Learn how to manage pain levels and prevent flare-ups
There are few things more painful than watching your fit, healthy horse struggle to take a single step in his stall when the day before he bounced around a field during a conditioning ride.
And there’s nothing more heart-wrenching than concluding that if your chronically endocrine-challenged Miniature Horse has one more laminitis flare-up despite preventive measures, the only fair thing to do is end her suffering.
Ask me how I know.
Dorado’s and Brandy’s cases were very different, but they were also much the same. Our veterinarians and farriers recommended similar therapies, we acted quickly and aggressively, and both outcomes were positive—neither had a recurrence. But I felt the same helpless anguish watching both horses struggle in pain.
Research has progressed in the five to 10 years since, and veterinarians and farriers have more techniques at their disposal when managing a laminitis case. Still, the condition is challenging to navigate. We asked two experts how they approach laminitis and try to keep affected horses comfortable.
Why Is Laminitis So Painful?
Laminitis pain is one of the most challenging types for veterinarians and farriers to control. The condition occurs when the laminae (the tissues that connect the hoof wall to the coffin, or pedal, bone within) become inflamed, which can cause them to separate or fail. The three types of laminitis horses can develop include:
- Sepsis-associated, which can happen hours to days following the onset of sepsis—a general or local infection that turns systemic. This can be related to serious conditions such as colic or, in broodmares, a retained placenta;
- Endocrinopathic, which is the most common form and what Brandy experienced; it is slow to develop and associated with endocrine diseases such as pituitary pars intermedia dysfunction (PPID, formerly known as equine Cushing’s disease) and equine metabolic syndrome (EMS); and
- Supporting-limb, which develops in the leg opposite a severely lame limb over weeks to months of compensation.
“In all three types of laminitis, the lamellae are damaged so that the pedal bone is no longer supported within the hoof,” says Nicola Menzies-Gow, MA, VetMB, PhD, Dipl. ECEIM, Cert EM (int med), MRCVS, a lecturer in equine medicine at the Royal Veterinary College, in Hertfordshire, U.K. “The pedal bone then may move due to the weight of the horse pushing down and the flexor tendons that run up the back of the leg pulling on the pedal bone (these tendons pull upward from their attachment on the bottom aspect of the bone). All of this is very painful for the horse.”
Further, says Teresa Burns, DVM, MS, PhD, Dipl. ACVIM, associate professor of equine internal medicine at The Ohio State University College of Veterinary Medicine, in Columbus, laminitis typically develops in multiple feet (or, in supporting-limb cases, the opposite, injured foot is also profoundly lame), making it difficult or even impossible to “guard” or unload the affected limb(s) because there’s no “good” limb to accommodate the load.
“It’s very difficult for affected horses to get away from the pain of laminitis, as the tissue affected is effectively responsible for supporting the weight of the horse while standing,” she says.
And don’t forget the horse’s rigid hoof capsule: “Inflammation, which usually causes swelling of soft tissues, causes pressure to increase significantly within the hoof capsule, which is very painful,” Burns says.
This pain causes a variety of clinical signs in affected horses, including:
- Reluctance or inability to walk;
- Frequent weight-shifting;
- A bounding digital pulse felt along the side and back of the pastern and fetlock;
- Feet that are hot to the touch;
- Increased heart and respiratory rates;
- Glazed eyes and a pained expression; and
- The classic “rocked back” (on the hind limbs) stance.
Not all horses with laminitis, however, display obvious signs or appear painful.
“Horses can get what is termed subclinical laminitis,” Menzies-Gow says. “There is a very low level of damage occurring in the feet but not enough to make the animal visibly painful.”
These horses can develop divergent growth rings (wider at the heel than the toe) in the hoof wall over time, she adds.
Horses with subclinical laminitis might not require the same aggressive treatments as their clinically affected counterparts. However, they’ll still benefit from a veterinarian visit to evaluate internal damage (via radiographs and possibly venograms), identify a possible cause, and implement measures to help improve their quality of life.
