Laminitis

Content

1. Intro
2. Not all hoof pain is laminitis
3. So, what is laminitis?
4. It's all about healthy blood flow
5. Recognising the symptoms
6. Update - March'20. Our MacAttack gets laminitis
7. Early intervention is critical
8. Once they're walking comfortably again?
   

I've personally experienced ...

... three first-hand cases of full-onset laminitis with our own horses.

The first was with husband's daughter, Tabatha's, first pony, the adorable Molly. Molly was all of 12hh of hardy native fluff who we bought from Sid the Gypsy (as he was well known), a perfectly amenable gypsy horse trader.

For those of you who know me, you'll know that with me it only takes one look and that's it - I'm hooked. Well, it only took one look to realise that when we first saw Molly she was in the throes of full blown laminitis, and to be honest I think that was the reason I took her there and then, and didn't even quibble the price. Apart from the fact that I instantly fell for her (I mean, come on - she was a hairy ball of jet black fluff with a heart-shaped white blaze 💖), I also knew there was no way I was going to let her go back with Sid, so Molly came to live with us there and then.

The second time was with Tabby's second pony, Dinky. He literally crashed overnigh after only owning him for 6 weeks. However, we'd not long moved to what we later discovered was a highly toxic enviroment, and I firmly believe that this was a contributory factor as to why Dinks, as well as our other horses, became extremely sick. For the full story, read our About chapter.

The third lami? Well, that was our MacAttack in 2020, one week after Covid lockdown, and was entirely my fault. See the page update down below.

I learnt so much from Molly and Dinks. When you see how brave and stoic these little ponies are while enduring crippling pain, it’s a humbling experience. Since then, and wearing my EquiNatural hat, I’ve heard many sad stories from our clients and their laminitic horses and ponies. On the positive side, the good news is that laminitis is one of the most researched and studied equine conditions, which is now shouting out two very clear messages :

• Laminitis can affect any horse, any pony, any breed – including TB’s.
• Laminitis is preventable.

However ...

Not all hoof pain is laminitis

There are many other causes of hoof pain that aren't related to laminitis - for starters, if your horse is unsound or has general hoof issues, just moving around can make them more uncomfortable. And lest we forget, abscess pain is excruciating, plus there's sole bruising, and arthritis/ringbone.

Equally, not all footy, obese horses will have laminitis - the strain of carrying around that extra weight will add extra risk of lameness and pain.

And then there's 'winter laminitis', in which Dr. Kellon shares valuable insights on cold-induced hoof pain in a Dr K’s HorseSense. It's commonly referred to as ‘winter laminitis’ due to the reluctance to move, yet there's apparently (quote) "no evidence of inflammation and typically no radiographic changes. The cause actually seems to be a failure of the hoof to effectively respond to cold induced changes in circulation.

In horses not bothered by the cold, homeostatic mechanisms will … prevent oxygen and nutrient levels from getting too low. In horses with cold-induced hoof pain, this process appears to fail and the tissues are not adequately perfused.”
 
With great recommendations on what to do, it’s well worth a read.

Meanwhile, specific event lines are a clear sign of laminitis, being very close together at the toe. wide apart at the heels, and heading downwards in an arc. If the lines are different to this, you're looking at other reasons for the event lines such as diet change, illness, or an extreme exercise event.

The most common hoof care errors tend to be long toes and low, underrun heels, which can lead to the bone column dropping in the hoof capsule, poor sole depth, mechanical stretching of the laminae, and strain on the DDFT (deep digital flexor tendon).

So, what is laminitis?

Laminitis is a serious inflammation of the sensitive laminae, or layers of tissue, inside the hoof. It is utterly debilitating, and can afflict any horse, young or old, and any breed.

The laminae have just one item in their Job Description – to secure the pedal bone (the wedge-shaped bone within the foot), also known a the coffin bone or P3, to the hoof wall.

There are two types of laminae in the hoof - the ‘sensitive’ which supports the pedal bone, and the ‘insensitive’ which is attached to the inner hoof wall – and they bind to each other to protect the pedal bone. However, when a ‘trigger’ happens further up in the system which causes the laminae to inflame (known as ‘acute’ laminitis), the function and form of the hoof as a whole can potentially be compromised. If not caught in time, the progression of laminitis from ‘acute’ to ‘chronic’ can be swift, and severe.

