably safe: soaking UK hays for up to 16 hours removed on average 27% of their water-soluble carbohydrate, and seven of the hays tested were still above the 100 g/kg dry matter ceiling suggested for laminitic animals afterwards (Longland et al., Veterinary Record 2011)
4. Apply frog supports — if available, Styrofoam pads, proprietary frog supports, or even rolled bandages taped to the frog can provide immediate relief by supporting the pedal bone from below
5. Ask your vet about icing the feet – cryotherapy is a veterinary-directed treatment, so do not start or stop it on your own, but do not assume it is too late either. The common belief that icing only helps before a horse goes lame is wrong: in a controlled trial, continuous digital hypothermia begun at the moment lameness was detected still reduced lamellar injury and prevented lamellar structural failure altogether (van Eps et al., Equine Veterinary Journal 2014;46(5):625-30), and the MSD Veterinary Manual describes cryotherapy during the developmental and acute stages as currently the most effective treatment for reducing laminar damage

Veterinary Treatment

• Pain relief — non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone (“bute”) or meloxicam are the mainstay. In severe cases, additional analgesia may be needed
• Cryotherapy – continuous icing of the feet using ice boots or immersion in ice water. Valuable both in the developmental phase (e.g., if a horse has gorged on grain and laminitis is anticipated before signs appear) and once the horse is already lame. It has to be continuous to work, which is why it is a vet-directed treatment rather than an occasional cold hose
• Addressing the underlying cause — treating the infection, managing the metabolic disorder, or correcting the dietary trigger
• Frog and sole support — the vet may apply specialist supports to redistribute weight away from the compromised laminae and onto the frog and sole
• Box rest — strict confinement on deep bedding until the acute phase has passed and the vet gives clearance for controlled movement

Remedial Farriery

Farriery plays a critical role in laminitis treatment. Working closely with the vet and guided by radiographs, a remedial farrier will:

• Trim the hoof to realign the pedal bone within the hoof capsule
• Apply heart-bar shoes or other supportive shoeing to redistribute weight
• Use impression material or pads beneath the shoe to support the frog and sole
• Schedule more frequent trimming cycles (typically every 4–6 weeks) to maintain correct alignment as the hoof grows

In severe cases of chronic laminitis with significant pedal bone rotation, a deep digital flexor tenotomy may be considered. This surgical procedure cuts the deep digital flexor tendon to relieve the pull that is rotating the pedal bone, allowing the bone to derotate and the horse to grow a healthier hoof capsule.

Managing Chronic Laminitis

Horses that have suffered laminitis require ongoing, careful management to prevent recurrence and maintain comfort.

Diet and Weight Management

• Feed low-sugar, low-starch forage – soaked hay or a commercially available low-sugar hay replacer. Warm water leaches more sugar than cold, not less, so a quick warm soak is not the equivalent of a long cold one: over a 16-hour soak, UK hays lost 28% of their water-soluble carbohydrate at 8°C against 46% at 16°C (Longland et al., Veterinary Record 2014). Long soaks also raise the bacterial load of the hay, so having your forage analysed beats guessing at a soaking time
• Avoid cereal-based hard feeds entirely — use a low-calorie ration balancer for essential vitamins and minerals
• Restrict grazing using a track system, bare paddock, or grazing muzzle
• Monitor body condition score regularly — aim for a score of 2.5–3 out of 5
• Weigh the horse regularly using a weigh tape — even a 10% reduction in bodyweight can dramatically reduce laminitis risk in overweight horses

Exercise

Once a laminitic horse has been cleared by the vet for exercise, controlled movement is beneficial. Walking in-hand on soft ground helps improve hoof blood flow and promotes weight loss. Build up gradually — start with 5–10 minutes of walking and increase over weeks as the horse’s comfort allows.

