Laminitis - A Medical Emergency for Horses

By Joanne Fehr, DVM, MS, Diplomate ACVS

11/8/2010

As most horse people know laminitis (founder) is a bad deal! The question that comes up is whether it is an emergency and therefore how fast should I react? The answers are YES and quickly!

Laminitis is a medical emergency and the sooner treatment begins the better chance of a good recovery. In this article I will go over how to identify an acute laminitic episode, what to do immediately until the veterinarian arrives, and provide information on the causes of the disease and long-term outcome.

So how do you know if your horse may be suffering from an acute episode of laminitis?

This is a painful disease of the feet and may present itself in many different ways involving only one foot to all four feet. The patient may show mild signs of lameness to severe pain causing them to lie down and not want to rise.

Most commonly your horse may display what is called a shifting leg lameness when standing. This means that they will intermittently or continually switch their weight from one foot to another – either in front or behind (as if they need to go to the restroom!). When you ask them to walk they may look like they are walking on eggshells (acting very hesitant to take a step) and resist turning. They may also stand in a sawhorse stance (with their front feet out in front of them and their back feet tucked under taking more of their weight).

As you run your hands down their legs you may identify that they are stocked up (swelling from the coronary band to above the fetlock) and you may also be able to feel a bounding digital pulse over the back of the fetlocks. These are indicators of inflammation in the feet. The hoof wall may also feel hot to the touch and in some severe cases you may not be able to get them to lift the opposite foot (too painful to bare full weight on one foot alone).

If any of these signs are present it is important to contact your veterinarian immediately and describe what you are observing. While you are waiting for your vet to come and examine the patient, your vet may recommend administration of an anti-inflammatory medication such as phenylbutazone of banamine (only do this after talking with your vet). At this point it is wise to move the patient to a small area with soft footing (a deeply bedded stall is preferable) and provide easily accessible fresh water and grass hay until your vet arrives.

Laminitis afflicts 2% of all horses annually, and in many cases may be initiated by us as owners killing our horses with kindness!  Laminitis results from a disruption in blood flow to the sensitive and insensitive lamina, the attachment between the hoof wall and the coffin bone. The exact mechanisms by which the lamina is damaged in a laminitic episode still remains a bit of a mystery but we do know certain precipitous events that may occur and that we can control to reduce the risk of laminitis.

Laminitis is most often associated with a disturbance elsewhere in the body such as a digestive upset (grain overload or exposure to lush grass), or systemic illness causing fever, infection and severe inflammation. A percentage of laminitic cases have been associated with Cushing Disease and Equine Metabolic Syndrome, which are related to high levels of circulating insulin (diabetes like syndromes). There is also some connection with excessive concussive forces and overweight bearing (support limb laminitis) as well as increased risk in heavy horses, ponies and donkeys. Due to the multiple and interconnected risk factors and potential causes of laminitis, it is very important to give a complete history to your vet so that any underlying problems can be identified and addressed. This will also help to minimize the risk of a repeat episode of laminitis in the future.

Initial treatment plans may include dietary restrictions, mineral oil via a nasogastric tube to treat grain overload, and non-steroidal anti-inflammatory medications to control pain and inflammation. To help ease the foot pain which is coming from the inflamed lamina moving the patient onto soft but supportive footing is extremely important. I have seen many acute laminitis patients exhale a relieving breath as we got them onto 6 inches of soft sand, allowing them to get complete support under the frog as well as letting them adjust their foot angle for pain relief (tip toes down or get more support in the heel region). Another option is to place them in support foam that will conform to the heel region and give diffuse support while elevating the heel. In the longer term, proper foot trimming and corrective shoeing is a very important step in treating this disease, therefore good communication and team work between you, your vet and farrier are essential. 

In many cases if the signs of laminitis are identified fast enough and addressed quickly, the acute episode will resolve in 24 to 72 hours. But if excessive damage has occurred to the laminar tissue it may take weeks to months of care and management to stabilize the feet and 10 to 12 months to grow a new hoof. Identifying and responding to the symptoms of laminitis as soon as possible is the key to giving your horse the greatest chance at a healthy recovery.