Until 2012, laminitis was only ever thought of as a hoof disease, then in 2012 that all changed with research showing that chronic laminitis was not just limited to the foot, specifically that the gut and immunity systems were also affected, and that it should now be considered a 'multi-system' disease. This is all the more important considering that back then the usual conventional vet/farrier route was simply to focus on making sure the hooves were comfortable, without considering preventative measures for the gut and immunity.

Chronic cases are termed as such due to the displacement, or sinking, of the pedal bone, also known as ‘rotation’, although in reality it doesn't actually rotate. The bond between the sensitive and insensitive laminae separates, which means the outer hoof wall can no longer support the leg bone-structure and weight of the body within the hoof. The pedal bone then becomes loose in the hoof structure, and the hoof structure itself becomes ‘mobile’. The horse’s bodyweight, together with added pressure from movement, can then cause the pedal bone to displace downwards, tearing through the weakened laminae. I know ... doesn't bear thinking about ...

The veins, arteries and the sole corium (a blood-filled gel pad which aids in shock absorption and produces the sole horn) surrounding the hoof wall and sole, are destroyed as the pedal bone, followed by the leg bone column, sinks (founders) through the hoof and penetrates the sole, devastating the entire hoof. NB – the more the hoof wall is raised with no sole support, i.e. remedial heart-bar shoes, the further the bone column can sink, which is why shoeing a laminitic hoof for 'protection' is far from appropriate.

If the laminitis gets to this stage, the horse's life could now be seriously at risk, although remarkably this is still survivable. A vet may recommend euthanasia, however, due to the extreme degree of suffering and the risk of infection.

It's all about healthy blood flow

Whether the laminitic trigger is feed-induced or brought on by a metabolic disruption, i.e. hindgut dysbiosis/leaky gut, the laminae in the hoof are affected by the disruption of a healthy blood flow to and from the hoof, in other words, undigested toxic waste leaking throught the intestinal wall into the bloodstream. It’s not funny, and not pretty, so everything should be done to make sure the gut system is healthy in order to prevent leaky gut and keep that vital blood supply clean and healthy. This also means being mindful of the gut:liver:kidneys pathway which is key to the body's natural - and very sophisticated - detoxification system, namely the liver, kidneys and lymph nodes, or as I call them, the 3-Amigos, all working in harmony with each other.

The root causes of laminitis are usually all interconnected, usually triggered by either a feed-disruption in a confirmed EMS/IR or Cushings/PPID pony/horse, or a poor/inappropriate diet causing hindgut disruption, which leads to a depressed immunity, or more recently (2021) with the latest science identifying a multi-metabolic detoxification disorder known as Cryptopyrroluria, aka KPU for short. Whatever the triggers, all lead to overburdened toxic levels in the bloodstream.

Back in 2013/2014, researchers at the University of Queensland studied blood flow to the hoof, in horses in temperate conditions. In normal healthy horses, it was noted that there were periods of normal blood flow interrupted with long periods of very low flow. The same studies were carried out on horses in the initial (low-grade) and ‘acute’ stage of laminitis, which showed that blood flow increased prior to the development of pain.

Those with heat in the hooves which indicated vasodilation - where the nervous system (CNS) automatically recognises that it must provide more nutrients to metabolically active tissue, and so widens the blood vessels and releases excess heat - developed onset laminitis. The studies then showed that if vasoconstriction occurred - where the blood vessels constrict and essentially decrease the blood flow - laminitis did not transpire.

Recognising the early signs of laminitis is crucial, so first up, cool those legs and hooves - cold hosing, ice buckets, whatever you can lay your hands on to reduce the heat and inflammation. Reduce the inflammation and heat, and you could well be on your way to preventing onset laminitis. However, if left untreated, the horse’s life can potentially be put at risk if the bone structure and the hoof wall separates.

Recognising the symptoms

The early 'acute' state can show early warning signs - uncoordinated movement, anxiety, increased heart rate, immobility, a reluctance to turn. Later signs, but still in the acute stage, may be a rocked-back stance, lameness, reluctance to move forward, and signs of pain such as heavy breathing, flared nostrils, or patches of sweat.