Ongoing Monitoring

• Regular veterinary check-ups, including repeat blood tests for EMS/PPID
• Routine radiographs to monitor pedal bone position
• Daily digital pulse checks — know what is normal for your horse
• Body condition scoring at least monthly

Preventing Laminitis

Prevention is always better than cure. For horses at risk of laminitis, the following measures are essential:

Grazing Management

• Restrict access to lush pasture — use strip grazing, track systems, or a bare paddock with hay fed from the ground
• Do not rely on a “safe” time of day – grass sugar does build through the day and fall overnight, but that pattern was measured in late summer, not in spring. Spring grass has been shown to hold high levels of non-structural carbohydrate right through the day and overnight, and Spillers science and nutrition director Edd Knowles put it plainly after the 2026 European Workshop on Equine Nutrition: “we mustn’t assume early morning turnout is always safe during periods when grass NSC levels remain high” (Horse & Hound, August 2026). For a severely insulin-dysregulated horse at a high-sugar time of year there is no safe grazing window, and complete removal from pasture may be needed
• Use a grazing muzzle — reduces grass intake by approximately 80% while still allowing the horse to move and socialise
• Test your pasture — some owners have their grass analysed for water-soluble carbohydrate content

Weight Management

• Maintain a healthy body condition score (ideally 2.5–3/5)
• Weigh regularly and track trends
• Provide a low-calorie, forage-based diet
• Ensure adequate exercise appropriate to the horse’s fitness and soundness

Metabolic Screening

• Test for PPID on the basis of clinical signs and age, not age alone. BEVA’s primary-care guideline rates the pre-test probability of PPID as low in equids under 10, and warns that testing where pre-test probability is low raises the risk of a false positive, which “could compromise horse welfare due to the commencement of lifelong therapy and/or failing to identify and treat an alternative potentially life-threatening condition” (Menzies-Gow et al., Equine Veterinary Journal 2024;56(2):220-242). Prevalence in equids aged 15 and over is 21-27%, so an older horse showing any suggestive sign is worth testing
• Screen at-risk breeds (native ponies, cobs, good doers) for EMS
• Treat diagnosed conditions promptly — pergolide for PPID, dietary management and sometimes metformin for EMS

Hoof Care

• Regular farrier visits every 6–8 weeks
• Maintain correct hoof balance and avoid excessively long toes
• Address any hoof abnormalities promptly

Laminitis and the Seasons

Laminitis is not a spring disease, and that is the single most important thing to unlearn about it. The two best British studies both say so. A cohort of 1,070 horses and ponies followed by the Royal Veterinary College and the Animal Health Trust found laminitis “occurred throughout the year with no significant differences between seasonal incidence estimates” (Pollard et al., Equine Veterinary Journal 2019;51(5):587-594), and an earlier case-control study of 191 vet-diagnosed British cases found summer and winter carried a higher risk than spring (Wylie et al., The Veterinary Journal 2013;198(1):57-69). What each season brings is still worth knowing; what must not change with the season is your vigilance.

• Spring (March–May) – rapid grass growth, high sugar content and horses that have gained weight over winter. Spring grass holds high levels of non-structural carbohydrate through the day and overnight, so there is no low-sugar window to turn out into
• Summer (June–August) – a genuine risk period rather than a lull, and the one season in which the classic daily pattern has actually been measured: in late summer, grass sugar peaked around 7pm and was at its lowest early in the morning
• Autumn (September–November) – autumn grass can be as sugar-rich as spring growth, and horses may be carrying extra weight from summer grazing
• Winter (December–February) – the lowest pasture intake, but not the lowest risk: the Wylie case-control study found winter carried a higher risk of vet-diagnosed laminitis than spring, and PPID-related laminitis occurs year-round. Sunny frosty mornings remain a recognised caution, when cold nights slow growth and sugars accumulate in the leaf

Recovery and Prognosis

The prognosis for laminitis depends heavily on the severity of the episode and the speed of treatment:

• Mild cases (Obel Grade 1–2) with no pedal bone displacement — good prognosis with prompt treatment. Most horses return to full work within 2–3 months
• Moderate cases with some pedal bone rotation — fair prognosis. Recovery may take 6–12 months, and the horse may require ongoing management and remedial farriery
• Severe cases with significant rotation or sinking — guarded prognosis. Some horses can be managed for comfort and light work, but others may face chronic pain that cannot be adequately controlled

It is vital to understand that a horse that has had one episode of laminitis is at significantly increased risk of recurrence. Lifelong management adjustments are usually necessary.

When to Call the Vet

Call your vet immediately if your horse shows any of the following:

• Reluctance to move or a pottery, shortened gait
• A strong, bounding digital pulse in one or more feet
• Heat in the hooves
• A characteristic leaning-back stance with front feet extended
• Lying down more than usual and reluctance to rise
• Any horse with known EMS or PPID that shows any change in gait or comfort

Laminitis is a veterinary emergency. Early treatment dramatically improves outcomes — do not wait to see if it improves on its own.

Frequently Asked Questions