Content

1. Intro
2. Not all hoof pain is laminitis
3. So, what is laminitis?
4. Types of laminitis and their causes
5. The importance of healthy blood flow
6. Recognising the symptoms
7. March 2020. Our MacAttack gets laminitis, and it's all my fault
8. Early intervention is critical
9. Once they're walking comfortably again?
10. To conclude
    

Quick disclaimer : the content of this page is based on my own personal research and experience, and is not intended as a substitute for veterinary advice. We would encourage everyone to make their own equine healthcare decisions based upon their own research.

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 incredibly cute Molly. Molly was all of 12hh of hardy native fluff who we bought from Sid the Gypsy (as he was known), a perfectly amenable horse trader.

For those of you who know me, you'll know that with me I'm a sucker for a sob story - 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 dead-centre white heart blaze. I also knew there was no way she going back with Sid. He knew salesmanship - he brought ponies to you instead of you going to see them (so you could still walk away), so Molly became one of the family there and then.

The second time was with Tabby's second pony, Dinky. We'd only had him for 6-weeks before he literally crashed overnight with lami. With hindsight, we'd not long moved to what we later discovered was a highly toxic area, and I firmly believe that this was a contributory factor as to why Dinks, as well as our other horses, became very sick. The full story's in our About chapter.

The third lami? Well, that was our MacAttack in 2020, one week after Covid lockdown, and was entirely my fault, all explained further on.

Back to Molly and Dinks though, and I learned so much from them. When you see how brave and stoic these little ponies are while enduring crippling pain, it's humbling. Since then, and wearing my EquiNatural hat, I’ve heard so many sad stories from clients over the years. 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.
• But the good news is, it’s 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 also sole bruising, and arthritis/ringbone ... the list goes on ...

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's utterly debilitating, and can afflict any horse, young or old, and any breed.

The laminae have just one job – to keep the pedal bone correctly secured within the hoof capsule.

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 the late 2000's, 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 immune systems were also affected, and that it should now be considered a metabolic '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. There's more:

• 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.

Types of laminitis and their causes

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
• a poor/inappropriate diet causing hindgut disruption, which leads to depressed immunity
• more recently (2021) with the science identifying a multi-metabolic detoxification disorder known as Cryptopyrroluria, aka KPU
  

The following summary breaks down each type of laminitis (as at 2024) into its key causes and treatment considerations.

1. Gut-Related Laminitis: Most cases stem from gut dysbiosis, where an imbalance in the gut microbiome triggers inflammation and toxin-related laminitis. Antibiotics can worsen this, as they damage the gut biome, causing glucose and insulin peaks that heighten laminitis risk. Treatment should focus on stabilising the gut, elevating pH, and feeding quality adlib meadow hay with natural grass forage-fibre feeds to support the biome.
   
   
2. Winter Laminitis: In colder weather, blood flow to the hooves can be restricted, particularly in horses with chronic laminitis. When temperatures drop, vasoconstriction occurs, limiting blood flow to the hoof and triggering symptoms. Warming the hooves, rather than cooling, is recommended in these cases.
   
   
3. Stress-Related Laminitis: Stress shifts blood flow to muscles, reducing supply to organs, including the hooves. In chronic stress, this reduced blood flow impairs hoof health over time, which can lead to laminitis. Encouraging movement and avoiding stabling helps maintain circulation, supporting hoof growth and recovery.
   
   
4. Endotoxin-Related Laminitis: Triggered when fructans or starch enter the hindgut, causing lactic acid bacteria to multiply and rapidly lower pH. This disrupts the fibre-fermenting microbiome, releasing endotoxins that lead to laminitis. Stabilising the hindgut and feeding adlib quality meadow hay can mitigate this.

The importance of healthy blood flow

Whichever the trigger, the laminae in the hoof are affected by the disruption of a healthy blood flow to and from the hoof. 

It’s not pretty, which is why everything we do should focus on keeping the gut functioning at its best - helping to prevent leaky gut and keeping that vital blood supply clean and healthy. It’s also important to be mindful of the gut:liver:kidneys pathway, which is key to the body's natural (and very sophisticated) detox system. When working in harmony together, the liver, kidneys, and lymph nodes are responsible for draining and excreting toxins, keeping the whole system running smoothly.

Back in 2013–2014, researchers at the University of Queensland looked at blood flow to the hoof in horses living in temperate conditions. In normal healthy horses, they found that normal blood flow was often interrupted by long periods of very low flow - all completely normal. However, when they studied horses in the early (low-grade) and acute stages of laminitis, they noticed something different: blood flow actually increased before any signs of pain appeared.

Those with heat in the hooves - a sign of vasodilation - went on to develop laminitis. What’s happening here is that the central nervous system (CNS) recognises the need to deliver more nutrients to metabolically active tissue, so it widens the blood vessels and releases excess heat. Interestingly, the studies also showed that when vasoconstriction occurred — where the blood vessels narrowed and blood flow decreased - laminitis didn’t develop.

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.