For the record, Molly, Dinky and Mac all presented with different symptoms - with Molly we had uncoordinated movement and awkward stiff walking; with Dinks we had seriously heavy breathing with significant sweating, enough to make me first think that he was having an extreme respiratory pollen reaction. With our MacAttack in March 2020 (see below), he was basically completely immobile at the top of the field. None of them had the rocked-back stance.

Whether you see the obvious signs or not, one of the easiest ways to monitor is to check for digital pulses. If your horse or pony is out on grass, check the hooves every day. If you feel the pulse bounding, and/or any unusual warmth in the hooves, or you see the formation of event lines appearing below the coronary band, usually curling down towards the heels, these could be the first signs of the early stages, also known as low-grade laminitis (LGL), and your signal to take preventative action.

Update - March'20. Our MacAttack gets laminitis

Two weeks after the first lockdown, our little thug went down with laminits. No sign of any event lines, but raging hot hooves, and he was completely rooted to the spot - he simply couldn't walk. His pulses, to me, weren't throbbing, just seemed slightly raised, but a 2nd opinion thought different and considered them pounding.

We took it very slowly to get Mac stoically shuffling himself down the field into a small corrall we rigged up next to our field shed (the yard and his stable were too far away), and I got him on our TriBute straight away with plenty of hay. He wasn't really interested in eating, just standing still or lying down and looking very sorry for himself. When he did try to take a step you could see he was in agony.

However, three days later he was standing more and shuffling very carefully, and by day 5 he seemed more comfortable and very keen to be back with his buddies on the other side of his corrall. By day 7 he finally went back out with a muzzle, which mysteriously came off overnight. True to his name - he's not called MacAttack for nothing - he refused to have it back on.

He staying on the TriBute for a week in total, shuffling within his comfort levels before we felt comfortable enough to switch him down to our DuoBute for the summer, although I've since kept him permanently on it in his feed every day as a preventative.

So how did he go down with it? My fault entirely. We had to move yards when the first Covid lockdown hit, literally on the Saturday before the Monday of the first major lockdown. We'd spent the previous 6-months on a friend's family-run barefoot no-grass yard and a hay-only diet, because I'd badly broken my leg the previous August and needed livery services through winter 2019. Cue Covid in Spring 2020 and with me hobbling fairly decently by then, we returned back to our former yard of ancient sheep moorland grazing.

It took just a week for him to crash. I was so stupid not to see it coming, especially considering he's high up on the metabolic spectrum, full onset IR. He's also impossible to walk out for exercise as he's an unrideable thug and tanks off (his full story's in our Case Studies) plus having myself not long recovered from the leg break I wasn't able to walk him out even if he wasn't a thug!

At the ripe age of 20, this was the first lami bout he'd had with us since we'd known him, but there's no doubt I had my head in the sand as being back on our previous yard where I'd met him 4-years previously, I clearly took it for granted that his gut system knew the grass to be 'safe'. In all honestly I didn't even consider it ...

The others were all absolutely fine, although thanks to Mac I put them all onto lami-watch and I immediately got a track system up. We've now got a smaller summer field with a rigid track system, hay stations set up and two field shelters with a lovely loafing area for them.

Edited to add - September 2021 - Having just completed an intensive equine nutrition training workshop, it's now clear that MacAttack is a classic KPU candidate. Since then we've been treating him as such (see our KPU page for the programme), and already within a short time we're seeing an immense improvement in both his health and demeanour.

Early intervention is critical

The first step with Laminitis is Alleviation. After getting your horse off grass asap (we couldn't with Mac, hence why I rigged up a small skid-row corrall in the field with his buddies on the other side), immediately apply cold water therapy, i.e. cold hosing or cold-water bucket soaking if you can lift a hoof up without causing pain in other affected hooves - if you can get ice-cubes in the water, all the better to help reduce the inflammation potentially reduce any damage, but never apply ice directly on the skin as it can destroy skin tissue.

Apply for 15-30 minutes every few hours for a couple of days only, as it's thereafter vital to allow the blood supply to get to the hooves to start the healing process. They'll also be experiencing severe pain and inflammation which needs immediate support.