There’s no magic bullet for keeping laminitic horses comfortable. You’ll likely need to take many approaches and involve multiple individuals to get the best result.
“The health care team for a laminitic patient often includes several people with different roles,” Burns says. “In a hospital setting for acutely affected cases (for example, a postpartum mare that retained her placenta and became laminitic), there are often several veterinarians and veterinary nurses caring for the horse to improve its comfort and stabilize its underlying disease before it can go home.
“At home, the team approach is just as essential, although the team is usually a little different—veterinarians, farriers, and horse owners are most often working together to optimize the horse’s recovery in those cases,” she adds. “Frequent rechecks and modifications to the medication and podiatry plans are important, and that means everyone working together toward a common goal.”
So where does management start?
“Two things are equally important,” Menzies-Gow says. “Giving the horse pain-relieving medication prescribed by the vet and supporting the feet so that the pedal bone doesn’t move any further, using a variety of different methods based on the vet and farrier’s advice.”
Non-steroidal anti-inflammatory drugs (NSAIDs such as phenylbutazone, flunixin meglumine, and firocoxib) are mainstays for treating laminitic horses, Burns says.
Horses with acute laminitis pain might require higher doses, more frequent administration, or even different NSAIDs than those with chronic discomfort; discuss with your veterinarian which options will be most beneficial for your horse.
But, Burns adds, “there are several other options that should be considered, particularly if the horse appears to have insufficient pain control.”
For example, your veterinarian might administer oral gabapentin (a drug used to treat nerve pain in people) or acetaminophen (the active ingredient in Tylenol) alongside NSAIDs. “Giving multiple pain medications at the same time can allow for lower doses of each drug to be given, thereby hopefully minimizing risk of adverse effects (such as gastric ulcer development and kidney damage) with chronic use,” says Burns.
In acute cases the veterinarian or farrier might pull a horse’s shoes, if applicable, and recommend cryotherapy (cold therapy or digital hypothermia via ice boots or slurries) to slow or stop the disease process. Researchers have learned that cryotherapy can help reduce pain and minimize internal damage in acute sepsis-associated laminitis cases if commenced early enough in the disease process.
Then, Menzies-Gow says, they might provide frog and sole support. Veterinarians and farriers can use hoof boots until the horse is comfortable or stable enough to wear therapeutic shoes designed to provide support, cushion, and comfort on a more permanent basis. Trimming and shoeing options can include:
- Squaring and beveling the horse’s toe to help improve breakover (how the horse’s heel lifts off the ground and rotates over the toe during movement), which can reduce flexor tendon stress on the laminae;
- Applying wooden clogs, rockers, heart-bars, banana shoes, or other alternatives that can help ease breakover and provide support; and
- Using cushioning material or hoof packing to soften impact.
“Often in the first several months following a bout of laminitis, it’s helpful to trim and reset the horse with the guidance of serial radiographs (X rays),” which can help guide therapeutic trimming and shoeing decisions, says Burns. “Veterinarians and farriers working closely together can optimize outcomes for laminitic horses in this way.”
Just remember to be patient. Finding the ideal trimming or shoeing prescription might take trial and error, and horses typically won’t become sound overnight. Have realistic expectations, and approach the process as a marathon, not a sprint.
There are additional ways to help keep laminitic horses comfortable. For example, ask your veterinarian if you should keep your horse confined during acute episodes or flare-ups.
“Box (stall) rest so the horse stands still as much as possible or even lies down to take the weight off their feet,” can be hugely helpful, Menzies-Gow says.
Also, make it easy on your horse to get the nutrients he needs if moving around is a challenge.
“For horses that are very painful, placing feed and water at multiple access points within the stall so they aren’t required to move around much to eat and drink, as well as directly offering feed and water to horses that are recumbent (down and unable to get up) on a regular schedule, are important facets of nursing care of these patients,” Burns says.