Recognising the symptoms

The early acute stage can show early warning signs - uncoordinated movement, anxiety, increased heart rate, immobility, a reluctance to turn. Later signs, but still in the acute stage, might 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 pollen allergy reaction. With Mac, he had no visible symptoms - he was just 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 regularly is to check for digital pulses. If your horse is 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 2025: Check out the Lami-Tag app, the world's first digital pulse smart sensor to help you monitor your equines digital pulse.

March 2020. Our MacAttack gets laminitis

Two weeks after the first lockdown, our little thug went down with laminits. No sign of any event lines, but he was completely rooted to the spot at the far end of a 10-acre field, with raging hot hooves. His pulses, to me, weren't throbbing, just seemed slightly raised, but a 2nd opinion thought different and considered them pounding. (If only Lami-Tag had been around then!).

He literally couldn't walk, so I syringed our TriBute into him while mentally beating myself up - this was all my fault. We rigged up a small corrall around him with hay, but for the next three days he really wasn't really interested in eating, just standing still or lying down and looking very sorry for himself.

However, three days later he was standing more and shuffling very carefully, and by day 5 he seemed more comfortable and clearly very keen to be back with his buddies on the other side of his corrall. By day 7 we crossed everything as 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 stayed 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 Mac get laminitis? 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 (yep; the clue was loud and clear!) - 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 few days 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 risk. 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 with no thuggery!

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 that I had my head in the sand. Being back on our previous yard where I'd met him 4-years previously, I obviously assumed that his gut knew that grass to be 'safe'. Truthfully 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 also 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.

Update, September 2021 Having just completed an intensive equine nutrition seminar on the multi-metabolic detoxification syndrome, Cryptopyrroluria (KPU), 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.

Update, March 2023 After 18-months we're now so happy to announce that MacAttack has been renamed to just Mac! After diligently following a KPU reset programme for 18-months, Mac's now in such a good place - he's turned into a soppy cuddle-monster! Who knew he had it in him?! Clearly he'd been in so much discomfort all his life with a seriously disrupted inner engine, and having helped stabilise his gut and liver detoxification function, he's now much more balanced, and frankly lovely to be around!

Early intervention is critical

No question - the first step with Laminitis is Alleviation.

• After getting your horse off grass asap, immediately apply cold therapy, i.e.
• Cold hosing or a cold-water bucket soak 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 to potentially reduce any damage. 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.
• Your horse will also be experiencing severe pain and inflammation which needs immediate support for at least a week, if not two.
• Never force a sore horse to move, as this can cause physical damage to the hoof structure – far better that the vet sees the horse where he is comfortable.
• If your horse can move, get them onto a conformable surface with as little pressure on the sole as possible. Remember though, that once they're able to stand reasonably comfortably, a stable means the only movement they can do are sharp pivot turns which will put enormous strain on their inflamed hooves. Far better to have a larger space to shuffle in, i.e. a small corrall in their field near their buddies.

Laminitis develops due to a disruption in the blood - toxins or circulatory issues, so perfect prevention is key.

• Everything starts with the gut - keep the gut system, microbiome and immunity strong and healthy. See our Gut System section.
  
  
• Fibre, fibre, fibre - feed hay, hay, and more hay
• If you feed a horse haylage, best avoided.
• If haylage was fed, the hindgut needs to deacidify, so feed Spirulina for a couple of weeks. It's an excellent toxin-binder and is mainly excreted via the liver-bile-intestine route, thus relieving the kidneys.
• If you soak your hay, not ideal.
• If you feed a horse alfalfa, not recommended (Dr Kellon says so too).
• If you let your horse run out of hay, especially if stabled overnight, seriously bad.
  
  
• 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. All covered in our Feeding our Horses section off the main menu, and specifically our Why what we feed has to be right page.
  
  
• Become Grass-Aware! All covered in our 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. Obvious we know, but if you can’t exercise, restrict, and do not feed CRAP junk feeds (carbs/refined/artificial/processed). But – do NOT starve your horse - see our EMS/IR Metabolic Horse page for more info. Feed a carefully managed diet with plenty of high-fibre meadow-grass hay, to stabilise and reset the hindgut fibre-fermenting microbiome.
  
  
• Balance the nutrient profile in your forage. Balanced minerals in your horse’s diet = a healthier horse = significantly less risk of laminitis. Horses need a clean, nutrient-rich, balanced diet with the right nutrients balance their inner chemistry and help support the healing process during recovery. See our Mineral Solutions page.

Once they're walking comfortably again?

It's Detox & Fortify time, but not until they've been walking comfortably for at least 2-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 - see our KPU page.

Fortify

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. Full stop. A horse has an absolute requirement for forage fibre, with the forage-nutrient deficiencies needing to be balanced by mineral supplementation.

There's also good forage, and bad forage. Here in the UK, there's only one good forage and that's stemmy, fibre-filled hay - not our neon-green leaf-blade-only-with-no-stem (so no fibre) grass; not lactic-acid bacteria-laden, acidic haylage; not alfalfa because it triggers gut, skin, and hoof sensitivities in so many horses, and especially our metabolics. Just hay, hay and more hay, as in late-cut grass preferably gone to seed so there's lots of lovely equine gut-appropriate cellulose fibre in the stems.

All covered in our Feeding our Horses Healthy section.

To conclude

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.