If your horse can move, get them onto a conformable surface with as little pressure on the sole as possible. Bring a field buddy in with them so they have company, which will help reduce any stress they may be feeling. If they can’t move, don’t force them as this can cause physical damage to the hoof structure – far better that the vet sees the horse where he is comfortable.

We know the first trigger in developing laminitis is from a toxin-burden in the blood-circulation, so preventing laminitis is making sure those toxins don't leak from the gut into the bloodstream in the first place.

• Everything starts with the gut - keep the gut system, microbiome and immunity strong and healthy. See our Gut System section, and specifically the chapters on Leaky Gut and The Microbiome.
• Species-appropriate Fibre, Fibre, Fibre. If you feed a horse haylage, forget it. If you soak your hay, forget it. If you let your horse run out of hay, especially if stabled overnight, forget it. If haylage was fed, the gut also needs to deacidify, so feed Spirulina for a couple of weeks which is an excellent toxin-binder and is mainly excreted via the liver-bile-intestine route, thus relieving the kidneys.
• Meanwhile, what not to feed! No beet, no alfalfa, no sugars, no pectins, no muslis, no pellets, no treats, and definitely no feedbags with pro-inflammatory gut-damaging wheatfeed, oatfeed, soya, NIS ... basically anything listed in our The Feedbowl – what’s really in those feedbags page. The more basic the feeding program – in other words, the more species-appropriate, as in what a horse is meant to eat and what a horse’s gut is meant to digest – the faster the hindgut environment will be restored to normal. This is all covered in our Feeding our Horses section off the main menu, and specifically the Why what we feed has to be right page.
• Become Grass-Aware! All covered in our Hay, hay, more hay and only hay page.
• Spring/Summer. Look at setting up a track system which is incredibly easy to implement with electric fence posts and tape. Position hay stations so as to allow plenty of movement between them while keeping grass consumption down.
• Winter. Don’t think you're out of the woods once summer is over - as autumnal nights cool down, the dangerous grass carbs once again increase. Frozen frosty grass is akin to a sugary grass-lolly so beware those glorious ice-blue, sunny frosty days. Sugar levels rise in that intense winter sunlight, triggering fructan formation which head straight to the hindgut for the lactic-acid bacteria to gorge on, releasing lactic acid and turning the hindgut acidic.
• Avoid obesity. If you can’t exercise, restrict. But – do NOT starve your horse - see our EMS/IR Metabolic Horse page for more info. Feed a managed diet with plenty of high fibre forage and appropriate vitamins/minerals to support and nourish the system.
• Balance the nutrient profile in your forage. Balanced minerals in your horse’s diet = healthier horse = significantly less risk of laminitis. See our Mineral Solutions page. They need a clean, nutrient-rich, balanced diet with vitamins and minerals to help support the healing process during recovery.

Once they're walking comfortably again?

It's Detox & Fortify time, but not until they've been walking comfortably for at least two weeks afterwards.

Detox

All on our Detoxification page. Clear out the bad stuff and replenish the microbiome which will reset the immune system. As I said earlier, it’s pointless throwing expensive ‘fix kits’ at your horse while the toxic overload is still blocking the body's basic function to be healthy. Also, don't forget - if we've got leaky gut, this needs to be fixed too. NB - if we're talking KPU, the fix-kit is slightly more involved but it's all explained on our KPU page.

Fortify

... And this is all about relooking at the feed regime, with a quick reminder that a horse is nothing more, and nothing less, than a hindgut fibre-fermenting machine - that's it, full stop. A horse has an absolute requirement for forage fibre, with the forage-nutrient deficiencies balanced by mineral supplementation.

Thing is, there's good forage, and bad forage. In our UK climate, there's only one good forage and that's lovely, stemmy, fibre-filled hay - not our neon-green leaf-blade-only-and-no-stem grass, not lactic-acid bacteria-laden, acidic haylage, and not potentially gut-disrupting alfalfa. Just hay, hay and more hay, as in long, stemmy, late-cut, grass preferably gone to seed so there's lots of lovely equine-gut-appropriate cellulose fibre in the stems type of hay.

All covered in our Feeding our Horses section.

Summary

The symptoms of laminitis are awful to witness, with the obvious pain and distress being enough to make us want to do all we can to prevent it ever happening again. Good supportive care such as proper nutrition and restricting grass intake can really help to keep a laminitic-prone horse healthy.