Q: What management changes should I keep in mind for a horse with a history of equine metabolic syndrome (EMS) and laminitis? Is there anything I need to keep a closer eye on than I would with another horse?

A:  A horse that has chronic laminitis will often have thin soles and poor hoof integrity. So chronic horses—those that have already experienced coffin bone rotation or displacement—will be more predisposed to having sore feet. Chronic laminitis cases usually require external appliances (such as shoes) to maintain comfort. If the horse is footsore, make sure to pick his feet out regularly. I know that sounds simple, but make sure they don’t have packed mud, dirt, or rocks that apply pressure to their sole. You would be surprised how many times regularly picking feet does not cross peoples’ minds.

If you have a horse that’s been diagnosed with EMS (characterized by increased fat deposits, insulin resistance, and laminitis risk), be really diligent with watching for changes in the grass. If they are muzzled, make sure the muzzle is staying on, and pay attention to their weight. It is easy to accidentally let them get overweight and not realize small but significant weight increases when you see the horse every day. Watching their overall body condition score and trying to maintain that at a healthy rating (of 4 to 6 on the 1-to-9 scale) is important. 

Any kind of slow feeding option can also help. Haynets can limit the amount of hay they are eating at one time, and paying attention to those small management changes makes a difference. Using a drylot and limiting access to grass is important. Once they are diagnosed with EMS, it isn’t something that ever truly goes away. You can manage it, but as soon as you stop managing it, the primary cause is still there, so the insulin levels just go right back up. That is something we run into a lot—we treat the horse and get the body condition score to a healthy point, and then the owner feels that the horse is doing really well, and they turn them back out in the pasture. And then two months later we are right back to the start, treating the same thing again. They did not fix the horse, they just maintained the horse. Caring for a horse with EMS is a long-term management situation, and staying ahead of potential issues is better than needing to treat problems once they occur.