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Laminitis

Laminitis is a common painful condition affecting the feet of horses, ponies and donkeys. The name describes the disease process well – ‘itis’ meaning ‘inflammation of’ and ‘Lamini’ referring to the laminae. The laminae are a network of intertwining finger-like soft tissue structures inside the hooves which attach the internal and external hoof structures to each other. They are incredibly strong and vitally important. When they become inflamed they swell and tear which causes the internal hoof structures to become separated from the external structures – this manifests as the pedal bone rotating and dropping away from the hoof wall. This process is extremely painful and a significant welfare issue for the affected horses.

Causes

Firstly, it is important to note that any horse can get laminitis, not just a certain type. All horses have a threshold which if it is crossed, they can be triggered into a laminitic state. We see laminitis cases in slim thoroughbreds as well as good-doer ponies.

The largest proportion of laminitis cases are caused by underlying hormonal conditions. These conditions are equine metabolic syndrome (EMS) and cushings disease. For more details on these conditions see their own pages. These conditions cause laminitis because they lower the horse’s laminitis threshold so that factors that would not normally trigger a laminitis episode then does. For example, there can be 10 horses in a field all eating the same grass and then one of them will get laminitis. If it was just the grass causing the laminitis they would all have it but they don’t, there is some dysregulation going on within the affected horse meaning their threshold has been lowered and then they get it. A common real-life example of this would be with an EMS horse – the sugar in the grass is the trigger but a healthy metabolic system would deal with this threat and prevent disease, however in EMS the horse is resistant to the hormone insulin meaning that they cannot manage the sugar threat and end up with clinical disease.

A less common cause of laminitis is traumatic. This can be due to overloading due to a severe injury on the other limb, known as weight-bearing limb laminitis. This should always be considered if a horse is non-weight bearing lame on one limb for a prolonged period – the other foot should be supported by deep bedding or frog support and closely monitored. Traumatic laminitis can also be caused by poor foot balance causing unhealthy forces through the feet or over-working on hard ground.

Another type of laminitis seen rarely is toxin induced laminitis. This is a severe consequence of systemic sepsis from a nasty infection such as colitis or retained foetal membranes and is caused by the endotoxins and reduced blood supply to the feet.

Symptoms

The symptoms can vary and be on quite a spectrum depending on the severity of the episode and how many feet are affected. Laminitis can affect one single foot, all four feet or anything in between. Likewise, it can affect the just the front feet, or just the hind feet or all-round.

The classic laminitic appearance is a horse or pony unwilling to move, in a ‘rocked-back’ stance with the front feet out in front and weight through their heels, bounding digital pulses and hot feet. This is usually if both front feet are affected either in isolation or much worse than the hinds.

If all four feet are affected the horse may not rock back as they can’t overload the hinds because they also hurt. These horses are just unwilling to move, stiff all over from holding themselves, with bounding digital pulses in all four feet. If you can force them to move they are lame on every foot and look like they are walking on hot coals.

If only one foot is affected it will present as a severe lameness in one foot and initially be indistinguishable from a foot abscess or bruised foot.

In more subtle cases the horse may be able to walk well enough in a straight line but show soreness on turns or just look stiff – there is a spectrum and if caught in the early or milder stages then it may not be immediately apparent that it is laminitis. In severe cases the horse may lie down to take the weight off the feet.

Treatment

First aid from you in the first instance involves getting the horse into a stable if possible and starting box rest on a deep bed whilst waiting for a vet. If you cannot move the horse from the field, then leave them there and we can help when we arrive. If you don’t have access to a stable don’t worry, we can wrap the feet with supports or you can put mats and/or bedding in a small area in the field.

The aims of initial veterinary treatment are:

1. Relieve pain and anti-inflammatory treatment.
2. Prevent it getting any worse – stabilise the feet to prevent any further laminae separation.

Pain relief is given intravenously and then a course oral medication will be prescribed for at least a few weeks. The pain relief used also has anti-inflammatory effects to treat the inflammation and reduce further damage. A combination of a non-steroidal anti-inflammatory such as phenylbutazone alongside paracetamol is often used.

Providing support to the soles of the feet is essential and is achieved by application of upward pressure in a certain way to the sole to support the pedal bone against the weight of the pony whilst the laminae (i.e. their attachment) is inflamed and at risk of failing. This can be achieved with standing on a very deep shavings bed so the feet sink into it, application of frog supports or whole sole supports such as squish pads. During this acute phase of disease it is essential that the horse stands still. The laminae are injured and are at risk of tearing which will result in pedal bone rotation with too much movement so box rest really is essential. Another element of stopping it getting any worse is reducing any sugar and starch intake as these will trigger further laminae damage – in practical terms this means soaking the hay and ceasing and feed which contains sugar or starch.

The next phase of treatment involves:

1. Identifying and treating any underlying conditions.
2. Assessing the level of pedal bone rotation to make a shoeing plan.

Blood tests are indicated to screen for cushings and EMS and then starting treatment as soon as possible to reduce the driving force behind the laminitis.

X-Rays are indicated to visualise where the pedal bone is within the hoof capsule and to see if there has been any gas pocket or seroma formation which would require further treatment. From the x-rays the vet and farrier can formulate a plan to best support the recovery and correct any rotation or sinking. Advanced farriery techniques have transformed the ability to treat severe pedal bone rotation and sinking. Farriery required in treating laminitis will range from a therapeutic trim right through to clogs and casts. A good working relationship between the vet and the farrier is key in laminitis cases.

Regular reassessments will be required to assess when the horse can resume some walking exercise and turn out safely. The time frame for recovery is very individual and depends on so many factors and can range from a few weeks to a few months.

Prognosis

Most horses make a full recovery from a laminitis episode however it can be life-threatening in severe cases where there is too much separation of the laminae to be able to recover. If a horse has laminitis our aim is to prevent it ever happening again. However some horses become prone to recurrent episodes and if this cannot be controlled by treating and managing underlying conditions then the horses welfare should be considered.

Prevention

Maintaining a healthy body weight and exercise level for your horse is something simple which can prevent insulin dysregulation and therefore laminitis. Consider high fibre, low starch/sugar feeds for most horses, prevent over-rugging and monitor grass intake. Hay is just dry grass and can be up to 10% sugar content – soaking can reduce the sugar content dramatically and is a good trick for managing good-doer horses without having to ration the amount they eat. We know that feed intake is responsible for body fat levels and exercise is responsible for insulin regulation. In the wild horses walk many miles every day and eat very low quality forage – if ever we are unsure of how to manage our horses we should consider this. Also keep up with regular farriery to prevent foot imbalances and monitor hoof health.

If you have any suspicion that your horse may have EMS or cushings then a blood test can be taken at any time. It will inevitably be better to treat these conditions before they result in laminitis as another way to prevent this painful condition.