Provide soft footing for affected horses, as hard surfaces can be jarring and cause additional pain. Deep, pliable footing can also offer solar support and allow the horse to position his hooves comfortably.
One of the most helpful surfaces for horses with laminitis is sand. Veterinarians have reported anecdotally that it supports the sole, takes pressure off the frog and hoof wall, eases breakover, and allows the horse to place his feet in the most comfortable position. Sand is easiest to install outside in part of a paddock or drylot, but owners can also add it to stalls.
Is It Working?
Your goal with medications, hoof care, and management approaches is to keep a laminitic horse comfortable. But how can you tell if your efforts are working?
“If we are successful, we expect to see improvements in the horse’s physical examination parameters,” Burns says. “Heart rate is a good gauge of this. For example, horses that are painful usually have an elevated heart rate (40-60 beats per minute), which returns to the normal range (30-40 beats per minute on average) with improved comfort.”
Other signs of improvement in acutely affected horses include:
- Increased voluntary movement;
- Resuming daily activities, such as eating, drinking, and defecating, at their normal frequency;
- For horses that have been recumbent, more time spent standing; and
- For horses that have been previously reluctant to lie down (generally because of pain experienced when returning to their feet), they might begin to do so as their comfort level increases; a clean, deeply bedded stall can help encourage this behavior, Burns says.
“For chronically affected horses, the improvements are usually not dramatic, but steady progress over the course of days to weeks should occur,” she adds.
Eventually, Menzies-Gow says, “they can be gradually weaned off the pain-relieving medication. However, remember that it takes animals weeks to months to recover from laminitis.”
In most cases there’s no time limit to how long you can manage a laminitic horse comfortably.
“It really does depend on the details of the case, but many of these strategies that are in common use have been used for months to years—intermittently, occasionally, and even constantly to some degree—in horses with chronic, complicated cases,” Burns says.
Of course, not all cases go so smoothly.
“Quality-of-life conversations are very important to have early and have often, as humane euthanasia is always an option for these cases,” Burns says. “Taking cues from owners about how they perceive their horse’s quality of life, counseling them about options, providing regular check-ins to stay in the loop with horses that can be chronically painful is very important, with the horse’s welfare at stake.”
The No. 1 Tool? Prevention
Laminitis is a painful and incredibly challenging condition to manage, and it’s claimed countless horses’ lives. For these reasons, “prevention is better than cure,” Menzies-Gow says.
“Over the past 20 years, research has provided a large amount of information about how the laminitis lesion develops in certain high-risk situations, but it hasn’t revealed nearly as many effective therapies for treating laminitis once it’s already present,” says Burns.
She says using preventive strategies—such as lower limb cryotherapy in horses at risk of sepsis-associated laminitis or weight loss, PPID testing, and dietary management for horses at risk of endocrinopathic laminitis—can help keep it from starting.
Ensure your horse receives regular veterinary and farrier care, says Burns, and pay attention and respond to changes in condition (from a new hitch in a horse’s step to irregular hoof growth).
While laminitis is not easy or quick to treat and manage, affected horses can recover with care and time. Brandy, while chronically affected, lived out her days comfortably thanks to an individualized diet, medication to treat her endocrine conditions, and regular therapeutic hoof care. And while it was a time-consuming, tedious, and expensive process, acutely affected Dorado ultimately returned to his previous form in eventing; we never determined the cause of his case.
“I hope owners remember that laminitis isn’t necessarily a death sentence anymore,” says Burns. “That’s not to say that refractory, very difficult cases don’t exist, and laminitis isn’t easy or a ‘sure thing’ to treat on a good day, but we have come from a time not that long ago when horses were essentially euthanized at the time of diagnosis due to lack of effective treatment options.”
Today, she says, vets, farriers, and owners can work together to manage laminitis and, in many cases, get horses through it to comfortable life on the other side.